Essays on the Adoption of New Health Behaviors: A Sociological Perspective From the COVID-19 Crisis

Thesis defense of Bartholomew Konechni, Doctoral programme in Sociology, Thursday, January 29th 2026. 

Essays on the Adoption of New Health Behaviors: A Sociological Perspective From the COVID-19 Crisis
Jury members: Ben ANSELL (University of Oxford, Nuffield College), Kevin Arceneaux (CEVIPOF), Nathalie Bajos (EHESS, IRIS), Kathryn Freeman Anderson (University of Houston), Karl Gauffin (Stockholm University), Lidia Panico (CRIS), Ettore Recchi (PhD Supervisor, CRIS)

This dissertation investigates, through three empirical articles, the sociological mechanisms that shaped the adoption of new health behaviors during the COVID-19 pandemic. While the pandemic generated enormous uncertainty for those who experienced it first hand, it also provided unique analytical opportunities for researchers to study the determinants of behavioral change, revealing three major social divides in the adoption of new practices: economic resources, political partisanship, and civic capital. The central goal of the work is to explain why these faultlines proved so significant in shaping the adoption of new practices and what these dynamics reveal about how behaviors spread during crises.

The first empirical article examines the divide in health behaviors along the dimension of resources. Using the staggered provision of unconditional cash transfers, given out as part of the CARES Act 2020,  this article studies how behaviors shift, particularly amongst poorer households, when governments tackle underlying inequalities in house liquidity. The article finds little evidence in favor of a large change in behaviors between households who received or did not receive the transfer – running counter to predictions from some scholars during the pandemic building on scarcity and procedural justice theories to explain the link between resources and behaviors. However, the paper finds strong evidence that these transfers did change one practice, with especially pronounced effects amongst poorer households, namely the use of facemasks. The article argues that this narrow effect likely results from the fact that unlike most other new health behaviors during the pandemic, facemasks required households to internalize their costs, and thus views these findings as supportive of access based narratives explaining why the poor have worse uptake of new practices than the rich. Moreover, the paper provides additional empirical support for this argument by examining not only the fact of using or not using a facemask, but also respondents’ own explanations for non-adoption of facemasks in the survey, demonstrating that ex post those who had received the transfer were significantly less likely to perceive cost as a barrier to facemask use. 

The second article studies the partisan divide in pandemic health behaviors. The central focus of this article is in understanding the extent to which the partisan divide during the pandemic can be explained as a product of selection (i.e. individuals sorting into party groups based on preexisting preferences) or communication (i.e. individuals setting their level of compliance to match leader’s messaging). To that end, the paper exploits Donald Trump’s sudden position reversal on facemasks to study the extent to which individuals maintained or changed behaviors around of his pivot. Ultimately, strong evidence is found that Trump’s change in position resulted in a substantial shift in masking behaviors amongst Republicans, with the gap between Republicans and Democrats closing by around 40-percent. But in contrast to most dominant theoretical explanations – particularly the health belief model – for how speech should influence behaviors, the paper finds no corresponding shift in belief about facemasks’ efficacy. By way of an explanation for this counterintuitive finding, the paper demonstrates that Trump’s speech was most impactful amongst Republicans living in states worst affected by the early-summer 2020 rise in COVID cases,  pointing towards the fact that his capacity to change practices resided not in rational persuasion but rather in taking advantage of a moment of renewed crisis when individuals were open to adopting novel practices. 

Moving focus to Sweden, the final empirical article studies the between-community divide in new behaviors, in this case the uptake of COVID vaccine, along the civic capital distribution. The paper finds substantial evidence for a neighborhood-level association between civic capital and vaccine uptake, with civic capital’s estimated effect across the distribution (+/- 2 S.D.) equivalent to 67-percent of the difference between those with and without a college degree by the third vaccine. However, this work shows that civic capital rich communities suffer from much wider disparities in vaccine uptake. That civic capital is associated both with higher adoption and widening inequalities suggests that – far from a traditional Putnamian narrative – civic capital does not help to disseminate behaviors by bridging across social strata, but by intensifying relationships within groups. 

Taken together, the work of this dissertation achieves three goals. (1) It contributes towards improving knowledge about the mechanisms underpinning new health practices’ spread. (2) It helps evaluate the efficacy of at least two key public policy interventions (transfers and political communication) which might impact health behaviors’ dissemination. (3) It provides important empirical evidence for what makes individuals and places more resilient and adaptable, helping to bridge debates which span across traditional theoretical camps and disciplinary boundaries.