When Family Helps—or Hurts—COVID-19 Prevention: Lessons from Filipino Undergraduates

 


Article information

Cleofas, J. V., & Oducado, R. M. F. (2022). Family relationships as a predictor of COVID-19 preventive behavioral intention and pandemic fatigue among young Filipino undergraduates. Asian Journal for Public Opinion Research, 10(4). https://doi.org/10.15206/ajpor.2022.10.4.277

What this study is about

During the COVID-19 pandemic, families became even more central to everyday life. Students were learning from home. Parents and siblings became constant companions. Health reminders, household rules, worries about infection, financial strain, and family conflict all happened inside the same domestic space. 

This study asks a simple but important question: Did the quality of family relationships influence whether young Filipino students intended to follow COVID-19 preventive behaviors—and whether they felt tired of pandemic rules and information?

The study focused on young Filipino undergraduates during a time when the Philippines was still under prolonged pandemic restrictions. The authors were especially interested in two outcomes:

  1. COVID-19 preventive behavioral intention — whether students intended to follow behaviors such as masking, hand hygiene, physical distancing, and information-seeking.
  2. Pandemic fatigue — the exhaustion or demotivation people feel after long exposure to COVID-related restrictions, rules, and information. 

Why family relationships matter

The paper starts from a very Filipino insight: health behavior is not only individual. It is social and relational.

The study draws on the Filipino concept of Kaginhawaan, or wellness/well-being, particularly the idea that family well-being helps support positive physical health behaviors and outcomes. In the Filipino context, family is often a major source of care, guidance, monitoring, reminders, emotional support, and decision-making. 

During the pandemic, this became even more visible. Families reminded members to wear masks, wash hands, avoid exposure, monitor symptoms, and stay updated. But family life could also become stressful. Long lockdowns created crowding, lack of privacy, financial pressure, online learning stress, and conflict at home. 

So the family could function in two ways:

  • as a protective system that strengthens health behavior, or
  • as a stress system that increases fatigue and reduces motivation.

What the researchers did

This was a cross-sectional online survey involving 1,665 undergraduate students aged 18–24 from a state college in the Visayas, Philippines. The survey was conducted in July 2021, about a year and a half into the pandemic. 

The study measured three dimensions of family relationships using the Brief Family Relationship Scale:

  • Family cohesion — closeness, support, and togetherness in the family.
  • Family expressiveness — openness in sharing thoughts and feelings.
  • Family conflict — tension, anger, disagreement, or hostility in the family. 

The researchers then tested whether these family relationship dimensions predicted:

  • COVID-19 preventive behavioral intention, and
  • pandemic fatigue. 

They also controlled for student characteristics such as age, sex, income, working status, residence, year level, and COVID-19 history in the family.

What the study found

1) Students still intended to follow COVID-19 preventive behaviors

The students reported high levels of preventive behavioral intention. This means that even after a long period of restrictions, many still intended to practice COVID-19 protective behaviors such as masking, hand hygiene, distancing, and seeking information. 

At the same time, they also reported moderate pandemic fatigue. So students were not necessarily rejecting preventive behavior, but many were tired of the prolonged pandemic situation.

2) Students generally reported strong family relationships—but conflict still mattered

On average, respondents reported:

  • high family cohesion,
  • high family expressiveness, and
  • low family conflict. 

But even when conflict was generally low, it still had important effects. Family conflict predicted both lower preventive intention and higher pandemic fatigue.

3) Family cohesion increased preventive behavioral intention

The strongest protective family factor was cohesion. Students who described their families as more close, supportive, and connected were more likely to intend to follow COVID-19 preventive behaviors. 

In plain language: when students felt that their family was united and supportive, they were more motivated to protect themselves and others.

This may be because cohesive families create a sense of shared responsibility. Health behaviors become less about “me” and more about “us.” Wearing a mask, washing hands, or avoiding risky exposure becomes a way of protecting the household.

4) Family conflict weakened preventive intention

Family conflict had the opposite effect. Students from more conflictual families reported lower intention to follow preventive behaviors. 

