Background: Social isolation measures though a requisites to control viral spread during the COVID-19 pandemic could result in adverse modification of people's health perceptions and lifestyle behaviors.
Objective: The aim of this cross-national survey was to report the real-time data on the public response to changes in lifestyle behavior during the COVID-19 pandemic.
Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status (2) adoption of healthy lifestyle choice. Statistical associations were assessed with linear and logistic regression analyses.
Results: We received 3371 responses; 1342 were from India, 983 from China, 669 from Italy, and 377 from Japan. A differential country wise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest for Japanese respondents (6.81, SD 3.44).Perception of interpersonal relationships was most pronounced in the Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. The influence of perception of interpersonal relationships on lifestyle choices was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). Perceived health status was a significant predictor of lifestyle change across all the countries, most prominently in China and Italy.
Conclusion: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior.