Scientific overview


The International Assessment of COVID-19-related Attitudes, Concerns, Responses and Impacts in Relation to Public Health Policies (iCARE) study

The iCARE study has been listed (ID #21680) among the COVID-19 Research Tools by the Office of Behavioral and Social Sciences Research (OBSSR) of the US National Institutes of Health as part of the NIH Public Health Emergency and Disaster Research Response (DR2).

Background: In the context of a highly contagious virus with no vaccine and no cure, the key to slowing the spread of COVID-19 and successfully transitioning through the phases of the pandemic and into ‘life after COVID’, is public adherence to the unprecedented and rapidly evolving behaviour-based public health policies being implemented around the world. However, adherence to public health policies involves making significant behaviour changes that may come with significant personal, social and economic costs, which may undermine their impact. Further, as we look towards deconfinement, people’s willingness to adhere to new government recommendations (e.g., re: school and store openings) will also be critical for transitioning through the phases of the pandemic and re-engaging the economy. Unfortunately, policies have varied greatly between provinces and countries, contributing to public uncertainty about government policy motives and confusion about which policies to follow. This too may contribute to sub-optimal policy impacts and outcomes. Several complex factors are likely to predict why people adhere (or not) to various public health measures. These factors can be summarized by two complementary behaviour prediction models: (1) The COM-B (Capability, Opportunity, Motivation-Behaviour) model; and the (2) The Health Beliefs Model, which together, provide a framework for understanding the psychological, behavioural, social, and environmental factors that predict behavior change and adaptation. In the context of this unprecedented health, social and economic crisis, where the global need for adherence to public health policies has never been greater, our understanding of the determinants of adherence at each phase of the infection curve in countries around the world is critical for effective policy planning and communication.

The iCARE Study is an ongoing, multi-wave international study of public awareness, attitudes, concerns and behavioural responses to public health policies implemented to reduce the spread of COVID-19, as well as the multidimensional impacts of the pandemic on people around the world. Our goal is to link behavioural survey data with policy, mobility and case data to provide behavioural science, data-driven recommendations to governments on how to optimize current policy strategies to reduce the impact of the COVID-19 pandemic in Canada and around the world.

The project aims to address the following research questions:

  1. What are the sociodemographic (e.g., age, sex, gender, ethnicity, parental status, employment/ student status, built environment, healthcare system factors), psychological (e.g., COVID-19 attitudes, beliefs and concerns), behavioural, physical/mental health, and economic determinants of adherence to major COVID-19 public health policies in general, and by country/province?
  2. What are the short and medium-term impacts of COVID-19, including physical and mental health, social, occupational, and economic outcomes, and do they vary as a function of key characteristics (e.g., age, sex/gender, ethnicity, healthcare worker status) in general and by country/province?

Using this data, we will determine (1) Which strategies, launched where, when, and for whom were most (and least) associated with adherence and most (and least) effective at reducing infection rates and mortality and minimizing impacts, in order to provide (2) data-driven recommendations to governments on how to optimize policy and communication strategies to improve policy adherence and health, economic, and quality of life outcomes.

Methods: This is an international multi-wave cross-sectional observational cohort study. Survey data will be collected in monthly waves from May-December 2020 using convenience snowball sampling (globally, 25-30K per wave, n=200-240K total) and parallel representative sampling (in targeted countries, n=1,500 per wave/country, n=81,000), generating data for 8 cohorts of participants that will be added to the first wave cohort launched on March 27, 2020. We have confirmed the collaboration of more than 150 international researchers from 40 countries and the survey is currently available in 36 languages. Survey data will be linked at the country/province-level with Oxford Government Policy Tracker data, Google Mobility data, and Johns Hopkins case/death/recovery data. The primary analyses will be general linear models accounting for time scale (i.e., the date of survey completion) using multilevel modelling software.

Relevance and impact: This study will provide high-quality, accelerated and real-time evidence to support COVID-19 policy strategy and communication in Canada and around the world. The study will leverage an existing online assessment platform, as well as the expertise and resources of 150 collaborators in 40 countries. Survey questions were chosen to enable harmonized data collection and analyses with similar international NIH and WHO studies. A unique strength of the study is the inclusion of low and middle-income countries in global and representative samples. This will help us understand what public health policies and strategies are working, where, and for whom, which can inform policy strategy and communication in real time to help mitigate the spread of COVID-19, and its physical/ mental health, social, economic and quality of life impacts, both locally and around the world.

The iCARE study has been approved by the Research Ethics Committee of the CIUSSS-NIM (Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal): approval # 2020-2099 / 03-25-2020.

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iCARE Canadian Longitudinal Study

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