Difficulties in adherence to social distancing and quarantine during the COVID-19 pandemic: lessons from a longitudinal study comparing migrants and non-migrants in a city in Norway.

BACKGROUND: Non-pharmaceutical interventions (NPIs) such as social distancing and quarantine were essential for containing COVID-19 transmission but had adverse effects on mental health and well-being. Migrants were often accused of non-adherence to NPIs, which was assumed to partly explain their higher infection rates compared to non-migrants. However, this perspective overlooked that migrants may have faced greater challenges adhering to interventions due to individual and structural barriers. Understanding these challenges is crucial for designing more inclusive, and effective public health strategies in future health crises. This study examines how perceived difficulty adhering to social distancing and quarantine evolved among migrants compared to non-migrants in Norway during the pandemic, examining contributing factors and disparities over time. METHODS: We conducted secondary analyses of data from the Bergen-In-Change study at three time points (March/April-2020, January-2021, March-2022). The sample comprised 25,418 participants, including 512 (2%) migrants from Asia, Africa, and Latin America (MAAL), and 1,253 (5%) migrants from other regions (MOR). Outcomes were difficulty adhering to social distancing and quarantine. We used descriptive statistics and generalized estimating equations to calculate incidence rate ratios (IRR) with 95% confidence intervals. Three models were run, adjusting for potential confounders and explanatory factors. RESULTS: Migrants reported difficulty adhering to social distancing less often than non-migrants (adjusted IRR: 0.79, CI: 0.70–0.90 for MAAL; 0.85 CI: 0.79–0.91 for MOR). In contrast, they were more likely to report difficulty adhering to quarantine (adjusted IRR: 1.68, CI: 1.17–2.42 and 1.66, CI: 1.31–2.11, respectively). MAAL reported increased difficulty with social distancing from 2020 to 2022, narrowing the gap with non-migrants. Difficulties adhering to quarantine also rose, particularly between 2020 and 2021 among MOR, widening disparities with non-migrants over time. Socioeconomic factors did not fully explain these differences. Living conditions and work type slightly attenuated the associations for quarantine, yet disparities remained after adjustments. CONCLUSION: Migrants reported difficulty adhering to social distancing less often, but more often reported difficulties with quarantine. Time trends pointed to increasing difficulties in adherence among migrants during the pandemic. The gaps persisted after adjusting for socioeconomic factors, suggesting an underlying role of migration-related factors that must be addressed to prevent inequities and social polarization in future health crises.