Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol

Aziz Mert Ipekci; Maximilian Filsinger; Diana Buitrago-Garcia; Cristopher I. Kobler Betancourt; Annika Frahsa; Nicola Low

doi:10.12688/f1000research.145852.1

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Study Protocol

Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol

[version 1; peer review: 2 approved]

Aziz Mert Ipekci ^1-3, Maximilian Filsinger^2,4, Diana Buitrago-Garcia³, Cristopher I. Kobler Betancourt^1-3, Annika Frahsa^2,3, Nicola Low^2,3

Aziz Mert Ipekci ^1-3, Maximilian Filsinger^2,4, [...] Diana Buitrago-Garcia³, Cristopher I. Kobler Betancourt^1-3, Annika Frahsa^2,3, Nicola Low^2,3

PUBLISHED 17 May 2024

Author details Author details

¹ Graduate School for Health Sciences, University of Bern, Bern, Switzerland
² Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
³ Institute of Social Preventive and Medicine, University of Bern, Bern, Switzerland
⁴ Institute of Political Science, University of Bern, Bern, Switzerland

Aziz Mert Ipekci
Roles: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Maximilian Filsinger
Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Diana Buitrago-Garcia
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Cristopher I. Kobler Betancourt
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Annika Frahsa
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Nicola Low
Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Coronavirus (COVID-19) collection.

Abstract

Introduction

The COVID-19 pandemic affected people’s health behaviours and health outcomes. Political or affective polarization could be associated with health behaviours such as mask-wearing or vaccine uptake and with health outcomes, e.g., infection or mortality rate. Political polarization relates to divergence or spread of ideological beliefs and affective polarization is about dislike between people of different political groups, such as ideologies or parties. The objectives of this study are to investigate and synthesize evidence about associations between both forms of polarization and COVID-19 health behaviours and outcomes.

Methods

In this systematic review, we will include quantitative studies that assess the relationship between political or affective polarization and COVID-19-related behaviours and outcomes, including adherence to mask mandates, vaccine uptake, infection and mortality rate. We will use a predetermined strategy to search EMBASE, Medline (Ovid), Cochrane Library, Cochrane COVID-19 Study Register, Global Health (Ovid), PsycInfo (Ovid), Web of Science, CINAHL, EconLit (EBSCOhost), WHO COVID-19 Database, iSearch COVID-19 Portfolio (NIH) and Google Scholar from 2019 to September 8 2023. One reviewer will screen unique records according to eligibility criteria. A second reviewer will verify the selection. Data extraction, using pre-piloted electronic forms, will follow a similar process. The risk of bias of the included studies will be assessed using the JBI checklist for analytical cross sectional studies. We will summarise the included studies descriptively and examine the heterogeneity between studies. Quantitative data pooling might not be feasible due to variations in measurement methods used to evaluate exposure, affective and political polarization. If there are enough relevant studies for statistical data synthesis, we will conduct a meta-analysis.

Discussion

This review will help to better understand the concept of polarization in the context of the COVID-19 pandemic and might inform decision making for future pandemics.

Protocol registration

PROSPERO ID: CRD42023475828.

Keywords

Systematic review, political-polarization, affective-polarization, COVID-19, vaccination, social-distancing, infection-risk, mortality.

Corresponding author: Aziz Mert Ipekci

Competing interests: No competing interests were disclosed.

Grant information: This study is funded by Multidisciplinary Center for Infectious Diseases, University of Bern (grant number MA21).
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Ipekci AM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Ipekci AM, Filsinger M, Buitrago-Garcia D et al. Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol [version 1; peer review: 2 approved]. F1000Research 2024, 13:488 (https://doi.org/10.12688/f1000research.145852.1) First published: 17 May 2024, 13:488 (https://doi.org/10.12688/f1000research.145852.1) Latest published: 17 May 2024, 13:488 (https://doi.org/10.12688/f1000research.145852.1)

Introduction

During the COVID-19 pandemic, researchers observed variations in adherence to infection control measures, such as mask-wearing or vaccine uptake,¹^,² and in health outcomes, such as infection and mortality rate.³ Political science research has long established that governmental action is often appraised through an ideological and partisan lens.⁴^–⁶ In this regard, increasing polarization of attitudes could contribute to explaining the variation in adherence to preventive behaviours and health outcomes. Studies have already shown that polarization of political or personal opinions can be associated with people’s COVID-19 pandemic behaviours and related health outcomes.⁷^–⁹ High levels of polarization might lead to poor health outcomes such as increased infection rate, reduced vaccine uptake or increased mortality⁷^,⁸^,¹⁰^–¹² and lack of adherence to COVID-19 prevention measurements such as social distancing.¹³

