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BALTIC JOURNAL OF LAW & POLITICS A Journal of Vytautas Magnus University VOLUME 15, NUMBER 2 (2022) ISSN 2029-0454 Cit.: Baltic Journal of Law & Politics 15:2 (2022): 77-98 https://content.sciendo.com/view/journals/bjlp/bjlp- overview.xml DOI: 10.2478/bjlp-2022-0011 MANAGEMENT OF THE COVID-19 PANDEMIC AND PUBLIC RESPONSE IN LITHUANIA: KNOWLEDGE, ATTITUDES, AND PRACTICES (KAP) Dainius Genys Dr. Vytautas Magnus University, Andrei Sakharov Research Center for Democratic Development (Lithuania) Contact information Address: Daukanto g. 27-304, Kaunas, Lithuania Phone: +370 37 206709 E-mail address: email@example.com Ričardas Krikštolaitis Professor Vytautas Magnus University, Faculty of Informatics (Lithuania) Contact information Address: Vileikos g. 8, 44404, Kaunas, Lithuania Phone: +370 37 327 898 E-mail address: firstname.lastname@example.org Received: October 5, 2022; reviews: 2; accepted: December 19, 2022. ABSTRACT The article aims to provide an overview of the interrelationships between public knowledge, attitudes, and practical behaviours in the context of a global pandemic and the risk management measures used by the government. By reviewing some of the key trends in crisis BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 management in Lithuania, it seeks to explore the response of society. The aim of the paper is to analyse the interrelationship among subjective public informativeness, attitudes, and behaviours according to different socio-demographic aspects. To meet the main objective of the paper, a representative public survey (N-804) on attitudes towards COVID-19 was conducted (at the end of 2020). The survey sought to explore individual self-protection measures, attitudes towards the dangerousness of the virus, the measures used by the government to combat the pandemic, and prevalent stereotypes and their implications on personal behaviour. The paper discusses the indicators, which are divided into separate blocks, on the basis of which the responses of the study participants are summed up and evaluated on a three-level (good, average, poor) rating scale, followed by correlation analyses on various socio-demographic parameters. The survey revealed that a higher proportion of Lithuanian society behaved responsibly, even being moderately informed and characterised by diverse attitudes. KEYWORDS Pandemic management, Lithuania, society, knowledge, attitudes and practice BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 INTRODUCTION Lithuania, like many other countries, has suffered from the dynamics of a severe 1 2 COVID-19 pandemic . International studies show that countries in Central and Eastern Europe dealt with the first wave of the virus relatively well. In contrast, the second wave of the virus was much more severe, and many of the government solutions that had worked so well up to that point turned out to be ineffective. Lithuania is a prime example: in the context of the first wave, it was ranked as one of the most effectively managed countries at the European level (OECD), but within a half-year, the country appeared to be the worst in terms of disease statistics . In addition, the small country was burdened by a sharp division in society, e.g., between those who supported strict quarantine and those who did not, between vaccinees and anti-vaxxers, which even burst out in violent protests . A robust and comprehensive study of Lithuania’s public policy response to the COVID-19 pandemic and the management of the crisis in 2020 show that the government did relatively well in managing the situation by organising an institutional response (taking into account the experience of foreign countries), providing financial support to business and the society, and mobilising the capacity of the public sector , but considerably worse in mobilising the society’s engagement and the expectations of different groups, ensuring the equal representativeness of social groups, and mitigating the policy’s impact on the most vulnerable groups of society . Previous At the end of June 2021, the total number of recorded COVID-19 cases in Lithuania had reached 278,769, or approximately 9.9% of the population. The largest month-by-month jump took place from November to December 2020, with 80,644 new cases (for recent updates visit: https://ourworldindata.org/coronavirus/country/lithuania). See https://www.ipsos.com/sites/default/files/ct/news/documents/2020-08/political-trust-and-the- covid-19-crisis.pdf ; https://www.europarl.europa.eu/at-your-service/files/be-heard/eurobarometer/2020/covid19/en-public- opinion-in-the-time-of-covid19-20200505.pdf. See https://www.lrt.lt/mediateka/irasas/2000133477/zinios-lietuva-pagal-sergamuma-covid-19- pirmoji-pasaulyje. Two surveys were carried out to assess Lithuania’s satisfaction with the measures implemented to deal with the COVID-19 pandemic, one in March and the other in June of 2020. Roughly 66% of the respondents from the March survey reported being satisfied with the measures aimed at alleviating the pandemic, while only 58.8% responded positively in the June survey (for more details visit: https://www.lrt.lt/en/news-in- english/19/1154046/coronavirus-two-thirds-of-lithuanians-support-government-action-survey and https://www.lrt.lt/en/news-in-english/19/1190708/most-lithuanians-happy-with-government-s- handling-of-covid-19-survey-shows). See https://www.lrt.lt/en/news-in-english/19/1466717/police-detain-26-people-during-riots-outside- lithuanian-parliament-18-officers-injured. Rasa Bortkevičiūtė, Patricija Kalkytė, Vytautas Kuokštis, Vitalis Nakrošis, Inga Patkauskaitė-Tiuchtienė, and Ramūnas Vilpišauskas, Nuo greitų pergalių prie skaudžių pralaimėjimų. Lietuvos viešosios politikos atsakas į COVID-19 pandemiją ir šios krizės valdymas 2020m. (Vilnius: Vilniaus universiteto leidykla, 2021), 277–279. Diana Janušauskienė, Sarmitė Mikulionienė, Inga Blažienė, and Inga Gaižauskaitė, Lietuvos