Application of the protection motivation theory for predicting COVID-19 preventive behaviors in Hormozgan, Iran: a cross-sectional study

Predicting medication adherence among children with epilepsy: Application of the protection motivation theory

PURPOSE

Based on the protection motivation theory (PMT), which is an extension of the health belief model that takes the "reward" brought by behavior in the long-term process as a consideration factor and considering the influence of environmental and social factors on behavior patterns, this cross-sectional study evaluated medication adherence among children with epilepsy using structural equation modeling.

METHODS

Children with epilepsy from pediatric neurology clinics were consecutively sampled at West China Second Hospital of Sichuan University from July 2021 to January 2024. According to PMT, we designed the 23-item questionnaire, which included seven factors, namely severity, susceptibility, external return, internal returns, self-efficacy, reaction efficiency, and reaction cost. Medication adherence was assessed using the Morisky Medication Adherence Scale. The reliability and validity of the scale were tested by confirmatory factor analysis, and path analysis was used to conduct hypothesis testing and calculate standardized path coefficients.

RESULTS

We enrolled 1357 children with epilepsy (mean age, 8.36 ± 4.04 years). Younger age, being an only child, caregivers' unemployment, and comorbidities were associated with high medication adherence scores. The designed scale of PMT displayed good reliability and validity. Through path analysis of the structural equation model, self-efficacy, susceptibility, and severity exerted significant positive effects on adherence, and external return, internal returns, and reaction cost had significant negative effects on adherence.

CONCLUSIONS

Medication adherence in children with epilepsy is relatively poor. PMT can explain and predict the medication adherence behavior and behavior intention of patients with epilepsy. It is recommended to increase the health education, personalize medication guidance, and provide telephone interventions to caregivers of children with epilepsy to enhance medication adherence and further improve therapeutic efficacy.

Predictors of self-care behaviors in hypertensive patients based on the protection motivation theory

INTRODUCTION

Globally, hypertension is a significant public health concern and a leading cause of premature death. Since this disease is incurable, it is necessary to promote patients' self-care behaviors to control it. The goal of this research was to identify the elements that influence self-care actions in individuals with hypertension, utilizing the Protection Motivation Theory (PMT) framework.

METHODS

A study was carried out in Omidiyeh, located in southern Iran, using a cross-sectional design, involving 397 adults with hypertension (198 females and 199 males) who were selected from comprehensive health centers using a stratified random sampling technique. Data was gathered through a demographic data collection form and a questionnaire created by the researcher, which was based on the PMT. Data were assessed utilizing SPSS 25 and AMOS 24 software, and various statistical tests including one-way ANOVA, Pearson correlation, multiple regression, independent t-test, and structural equation modeling were conducted.

FINDINGS

The variables of intrinsic reward (r = 0.182), extrinsic reward (r = 0.288), and response cost (r = 0.126) showed a significant negative correlation with self-care behaviors. On the other hand, perceived susceptibility (r = 0.212), perceived severity (r = 0.110), self-efficacy (r = 0.555), and response efficacy (r = 0.424) demonstrated a significant positive correlation with self-care behaviors. Specifically, self-efficacy and response efficacy were the most powerful predictors of self-care behaviors, respectively.

CONCLUSION

The results showed that several factors can forecast self-care behaviors in patients with hypertension. Researchers are recommended to incorporate PMT in educational interventions and concentrate on self-efficacy and response efficacy constructs.

Effects of health-related dispositions on citizens' appraisals toward the COVID-19 pandemic and protective behavior

In this study, health risk attitude and health locus of control were included as dispositional factors in the Protection Motivation Theory (PMT) to explain people's protective behavior in the context of COVID-19 pandemic. Empirical data involved two waves of data with a sample of 526 adults with full-time jobs from Beijing, China, and structural equation model results confirmed a partial successful extension of the PMT. Specifically, health risk attitude had a direct effect on citizens' protective behavior, but without an indirect effect mediated by threat appraisal toward the COVID-19 pandemic; health locus of control did not directly associate with citizens' protective behavior, but had an indirect effect on it fully via coping appraisal toward the COVID-19 pandemic. Thus, the PMT has been extended by adding a distal dispositional factor on the impact of coping appraisal on protective behavior. Implications for advancing the government's anti-epidemic strategy are discussed.

Online cancer information seeking and colorectal cancer screening in China: Considering threat and coping Appraisals, and cancer fatalism

Background

Colorectal cancer is major public health concern in China. This study seeks to explore the role of online cancer information seeking in influencing colorectal cancer screening, by taking into account one's coping appraisals (i.e., self-efficacy, response efficacy), threat appraisals (i.e., perceived severity, cancer worry) and cancer fatalism.

Methods

A cross-sectional survey was conducted with 730 participants in China recruited from a Chinese survey company's online panels. Path analysis was performed to investigate the relationships between the key constructs.

Results

First, online cancer information seeking increased both coping appraisals and threat appraisals. Second, threat appraisal did not significantly influence cancer fatalism, but coping appraisal reduced cancer fatalism. Third, cancer fatalism had no effects on colorectal cancer screening. Lastly, online cancer information also had a direct and positive relationship with cancer screening.

Conclusions

This research emphasises the need for health organisations to offer timely cancer information to people, and educate them about the importance of cancer screening. Health authorities may also regulate online cancer information to ensure that the information is accurate and appropriate in improving people's cancer prevention and cancer screening knowledge.

COVID-19 vaccination intention among internally displaced persons in complex humanitarian emergency context, Northeast Nigeria

Internally displaced persons (IDPs) are at high risk for COVID-19 transmission because of congested and unsanitary living conditions. COVID-19 vaccination is essential to build population immunity and prevent severe disease among this population. We determined the prevalence and factors associated with intention to accept COVID-19 vaccine among IDPs in Northeast Nigeria. This cross-sectional study, conducted during July-December 2022, included 1,537 unvaccinated IDPs from 18 IDPs camps. We performed a complex sample survey analysis and described participants' characteristics and vaccination intention with weighted descriptive statistics. We fitted weighted logistic regression models and computed adjusted odds ratios with 95% confidence intervals to identify factors associated with intention to accept COVID-19 vaccine. Of 1,537 IDPs, 55.4% were 18-39 years old, 82.6% were females, and 88.6% had no formal education. Among them, 63.5% (95% CI: 59.0-68.1) expressed intention to accept COVID-19 vaccine. Among the IDPs who intended to reject vaccine, 42.8% provided no reason, 35.3% had COVID-19 misconceptions, 9.5% reported vaccine safety concerns, and 7.4% felt no need. IDPs who perceived COVID-19 as severe (Adjusted Odds Ratio (AOR) = 2.31, [95% CI: 1.35-3.96]), perceived COVID-19 vaccine as effective (AOR = 4.28, [95% CI: 2.46-7.44]) and resided in official camps (AOR = 3.29, [95% CI: 1.94-5.56]) were more likely to accept COVID-19 vaccine. However, IDPs who resided 2 kilometers or farther from the nearest health facility (AOR = 0.34, [95% CI: 0.20-0.58]) were less likely to accept vaccine. Intention to accept COVID-19 vaccine among the IDPs was suboptimal. To improve vaccination acceptance among this population, health education and risk communication should be intensified to counter misinformation, strengthen vaccine confidence, and shape perception of COVID-19 severity, focusing on IDPs in unofficial camps. Appropriate interventions to deliver vaccines to remote households should be ramped up.

The causal relationship model of factors influencing COVID-19 preventive behaviors during the post-pandemic era and implications for health prevention strategies: a case of Bangkok City, Thailand

BACKGROUND

Though, many countries are currently in the COVID post-pandemic era, people's health protective behaviours are still essential to protect their health and well-being. This study aims to evaluate people's understanding and perceptions of COVID-19 risk characteristics (i.e. threat occurrence, threat severity, perceived susceptibility and exposure), the health risk perception towards COVID-19, and health protective behaviours. The study also aims to estimate the associations among these factors by the analysis of structural equation modelling (SEM).

METHODS

From 15 October to 9 November 2022, questionnaire surveys were administrated to 521 people living in Bangkok of Thailand by using the convenience sampling technique. The analyses were carried out in three phases including descriptive statistical analyses, a measurement model assessment using a confirmatory factor analysis (CFA), and structural equation modelling (SEM) analysis.

RESULTS

The results of descriptive analyses demonstrated that the majority of respondents, 39.9%, had the age between 20 and 30 years old, and 61.4% of them were female. Approximately 52.1% of them had a bachelor's degree. Upon analysing individuals' understanding and perceptions of all risk characteristics, individuals' understanding of COVID-19 severity did not statistically affect health risk perception towards COVID-19, whereas perceived exposure had the strongest effect and in turn influenced health protective behaviours. Perceived susceptibility and understanding of the threat occurrence also significantly affected health risk perception, and indirectly affected health protective behaviours.

CONCLUSIONS

This study implies that though the potential health impact of COVID-19 is perceived as less severe, people can still construct a perception of its risk particularly based on their perceived exposure and susceptibility. Thus, communicating people about exposure conditions and susceptibility can greatly contribute to people' construction of risk perception towards COVID-19 which subsequently leads to the decision to perform health protective behaviours.

Use of the PRECEDE-PROCEED Model in Piloting Vaccine Promotion and Infection Self-Protection: Intervention Development and Effectiveness Examination

OBJECTIVES

This study aimed to tailor and pilot a health education program using the PRECEDE-PROCEED model to promote vaccination and enhance self-protective behaviors against COVID-19 in Hong Kong populations.

STUDY DESIGN

Quasi-experimental study.

METHODS

Phases 1-4 of the PRECEDE-PROCEED model were used to identify the needs for COVID-19 prevention. Strategies to address predisposing, reinforcing, and enabling factors in the PRECEDE-PROCEED model were developed, and an intervention package was generated thereafter. A pre-post experimental study was conducted among 50 participants to preliminarily assess the effects of the intervention based on Phases 5 and 8 of the PRECEDE-PROCEED model.

RESULTS

The 3-month intervention package contained 16 health education videos, 36 health tips, individual consultations, regular reminders of vaccination, incentive of anti-epidemic packages, and vaccine booking services. By the third month, 33 participants took a new dose of COVID-19 vaccine, and 5 participants withdrew. The vaccination rate for new dose achieved 73.3% (95% CI: 58.06-85.40%). Compared with the Hong Kong population in the same period, our study demonstrated higher increase in vaccination rate (9.97 vs. 1.36 doses per 1000 person-days). The percentage of early testing in personal and family level increased to 86.7% and 84.4%, respectively (both p < 0.05). For correct mask wearing and hand washing, the scores increased from a baseline score of 9.1 ± 1.6 and 4.9 ± 1.3 to 9.5 ± 1.0 and 5.3 ± 1.2, respectively (both p < 0.05).

CONCLUSIONS

The application of the PRECEDE-PROCEED model effectively facilitated the stepwise development, implementation, and evaluation of a health education program for improving vaccination rates and fostering self-protective behaviors against infections.

Exploring the relationship between older adults' online health information seeking, negative emotions and prevention behaviors in the pandemic context: a two-wave longitudinal study

Introduction

During the COVID-19 pandemic, older adults were facing more mental health issues that may cause complex impacts on pandemic prevention, and turning to the internet for health information is a double-edged sword for them. This study aimed to investigate the reciprocal relationship between negative emotions and prevention behaviors in older adults, as well as the direct and moderating effects of online health information seeking (OHIS) on negative emotions and prevention behaviors.

Methods

Based on the common-sense model of self-regulation (CSM) and a sample of more than 20,000 participants from the Survey of Health, Aging and Retirement in Europe (SHARE), this study first used an autoregressive cross-lagged panel model (CLPM) to analyze the longitudinal effect of negative emotions on prevention behaviors. Second, the study used ordinary least squares (OLS) regression to explore the influence of OHIS usage frequency changes on negative emotions and prevention behaviors. Third, the study used multigroup analysis to examine the moderating effect of OHIS usage frequency changes on the CLPM.

Results

The findings indicate a significant longitudinal association where initial negative emotions predicted later prevention behaviors (β = 0.038, p < 0.001), and increased OHIS frequency was linked to positive changes in prevention behavior (β = 0.109, p < 0.001). Multigroup analysis revealed that the connection between negative emotions or increased negative emotions and prevention behaviors remained significant for those with no change or an increase in OHIS frequency but not for those with a decrease.

Conclusion

This study suggested that negative emotions may drive older adults to engage more in prevention behaviors and that OHIS can augment this effect. These results underscore the importance of addressing mental health and providing reliable online health information to support older adults in managing infectious disease risks.

A Worldwide Bibliometric Analysis of Published Literature Assessing Fear of COVID-19

Many people experience intense fear of COVID-19. The purpose of this study was to provide a comprehensive visual overview of the published literature from 2020 to 2022 assessing fear of COVID-19. From 2020 to 2022, we employed the Scopus database to conduct a bibliometric analysis. We used the VOSviewer program to perform the author co-citation analysis, Mapchart to produce a worldwide map, and Wordart to make a word cloud image. From the 1769 records examined, 1654 (93.50%) were articles, with English being the most common language (96.31%). From 2020 to 2022, annual citations experienced significant growth (R2 = 99.91%; p = 0.0195). The Institut National de la Santé et de la Recherche Médicale (INSERM, France) and China led in terms of publication output (n = 36; n = 255). M. D. Griffiths authored the highest number of articles (n = 21). The most active journal was the International Journal of Environmental Research and Public Health (n = 146), and the most prevalent keyword was "human/s" (11.51%). This bibliometric analysis evaluates the quality of the research on fear of the pandemic and the crisis management of COVID-19, which can provide managers and researchers with crucial insights for future decision making.