Affective and political polarization are related but different concepts. Political polarization refers to the degree to which political beliefs and opinions diverge along ideological lines,¹⁴ whereas affective polarization refers to feelings of dislike and/or distrust that individuals or groups hold about those from a group with opposite views.¹⁵ Political polarization can exist without affective polarization, which means people can have different political views without feeling hostile towards those with opposing views. Both political and affective polarization can be measured quantitatively¹⁶^,¹⁷ using tools based on self-report, such as the ideology scale,¹⁸ feeling thermometer,¹⁹ like-dislike ratings²⁰ and social distance scales.²⁰ Owing to differences between measurement methods, researchers should be cautious in comparing different measurement methods directly.¹⁸

Within the research literature, a number of studies have focused on health-related behaviours and outcomes of polarization. Fraser and colleagues reported that in the United States of America (USA), based on polarization measured on a scale from 0 to 10, for each 1 unit increase in state-level perceived polarization the incidence rate of experiencing poor physical health increased by 1.03 times.²¹ Krupenkin studied the effects of political partisanship on children’s vaccination rate. They dichotomised people into in-partisans (people who voted for the government in power), and out-partisans (people who voted against the government in power).⁸ In a multivariable logistic regression model, presidential out-partisans had lower odds of adhering to USA Government vaccination recommendation than in-partisans.⁸ Nayak and colleagues measured both perceived polarization change and self-reported health with a 5-point Likert scale.²² They found that individuals who reported higher levels of polarization had higher odds of developing depressive and anxiety disorders than those who reported no change in polarization.²² In the context of the COVID-19 pandemic, Gollwitzer et al. studied partisanship at the county level in the USA based on the 2016 presidential election and reported that pro-Trump counties reduced their general movement 9.5 per cent less than Clinton-voting counties.⁷

We found two systematic reviews on polarization but they focus on the association with social media.¹⁸^,²³ Both conducted descriptive syntheses of the data,¹⁸^,²³ with Kubin and colleagues stating that they were unable to perform meta-analysis due to inconsistencies in measurement.¹⁸ To our knowledge, there are no systematic reviews focusing on the association between polarization and health-related health behaviours or outcomes despite the consistent associations found between different forms of polarization and health-related behaviours. This systematic review aims to fill the gap in the literature on the association between polarization and COVID-19 related health behaviours/outcomes to better understand the COVID-19 pandemic and prepare for future pandemics.

Review questions

Question 1: What is the association between political or affective polarization and COVID-19 health behaviours?

Question 2: What is the association between political/affective polarization and COVID-19-related health outcomes?

Methods

This protocol is reported following the Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guideline (Extended data A),²⁴ PROSPERO registration number, CRD42023475828.

Eligibility criteria

Inclusion criteria	Study population: individuals of any age and gender. Exposure: Affective and political polarization measured quantitively Outcome: COVID-19 infection risk, COVID-19 hospitalization risk, COVID-19 mortality risk, COVID-19 vaccine uptake, compliance with mask wearing advice, compliance with physical distancing advice, perceived COVID-19 risk. Publication type: Manuscript reporting primary data, irrespective of publication status. No language restriction.
Eligible study designs	Cohort studies Case-control studies Cross-sectional studies Ecological studies
Exclusion criteria	No additional exclusion criteria
Excluded study designs	Reviews, editorials or commentaries not reporting original data

Search strategy

We searched electronic databases using predefined terms for polarization and COVID-19 (Extended data B) on 8th of September 2023. We will include studies published from 2019 to 2023. Because the topic is multidisciplinary, we will search the following databases: EMBASE (RRID:SCR_001650), Medline (Ovid), Cochrane Library (RRID:SCR_013000), Cochrane COVID-19 Study Register, Global Health (Ovid), PsycInfo (Ovid), Web of Science (RRID:SCR_022706, CINAHL (RRID:SCR_022707), EconLit (EBSCOhost), We will use WHO COVID-19 Database and iSearch COVID-19 Portfolio (NIH) (RRID:SCR_018295) as the source of preprint publications. We will also run a Google Scholar (RRID:SCR_008878) search using keywords such as polarization, affective, political and COVID-19. We will review the first 200 hits on Google Scholar to see if we can identify any study that cannot be identified via our literature search. We will check the reference lists of relevant studies and systematic reviews. We will also contact experts in the field to ask for recommendations about studies that might be eligible. We will not perform hand-searching. We will merge the electronic database search results and remove duplicates using reference management software (EndNote – Clarivate, version 20.4).