socialinių tyrimų centro vykdomo projekto ‘COVID-19 pasekmės visuomenės saugumui: grėsmės ir naujos galimybės’ tyrimų rezultatų pristatymas (Vilnius: Lietuvos socialinių tyrimų centras, 2020) // https://www.lstc.lt/wp-content/uploads/2020/12/COVID-19-PASEKMES-VISUOMENES- SAUGUMUI_rezultatu_pristatymas.pdf; Audronė Telešienė, Aistė Balžekienė, Agnė Budžytė, and Eimantė Zolubienė, “COVID-19 rizikos suvokimas ir socialiniai daugikliai Lietuvoje,” Filosofija. Sociologija 32 (2021). BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 research found that strict governmental measures had varying effects on different social groups, though the relationship between crisis management and public response is still unknown. The KAP approach contributes to this debate as an illustrative way to observe how various contradictions between the governing attempt to mitigate the crisis and the reality are reflected in society (both in terms of approval and disapproval), namely in terms of knowledge, attitudes, and practices. The development of the KAP research method makes it possible to identify and assess the consequences of the contradictions , which is very important when trying to establish trust in governmental decisions . Meanwhile, as research shows, knowledge, attitudes, and practices become essential in coping with the anxiety and uncertainty caused by the unknown disease . The knowledge, attitudes, and practices that people hold towards the virus play an integral role in determining a society’s readiness to accept behavioural change measures from health authorities . KAP is often used as the conceptual approach and the method in public health research, gathering sufficient and empirically based data on interrelationships between public knowledge, attitudes, and practical behaviours in specific conditions. Such an approach is quite valuable from the point of view of public governance when a deeper understanding of public awareness and behaviour in relation to existing governing programmes or the efficiency of public policy is needed to be validated. The KAP research in the COVID- 19 context becomes a resourceful tool to both measure and compare people’s responses to pandemics around the globe , especially under similar conditions. Dainius Genys and Jūratė Imbrasaitė, “Pilietinės saviraiškos ir valstybinio paternalizmo konfigūracijos COVID-19 pandemijos laikotarpiu” (Dynamics between civic expression and state paternalism during the COVID-19 pandemic), Darbai ir Dienos 75 (2021). Haojun Yang, Zhuohui Chen, Yishu Fan, Xinhang Hu, Tong Wu, Shuntong Kang, Bo Xiao, and Mengqi Zhang, “Knowledge, attitudes and anxiety toward COVID-19 among domestic and overseas Chinese college students,” Journal of Public Health Vol. 43, No. 3 (September 2021): // https://doi.org/10.1093/pubmed/fdaa268; Yilan Lin, Lijuan Huang, Shaofa Nie, Zengyan Liu, Hongjie Yu, Weirong Yan, and Yihua Xu, “Knowledge, attitudes and practices (KAP) related to the pandemic (H1N1) 2009 among Chinese general population: a telephone survey,” BMC Infect Diseases Vol. 16, No. 11 (2011): 128 // doi: 10.1186/1471-2334-11-128. Constantine Vardavas, Satomi Odani, Katerina Nikitara, Hania El Banhawi, Christina Kyriakos, Luke Taylor, and Nicholas Becuwec, “Public perspective on the governmental response, communication and trust in the governmental decisions in mitigating COVID-19 early in the pandemic across the G7 countries,” Preventive Medicine Reports 21 (2021). Zelalem Desalegn, Negussie Deyessa, Brhanu Teka, Welelta Shiferaw, Damen Hailemariam, Adamu Addissie, Abdulnasir Abagero, Mirgissa Kaba, Workeabeba Abebe, Berhanu Nega, Wondimu Ayele, Tewodros Haile, Yirgu Gebrehiwot, Wondwossen Amogne, Eva Johanna Kantelhardt, and Tamrat Abebe, “COVID-19 and the public response: Knowledge, attitude and practice of the public in mitigating the pandemic in Addis Ababa, Ethiopia,” PLOS ONE Vol. 16, No. 1 (January 2021) // https://doi.org/10.1371/journal.pone.0244780. Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern, Suffian Hadi Ayub, and Emma Mohamad, “Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia,” PLOS ONE Vol. 15, No. 5 (May 2020) // https://doi.org/10.1371/journal.pone.0233668. Bodrun Naher Siddiquea, Aishwarya Shetty, Oashe Bhattacharya, Afsana Afroz, and Baki Billah, “Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis,” BMJ Open Vol. 11, No. 9 (September 2021) // doi: 10.1136/bmjopen-2021-051447; Fabio Alexis Rincón Uribe, Rejane Célia de Souza Godinho, Marcos Antonio Santos Machado, Kleber Roberto da Silva Gonçalves Oliveira, Cristian Ariel Neira Espejo, Natalia Carvalho Vianna de Sousa, Leonardo Lucas de Sousa, Marcos Vinicius Monteiro Barbalho, Pedro Paulo Freire Piani, and Janari da Silva Pedroso, “Health knowledge, BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 This paper aims to analyse the correlation between the public’s subjective informativeness, attitudes, and practices when facing the COVID-19 pandemic and discusses the differences between groups regarding socio-demographic characteristics. The paper seeks to establish a deeper connection between public knowledge, attitudes, and practices under severe crisis. The KAP research method highlights the impact of the pandemic and governmental countermeasures on the daily lives of ordinary people when faced with everyday decisions. 