Preventive behaviors against COVID-19 among health care providers in Iran: A cross-sectional study

Background and Aim

During outbreaks of infectious diseases, if healthcare providers do not follow the principles of prevention, the risk of personal infection increases and they become a source of infection spread. This study aimed to determine the factors related to the preventive health behaviors of COVID-19 among Iranian healthcare providers based on protection motivation theory (PMT).

Methods

This analytical cross-sectional study included 346 healthcare providers. Data was collected by an online researcher-made questionnaire based on PMT. To analyze the data, independent T tests, analysis of variance (ANOVA), Spearman correlation coefficient, multiple linear regression, and SPSS 22 software were used. α was considered as 0.05.

Results

85.3% of the healthcare providers would always wear masks, 80.7% would always refuse to kiss and touch hands with others, and 34.7% sometimes would exercise at home. The preventive behaviors were significantly correlated with protection motivation (r = 0.84), self-efficacy (r = 0.51), response efficiency (r = 0.43), perceived severity (r = 0.41) Fear (r = 0.21), perceived susceptibility (r = 0.11), response cost (r = -0.14), and reward (r = -0.15). PMT constructs were able to predict 77% of the variance of the behaviors and the protection motivation construct was the strongest predictor (β = 0.806). Income above 300 Dolars per month was significantly related to the decrease in the mean score of preventive behaviors against COVID-19. The female sex and the individual or family history of infectious diseases were significantly related to increasing the mean score of COVID-19 preventive behaviors.

Conclusion

Based on the study results, it is suggested that some educational interventions be designed and implemented with a focus on this construct and the perceived severity construct and that more attention be given to the education of health care providers with high-income levels, male providers, and the individuals without a history of corona infection in themselves or their family members.

Predictors of hospital nursing staff's adherence to safe injection guidelines: application of the protection motivation theory in Fars province, Iran

BACKGROUND

Needle stick injuries (NSI) can lead to dangerous infectious diseases for health care workers. This study aimed to determine the predictors of observance of safe injection guidelines in hospital nursing staff, based on protection motivation theory.

METHODS

This cross-sectional study was conducted on the nursing staff of five randomly selected teaching and general hospitals of Shiraz University of Medical Sciences, Fars province, Iran, in 2021. Data were collected using a researcher-made questionnaire which was developed based on protection motivation theory. Data were processed and analyzed using SPSS 22 and Amos 24 at a significance level of  < 0.05. Pearson's correlation coefficient, Multiple linear regression, and Structural Equation Modeling were used.

RESULTS

The mean age of the participants (No = 280) was 32.5 ± 8.09 years. Most of the participants [80%] had encountered NSI, patients' blood, or body fluids at least once. Protection motivation was the only predictor of protective behaviors (β = 0.573), while perceived efficacy (β = 0.142) and perceived rewards (β = -0.229) were the strongest predictors of motivation. The structural equation modeling analysis showed that standardized total effects of protection motivation, perceived response costs, rewards, and efficacy on the protective behaviors were 0.573, -0.159, -.104, and 0.81, respectively. While standardized total effects of perceived rewards, efficacy, and response cost on protection motivation were -0.229, 0.142, and -0.033, respectively. The model fit indices indicated the acceptable final model fit.

CONCLUSION

The results suggest that perceived efficacy, perceived effectiveness, and perceived rewards were the most important predictors of adherence to Safe Injection Guidelines in nursing staff.

Effect of educational intervention based on protection motivation theory on preventive behaviors of respiratory infections among hospital staff

Background

Hospital staff represent a vulnerable population for respiratory diseases. Consequently, the implementation of training programs becomes imperative as a preventive measure against such infections in these populations. The current study was conducted to examine the impact of an educational intervention based on the Protection Motivation Theory (PMT) on preventive behaviors for respiratory infections among a group of hospital staff.

Methods

This experimental study involves a sample of 150 hospital staff from Gachsaran City, Iran, in 2021-2022. The sampling technique involved the utilization of a random assignment approach to allocate individuals into two distinct groups: the experimental group, consisting of 75 participants, and the control group, also including 75 individuals. The data collection instrument was a questionnaire designed in accordance with the PMT. This questionnaire was administered to both the experimental and control groups prior to the intervention as well as two months following the intervention. The intervention program consisted of a total of five sessions, each lasting for 60 min, for the experimental group. These sessions were conducted on a weekly basis over a period of two and a half months. Specifically, there were two sessions held every month and one session held every two weeks. Following the completion of the program, the data was entered into SPSS-24 statistical software for analysis using paired t-tests, independent t-tests, and chi-square tests.

Results

The results indicated that prior to the intervention, there was no significant difference between the two groups in terms of perceived vulnerability constructs (p = 0.25), perceived severity (p = 0.63), perceived response (p = 0.32), and perceived reward (p = 0.11). Besides, there was no considerable distinction in perceived self-efficacy (p = 0.84), perceived response cost (p = 0.33), fear (p = 0.45), behavior motivation (p = 0.51), knowledge (p = 92), or vaccination behavior (p = 0.12) before the educational intervention. However, a significant change was noticed in each of the mentioned variables between the two groups after the intervention (p < 0.05).

Conclusion

The results of this study indicated that the implementation of an educational intervention grounded in the PMT yields positive outcomes in enhancing preventative behaviors pertaining to respiratory infections. Hence, it is recommended to utilize an intervention grounded in this theory among hospital staff as a viable approach to mitigating the occurrence of respiratory infections.

Predicting m-health acceptance from the perspective of unified theory of acceptance and use of technology

Addressing the growing popularity of mobile health (m-Health) technology in the health industry, the current study examined consumers' intention and behaviour related to the usage of digital applications based on the unified theory of acceptance and use of technology (UTAUT). In particular, this study quantitatively assessed the moderating role of perceived product value and mediating role of intention to use m-Health application among Indonesians. This study adopted a cross-sectional design and collected quantitative data from conveniently selected respondents through an online survey, which involved 2068 Telegram users in Indonesia. All data were subjected to the analysis of partial least square- structural equation modeling (PLS-SEM). The obtained results demonstrated the moderating effect of perceived product value on the relationship between intention to use m-Health application (m-health app) and actual usage of m-Health app and the mediating effects of intention to use m-Health app on the relationships of perceived critical mass, perceived usefulness, perceived convenience, perceived technology accuracy, and perceived privacy protection on actual usage of m-Health app. However, the intention to use m-Health app did not mediate the influence of health consciousness and health motivation on the actual usage of m-Health app. Overall, this study's findings on the significance of intention to use m-Health app and perceived product value based on the UTAUT framework serve as insightful guideline to expand the usage of m-Health app among consumers.