Screening and study selection

We will use the liberal screening approach²⁵ to accelerate our screening process. AMI will screen all titles and abstracts and select potentially relevant articles according to the eligibility criteria. A second reviewer (MF, AF, CK-B or DB-G) will verify the screened articles. AMI will retrieve the full-text of all potentially eligible articles and mark those eligible for inclusion. MF, AF, CK-B or DB-G will verify the results of the full-text screening. In case of disagreements that are not resolved by discussion, the senior reviewer NL will decide. We will report the study selection process, and reasons for exclusion, in the PRISMA 2020²⁶ flow diagram.

Data extraction

We will use a predetermined data extraction form in the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia, available at www.covidence.org, RRID:SCR_016484). We piloted extraction from 5 included studies. We will revise and finalize the form (Extended data C) after our pilot extraction. We plan to extract data on how polarization and COVID-19 related health behaviours/outcomes were measured, the main findings, and possible confounding factors, such as data collection date, participant’s age, gender and socioeconomic status. The full list of questions can be found in Extended data C. AMI will extract data from all included articles and MF, AF, CK-B and DB-G will independently verify the accuracy of the extracted data. NL will resolve disagreements if necessary.

Dealing with missing data

We will contact corresponding authors in case of any missing data in the included study. If the author does not reply, researchers (AMI, MF) will decide on whether the study can still be included.

Quality and risk of bias assessment

AMI, MF and DB-G will assess risk of bias independently for each included study. NL will resolve disagreements if the two reviewers cannot reach a consensus. We will use the JBI checklist for analytical cross sectional studies.²⁷

Data synthesis and analysis

The data analysis will start with a description of countries of origin, study population, the methods used to measure exposure and outcome, and the participants’ age and sex in the included studies.

We will employ narrative synthesis methods to explore our dataset following the Synthesis Without Meta-analysis guideline.²⁸ We will group the studies for synthesis based on exposure, affective or political polarization, and outcome, e.g., vaccination uptake and perceived COVID-19 risk. Then, we will describe the metrics for each exposure and outcome. We will justify our reasoning, if certain studies are prioritized to draw conclusions. Lastly, we will report on the heterogeneity and assess the certainty of the synthesis findings.

Our preliminary overview of the literature indicated that there might be too few comparable studies for quantitative data synthesis, owing to variations in measurement methods used to evaluate exposure, and affective and political polarization. Additionally, the potential for heterogeneity exists due to differences in study setups, countries of origin and pandemic severity at the time of study data collection.

We will examine statistical heterogeneity using the I-squared statistic if there are estimated proportions from three or more studies.²⁹ After considering sources of heterogeneity, we will decide if statistically combining effect estimates with a meta-analysis is appropriate for included studies.³⁰

Dissemination

The results of this study will be published in a peer-reviewed journal.

Study status

The literature search for the study has been done. Screening is ongoing, the data extraction, risk of bias analysis, data synthesis and writing of the final report have not started yet.

Discussion

Our study has two main strengths. First, our comprehensive search strategy includes both preprint and published articles gathered from a range of databases in health and political sciences. This will ensure the incorporation of evidence from various fields. Second, our team includes experts with varied backgrounds, including epidemiology, medicine, political sciences, and anthropology, ensuring a wide range of perspectives. This diverse outlook will enable us to adopt a comprehensive approach to both analysis and data interpretation.

Our review also has weaknesses. We will not perform independent screening and extraction in our systematic review owing to time and resource constraints. However, the liberal approach, to include more articles for full-text screening, will reduce the risk of missing important articles. Second, it might not be possible to pool the data quantitatively. Narrative synthesis methods will, however, provide a valid interpretation of the data.

Our preliminary search shows a need for a systematic literature review and evidence synthesis on the association between pandemic related health behaviours/outcomes and polarization. Our systematic review aims to fill the gap in the literature to better understand the COVID-19 pandemic, which could inform decision making for future pandemics.

Ethic and consent

Ethical approval and written consent were not required.

Data availability

Underlying data

No data is associated with this article.