1. PANDEMIC MANAGEMENT IN LITHUANIA At the very beginning of the pandemic, in March 2020, many EU countries took very strict measures to stop the spread of the coronavirus and reduce the burden on the health system. In Lithuania, the health response has also been based on the paradigm of infection suppression, thus a severe lockdown of the country was implemented. Subsequently, the pandemic management paradigm shifted in both the EU and Lithuania, where the extreme losses from strict regulation were considered to make it appropriate to move away from large-scale restrictions and towards differentiation and localisation. During the summer, objective reasons for loosening strict regulation emerged, such as an increased health system and testing capacity and decreasing numbers of registered infections. However, shortly afterwards, in the autumn, the number of infections started to rise again, resulting in a significant tightening of pandemic management in Lithuania (the second lockdown). According to experts , the Lithuanian crisis management structure (which consisted of two pillars – the Government Chancellery and the Ministry of Health) was adequate. The centralised management of the COVID-19 crisis proved to be successful, enabling quick and decisive decisions to be taken during the first wave of the coronavirus. However, its functioning was only partially effective during the second wave, as the lack of resilience of the public governance system and the lack of systemic change started to appear. Interestingly enough, crisis management in Lithuania was based not on the civil service nor state services, but on politicians. However, leadership at the political level was also not strong: it was more paternalistic, lacking trust-based inter-institutional and inter-sectoral cooperation, health behaviors and attitudes during pandemic emergencies: A systematic review,” PLoS One Vol. 16, No. 9 (2021 September) // doi: 10.1371/journal.pone.0256731. Gintaras Šumskas, Remigijus Civinskas, and Jaroslav Dvorak, “Baigiamoji diskusija: ‘COVID-19 krizės valdymo politikos pamokos: nuo ligoninių priimamųjų iki savivaldybės kabinetų’,” Vytauto Didžiojo universitetas, Politikos mokslų ir diplomatijos fakultetas, ir partneris Vilniaus politikos analizės institutas (December 18, 2020) // https://www.youtube.com/watch?v=eHaKcMsDJBc&ab_channel=Vilniauspolitikosanaliz%C4%97sinstitut as. BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 open and empathetic communication, and (especially in the face of the second wave of the virus) timely response in crisis management decisions . Crisis management in Lithuania was characterised by a fairly hierarchical management structure, strict measures, and quite rapid implementation, but also by a lack of public explanation of why certain measures were necessary and what was expected to be achieved, and by monological rather than dialogical communication. The realities of the pandemic have highlighted the importance of close cooperation between government and society. According to literature, as it grows, cohesive solutions are more likely to emerge, and conversely, as it diverges, not only is there dissatisfaction with government decisions but also a deterioration in the subjective assessment of well-being . During the crisis management period, medical experts and data analysts were the most frequently consulted, and the private sector less so. The involvement of health professionals was not systematic (at the beginning of the crisis, intensive cooperation decreased as the epidemiological situation in the country improved), they were not sufficiently used in the government's communication, and the emergence of a more integrated approach is due to the activities of the Council of Health Experts, initiated by the President. Partnerships with donor funds outside the public sector were weak; national and municipal actions were not sufficiently coordinated with voluntary initiatives; and NGOs were not included in crisis management mechanisms, leading to a less efficient use of resources and less informed decision-making. Cooperation was more successful where this practice had been in place before the crisis, where it was driven and supported by leaders, and where citizens' support was seen as essential for the continuation of certain functions. The concept of public resilience is related not only to consistent and thorough management but also to the ability to learn from and adapt to different crisis situations. Therefore, mobilisation of the public (in particular in terms of knowledge, attitudes, and behaviour) and its support for governmental measures become of utmost importance in order to overcome the crisis without negative (at least as much as possible) implications for society (especially more vulnerable groups). It is therefore important to go beyond an expert understanding and to select appropriate measures that take into account and mobilise different groups. The management of the first wave of the COVID-19 crisis was relatively closed, with health or data analysis experts and civil society more often used when the public sector lacked internal resources. Initial collaborations were often focused on solving existing problems, and as the epidemiological situation in the country improved, Rasa Bortkevičiūtė et al., supra note 6, 17–18. To read more about this link in Lithuania, see: https://lmaleidykla.lt/ojs/index.php/filosofija- sociologija/article/download/4617/3829?inline=1. BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 partnerships began to dissolve. In the face of a complex crisis, the need for data availability and analysis also became apparent: existing systems and capacities were inadequate for informed decision-making. Finally, there was a lack of openness not only in internal governance but also in external communication: a lack of political leadership prevented effective mobilisation of the public around a common long-term goal. In the absence of detailed studies on pandemic management, it is difficult to unambiguously summarise the case of Lithuania, but the collective body of knowledge tentatively suggests two parallel strands of crisis management: one to protect public health and well-being, and the other to protect the country’s economy and economic sustainability. Obviously, these different orientations require different efforts, capacities, and governance structures. From a political-sociological point of view, while in one case one can rely on a risk prevention plan, the effectiveness of public governance, and institutional resilience, in the other case, one needs first and foremost public support (trust and cooperation). While crisis management is usually based on a hypothetical relationship between hypothetical public information, expected attitudes, and desired behaviour, KAP reveals the reality by exploring the functional relationship between variables unfolding under the severe consequences of an invisible crisis and concrete measures implemented by the government . The empirical part of the paper elaborates on public support (in terms of knowledge, attitudes, and behaviour) for government policies during pandemic management. 