Influence of social and psychological factors on smartphone usage during the COVID-19 pandemic

Objective

This study investigates the influence of psychological factors-specifically affective and cognitive risk perceptions, social distancing attitudes, subjective norms, and cabin fever syndrome-on smartphone usage intensity during the COVID-19 pandemic, with a particular focus on university students.

Methods

Utilizing a cross-sectional survey design, data were collected from 314 university students from South Korea and Vietnam. Structural equation modeling was employed to analyze the relationships between the psychological constructs and their impact on smartphone usage.

Results

The analysis confirms that both affective and cognitive risk perceptions significantly influence attitudes towards social distancing. Furthermore, these social distancing attitudes are found to significantly affect cabin fever syndrome, suggesting that positive attitudes towards social distancing are closely associated with higher reports of cabin fever. Notably, cabin fever syndrome emerges as a significant predictor of increased smartphone usage, underscoring its role as a mediator between prolonged isolation and digital engagement. Additionally, subjective norms are also shown to significantly influence smartphone usage intensity, highlighting the impact of social expectations on digital behaviors during the pandemic.

Conclusion

The study highlights the complex interplay between psychological distress induced by social restrictions and increased reliance on digital technology for social connectivity. These insights suggest that mental health interventions and digital literacy programs tailored to university students' needs can be effective in managing the negative impacts of prolonged social isolation.

A machine learning ensemble approach to predicting factors affecting the intention and usage behavior towards online groceries applications in the Philippines

The emergence of e-commerce platforms, especially online grocery shopping, is heightened by the COVID-19 pandemic. Filipino consumers started to adapt online due to the strict quarantine implementations in the country. This study intended to predict and evaluate factors influencing the intention and usage behavior towards online groceries incorporating the integrated Protection Motivation Theory and an extended Unified Theory of Acceptance and Use of Technology applying machine learning ensemble. A total of 373 Filipino consumers of online groceries responded to the survey and evaluated factors under the integrated framework. Artificial Neural Network that is 96.63 % accurate with aligned with the result of the Random Forest Classifier (96 % accuracy with 0.00 standard deviation) having Perceived Benefits as the most significant factor followed by Perceived Vulnerability, Behavioral Intention, Performance Expectancy, and Perceived. These factors will lead to very high usage of online grocery applications. It was established that machine learning algorithms can be used in predicting consumer behavior. These findings may be applied and extended to serve as a framework for government agencies and grocers to market convenient and safe grocery shopping globally.

Using the Health Belief Model to assess COVID-19 perceptions and behaviours among a group of Egyptian adults: a cross-sectional study

BACKGROUND

It is crucial to study the public's perceptions and behaviour during a pandemic as this will be the driving force for practicing recommended precautions. The current study aimed to identify perceptions of a group of Egyptian adults to COVID-19 using the Health Belief Model (HBM), to measure self-reported practice of preventive behaviours and to identify influencing factors.

METHODS

Cross sectional study was used, including Egyptian adults aged 18 + years. A structured anonymous online questionnaire was used including: a demographic section, the modified MERS- CoV Health Belief Model scale after addition of questions related to COVID-19 and questions on preventive behaviours to COVID-19.

RESULTS

Of the 532 study participants, 28.6% were males, age ranges (18 to 74 years). There was a statistically significant positive correlation between total practice score and all COVID-19 Health Belief Model constructs total scores except for perceived barriers score showing negative correlation (P value < 0.05). Linear regression analysis showed that older age, male gender and living inside Cairo were associated with lower practice score (P value < 0.01).

CONCLUSIONS

Increased perceived susceptibility, perceived benefits, cues to action and perceived self-efficacy scores were associated with higher practice score in the current study. Additionally, results revealed that social media and websites can play an important role in shaping risk perception in the community. Stressing risk perception and efficacy beliefs prevention message can drive people to practice preventive behaviors.

Changes in Confidence, Feelings, and Perceived Necessity Concerning COVID-19 Booster

The COVID-19 booster first became available to all adults in the U.S. in November 2021 and a bivalent version in September 2022, but a large population remains booster-hesitant; only 17% of Americans have obtained the updated vaccine as of June 2023. We conducted two cross-sectional surveys in 2021 and 2022 (n = 1889 and 1319) to determine whether changes in booster-related feelings or perceptions had occurred and whether they altered vaccination rates over time. We found that both positive and negative emotions had grown stronger between the two years, with the prevalence of annoyance increasing the most (21.5% to 39.7%). The impact of trust on booster intention more than doubled (OR = 7.46 to 16.04). Although perceived risk of infection decreased, more participants in 2022 indicated uncertainty or unwillingness to obtain a new booster than in 2021, while the proportion refusing a booster remained constant at 22.5%. Confidence in the COVID-19 vaccine and feelings of hope from the booster motivated acceptance; both were stronger predictors of booster receptivity than prior vaccination history. Our findings signal a need to rebuild trust by informing people of their continued risk and appealing to positive, especially optimistic emotions to encourage booster uptake. Future research should explore longitudinal trends in behavior and feelings toward new booster doses and the impact of prolonged vaccine hesitancy on infection rates.

Afraid but misinformed: Conspiracist beliefs cancel the positive influence of fear of COVID-19 on vaccination intentions - Findings from a Romanian sample

Understanding the factors that make people more likely to refuse vaccination against COVID-19 is crucial in order to design public health messages efficient in increasing vaccination rates. As COVID-19 creates risks of seriously damaging health effects, fear of this disease is as a significant determinant of vaccination intentions, as indicated by past research. Nevertheless, this positive influence may be limited in people who do not consider vaccines as a solution to protect against COVID-19, especially those who hold conspiracist beliefs about the new coronavirus and, implicitly, about the newly developed vaccines. The present study examined in a cross-sectional design on a convenience sample (N = 564) the joint effect of fear of COVID-19 and conspiracist beliefs on vaccination intentions, advancing past research on their independent influences. Furthermore, we investigated and controlled the effects of perceived risk of catching COVID-19, trust in medical experts, attitude towards vaccination and socio-demographical characteristics (i.e., gender, age, and education), previously found to be associated to COVID-19 vaccination intentions. We also tested the effect of ambivalence towards vaccination, i.e., the degree to which people simultaneously hold positive and negative evaluations of this intervention, as the widespread misinformation on the new coronavirus and its vaccines may induce ambivalence on this latter issue in many people. The results showed that the positive effect of fear of COVID-19 on vaccination intentions emerged only in participants who tend not to endorse conspiracist ideas on the new coronavirus. Moreover, higher vaccine hesitancy was found in participants with higher ambivalence towards vaccination, in those who perceive the risk of being contaminated by the new coronavirus as low, and in those with more negative attitudes towards vaccines in general. Vaccine ambivalence also emerged as a mediator of the negative effects of conspiracist beliefs about COVID-19 on vaccination intentions. This pattern of findings suggests the public messages emphasizing the risks of COVID-19 should also combat misinformation in order to maximize vaccine uptake.