Extended data

OSF: Extended Data, https://doi.org/10.17605/OSF.IO/DG87Q.³¹

This project contains the following underlying data:

A. PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol
B. Full search strategy per database
C. Data extraction form.

The data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Reporting guidelines

OSF: Checklist for Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol, https://doi.org/10.17605/OSF.IO/DG87Q.³¹

Software availability

Covidence (Veritas Health Innovation, Melbourne, Australia, available at www.covidence.org). is a proprietary software. An alternative software that can be used for free is Rayyan (https://www.rayyan.ai/) that allows management and organization of systematic reviews.

Acknowledgments

The authors thank Beatrice Minder and Doris Kopp-Heim (Information Specialists at the Public Health and Primary Care Library, University of Bern, Switzerland) for helping us to develop the literature search strategy.

References

1. Albrecht D: Vaccination, politics and COVID-19 impacts. BMC Public Health. 2022; 22(1): 1–12. Publisher Full Text
2. Hearne BN, Niño MD: Understanding how race, ethnicity, and gender shape mask-wearing adherence during the COVID-19 pandemic: evidence from the COVID impact survey. J. Racial Ethn. Health Disparities. 2021; 9: 176–183. Publisher Full Text
3. Unruh LH, Dharmapuri S, Xia Y, et al.: Health disparities and COVID-19: A retrospective study examining individual and community factors causing disproportionate COVID-19 outcomes in Cook County, Illinois. PLoS One. 2022; 17(5): e0268317. PubMed Abstract | Publisher Full Text | Free Full Text
4. Gadarian SK, Goodman SW, Pepinsky TB: Partisanship, health behavior, and policy attitudes in the early stages of the COVID-19 pandemic. PLoS One. 2021; 16(4): e0249596. PubMed Abstract | Publisher Full Text | Free Full Text
5. Bartels LM: Beyond the running tally: Partisan bias in political perceptions. Polit. Behav. 2002; 24: 117–150. Publisher Full Text
6. Malhotra N, Kuo AG: Attributing Blame: The Public’s Response to Hurricane Katrina. J. Polit. 2008; 70(1): 120–135. Publisher Full Text
7. Gollwitzer A, Martel C, Brady WJ, et al.: Partisan differences in physical distancing are linked to health outcomes during the COVID-19 pandemic. Nat. Hum. Behav. 2020; 4(11): 1186–1197. PubMed Abstract | Publisher Full Text
8. Krupenkin M: Does Partisanship Affect Compliance with Government Recommendations? Polit. Behav. 2021; 43(1): 451–472. PubMed Abstract | Publisher Full Text | Free Full Text
9. Kerr J, Panagopoulos C, van der Linden S : Political polarization on COVID-19 pandemic response in the United States. Personal. Individ. Differ. 2021; 179: 110892. PubMed Abstract | Publisher Full Text | Free Full Text
10. Panagopoulos C, Fraser T, Aldrich DP, et al.: Bridging the Divide: Does Social Capital Moderate the Impact of Polarization on Health? Polit. Res. Q. 2021; 75(3): 875–891.
11. Dolman AJ, Fraser T, Panagopoulos C, et al.: Opposing views: associations of political polarization, political party affiliation, and social trust with COVID-19 vaccination intent and receipt. J. Public Health. 2023; 45(1): 36–39. PubMed Abstract | Publisher Full Text | Free Full Text
12. Curtis C, Stillman J, Remmel M, et al.: Partisan polarization, historical heritage, and public health: Exploring COVID-19 outcomes. World Med. Health Policy. 2022; 15: 163–178. Publisher Full Text
13. Allcott H, Boxell L, Conway J, et al.: Polarization and public health: Partisan differences in social distancing during the coronavirus pandemic. J. Public Econ. 2020; 191: 104254. PubMed Abstract | Publisher Full Text | Free Full Text
14. Fiorina MP, Abrams SJ: Political polarization in the American public. Annu. Rev. Polit. Sci. 2008; 11: 563–588. Publisher Full Text
15. Iyengar S, Lelkes Y, Levendusky M, et al.: The Origins and Consequences of Affective Polarization in the United States. Annu. Rev. Polit. Sci. 2019; 22(1): 129–146. Publisher Full Text
16. Druckman JN, Levendusky MS: What Do We Measure When We Measure Affective Polarization? Public Opin. Q. 2019; 83(1): 114–122. Publisher Full Text
17. Tucker JA, Guess A, Barberá P, et al.: Social media, political polarization, and political disinformation: A review of the scientific literature. Soc. Sci. Res. Netw. 2018. Publisher Full Text
18. Kubin E, von Sikorski C : The role of (social) media in political polarization: a systematic review. Ann. Int. Commun. Assoc. 2021; 45(3): 188–206. Publisher Full Text
19. Gidron N, Sheffer L, Mor G: Validating the feeling thermometer as a measure of partisan affect in multi-party systems. Elect. 2022; 80: 102542. Publisher Full Text
20. Kekkonen A, Suuronen A, Kawecki D, et al.: Puzzles in affective polarization research: party attitudes, partisan social distance, and multiple party identification. Front. Polit. Sci. 2022; 4: 78. Publisher Full Text
21. Fraser T, Aldrich DP, Panagopoulos C, et al.: The harmful effects of partisan polarization on health. PNAS Nexus. 2022; 1(1). PubMed Abstract | Publisher Full Text | Free Full Text
22. Nayak SS, Fraser T, Panagopoulos C, et al.: Is divisive politics making Americans sick? Associations of perceived partisan polarization with physical and mental health outcomes among adults in the United States. Soc. Sci. Med. 2021; 284: 113976. PubMed Abstract | Publisher Full Text
23. Arora SD, Singh GP, Chakraborty A, et al.: Polarization and social media: A systematic review and research agenda. Technol. Forecast. Soc. Change. 2022; 183: 121942. Publisher Full Text
24. Shamseer L, Moher D, Clarke M, et al.: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. Br. Med. J. 2015; 349: g7647. PubMed Abstract | Publisher Full Text
25. Pussegoda K, Turner L, Garritty C, et al.: Systematic review adherence to methodological or reporting quality. Syst. Rev. 2017; 6(1): 1–14.
26. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst. Rev. 2021; 10(1): 1–11.
27. Joanna Briggs Institute: Checklist for analytical cross sectional studies. Adelaide: The Joanna Briggs Institute2017; p. 7. Reference Source
28. Campbell M, McKenzie JE, Sowden A, et al.: Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020; 368: l6890. Publisher Full Text
29. Riley RD, Higgins JP, Deeks JJ: Interpretation of random effects meta-analyses. BMJ. 2011; 342: d549. Publisher Full Text
30. Dekkers OM, Vandenbroucke JP, Cevallos M, et al.: COSMOS-E: Guidance on conducting systematic reviews and meta-analyses of observational studies of etiology. PLoS Med. 2019; 16(2): e1002742. PubMed Abstract | Publisher Full Text | Free Full Text
31. Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol. dataset. Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 17 May 2024