This makes sense. If home life is tense, reminders about COVID-19 may feel like nagging, control, or another source of argument. Conflicts about rules, health information, politics, social media, money, or household space can make preventive behaviors harder to sustain.

5) Family conflict increased pandemic fatigue

The clearest fatigue-related finding was that family conflict predicted higher pandemic fatigue. Students in more conflictual households were more likely to feel exhausted or demotivated by COVID-19 rules and information. 

This is important because pandemic fatigue is often discussed as an individual attitude problem. But this study shows that fatigue may also come from the home environment. If the family is a source of stress, the student may become more tired of everything associated with the pandemic.

6) Family expressiveness was not a significant predictor

Interestingly, family expressiveness did not significantly predict preventive intention or pandemic fatigue in the regression models. 

This does not mean openness is unimportant. Rather, in this study, family closeness and conflict were more powerful predictors of COVID-19 behavioral outcomes than expressiveness alone.

7) Gender and working status also mattered

Female students reported higher COVID-19 preventive behavioral intention than male students. Working students reported higher pandemic fatigue. 

The working-student finding is especially important in the Philippine pandemic context. Students who had to work may have faced more exposure risk, more responsibilities, and more pressure to navigate both economic survival and health protection.

Bottom line

This study shows that health behavior during a pandemic is deeply relational. Filipino undergraduates were not making COVID-19 decisions alone. Their motivation to follow protective behaviors—and their exhaustion from pandemic life—was shaped by the emotional climate of the family. 

Cohesive families helped sustain prevention. Conflictual families increased fatigue and weakened intention. For public health, this means that pandemic communication should not only target individuals. It should also support families as health-promoting systems.

Policy/practice recommendations

  1. Include families in health promotion programs
    COVID-19 and future outbreak campaigns should target households, not only individuals. Families can be taught how to remind, support, and protect one another without creating conflict. 
  2. Assess students’ home conditions during online learning
    Colleges and universities should regularly check whether students have supportive or stressful home environments, especially during crisis-based remote learning. 
  3. Use family cohesion as a protective resource
    Schools and community health workers can encourage family-based routines: shared health reminders, household safety plans, symptom monitoring, and collective care practices.
  4. Address family conflict as a public health concern
    When families are in conflict, health instructions may become harder to follow. Psychosocial support, counseling referral systems, and family communication resources should be part of pandemic response.
  5. Support working students
    Working students may experience higher pandemic fatigue. Schools should offer flexible deadlines, health guidance, mental health support, and workplace-sensitive advising.
  6. Design gender-responsive health messaging
    Since male students showed lower preventive behavioral intention, health promotion programs may need targeted strategies that engage young men without moralizing or shaming them.

Glossary of key terms

  • COVID-19 preventive behavioral intention — A person’s intention to follow behaviors that reduce COVID-19 risk, such as masking, distancing, hand hygiene, and information-seeking. 
  • Pandemic fatigue — Exhaustion, demotivation, or reduced commitment after prolonged exposure to pandemic restrictions, behaviors, and information. 
  • Family cohesion — The closeness, support, connection, and togetherness experienced within a family.
  • Family expressiveness — The openness of family members in sharing feelings, thoughts, and concerns.
  • Family conflict — Tension, disagreement, anger, hostility, or recurring conflict within the family.
  • Brief Family Relationship Scale / BFRS — A tool used to measure family cohesion, expressiveness, and conflict. 
  • Kaginhawaan — A Filipino concept of wellness or well-being. In this study, it supports the idea that family well-being can shape health behavior. 
  • Health behavior — Actions people take to protect or improve health, such as following infection prevention guidelines.
  • Protective behavioral intention — A person’s planned or intended willingness to perform a protective behavior in the near future.
  • Cross-sectional study — A study that collects data at one point in time. It can identify associations but cannot prove cause and effect.
  • Multiple regression — A statistical method used to test whether several variables predict an outcome while accounting for other factors.
  • Bootstrapping — A statistical technique that repeatedly resamples data to make estimates more stable and reliable.

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