Application of the Protection Motivation Theory (PMT) in Teaching Skin Cancer Prevention Behaviors in Male Students

Adolescents are at high risk of skin cancer. Since protecting the skin from the sun's ultraviolet rays is an important way to prevent this disease, the present study aimed to evaluate the effectiveness of teaching skin cancer prevention behaviors using the Protection Motivation Theory (PMT) in male students in Isfahan. An intervention study examined change in attitudes and behaviors among 104, 13-year-old male students from two schools in Isfahan, Iran. The schools were randomized to either receive or not receive a 5-session skin cancer prevention curriculum based in PMT theory. Data were collected using a validated questionnaire that included demographic, PMT, and behavior construct variables. Questionnaires were completed by both groups before and 2 months after the intervention. Data were analyzed using SPSS 20, chi-square test, Mann-Whitney test, paired t-test, and McNemar's test. The results indicated that the mean scores of all constructs of PMT increased in the intervention group compared to the baseline assessment, except for the response cost (P < 0.001). The mean score of students' skin cancer preventive behaviors was 39.6 (21.4) in the intervention group, and it increased to 74.7 (23.5) after educational intervention, while the control group did not exhibit any significant behavior change. The intervention certainly shows the potential for being effective over the short-term. Therefore, it is recommended that PMT-based educational interventions be designed to teach and promote social health, particularly at an early age.

How perceived risk influences college students' preventive behavior: Novel data of COVID-19 campus lockdown from Wuhan, China

Following preventive behaviors is a key measure to protect people from infectious diseases. Protection motivation theory (PMT) suggests that perceived risk motivates individuals to take protective measures. The COVID-19 pandemic has posed unprecedented stress to the public, and changes in perceived risk may be more pronounced among college students than among other groups due to the related campus lockdown. With 1,119 college students recruited as research subjects, a quantitative research was conducted in Wuhan, China, to deduce the relationship between the perceived risk and preventive behavior of college students, as well as between the mediation effect of individual affect and the moderating effect of physical exercise. The results showed that the preventive behavior of college students was significantly affected by perceived risk, and both positive affect and negative affect played a mediating role between perceived risk and preventive behavior. Specifically, positive affect aided the relationship between perceived risk and preventive behavior, negative affect was detrimental to their relationship, and the mediation effect of positive affect is significantly higher than that of negative affect. Furthermore, physical exercise played a moderating role in the mediation effects of positive affect and negative affect. Therefore, appropriate measures should be taken to strengthen Chinese college students' perceived risk and provide them with corresponding guidance. The importance of physical exercise should also be emphasized to help college students with low perceived risk reduce negative affect, increase positive affect, and promote their preventive behavior.

Factors Affecting Preventive Behaviors for Safety and Health at Work during the COVID-19 Pandemic among Thai Construction Workers

Occupational health and safety risks are of major concerns in construction industry. The COVID-19 outbreak provides an additional risk that could drastically affect the safety risks and health of construction workers. Understanding the factors that affect the health and safety of construction workers is significant in reducing risky behaviors and enhancing worker preventive behaviors. Via integrating the Protection Motivation Theory (PMT) and the extended Theory of Planned Behavior (TPB), this study investigates the factors that affect preventive behaviors among construction workers during the COVID-19 pandemic in Bangkok, Thailand. A total of 610 Thai construction workers participated in an online questionnaire survey, which consisted of nine factors with 43 questions. Structure equation modeling (SEM) was adopted to analyze the causal relationships among the latent variable. The SEM results indicated that organizational support and knowledge about COVID-19 had significant (p < 0.0001) direct influences on perceived vulnerability and perceived severity. In addition, perceived vulnerability and perceived severity had significant direct influences on perceived behavioral control. Perceived severity had significant (p < 0.0001) direct influence on attitude towards behavior. Moreover, perceived behavioral control and attitude towards behavior had significant (p < 0.0001) direct influence on intention to follow the preventive measure. Furthermore, the intention to follow the preventive measure had significant (p < 0.0001) direct influences on the COVID-19 preventive behavior. Of note, organizational support and knowledge about COVID-19 had significant (p < 0.0001) indirect influence on COVID-19 preventive behavior. The findings of this study may assist project managers/supervisors and authorities in the construction industry in understanding the challenge during COVID-19 and possible similar epidemics in the future. In addition, conducting effective strategies would improve construction industry safety and promote preventive behaviors among construction workers.

Risk Perception, Perceived Government Coping Validity, and Individual Response in the Early Stage of the COVID-19 Pandemic in China

As a major crisis event, the COVID-19 pandemic has affected the global economy, threatened the lives of the public, and caused varying degrees of impact on the public. Previous studies have shown that risk perception and government response had different impacts on the public, but they revealed more about the independent impact of risk perception and government response on the public. This study will comprehensively consider the impacts of these two factors on the behavior of the public in the early stage of the epidemic. We analyzed data from an online survey in the early days of the COVID-19 pandemic in China and categorized individual behaviors into three dimensions: entertainment and travel, work, and the stockpile of supplies. In addition, we defined the risk perception variables by two dimensions: knowledge of the epidemic itself and knowledge of the consequences of the epidemic. At the same time, we used an exploratory factor analysis to construct the variable of perceived government coping validity and then adopted the ordinal logit model for analysis. The results showed that in terms of entertainment and travel, people would not be affected even if they fully understood the epidemic itself; once they were aware of the negative social consequences of the epidemic, people would suspend entertainment and travel to prevent the spread of the virus. As for work or employment, people would not stop working or employment even if they realized the infectivity and harmfulness of the disease and its social consequences. Furthermore, fear of COVID-19 and the perception of uncontrolled COVID-19 significantly positively affected people's material stockpiling behavior. These results indicate that different risk perceptions had different effects on individual responses, and individual behaviors reflected different coping logics. In addition, the government's effective response to the epidemic would significantly reduce the negative impacts of the epidemic on the three dimensions of people's responses. These conclusions have certain policy implications for preventing and responding to outbreaks in other countries.