Author details Author details

¹ Graduate School for Health Sciences, University of Bern, Bern, Switzerland
² Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
³ Institute of Social Preventive and Medicine, University of Bern, Bern, Switzerland
⁴ Institute of Political Science, University of Bern, Bern, Switzerland

Aziz Mert Ipekci
Roles: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Maximilian Filsinger
Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Diana Buitrago-Garcia
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Cristopher I. Kobler Betancourt
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Annika Frahsa
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Nicola Low
Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This study is funded by Multidisciplinary Center for Infectious Diseases, University of Bern (grant number MA21).
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (1)

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Published: 17 May 2024, 13:488

https://doi.org/10.12688/f1000research.145852.1

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© 2024 Ipekci AM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ipekci AM, Filsinger M, Buitrago-Garcia D et al. Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol [version 1; peer review: 2 approved]. F1000Research 2024, 13:488 (https://doi.org/10.12688/f1000research.145852.1)

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Reviewer Report 17 Jul 2024

Markus Wagner, University of Vienna, Vienna, Austria

Approved

https://doi.org/10.5256/f1000research.159858.r298434

This systematic review protocal addresses an important and relevant question concerning health behaviours and health outcomes, namely the impact of various types of political polarization. Given what we know from political science, it is highly likely that political ideologies and ... Continue reading

This systematic review protocal addresses an important and relevant question concerning health behaviours and health outcomes, namely the impact of various types of political polarization. Given what we know from political science, it is highly likely that political ideologies and partisanship will influence how people behave, and people may even take decisions that will harm themselves due to their political biases.