2. METHODOLOGY To achieve the main objective of the paper, a representative public survey (N-804) on attitudes towards COVID-19 was conducted in cooperation with VMU researchers and the research section of the largest Lithuanian news portal Delfi.lt. A survey (December 2020) was carried out as a computer-assisted web-based interviewing program (CAWI) surveying the Lithuanian population aged 15–74 years that matched the Lithuanian demographic distribution by age and sex. A total of 804 respondents were interviewed. Having assumed that a sample was proportional, the statistical error was 3.3% within the 95% confidence interval. The main characteristics of the participants are presented in Table 1. The study aimed to investigate personal protective measures and attitudes towards the dangers of the virus, the government’s response to the pandemic, and prevalent stereotypes and their consequences for subjective well-being. It should be Saeede Saadatjoo, Maryam Miri, Soheil Hassanipour, Hosein Ameri, and Morteza Arab-Zozani, “Knowledge, attitudes, and practices of the general population about Coronavirus disease 2019 (COVID- 19): a systematic review and meta-analysis with policy recommendations,” Public Health Vol. 194 (2021). BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 noted that respondents were asked to assess the impact of the first wave; however, the survey was carried out at the end of last year when the second wave of the pandemic was already well underway, which is likely to have influenced the responses. Data were analysed using IBM SPSS Statistics 19. A descriptive analysis was performed. Specific knowledge, attitude, and practice questions were used to establish a scoring system to assess the overall status of the participants. For each question, 1 point was given for a correct answer, whereas 0 points were awarded for an incorrect answer. Based on the total score relative to the maximum score, public KAP levels were categorised as good, moderate, or poor, taking into account modified Bloom’s cut-off points. Associations between the socio-demographic factors and public KAP in relation to COVID-19 were investigated using a chi-square homogeneity test. A statistically significant association was declared at a p level < 0.05. Table 1. Demographic characteristics of the research participants Characteristics Count (%) Sex Male 417 (51.9) Female 387 (48.1) Age group 16–25 54 (6.7) (years) 26–35 152 (18.9) 36–45 172 (21.4) 46–55 200 (24.9) 56–65 164 (20.4) > 65 62 (7.7) Marital status Single 135 (16.8) Married 467 (58.1) I live with a partner 103 (12.8) Divorced 79 (9.8) Widow/er 20 (2.5) Education Primary/basic 8 (1.0) Secondary 42 (5.2) Vocational 40 (5.0) Advanced vocational 98 (12.2) Incomplete higher education 55 (6.8) Higher education 561 (69.8) Income Up to 200 EUR 15 (1.9) 201–400 EUR 83 (10.3) 401–600 EUR 114 (14.2) 601–800 EUR 128 (15.9) BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 801–1000 EUR 106 (13.2) 1001–1200 EUR 92 (11.4) > 1200 EUR 164 (20.4) Did not answer 102 (12.7) The survey sample reflects the distribution of the current Lithuanian population by age and sex. Data were categorised using a modified Bloom’s cut-off point. Participants’ overall knowledge was categorised, using a modified Bloom’s cut- off point, as good if the score was between 80 and 100% (9–11 points), moderate if the score was between 50 and 79% (6–8 points), and poor if the score was less than 50% (< 6 points). Overall attitude was categorised, using a modified Bloom’s cut-off point, as good if the score was 80–100% (8–10 points), moderate if the score was 50–79% (5–7 points), and poor if the score was less than 50% (< 5 points). The participants’ overall practise was categorised as good if the score was 80–100% (13– 16 points), moderate if the score was 50–79% (8–12 points), and poor if the score was less than 50% (< 8 points). 3. OPERATIONALISATION The KAP research emerged in the 1960s in the fields of family planning and population studies. Known as knowledge, attitude, behaviour, and practice research, it is now widely used to study health-related practices and health-seeking practices . A KAP survey is a representative survey of the target population; it aims to find out what is known (knowledge), believed (attitudes), and done (practices) in relation to the topic of interest. This paper examines where and how often respondents received information, how they assessed its quality and sufficiency, what attitudes they formed on the basis of this, and, finally, how this is reflected in practice (i.e., in their behaviour and compliance with the measures in force in the country). At the same time, the KAP approach, mainly through socio-demographic analysis, allows us to identify differences between various social groups. The indicators used in the paper are divided into separate sections. The responses of the study participants are aggregated and scored on a three-level scale (good, moderate, and poor), followed by a correlation analysis based on various socio-demographic parameters. Section 1 – Knowledge. Two sets of questions were asked to assess the respondents’ knowledge about COVID-19. The first one was designed to elicit news See https://www.anthropologymatters.com/index.php/anth_matters/article/view/31/53. BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 sources (e.g., e-press, TV, radio, specialised