Attitudes about covid-19 and health (attach): Online survey and mixed methods study

Anna M. Hood*, Hanne Stotesbury, Jennifer Murphy, Melanie Kölbel, April Slee, Charlie Springall, Matthew Paradis, Nadia Saraí Corral-Frías, Azalea Reyes-Aguilar, Alfredo B. Cuellar Barboza, Amy E. Noser, Stacey Gomes, Monica Mitchell, Sharon M. Watkins, Melinda Butsch Kovacic, Fenella J. Kirkham, Lori E. Crosby

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper-Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics.

Original languageEnglish
Article numbere29963
JournalJMIR Mental Health
Issue number10
StatePublished - Oct 2021

Bibliographical note

Funding Information:
The CCTST at the University of Cincinnati is funded by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant 2UL1TR001425-05A1. The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS). The content of this manuscript is solely the responsibility of the CCTST and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2021 JMIR Publications. All rights reserved.


  • COVID-19
  • Deprivation
  • International
  • Mental health
  • Mitigation strategies


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