This protocol is clear and transparent, and all key steps are described well. All procedures conform to best practice, at least to my knowledge. I have a couple of comments that may be useful to the researchers:
- The protocal addresses political polarization and affective polarization. I would suggest a different way of capturing this, as I think most political scientists would argue that there is an overarching phenomenon of political polarization, which can be subdivided into ideological polarization and affective polarization. The former is what the authors here call "political" polarization, but I think that is a little misleading, as affective polarization is also political.
- Within affective polarization, it would be important to pay additional attention to the role of partisanship and party identities more explicitly. This could encompass both positive and negative partisan identities.
- An important additional aspect of interest could be to examine whether polarization from/by the left or from/by the right has more of an impact on health behaviours and outcomes. Polarization is a deceptively neutral term, and may be the result of growing extremism and stronger affective patterns on both sides of the political spectrum. Including this in the analysis as best possible would be an important addition.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Political science

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 19 Jun 2024

Ray Block, The Pennsylvania State University - University Park Campus, University Park, Pennsylvania, USA

Approved

https://doi.org/10.5256/f1000research.159858.r287860

I am pleased to support the advancement of the manuscript titled "Polarization and Health-Related Behaviours and Outcomes During the COVID-19 Pandemic: A Systematic Review Protocol."

The authors are addressing a crucial aspect of the pandemic by synthesizing ... Continue reading

I am pleased to support the advancement of the manuscript titled "Polarization and Health-Related Behaviours and Outcomes During the COVID-19 Pandemic: A Systematic Review Protocol."

The authors are addressing a crucial aspect of the pandemic by synthesizing the existing (quantitative) empirical literature on polarization and COVID-19 mitigation behaviors. This work is not only timely but also essential in understanding how societal divisions affect health-related behaviors and outcomes.

One of the standout features of this manuscript is its ambitious scope. The authors aim to synthesize research from various geographic contexts over multiple years of the pandemic. Additionally, they consider a broad range of mitigation behaviors, such as masking and vaccine uptake, and examine different forms of polarization, including affective and political. This comprehensive approach is commendable and will provide valuable insights into the complex interplay between polarization and health behaviors during the COVID-19 pandemic.

The research design outlined by the authors is detailed and appropriate for a literature synthesis of this magnitude. While there may be concerns about the availability of a sufficient number of studies to conduct a statistical analysis of effect sizes, I am hopeful that such meta-analyses will be feasible. Having this information could significantly inform future policymaking, both for the ongoing pandemic and for future public health emergencies.

The author team is uniquely positioned to undertake and complete this ambitious project. I look forward to seeing future iterations and the final outcomes of this research. Their work will undoubtedly contribute significantly to the understanding of polarization and health-related behaviors during the COVID-19 pandemic.

I have minimal critique to offer this study. My main suggestion is the inclusion of research conducted by my colleagues, such as [1],[2]. These studies could add valuable data to the synthesis.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

References

1. Block R, Plutzer E: The Self-Appraisal of Masking Instrument. Measurement Instruments for the Social Sciences. 2022; 4 (1). Publisher Full Text
2. Block R, Burnham M, Kahn K, Peng R, et al.: Perceived risk, political polarization, and the willingness to follow COVID-19 mitigation guidelines.Soc Sci Med. 2022; 305: 115091 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Political science (race and ethnic politics, political behavior, public opinion)

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Ray Block, The Pennsylvania State University - University Park Campus, University Park, USA
Markus Wagner, University of Vienna, Vienna, Austria

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Markus Wagner, University of Vienna, Vienna, Austria

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Approved

This systematic review protocal addresses an important and relevant question concerning health behaviours and health outcomes, namely the impact of various types of political polarization. Given what we know from political science, it is highly likely that political ideologies and partisanship will influence how people behave, and people may even take decisions that will harm themselves due to their political biases.

This protocol is clear and transparent, and all key steps are described well. All procedures conform to best practice, at least to my knowledge. I have a couple of comments that may be useful to the researchers:
- The protocal addresses political polarization and affective polarization. I would suggest a different way of capturing this, as I think most political scientists would argue that there is an overarching phenomenon of political polarization, which can be subdivided into ideological polarization and affective polarization. The former is what the authors here call "political" polarization, but I think that is a little misleading, as affective polarization is also political.
- Within affective polarization, it would be important to pay additional attention to the role of partisanship and party identities more explicitly. This could encompass both positive and negative partisan identities.
- An important additional aspect of interest could be to examine whether polarization from/by the left or from/by the right has more of an impact on health behaviours and outcomes. Polarization is a deceptively neutral term, and may be the result of growing extremism and stronger affective patterns on both sides of the political spectrum. Including this in the analysis as best possible would be an important addition.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Political science

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Reviewer Report

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19 Jun 2024 | for Version 1

Ray Block, The Pennsylvania State University - University Park Campus, University Park, Pennsylvania, USA

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Approved

I am pleased to support the advancement of the manuscript titled "Polarization and Health-Related Behaviours and Outcomes During the COVID-19 Pandemic: A Systematic Review Protocol."

