1 Department of Health, Kinesiology & Applied Physiology, Concordia University, Montréal, Québec, Canada.
2 Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada.
3 Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
4 University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada.
5 Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
6 Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
7 Department of Psychology, University of Quebec at Montreal, Montreal, Québec, Canada.

Background: Italy was the first European country to be affected by COVID-19. Considering that many countries are currently battling the 2nd wave of the pandemic, understanding people's perceptions and responses to government policies remains critical for informing on-going mitigation strategies. We assessed attitudes towards COVID-19 policies, levels of adherence to preventive behaviours, and the association between COVID-19 related concerns and adherence levels.

Methods: We recruited a convenience sample of Italian individuals from an international cross-sectional survey (www.icarestudy.com) from March 27th to May 5th 2020. Multivariate regression models were used to test the association between concerns and the adoption of preventive measures.

Results: The survey included 1,332 participants (female (68%), younger than 25 (57%)) that reported high awareness (over 96%) and perceived importance (88%) of policies. We observed varied levels of adherence to: hand washing (96%), avoiding social gatherings (96%), self-isolation if suspected or COVID-19 positive (77%). Significantly lower adherence to self-isolation was reported by individuals with current employment. High levels of concerns regarding health of other individuals and country economy were reported. Only health concerns for others were significantly associated with higher adherence to hand washing behaviour.

Conclusions: In order to inform current/future government strategies, we provide insights about population's responses to the initial pandemic phase in Italy. Communication approaches should consider addressing people's concerns regarding the health of other individuals to motivate adherence to prevention measures. Provision of social and economic support is warranted to avoid unequal impacts of governmental policies and allow effective adherence to self-isolating measures.