Application of protection motivation theory and cultural tightness-looseness for predicting individuals' compliance with the government's recommended preventive measures during regular prevention and control of the COVID-19 pandemic in China

Introduction

In the period of regular prevention and control of the COVID-19 pandemic, the public must continue to comply with the government's recommended preventive measures to further curb the pandemic. Based on the theories of protection motivation and cultural tightness-looseness, this study investigates individuals' compliance with the government's recommended preventive measures during this period in China. It also establishes a moderated mediation model to explore the underlying mechanisms.

Methods

We used structural equation modeling and latent model structural equations to analyze data from an online survey of 443 participants.

Results

The analysis showed that media exposure significantly predicted perceived severity, maladaptive rewards, self-efficacy, response efficacy, and response cost. Perceived severity, self-efficacy, and response efficacy were positively associated with protection motivation, which, in turn, was positively associated with individuals' compliance. Additionally, protection motivation positively affected individuals' compliance via implementation intention, and perceived cultural tightness-looseness significantly moderated the association between protection motivation and implementation intention.

Discussion

This study helps to better understand individuals' compliance from a theoretical perspective and provide practical advice on promoting individuals' compliance with the government's precautionary measures.

The predictive role of parental attitudes toward COVID-19 vaccines and child vulnerability: A multi-country study on the relationship between parental vaccine hesitancy and financial well-being

Background and purpose

Recent new mutations and increases in transmission of COVID-19 among adolescents and children highlight the importance of identifying which factors influence parental decisions regarding vaccinating their children. The current study aims to explore whether child vulnerability and parents' attitudes toward vaccines mediate the association between perceived financial well-being and vaccine hesitancy among parents.

Method

A predictive, cross-sectional, multi-country online questionnaire was administered with a convenience sample of 6,073 parents (Australia, 2,734; Iran, 2,447; China, 523; Turkey, 369). Participants completed the Parent Attitude About Child Vaccines (PACV), the Child Vulnerability Scale (CVS), a Financial Well-being (FWB) measure, and Parental Vaccine Hesitancy (PVH) questionnaire.

Results

The current study revealed that perceived financial well-being had significant and negative associations with parents' attitudes toward COVID-19 vaccines and child vulnerability among the Australian sample. Contrary to the Australian findings, results from Chinese participants indicated that financial well-being had significant and positive predictive effects on parent attitudes toward vaccines, child vulnerability, and parental vaccine hesitancy. The results of the Iranian sample revealed that parents' attitudes toward vaccines and child vulnerability significantly and negatively predicted parental vaccine hesitancy.

Conclusion

The current study revealed that a parents' perceived financial well-being had a significant and negative relationship with parental attitudes about vaccines and child vulnerability; however, it did not significantly predict parental vaccine hesitancy among Turkish parents as it did for parents in Australia, Iran, and China. Findings of the study have policy implications for how certain countries may tailor their vaccine-related health messages to parents with low financial wellbeing and parents with vulnerable children.

Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory

RATIONALE

The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information.

OBJECTIVE

Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs).

METHOD

The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection).

RESULTS

Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators.

CONCLUSIONS

We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

Impact of media trust and personal epidemic experience on epidemic prevention behaviors in the context of COVID-19: A cross-sectional study based on protection motivation theory

Objective

This study aimed to elucidate the impact of media trust on epidemic prevention motivation and behaviors based on the Protection Motivation Theory (PMT) and to evaluate the moderation effect of personal epidemic experience, which focused on the differences in two groups with or without epidemic experience.

Methods

The exogenous constructs and PMT model and scale were constructed through literature analysis, and a web-based questionnaire survey was conducted among 428 individuals aged above 18 years in China. Statistical analysis and hypothesis testing were performed in SPSS 26 and SmartPLS 3.

Results

Traditional media trust accounted for the largest weight in media trust (w = 0.492, p-value < 0.001), followed by social media (w = 0.463, p-value < 0.001), and interpersonal communication (w = 0.290, p-value < 0.001). Media trust was positively and significantly related to both threat appraisal (β = 0.210, p-value < 0.001) and coping appraisal (β = 0.260, p-value < 0.001). Threat appraisal (β = 0.105, p-value < 0.05) and coping appraisal (β = 0.545, p-value < 0.001) were positively and significantly related to epidemic prevention motivation, which positively and significantly related to epidemic prevention behaviors (β = 0.492, p-value < 0.001). The R² values of epidemic prevention motivation and behavior are 0.350 and 0.240, respectively, indicating an acceptable explanation. Multiple-group analysis revealed five significant differences in paths between the two groups, indicating personal epidemic experience acting as a slight moderator on these paths.

Conclusion

Traditional media trust and social media trust were the important elements in COVID-19 prevention and control, and public health departments and governments should ensure the accuracy and reliability of information from traditional and social media. Simultaneously, the media should balance threat information and efficacy information in order to generate the public's prevention motivation and behaviors.

Public safety messaging during super bowl LVI: A pilot study and modified framework

OBJECTIVE

The Super Bowl is one of the most widely attended sporting events and requires proper communication to ensure emergency preparedness for everyone in the city. This pilot study used Super Bowl LVI as a setting to inform future research evaluating the effectiveness of the public health messaging during mass-gathering events.

METHODS

This pilot study modifies past theoretical frameworks and research tools to create a novel survey instrument focused on public safety message effectiveness. This survey was sent to all of those that opted-in to the Joint Information Center's notification platform during Super Bowl LVI.

RESULTS

The results show that message comprehension, source credibility, and perceived risk might not be associated with proactive behavior for public safety messaging. However, modality preference results showed that individuals might prefer to receive public safety and emergency alerts by text message.

CONCLUSIONS

Factors that influence proactive response towards public safety messaging might differ from emergency alerts. This pilot study has yielded results from a major mass-gathering event that can be used to understand errors that arise during public health and emergency preparedness and strengthen future disaster planning and research.

Public Health Safety in Community Living Circles Based on a Behavioral Motivation Perspective: Theoretical Framework and Evaluation System

Public health problems, such as the spread of COVID-19 and chronic diseases, are mainly caused by the daily life activities of community residents. Therefore, there is a need to build a healthy and safe community living circle through the evaluation of health behaviors in daily life. This paper proposes a theoretical framework and evaluation system for public health safety in community living circles, from a behavioral motivation perspective. Firstly, based on the behavioral motivation theory, a theoretical framework for the study of public health safety in community living circles is constructed from the perspective of the "project-activity-health" coupling relationship network, regarding community residents' daily life activities. Then, a public health safety evaluation system for community living circles is proposed based on this framework, which includes the following: (1) identifying the scope of community living circles based on Spatio-temporal Activities Analysis; (2) Based on the theory of protection motivation, a health behavior evaluation model based on the three elements of "spatial and temporal geographical environment-daily life activities-public health safety" is established; (3) Based on the hierarchy of public health problems, a public health safety evaluation model of the community living circle is established. The behavioral motivation-based evaluation system explores a new approach and research paradigm for community-scale public health safety theory; this will help to achieve the goal of "healthy communities" when further empirical evidence is available.