The authors are addressing a crucial aspect of the pandemic by synthesizing the existing (quantitative) empirical literature on polarization and COVID-19 mitigation behaviors. This work is not only timely but also essential in understanding how societal divisions affect health-related behaviors and outcomes.

One of the standout features of this manuscript is its ambitious scope. The authors aim to synthesize research from various geographic contexts over multiple years of the pandemic. Additionally, they consider a broad range of mitigation behaviors, such as masking and vaccine uptake, and examine different forms of polarization, including affective and political. This comprehensive approach is commendable and will provide valuable insights into the complex interplay between polarization and health behaviors during the COVID-19 pandemic.

The research design outlined by the authors is detailed and appropriate for a literature synthesis of this magnitude. While there may be concerns about the availability of a sufficient number of studies to conduct a statistical analysis of effect sizes, I am hopeful that such meta-analyses will be feasible. Having this information could significantly inform future policymaking, both for the ongoing pandemic and for future public health emergencies.

The author team is uniquely positioned to undertake and complete this ambitious project. I look forward to seeing future iterations and the final outcomes of this research. Their work will undoubtedly contribute significantly to the understanding of polarization and health-related behaviors during the COVID-19 pandemic.

I have minimal critique to offer this study. My main suggestion is the inclusion of research conducted by my colleagues, such as [1],[2]. These studies could add valuable data to the synthesis.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

References

1. Block R, Plutzer E: The Self-Appraisal of Masking Instrument. Measurement Instruments for the Social Sciences. 2022; 4 (1). Publisher Full Text
2. Block R, Burnham M, Kahn K, Peng R, et al.: Perceived risk, political polarization, and the willingness to follow COVID-19 mitigation guidelines.Soc Sci Med. 2022; 305: 115091 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Political science (race and ethnic politics, political behavior, public opinion)

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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[1] 1. Albrecht D: Vaccination, politics and COVID-19 impacts. BMC Public Health. 2022; 22(1): 1–12. Publisher Full Text

[2] 2. Hearne BN, Niño MD: Understanding how race, ethnicity, and gender shape mask-wearing adherence during the COVID-19 pandemic: evidence from the COVID impact survey. J. Racial Ethn. Health Disparities. 2021; 9: 176–183. Publisher Full Text

[3] 3. Unruh LH, Dharmapuri S, Xia Y, et al.: Health disparities and COVID-19: A retrospective study examining individual and community factors causing disproportionate COVID-19 outcomes in Cook County, Illinois. PLoS One. 2022; 17(5): e0268317. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Gadarian SK, Goodman SW, Pepinsky TB: Partisanship, health behavior, and policy attitudes in the early stages of the COVID-19 pandemic. PLoS One. 2021; 16(4): e0249596. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Bartels LM: Beyond the running tally: Partisan bias in political perceptions. Polit. Behav. 2002; 24: 117–150. Publisher Full Text

[6] 6. Malhotra N, Kuo AG: Attributing Blame: The Public’s Response to Hurricane Katrina. J. Polit. 2008; 70(1): 120–135. Publisher Full Text

[7] 7. Gollwitzer A, Martel C, Brady WJ, et al.: Partisan differences in physical distancing are linked to health outcomes during the COVID-19 pandemic. Nat. Hum. Behav. 2020; 4(11): 1186–1197. PubMed Abstract | Publisher Full Text

[8] 8. Krupenkin M: Does Partisanship Affect Compliance with Government Recommendations? Polit. Behav. 2021; 43(1): 451–472. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Kerr J, Panagopoulos C, van der Linden S : Political polarization on COVID-19 pandemic response in the United States. Personal. Individ. Differ. 2021; 179: 110892. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Panagopoulos C, Fraser T, Aldrich DP, et al.: Bridging the Divide: Does Social Capital Moderate the Impact of Polarization on Health? Polit. Res. Q. 2021; 75(3): 875–891.

