Psychological and social dimensions of attitudes and experiences related to COVID-19 infection control measures in Japan: an exploratory sequential mixed-methods study

Abstract

During the COVID-19 pandemic, Japan achieved high adherence to infection control measures despite relying largely on voluntary requests rather than legally enforced lockdowns. However, psychological dimensions of public attitudes and experiences related to these measures, including perceptions of both benefits and burdens, remain insufficiently understood. This study explored these dimensions in Japan. We conducted an exploratory sequential mixed-methods study. Focus group interviews were conducted with 18 participants from different age groups and analyzed thematically. Based on these findings, a web-based questionnaire was administered to 1,248 adults in Japan. Exploratory factor analysis examined the structure of psychological responses. Factor scores were compared across participant characteristics, and multivariable sensitivity analyses examined associations with COVID-19 vaccination history. The thematic analysis identified five themes: intergenerational communication gap, conformity pressure, fear of infecting others, resigned acceptance, and media influence. Survey responses varied substantially in perceived effectiveness and disadvantages across infection control measures. Hand hygiene, mask wearing, and ventilation were widely perceived as effective, whereas several measures were perceived as less effective. Economic, social, medical, and educational disadvantages were relatively well recognized, whereas some indirect social harms were less frequently recognized. Exploratory factor analysis identified three psychological dimensions: Perceived information influence, Perceived social pressure, and Normative endorsement. These dimensions did not correspond one-to-one with the qualitative themes; instead, qualitative meanings were confirmed, differentiated, or contextualized through the quantitative factor structure. While associations with other examined participant characteristics were generally small, COVID-19 vaccination history showed more apparent associations with Perceived social pressure and Normative endorsement, with similar patterns after covariate adjustment. This study identified three exploratory psychosocial dimensions of retrospective attitudes and experiences related to COVID-19 infection control measures in Japan. The findings suggest that public responses involved social and normative processes as well as risk- and information-related perceptions, and that apparent acceptance could coexist with uncertainty or resigned acceptance. Future pandemic responses may benefit from opportunities to express concerns, consider alternatives, and periodically review measures, alongside transparent evaluation of benefits and harms.