seminars, meetings, social media, family/friends), and the second one was designed to elicit a subjective assessment of the sufficiency and reliability of the knowledge available (e.g., I know and can recognise most of the symptoms of COVID-19; I know the basic self-protection measures; I have sufficient information on the situation in other countries; and I am sufficiently informed about the most recent scientific developments in the world in the fight against COVID-19). This section consisted of 11 questions in total. Section 2 – Attitudes – was designed to explore attitudes towards COVID-19 and related aspects. To measure public attitudes towards the pandemic, respondents were asked to evaluate a number of the statements made in the public domain, some of which were true and some of which were false. Accordingly, the statements tested public attitudes at three levels, namely, in terms of trend (the origin and reality of COVID-19), nature (the preventability and plausibility of the virus), and impact (the prevalence and threat). The second set of questions in this section was designed to measure the respondents’ acceptance of the mitigation strategies used by the government. For this purpose, the respondents were asked to assess the government’s official programme for combating the virus (e.g., protection of priority groups, speed and accuracy of case tracing, the timeliness of public information, evidence-based decision-making in the fight against COVID-19) and the adequacy of the mechanisms to provide financial support to the public (e.g., the size and feasibility of the economic stimulus plan, the adequacy of the financial instruments used). This section consisted of a total of 10 questions. Finally, Section 3 – Practices – was designed to identify personal behaviour. Again, two sets of questions were used; namely, the aim of the first set of questions was to identify everyday individual protective behaviours (e.g., avoiding physical contact and visiting shops, institutions, and establishments, washing hands, and wearing masks), while the second set of questions was intended to identify changes in psychological health caused by the virus (e.g., emotional difficulties, changes in sleep, anxiety levels, ability to relax, stress levels) and to discuss the strategies for coping with the psychological consequences (e.g., seeking help from family, professionals, or helplines, using alcohol or medication). This section consisted of 16 questions in total. See COVID-19 valdymo strategija // https://lrv.lt/uploads/main/documents/files/COVID-19%20valdymo%20strategija_aktuali.pdf. BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 4. REVIEW OF GENERAL TENDENCIES Table 2. General tendencies in KAP responses Sum of correct answers Mean Specialised seminars, meetings 43 0.053 Family, friends, colleagues, neighbours 364 0.453 Lithuanian press (printed) 109 0.136 Lithuanian news portals 763 0.949 Lithuanian television, radio 623 0.775 Social media (Facebook, Instagram, etc.) 398 0.495 Foreign resources (media, websites, databases) 359 0.447 I know and could recognise most of the symptoms of Knowledge 653 0.812 COVID-19 I know the basic individual protective measures 775 0.964 against COVID-19 I have enough information on the COVID-19 situation 652 0.811 in other countries I have sufficient information on the latest scientific developments in the world in the fight against COVID- 571 0.710 COVID-19 is not a dangerous virus, and its damage is 661 0.822 exaggerated Most of the news about COVID-19 is false 574 0.714 It is essential to follow the instructions of professionals and health precautions when protecting yourself from 749 0.932 COVID-19 The emergence and spread of the COVID-19 virus is 531 0.660 linked to the activities of the secret services Attitude Protecting people in high-risk groups 494 0.614 Speed and accuracy of localisation of cases 349 0.434 Promptness and objectivity of public information 501 0.623 Evidence-based decision-making against COVID-19 504 0.627 Size and feasibility of the EUR 5 billion economic 457 0.568 stimulus plan approved by the government Adequacy of the financial assistance instruments used by the government of the Republic of Lithuania to help 375 0.466 the public Practice I avoid physical contact only with strangers 711 0.884 BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 I avoid physical contact even with acquaintances 0.764 (colleagues/neighbours) I wear a protective face mask 773 0.961 I wash and disinfect my hands 0.938 I avoid going to institutions 711 0.884 I avoid unnecessary visits to shops 687 0.854 I avoid going out to eat 720 0.896 I avoid going to places of entertainment 746 0.928 Changes in my sleeping and/or eating habits 0.571 I was able to relax and calm down 388 0.483 I felt that I could no longer cope with the difficulties of 0.817 life I was looking for ways to overcome a situation or 0.648 difficulty Support from family or friends is essential when 0.948 experiencing emotional health difficulties It is hard to find someone in my surroundings who can 0.675 give me emotional support Emotional support lines help people overcome 0.646 emotional difficulties (e.g. “Jaunimo linija”, “Vaikų 519 linija”, “Sidabrinė linija”, etc.) If someone is experiencing severe emotional health 0.708 difficulties, it is better not to show it to others Looking at the “Knowledge” scores of the participants, the majority of the participants had moderate knowledge (66.8%), with just over a fifth (22.3%) scoring poor, and a small proportion (10.9%) scoring good. Differences arise from unequal responses within the section, e.g., only a tiny proportion of the respondents (5.3%) obtained information from specialised seminars and meetings. Still, the vast majority of the respondents received their information from Lithuanian news portals (as much as 94.9%). In comparison, less than half of the participants (44.7%) used data from foreign sources (the