If the risk feels low, why follow disruptive public health rules? This study finds that adherence is not just about fear of disease—it can also grow from clarity, trust, community connection, and concern about stigma. Public health measures are actions taken by governments, organizations, or individuals to reduce the spread and burden of disease.

During the COVID-19 pandemic, these measures ranged from symptom checking to mandatory isolation orders, and they differed between countries and local jurisdictions. Although public health measures target individual behaviour, their success depends on the adherence of everyone.

Research identifies perception of risk, social integration, empathy, and social responsibility as factors that facilitate adherence. At the same time, previous research identified young adults among non-compliant populations. Less is known about why people at low risk adhere, and whether the same motivators and deterrents apply to all public health measures.

Earlier research often focused on a single measure and quantitatively analyzed factors that motivate or deter adherence rather than the process of adherence. Qualitative research is needed to capture the humanism of adherence and provide an in-depth understanding of why individuals adhere.

Prince Edward Island provided a unique low-risk environment because it had the lowest COVID-19 case rate in Canada in early twenty twenty-one. Young adults have been identified as a non-adherent population, but there is considerable debate about why young adults are non-adherent.

Some explanations emphasize large social networks and active social lives, while others emphasize low self-control, impulsivity, and certain personality traits. Young adults make up a significant portion of the population, have large social networks, and are more risk tolerant than older adults, making them more likely to transmit the virus and other infectious diseases.

The World Health Organization and the Centers for Disease Control and Prevention highlighted the need to motivate adherence among this population. The study therefore used qualitative inquiry to understand young adults’ adherence to public health measures.

Its objectives were to understand the socio-psychological motivators and deterrents of adherence, and to understand differences and similarities across the various public health measures. A qualitative research approach was chosen because of its strength in generating knowledge grounded in human experience.

Qualitative data came from semi-structured interviews between the researcher and participants. Semi-structured interviews allowed the interviewer to guide the discussion while permitting other topics important to the research question to be discussed in greater detail as they arose.

The study population consisted of English-speaking individuals in their twenties currently living in Prince Edward Island. Young adults were defined as individuals twenty to twenty-nine years old because some provincial COVID-19 testing recommendations specifically targeted that age group.

At the time of the first interview, Prince Edward Island reported one hundred sixty-three total COVID-19 cases among a population of approximately one hundred fifty-nine thousand. Most cases were travel-related, there was little community spread, and there were no deaths directly attributable to the virus.

During recruitment, the study was labelled an analysis of pandemic experiences of young adults to avoid attracting only individuals who adhered to public health measures and influencing participant responses. Participants were recruited through a public Facebook group called Ask PEI, a radio advertisement through Island News, and network sampling.

The final sample included thirty participants because data saturation occurred at that point; data saturation occurs when additional interviews cease producing new themes. The semi-structured interview guide consisted of key questions that guided the discussion.

Creating the guide involved reviewing relevant literature, assessing question guides from similar qualitative studies, and discussing the guide among the research team. The guide was pilot-tested with three individuals who were not included in the analysis, and their feedback resulted in minor changes.

The interviews took place during April and May twenty twenty-one, between Prince Edward Island’s fourth and fifth pandemic waves. Most interviews occurred over Zoom, while the remaining three took place by telephone at the participant’s request. All interviews were led by the same researcher, whose video remained on regardless of the participant’s choice to ensure consistency across interviews.

Online videoconferencing was used because public health guidelines discouraged in-person meetings, and previous research found Zoom interviews had similar quality to in-person interviews and were preferred to other forms of interviews. Deductive and inductive thematic analysis was used to analyze the transcripts.

Coding was done by G.P., and selected transcripts were reviewed and discussed by the larger research group in weekly research meetings. Meeting minutes were recorded to establish an audit trail. Transcripts were deductively coded in relation to the Theoretical Domains Framework, which provides a systematic, structured approach for integrating well-supported theories on health behaviour.

The framework consists of fourteen domains that synthesize thirty-three psychological theories and one hundred twenty-eight constructs related to behaviour change. Systematic reviews have shown that the framework enables analysis of deterrents to adopting new health behaviours.

Participant codes that did not fit neatly into the Theoretical Domains Framework were also considered. Inductive and deductive codes were considered together, and themes were generated through an iterative process that grouped codes with similar sentiment and labelled them according to the meaning conveyed by participants.

The final codebook consisted of eight themes, with nineteen parent codes and fifty-two child codes across those themes. Participants were young adults aged twenty to twenty-nine years living in Prince Edward Island, and they varied in key demographic factors. None of the participants had contracted COVID-19, to their knowledge, at the time of the study.

On a seven-question knowledge test, the median and mean were six correct answers, with a range of four to seven correct answers. Table one profiles the thirty young adults interviewed, who were aged twenty to twenty-nine, with a mean age of twenty-four point four and a median of twenty-four.

The table reports gender, birthplace, education, student and employment status, housing, relationships, household composition, and whether participants lived with older, immunocompromised, or dependent people. This context matters because the participants lived in Prince Edward Island, varied across key demographic factors, and none had contracted COVID-19 to their knowledge, framing the later analysis of public-health-measure adherence.

The young adults interviewed adhered to a public health measure when public health officials clearly explained its purpose and the measure was perceived as necessary and executable. A clear, purpose-driven rationale helped justify the challenges of adherence.

Tariq described the information about circuit breakers as clear, with a good understanding of what he had to carry out to comply. He also said the circuit breaker was justified because its consequences were clear. The newness of pandemic rules was both a barrier and a motivator to adherence for young adults.

Initially, young adults perceived adherence to new measures as more challenging, especially when a new measure required behaviour change. Young adults described challenges in adopting masks because masks changed their routines and social interactions. None of the young adults described novelty as an absolute deterrent; instead, they described novelty as an obstacle they had to work around.

Figure one organizes eight common themes from young adults’ accounts into motivators, deterrents, or both. Motivators included a clear rationale, manageable disruption, reducing anxiety, community duty, trust in local leadership, and moral culpability; caution rather than compliance was a deterrent, while adapting to novel measures could work in either direction.

This matters because adherence was shaped not only by the rules themselves, but also by how understandable, disruptive, emotionally meaningful, and trustworthy they felt. The study explains why young adults in a low-risk environment did and did not adhere to public health measures.

The identified themes demonstrate specific rationales for adherence behaviour that policy makers can target. Because the success of public health measures depends on adherence by those at low risk, these findings are useful for coordinating measures in future public health emergencies.

The rationales for adherence can compound with one another; novelty, community pride, and clarity can all buttress one another. When public health officials have difficulty motivating adherence, including because of COVID-fatigue, they can draw on strategies such as developing trust and community.

Socio-psychological factors such as attitudes are not always reflective of behaviour, and the relationship between attitudes and self-reported behaviours is complex and non-linear. Participants were interviewed at a single point in time, during April and May twenty twenty-one, so their views do not reflect later stages of the pandemic.

The findings provide details on experiences and perspectives, but they are not statistically generalizable. Future research should replicate these findings in other communities to strengthen understanding of how cultural elements shape adherence in other low-risk settings.

Young adults in a very low-risk setting followed public health measures when the purpose was clear and adherence felt connected to community, leadership, and responsibility. That gives public health officials several strategies beyond simply emphasizing danger.