OBJECTIVES: To assess the continued burden of the COVID-19 pandemic on high-risk populations, it is crucial to understand how individuals continue practicing behaviors to avoid COVID-19. This research’s objective was to develop a short questionnaire to measure physical distancing (PD) behaviors to avoid COVID-19.

METHODS: Item development was informed by a targeted literature review (TLR) to identify existing COVID-19-related PD questionnaires, review of health authorities’ public health guidance, and four focus groups (FGs) with individuals at high-risk of severe COVID-19 (April-July 2022). Test items were piloted with high-risk individuals in two asynchronous online forums (OF1, OF2; both 1-week duration) involving the same participants (UK, US, Canada, Spain) between July-August 2022. OF1 aimed to understand item relevance and inform adaptations; OF2 aimed to confirm adequacy of updated items.

RESULTS: No COVID-19-specific validated questionnaires focusing on PD were identified in the TLR. Country-level and World Health Organization guidance largely focused on PD-related concepts: people avoidance (crowds, busy places) and activities involving people (work/school/leisure). Nonetheless, country-specificities were present (e.g., embracing when greeting, France). In FGs (N=14 participants), similar PD-related avoidance behaviors were identified. Eight test items were initially developed to capture past 4-week PD behaviors whilst minimizing country specificities. In OF1 (N=23), all participants comprehended the term ‘avoiding COVID-19’ and most (N=16, 69.6%) agreed the “right level of questions (were) asked”. Some participants suggested formatting (e.g., “simplify things”) and wording (e.g., “change ‘meetings’ to ‘gatherings’”) modifications. Most participants (N=20, 87.0%) could recall their behaviors back to the beginning of the pandemic. After modifications, in OF2 (N=22) most participants (N=19, 86.4%) believed items were all relevant (e.g., “covered every scenario”). After analyzing both forum insights, an additional item was included (non-essential travel) to complement “essential travel”.

CONCLUSIONS: The novel Physical Distancing Scale COVID-19 (PDS-C19) was well understood and included avoidance behaviors relevant to individuals at high-risk of COVID-19.