media, databases). It was sufficient for the respondents to subjectively assess themselves as “knowing and being able to recognise most of the symptoms of COVID-19” (81.2%), to be even more likely to say that they “know the basic individual protective measures against the virus” (96.4%), and to be confident that they have “enough information about the latest scientific developments in the world in the fight against pandemics” (71%). Various information sources and the different frequency of their use resulted in only a small proportion of respondents being in the “good” section of the final category of knowledge. On the other hand, it BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 was enough for them to rate the level of information about the problem as very good in their own subjective view. At the “Attitudes” level, the majority (but only by a small margin) scored moderate (41.3%), but there was a significant increase in the number of high scores (38.1%), and almost a fifth of low scores (20.7%). The uneven distribution of responses in the final section was due to differences in public attitudes towards the virus, as well as variations in virus management strategies. For instance, the majority (82.2%) thought that “the virus is not dangerous and its harm is exaggerated”, but an absolute majority thought that “it is important to follow the instructions of professionals and health safety measures to protect oneself from the virus” (93.2%). Finally, attitudes to the origin of the virus differed considerably, with a higher proportion (66%) associating it with “secret services”. The respondents were even more divided when it came to the Lithuanian government’s virus management strategy. While the majority of the respondents agreed with the strategic priorities (61.4% for the protection of at-risk groups, 62.7% for evidence-based decision- making, and 62.3% for the timeliness of public information), less than half of the respondents agreed with the implementation priorities (43.4% for the speed and accuracy of disease case detection and 46.6% for the adequacy of the financial support measures to the public). At the “Practices” level, the overwhelming majority of the participants scored “good” (60.6%) and “moderate” (37.4%). Only a small proportion, within the margin of error (2%), scored poorly. Although not everyone experienced the same psychological burden of the virus (e.g., not being able to relax and calm down – 51.7%; changes in sleeping and/or eating habits – 57.1%), the majority of people knew where to go to get help (e.g., helplines – 64.6%), and a higher proportion had personally tried to find a way to cope with the situation or difficulties (64.8%). This mature behavioural attitude is explained by the fact that the vast majority of the respondents were inclined to take individual protective measures (e.g., avoiding contact with strangers – 88.4%, washing and disinfecting hands – 96.1%, and avoiding places of entertainment – 92.8%). Table 3. Number of questions, range, scores, and levels of KAP of the research participants Number of Level questions Mean Std. Deviation Poor Moderate Good Knowledge 11 6.60 1.64 179 (22.3) 537 (66.8) 88 (10.9) Attitude 10 6.46 2.43 166 (20.7) 332 (41.3) 306 (38.1) Practice 16 12.60 2.46 16 (2.0) 301 (37.4) 487 (60.6) BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 To summarise the results, the trend shows that while the primary hypothesis of the KAP research is based on the assumption that more knowledge leads to more moderate attitudes (towards the phenomenon in question) and more responsible attitudes, in this particular case, the opposite is observed. In other words, while the overall distribution of “knowledge” and “attitudes” of the study participants was mainly moderate, a mature personal behaviour emerged at the “practice” level. This atypical result can be explained by the above-mentioned peculiarities regarding the distribution of the responses within the sections, the dangerousness of the virus, and the natural desire to avoid the virus and protect oneself irrespective of one’s knowledge or attitudes, and, last but not least, the strict measures introduced by the government. 5. DATA CORRELATION BY SOCIO-DEMOGRAPHIC CHARACTERISTICS To better identify the differences between the groups and the factors underlying these differences, the next section of the paper looks at correlations, namely, how the results discussed above are distributed in terms of socio-demographic data. Table 4. Association between respondent demographic characteristics and level of KAP scores Knowledge p Attitude p Practise p Poor Mod. Good Poor Mod. Good Poor Mod. Good N(%) N(%) N(%) N(%) N(%) N(%) N(%) N(%) N(%) Sex Male 93 288 36 0.067 90 163 164 0.504 9 170 0. 2109 (11. (35. (4.5) (11.2) (20.3) (20.5) (2.1) (40.8) 38 6) 9) (57. 1) Female 86 248 53 78 167 142 7 131 2 (22. (64. (13. (20.2) (43. (36.7) (1.8) (33.9) 49 2) 1) 7) 1) (64. 3) Age 16-25 9 36 9 0.724 15 22 17 0.000* 1 30 0. 2082 group (16. (66. (16. (27.8) (70. (31.5) (1.8) (55.6) 3 7) 6) 7) 4) (42. 6) 26-35 31 107 14 41 59 52 3 50 9 (20. (38. (34. (27.0) (38. (34.2) (2.0) (32.9) 9 4) 8) 2) 8) (65. 1) 36-45 44 114 14 49 69 54 7 58 1 (25. (66. (8.1) (28.5) (40. (31.4) (4.1) (33.7) 07 6) 3) 1) (62. 2) 46-55 48 130 22 39 81 80 3 76 1 (24. (65. (11. (19.5) (40. (40.0) (1.5) (38.0) 21 0) 0) 0) 5) (60. 5) 56-65 34 110 20 18 75 71 1 67 9 (20. (67. (12. (11.0) (45. (43.3) (0.6) (40.9) 6 7) 1) 2) 7) BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 (58. 5) > 65 13 40 9 4 26 32 1 20 4 (21. (64. (14. (6.5) (41. (51.6) (1.6) (32.3) 1 0) 5) 5) 9) (66. 1) Marital Single 26 94 15 0.010* 38 51 46 0.062 4 62 0.6037* status (19. (69. (11. (28.1) (37. (34.1) (3.0) (45.9) 9 3) 6) 1) 8) (51. 1) Married 101 311 55 85 195 187 8 151 3 (21. (66. (11. (18.2) (41. (40.0) (1.7) (32.3) 08 6) 6) 8) 8) (66. 0) Live 26 69 8 28 41 34 1 47 5 with a (25. (67. (7.8) (27.2) (39. (33.0) (1.0) (45.6) 5 partner 2) 0) 8) (53. 