[11] 11. Dolman AJ, Fraser T, Panagopoulos C, et al.: Opposing views: associations of political polarization, political party affiliation, and social trust with COVID-19 vaccination intent and receipt. J. Public Health. 2023; 45(1): 36–39. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Curtis C, Stillman J, Remmel M, et al.: Partisan polarization, historical heritage, and public health: Exploring COVID-19 outcomes. World Med. Health Policy. 2022; 15: 163–178. Publisher Full Text

[13] 13. Allcott H, Boxell L, Conway J, et al.: Polarization and public health: Partisan differences in social distancing during the coronavirus pandemic. J. Public Econ. 2020; 191: 104254. PubMed Abstract | Publisher Full Text | Free Full Text

[14] 14. Fiorina MP, Abrams SJ: Political polarization in the American public. Annu. Rev. Polit. Sci. 2008; 11: 563–588. Publisher Full Text

[15] 15. Iyengar S, Lelkes Y, Levendusky M, et al.: The Origins and Consequences of Affective Polarization in the United States. Annu. Rev. Polit. Sci. 2019; 22(1): 129–146. Publisher Full Text

[16] 16. Druckman JN, Levendusky MS: What Do We Measure When We Measure Affective Polarization? Public Opin. Q. 2019; 83(1): 114–122. Publisher Full Text

[17] 17. Tucker JA, Guess A, Barberá P, et al.: Social media, political polarization, and political disinformation: A review of the scientific literature. Soc. Sci. Res. Netw. 2018. Publisher Full Text

[18] 18. Kubin E, von Sikorski C : The role of (social) media in political polarization: a systematic review. Ann. Int. Commun. Assoc. 2021; 45(3): 188–206. Publisher Full Text

[19] 19. Gidron N, Sheffer L, Mor G: Validating the feeling thermometer as a measure of partisan affect in multi-party systems. Elect. 2022; 80: 102542. Publisher Full Text

[20] 20. Kekkonen A, Suuronen A, Kawecki D, et al.: Puzzles in affective polarization research: party attitudes, partisan social distance, and multiple party identification. Front. Polit. Sci. 2022; 4: 78. Publisher Full Text

[21] 21. Fraser T, Aldrich DP, Panagopoulos C, et al.: The harmful effects of partisan polarization on health. PNAS Nexus. 2022; 1(1). PubMed Abstract | Publisher Full Text | Free Full Text

[22] 22. Nayak SS, Fraser T, Panagopoulos C, et al.: Is divisive politics making Americans sick? Associations of perceived partisan polarization with physical and mental health outcomes among adults in the United States. Soc. Sci. Med. 2021; 284: 113976. PubMed Abstract | Publisher Full Text

[23] 23. Arora SD, Singh GP, Chakraborty A, et al.: Polarization and social media: A systematic review and research agenda. Technol. Forecast. Soc. Change. 2022; 183: 121942. Publisher Full Text

[24] 24. Shamseer L, Moher D, Clarke M, et al.: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. Br. Med. J. 2015; 349: g7647. PubMed Abstract | Publisher Full Text

[25] 25. Pussegoda K, Turner L, Garritty C, et al.: Systematic review adherence to methodological or reporting quality. Syst. Rev. 2017; 6(1): 1–14.

[26] 26. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst. Rev. 2021; 10(1): 1–11.

[27] 27. Joanna Briggs Institute: Checklist for analytical cross sectional studies. Adelaide: The Joanna Briggs Institute2017; p. 7. Reference Source

[28] 28. Campbell M, McKenzie JE, Sowden A, et al.: Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020; 368: l6890. Publisher Full Text

[29] 29. Riley RD, Higgins JP, Deeks JJ: Interpretation of random effects meta-analyses. BMJ. 2011; 342: d549. Publisher Full Text

[30] 30. Dekkers OM, Vandenbroucke JP, Cevallos M, et al.: COSMOS-E: Guidance on conducting systematic reviews and meta-analyses of observational studies of etiology. PLoS Med. 2019; 16(2): e1002742. PubMed Abstract | Publisher Full Text | Free Full Text

[31] 31. Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol. dataset. Publisher Full Text

Polarization and health-related behaviours and outcomes during the COVID-19 pandemic: a systematic review protocol

Abstract

Introduction

Methods

Discussion

Protocol registration

Keywords

Introduction

Review questions

Methods

Eligibility criteria

Search strategy

Screening and study selection

Data extraction

Dealing with missing data

Quality and risk of bias assessment

Data synthesis and analysis

Dissemination

Study status

Discussion

Ethic and consent

Data availability

Underlying data

Extended data

Reporting guidelines

Software availability

Acknowledgments

References

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