New Study Casts COVID-19 and Government Mandates in a New Light in Rural America

When Adam Koon, PhD, MPH, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health, arrived in his wife’s hometown last summer to quarantine with their children, they were surprised to see so few people in masks. With his wife, Emily Mendenhall, PhD, MPH, a professor at Georgetown University, they set out to conduct a study in this small, rural Midwestern tourist town by interviewing local residents about COVID-19 and why so few took COVID-19 precautions seriously. The study was published in Social Science & Medicine in March 2021. According to Koon, “As a research team, we were motivated by an equal mix of concern and curiosity about a community we love dearly. Most of the team grew up in the area and the rest either live there or spend a considerable amount of time there. On a tacit level, we understood some of what was going on, but I think we learned several new things along the way.”  

Photo credit: David Thoreson

At the beginning of the pandemic, the town shut down for approximately one month, and then reopened without any public health mandates in place for social distancing, masking and closures on May 1, 2020, at the outset of the popular tourist season. Although the community was mostly white, conservative, and Christian, people held widely different views that cut across political, religious, and class affiliations. “We found that when the tourist season came, people shifted their collective priorities away from the novel coronavirus to focus on saving the economy because the 100 days of summer are the only months when many locals earn income,” Mendenhall said. Yet, the researchers wanted to go further by understanding how a variety beliefs and values were tied to actions. 

Framing is a fundamental concept in the social sciences that explains how moral worldviews are constructed. Differences in framing contested issues, such as gun control and abortion, lie at the heart of policy controversy. This helps us understand, in part, how people make sense of the world around them and their relationships in which health becomes embedded. According to Koon, “I often use a particular form of framing analysis that looks more at the policymaking process, but in this instance it made sense to focus on the frames themselves. In some ways, this is kind of a classic sociological approach to frame analysis, but we also drew a little bit on some newer theories of framing from critical policy studies.” Koon’s expertise on framing and Mendenhall’s skill as an ethnographer allowed them to rapidly explore these complicated processes.

The researchers collected data through semi-structured interviews with local community members from June to August 2020. They also observed community meetings, events, and daily life. The researchers found four main frames that enabled individuals to make sense of the coronavirus: concern, crisis, constraint, and conspiracy:

• Concern frames focused on how some people are uniquely affected by COVID-19 (e.g. the elderly, people with co-morbidities, or front-line workers) and as a result, these individuals were likely to take preventive actions, especially to protect themselves and loved ones. 
• Crisis frames recognized coronavirus as a pervasive and profound threat requiring unprecedented action. Individuals with this frame were likely to follow science and public health recommendations closely. 
• Constraint frames emphasized the coronavirus response as a threat to financial stability and personal growth that should be resisted. Individuals with this frame were likely to be business owners and employees more concerned about economic implications than the biological threat, or younger people who perceived the threat of COVID-19 to be minimal to themselves but with a big impact on their social lives.
• Conspiracy frames denied its biological basis and did not compel action. Individuals with this frame were likely to have a strong anti-government sentiment and unwillingness to follow public health recommendations. 

The frames constructed around COVID-19 in this small Midwestern tourist town matter. For example, residents who subscribed to a concern frame often felt socially obligated to comply with COVID-19 safety guidance in the absence of government mandates if it only directly affected themselves or their families and not the broader community, whereas constraint and conspiracy frame adherents were much more resistant. This allowed COVID-19 to thrive and spread rapidly, as there was neither a coherent appreciation of the biological risk nor widespread adoption of control measures used in this community. These frames help to explain the controversy surrounding COVID-19, even in settings with fewer obvious political, ethnic, and class distinctions. “This is not a blue state–red state thing. We’re not talking party politics,” said Koon. “The study helps us understand why COVID-19 guidelines have been so inconsistent and divisive even in less diverse settings. These findings provide a social rationale for public health mandates—such as masking, school and business closures, and social distancing—when contested beliefs impede collective action,” he added.  

The research team is currently using this evidence to advise targeted communication and outreach efforts that seek to reframe the pandemic response in ways that resonate with greater segments of the population. In this way, they hope policymakers will be better positioned to strengthen guidance on measures to prevent viral transmission. According to Koon, “We still have more work to do, and Emily’s writing a wonderful book on the subject, but we’re pleased that we’re able to contribute in this small way.”

The study was published in Social Science & Medicine in March 2021 and written by Adam D. Koon, Emily Mendenhall, Lori Eich, Abby Adams, and Zach A. Borus. Koon and Mendenhall also wrote a companion piece with Nora Kenworthy drawing on the same data to look at the cultural politics of the American COVID-19 response. It was recently published in Global Public Health. The research for both papers was not funded by any organization and done entirely for free.