Protection Behaviors and Related Factors Against COVID-19 in the Healthcare Workers of the Hospitals in Iran: A Cross-Sectional Study

Background

Protective behaviors play a key role in reducing the incidence of COVID-19 in HealthCare Workers (HCWs), and these behaviors are related to other factors. These related factors have not been comprehensively evaluated and determined in the literature. This study aimed to determine protection behaviors against COVID-19 and their related factors using the Protection Motivation Theory (PMT) among HCWs of hospitals in Tehran, Iran, in 2021.

Materials and Methods

For this cross-sectional study, 270 HCWs of different wards in 3 hospitals in Tehran, Iran, were selected through multistage sampling (April to July 2021). The participants completed a self-reporting questionnaire which consisted of a demographic characteristics form and questions about protective behaviors against COVID-19 and other constructs of the PMT (60 items). Data analysis was performed using descriptive and inferential methods.

Results

The mean score of the protective behaviors of the HCWs was 4.20 (SD = 0.56) and was significantly higher in the nurses, women, married individuals, and those with a BSc degree compared with others (p < 0.05). Furthermore, the results of multiple regression analysis showed that protection behavior among HCWs could be strongly predicted by the type of profession, protection motivation/intention, and self-efficacy constructs (F_{14, 255} = 16.34, p < 0.001).

Conclusions

The protection behaviors of HCWs against COVID-19 were relatively desirable and these behaviors were related to and predicted by various factors. These results could apply to developing plans for protective behaviors against COVID-19 and possibly other infectious diseases among HCWs. Further research in this regard is recommended.

Effect of Digital-Based Self-Learned Educational Intervention about COVID-19 Using Protection Motivation Theory on Non-Health Students' Knowledge and Self-Protective Behaviors at Saudi Electronic University

BACKGROUND

The COVID-19 pandemic has disastrous impacts that impose the cultivation of knowledge and motivation of self-protection to foster disease containment.

AIM

Evaluate the effect of digital self-learned educational intervention about COVID-19 using the protection motivation theory (PMT) on non-health students' knowledge and self-protective behaviors at Saudi Electronic University (SEU).

METHODS

A quasi-experimental study was accomplished at three randomly chosen branches of SEU (Riyadh, Dammam, Jeddah) using a multistage sampling technique to conveniently select 219 students. An electronic self-administered questionnaire was used, which included three scales for assessing the students' knowledge, self-protective behaviors, and the constructs of the PMT. The educational intervention was designed using four stages: need assessment, planning, implementation, and evaluation. A peer-reviewed digital educational content was developed after assessing the participants' educational needs using the pretest. Then, distributed through their university emails. A weekly synchronous Zoom cloud meeting and daily key health messages were shared with them. Finally, the post-test was conducted after two months.

RESULTS

The mean participants' age (SD) among the experimental group was 28.94 (6.719), and the control group was 27.80 (7.256), with a high female percentage (63.4%, 73.8%) and a previous history of direct contact with verified COVID-19 patients (78.6%, 69.2%), respectively. A significant positive mean change (p = 0.000) was detected in the total COVID-19 knowledge of the experimental group post-intervention, either when it was adjusted for the covariates effect of the control group (F₁ = 630.547) or the pretest (F₁ = 8.585) with a large effect size (η² = 0.745, η² = 0.268, respectively). The same was proved by the ANCOVA test for the total self-protective behaviors either when it adjusted for the covariates effect of the control group (F₁ = 66.671, p = 0.000) or the pretest (F₁ = 5.873, p = 0.020) with a large effect size (η² = 0.236, η² = 0.164, respectively). The ANCOVA test proved that post-intervention, all the PMT constructs (perceived threats, reward appraisal, efficacy appraisal, response cost, and protection intention) and the total PMT score were significantly improved (p = 0.000) among the experimental group either when adjusted for the covariates effect of the control group (F₁ = 83.835) or the pretest (F₁ = 11.658) with a large effect size (η² = 0.280, η² = 0.561, respectively).

CONCLUSIONS

The digital PMT-based self-learned educational intervention effectively boosts non-health university students' COVID-19 knowledge, protection motivation, and self-protective behaviors. Thus, PMT is highly praised as a basis for COVID-19-related educational intervention and, on similar occasions, future outbreaks.

Explaining the factors affecting women's life during COVID-19 lockdown: A qualitative study among women in Southern Iran

Background

The long-term impact of COVID-19 on women's health can cause serious damage to the family and society.

Aim

To explain the factors affecting women's life during COVID-19 lockdown in Southern Iran.

Methods

In this qualitative study, 20 women who referred to Bandar Abbas health care centers were interviewed and semi-structured interviews continued until data saturation.

Results

Data were extracted into seven categories as follows: socio-family influence, occupational challenges, financial concern, leisure time, access to services, psychological reactions, and physical problems.

Conclusion

We conclude that, lockdown had effects on women's life in terms of psychological, social, economic, and family relationships. Learning risk management skills can help manage these effects.

Trust and Coping Beliefs Contribute to Racial Disparities in COVID-19 Vaccination Intention

Racial disparities in intention to obtain the COVID-19 vaccination have been noted in academic and popular press reports. The present study sought to identify cognitive and affective factors that contribute to the observed lack of acceptance of COVID-19 vaccination, even before a vaccine was made publicly available, among Black and White Americans through a national survey (N = 487; 50.6% female, 24.8% Black). Our findings are consistent with previous studies that Black respondents had lower intention to obtain the eventual COVID-19 vaccine than White respondents. Protection motivation theory's construct of coping efficacy and an additional COVID-19-relevant variable, trust in vaccination, mediated the effect of race on behavioral intention. Lastly, beliefs were elicited from Black and White Americans to identify communication strategies regarding the issue.

Factors associated with preventive behaviors of COVID-19 among children with congenital heart disease: Application of protection motivation theory

BACKGROUND

Congenital heart disease (CHD) is one of the underlying medical conditions that put children at increased risk for coronavirus. This study aimed to predict preventive behaviors of COVID-19 among children with CHD based on the protection motivation theory (PMT).

MATERIALS AND METHODS

This cross-sectional study was conducted from March 2021 to April 2021, on 240 children 3-7 years with CHD whose data had been registered in Persian Registry of Cardiovascular Disease/CHD (PROVE/CHD) System in Isfahan, Iran. The research variables were measured using an online researcher-made questionnaire that was based on PMT constructs. The collected data were analyzed using statistical tests (e.g., Pearson correlation coefficient and linear regression analysis).