4) Divorc- 22 52 5 15 34 30 2 34 4 ed (27. (65. (6.3) (19.0) (43. (38.0) (2.6) (43.0) 3 9) 8) 0) (54. 4) Widow/ 0 15 5 0 11 9 (45.0) 1 7 1 er (0.0) (75. (25. (0.0) (55. (5.0) (35.0) 2 0) 0) 0) (60. 0) Educa- Primar/ 3 5 0 0.135 3 4 1 0.034* 1 5 0.2 000* tion basic (37. (62. (0.0) (37.5) (50. (12.5) (12. (62.5) (25. 5) 5) 0) 5) 0) Second- 5 32 5 9 19 14 2 17 2 ary (11. (76. (11. (21.4) (45. (33.3) (4.8) (40.4) 3 9) 2) 9) 3) (54. 8) Voca- 14 24 2 15 13 12 5 23 1 tional (35. (60. (5.0) (37.5) (32. (30.0) (12. (57.5) 2 0) 0) 5) 5) (30. 0) Advanc 30 57 11 16 38 44 2 44 5 -ed (30. (58. (11. (16.3) (38. (44.9) (2.0) (44.9) 2 voca- 6) 2) 2) 8) (53. tional 1) educa- tion Higher 12 39 4 18 16 21 0 22 3 educa- (21. (70. (7.3) (32.7) (29. (38.2) (0.0) (40.0) 3 tion/ 8) 9) 1) (60. no 0) diplo- ma Higher 115 381 65 105 242 214 6 190 3 educa- (20. (67. (11. (18.7) (43. (38.1) (1.1) (33.9) 65 tion 5) 9) 6) 1) (65. 0) Income Up to 2 10 3 0.000* 7 4 4 0.000* 1 10 0.4 000* 200 (13. (66. (20. (46.6) (26. (26.7) (6.7) (66.6) (26. EUR 3) 7) 0) 7) 7) BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 201- 37 38 8 14 34 35 2 38 4 400 (44. (45. (9.6) (16.9) (40. (42.2) (2.4) (45.8) 3 EUR 6) 8) 9) (51. 8) 401- 25 81 8 25 49 40 1 48 6 600 (21. (71. (7.0) (21.9) (43. (35.1) (0.9) (42.1) 5 EUR 9) 1) 0) (57. 0) 601- 18 87 23 24 49 55 3 50 7 800 (14. (68. (18. (18.7) (38. (43.0) (2.3) (39.1) 5 EUR 0) 0) 0) 3) (58. 6) 801- 21 71 14 17 40 49 1 37 6 1000 (19. (67. (13. (16.1) (37. (46.2) (0.9) (34.9) 8 EUR 8) 0) 2) 7) (64. 2) 1001- 6 1200 18 65 47 7 EUR (19. (70. 9 15 (51. 30 0 25 (72. 6) 6) (9.8) (16.3) 1) (32.6) (0.0) (27.2) 8) > 1200 1 EUR 31 58 17 15 03 (29. (54. (16. 32 (14. 59 3 0 (97. 3) 7) 0) (30.2) 1) (55.7) (2.8) (0.0) 2) Prefer 6 not to 27 59 26 2 answer (29. (64. 6 32 (28. 34 5 25 (67. 4) 1) (6.5) (34.8) 3) (36.9) (5.4) (27.2) 4) *Asterisk means statistically significant difference at 0.05 significance level Interestingly, the data analysis did not reveal a statistically significant difference in responses by sex, although there are substantial differences. For instance, in the “good” category, women are better informed (13.7% vs 4.5%, respectively), have a more balanced approach (36.7% vs 20.5%, respectively) and are more cautious than men (64.3% vs 57.1%, respectively). When analysing the data by age, statistically significant differences were only found in the area of attitudes. Hence, while there are some attitudinal variation between different age groups (e.g., younger people are better informed, but older people are more moderate), it is only at the level of attitudes that the differences are statistically significant. The general trend in this area is that the respondents’ attitudes become more consistent as they get older. When analysing the data on a family basis, in contrast to the previous case, statistically significant differences are observed in the areas of knowledge and practice, but not in attitudes. A vital feature of this approach is that married people are more cautious (66% good) than the representatives of the other categories. On the other hand, the trend in knowledge is not significant, and the percentage differences between the groups are not substantial. As mentioned above, the BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 differences in attitudes are not statistically significant. However, the percentages of distributed responses show a similar trend. Some interesting results were obtained from a correlation analysis in relation to education. Surprisingly, no statistical significance was found in the category of knowledge. However, in the areas of attitudes and practice, the differences in this category are statistically significant. In the area of practice, the trend (with the small exception of the vocational education category) is consistently upwards, i.e., the higher the education, the more responsible the behaviour (in the category “good”). An exception emerged in the vocational education category, where a higher proportion of the respondents exhibited a “moderate” practice (including the highest “poor” practice rating of 12.5% among the groups, together with “incomplete higher education”). There is no clear trend in terms of differences in attitudes, except for a negative one, again in the vocational education category. In this group, most respondents had their perspectives in the “poor” category. However, no trend could be detected that higher education equals a better attitude. For instance, the group with advanced vocational education has a “better” attitude, and the same counted for the group with higher education. Partially, these differences could be explained by the assumption that more educated people in general tend to be more critical. Since this section has covered not only attitudes towards the virus but also strategies for managing the virus situation (used by the government), it is possible that the criticality revealed in these questions may have altered the final distribution of the responses in the categories of “good”, “moderate”, and “poor”. Finally, when looking at the differences in responses by different income groups, statistically significant differences were found in all areas. There are several trends in this area that differ significantly between groups. The lowest income group (up to 400 EUR) has a moderate and relatively poor awareness, and their attitudes are scattered, and, in the case of the poorest group, also very poor. In the latter case, even their practice is moderate (“poor” is the highest among the groups), which is uncharacteristic of the entire study. Later (in the second-lowest income group), the behaviour stabilises, but the difference between “moderate” and “good” remains the smallest between the groups. Interestingly, when looking at the distribution of “knowledge” by income level, even in the case of higher income, there is no “good” knowledge, but rather a predominance of “moderate” knowledge. In terms of attitudes, the middle and upper-income groups (400–1000 EUR) are divided into two main categories: “moderate” and “good”. In the area of practice, “good” starts to dominate, with a tendency that shows that the higher the income, the more responsible the respondents’ behaviour becomes. The highest income group BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 (above 1,200 EUR) is also interesting: in the section of knowledge, the “moderate” category dominates, with “poor” responses outnumbering “good” ones. The “moderate” responses decrease in the attitudinal area, while the “good” category shows an upward trend. At the same time, the “poor” category is twice as large as the “moderate” one. However, the situation changes in the area of practice, where the above-mentioned trend continues, with an impressive rate of responsible practice (97.2%). Finally, the group with no income indication is distinctive: quite moderately informed (with the lowest score in the “good” category) and with a very dispersed attitude (similar proportions in all three categories). Even in this case, however, a more responsible behaviour is recorded than in the case of the lower-income group. CONCLUSIONS The overall score for public knowledge falls into the “average” category. The variable frequency of information sources and their use meant that only a small proportion of the respondents fell into the category “good”. In terms of attitudes, the “moderate” category also had the highest number of responses. However, there was a significant increase in the category “good”. Although the respondents differed considerably in their views on the danger and origin of the virus and the measures used by the Lithuanian government to fight the pandemic, the overwhelming majority of the respondents were in favour of individual protection and obedience to the instructions of specialists. This was the reason why the majority of the reposndents scored “good” (60.6%) and “moderate” (37.4%) in the area of “Practice”. Even though the respondents in the study experienced the effects of the pandemic in different ways, the general trend was that most behaved responsibly and knew where to go for help if needed. A detailed analysis of the data using the KAP research method revealed an unexpected interdependence among knowledge, attitudes, and practices. This suggests an ambiguous relation between governmental measures to manage the crisis and public response. Having in mind that the communication was not clear enough, or at least it did not receive unanimous support of society, it contributed to the diversity of public attitudes, but strict measures and the magnitude of the danger led to particular social behaviour. Another important factor that definitely had an impact on public attitudes, was the election of the LR Seimas and the eventual change of political power (the election campaign was accompanied with harsh debates among the candidates, which might have impacted public attitudes). However, it is still unclear what is driving public behaviour – an understanding of personal responsibility BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454 VOLUME 15, NUMBER 2 2022 in the light of a global threat and acting accordingly, or simply adherence to strict crisis management measures? The function of official communication remains unclear, whether it actually promoted responsible behaviour or whether it was drowned in a plethora of pandemic-related information with diverse interpretations, contributing to the polarisation of opinion in society. As the study did not attempt to capture the content of the information used by the respondents, it is not possible to answer unequivocally why attitudes are significantly divided between groups. Obviously, this content was different, despite the similar use of information tools. It is also likely that there are other (value-based and psychological) factors at play that directly contribute to the reinforcement of personal attitudes. It is clear, however, that official communication wasn’t been sufficient to create a more unified view of society. As expected, those who were married and better educated showed more responsible practices. However, the analysis of knowledge and attitudes did not confirm statistically significant differences. Nevertheless, the most striking differences were found in the different income groups. As mentioned above, the lowest income group experienced high levels of frustration or even despair in all areas, such as frequency of interest, subjective knowledge, attitudes towards the inevitability of the virus and the natural stress of not knowing where to turn for help. Not surprisingly, this eventually leads to a lack of personal responsibility. The opposite trend is observed in the case of the higher and highest income groups, which have objectively better living conditions (which provide privacy) and usually a much wider social circle of acquaintances (which provide mutual help when needed). This is probably why knowledge does not play a key role here, and attitudes are irrelevant, as this group has the resources to take better precautions and can be autonomous. A further implication is that the objective deprivation/well-being of both the poorest and the wealthiest groups became a more critical factor in practice than knowledge or attitudes towards the virus. However, more research would be needed to substantiate this assumption. Without additional research, it is difficult to say whether the pandemic managers were aware (and to what extent) of the differences in knowledge, attitudes, and behaviour that existed in society, but the strict measures that were applied suggest that differences were not taken into account. 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Baltic Journal of Law and Politics – de Gruyter
Published: Dec 1, 2022
Keywords: Pandemic management; Lithuania; society; knowledge; attitudes and practice
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