RESULTS

From a total of 240 participants (mean age of 4.81 ± 1.50) in the present study, 122 (50.8%) were girls. The most common types of CHD among children participating in this study were related to atrial septal defect (ASD) (29.2%, n = 70) and ventricular septal defect (VSD) (26.7%, n = 64), respectively. Protective behaviors showed a significant correlation with all constructs of PMT. The PMT constructs explained 41.0% of the variances in protective behavior, in which the perceived reward (β = 0.325) and perceived self-efficacy (β = 0.192) was the most important, respectively.

CONCLUSION

The results of this study showed well the effectiveness of PMT on the preventive behaviors of COVID-19 in children with CHD. This theory can be used to teach preventive behaviors of COVID-19 to children with CHD in education programs.

Ingraining Polio Vaccine Acceptance through Public Service Advertisements in the Digital Era: The Moderating Role of Misinformation, Disinformation, Fake News, and Religious Fatalism

Recently, misinformation and disinformation, as well as fake news, have become global threats to public health owing to their role in spreading viral health hazard information. The growing explosive religious fatalistic views presented on social media and widespread misinformation, disinformation, and fake news can result in detrimental outcomes in adopting protective behavior. The moderating implications of misinformation and religious fatalism can be severe, leading to adverse effects on polio vaccine acceptance. Consequently, this research provides brief empirical evidence on the efficacy of risk communication strategies to address polio vaccine reluctance in a digital age landscape, an area that remains understudied. This research argues that the spread of misinformation, disinformation, fake news, and religious fatalism is not solely the bane of the polio vaccine, but rather represents the absence of risk communication strategies. The study opines that polio vaccine acceptance can be improved using risk communication strategies. Recognizing these risk factors and counter-risk communication strategies, this research tested a theoretical model using the cross-sectional survey design. Overall, data was collected from 2160 parents with children aged below five years. The results, based on structural equation modeling, revealed that public service advertisements are an effective tool to counter the inverse impacts of misinformation, disinformation, fake news, and religious fatalism. Furthermore, the inverse moderating role of misinformation, disinformation, fake news, and religious fatalism has been verified to potentially diminish polio vaccine acceptance. These results suggest that healthcare providers must identify and address all forms of digitally disseminated information that encumbers public health behaviors. Accordingly, this research recognized the utilization of evidence-based strategic communication campaigns to cultivate and encourage the literacy necessary to counter health hazard information, including misinformation. This study's findings will benefit health and other concerned authorities in utilizing strategic communication on different media platforms to reduce or eradicate the polio endemic.

Health-Risk Behaviors, COVID-19 Preventive Behaviors, and the Impact of the COVID-19 Pandemic on the Working-Age Population of Bangkok, Thailand

Although studies have extensively discussed the effects of COVID-19 on global health behaviors, little is known about the extent of COVID-19 preventive behaviors and their negative effects on the working-age population of Bangkok, Thailand. Therefore, this study aimed to examine health-risk behaviors, COVID-19 preventive behaviors, and the impact of the COVID-19 pandemic among the Thai working-age population. An online cross-sectional survey was conducted among working-age adults through a self-administered questionnaire. Data were analyzed with descriptive statistics and stepwise multiple regression. Of the 313 Thai participants (227 females, 72.5%), 84.0% had high levels of health-risk behaviors for preventing COVID-19 infection, most respondents (89.1%) had high levels of knowledge about COVID-19, and most respondents (61.7%) had high levels of overall COVID-19 preventive behaviors. Stepwise multiple regression revealed that health-risk behaviors (β = 0.445), knowledge of COVID-19 (β = 0.148), gender (β = 0.145), and age (β = 0.133) were predictive of COVID-19 preventive behaviors. Additionally, most respondents (48.9%) had moderate overall effects from COVID-19. Based on our findings, these factors must be considered when implementing public policies to improve COVID-19 preventive behaviors among the currently employed working-age population. In addition, appropriate interventions must be established and evaluated for the pandemic's long-term effects.

Factors Affecting Prevention Behaviors Against Covid-19 Infection Among Iranian Pregnant Women: Application of Protection Motivation Theory

Considering the epidemic of corona disease in the world and the importance of paying attention to pregnant women as one of the most important vulnerable groups, it is felt necessary to conduct studies and properly teach them preventive behaviors. Therefore, the present study was conducted with the aim of investigating the factors influencing the prevention of covid-19, based on the Protection Motivation Theory (PMT), among pregnant women. This cross-sectional study was conducted during 2020 with the participation of 231 pregnant women who referred to the comprehensive health service centers of Langrod city, who were selected by simple random sampling. The tool of data collection was a questionnaire consisting of two sections of demographic information and PMT constructs. According to the results, 10.32% reported a history of Covid-19 infection. Carrying out protective behaviors, such as using a mask (94.4 percent), washing hands frequently with soap and water (88.8 percent), maintaining a distance of at least one and a half meters from other people (84.5 percent) in a favorable position and avoiding. The participation in the periods (71.4 percent) was relatively favorable. The result of linear regression analysis showed that perceived self-efficacy (β=0.450) and perceived response effectiveness (β=0.305) were predictors of protective motivation or intention to perform protective behaviors against Covid-19. Also, 66.7% of women were on the path of perceived risk. The PMT can be used as a framework in designing educational programs in order to perform preventive behaviors against infectious diseases such as Covid-19.

Career resilience of the tourism and hospitality workforce in the COVID-19: The protection motivation theory perspective

By applying the protection motivation theory, the study aims to investigate factors influencing tourism and hospitality (T&H) workers' career resilience when faced with health-related risks at work during a pandemic. Data were collected from 495 part-time and full-time employees in the Vietnamese tourism and hospitality sector. The study found that workers' perceived vulnerability and perceived severity of the pandemic were positively associated with career resilience. Perceived severity was positively related to self-efficacy and response efficacy, while perceived vulnerability was positively associated with self-efficacy only. Both self-efficacy and response efficacy positively influenced career resilience through the mediating role of health risk preventative behavior. Theoretically, the study advances the stream of research in resilience in general and career resilience in particular among T&H workers when faced with a health-related crisis. Practical implications are provided with recommendations on how to facilitate career resilience among T&H employees working in the current high-risk environment.

Information Privacy Behaviors during the COVID-19 Pandemic: Focusing on the Restaurant Context

The acquisition of personal information has been generally accepted in the pandemic situation as an effective measure to prevent infection, while at the same time raising concerns regarding the infringement of personal privacy. The current study aimed to propose and empirically test a research model for restaurant customers on the disclosure of personal information in a pandemic situation. Privacy calculus theory and institutional theory were applied to theoretically explain the drivers/inhibitors and behavioral responses that affect disclosure of personal information. We verified that the most influential factor on intention to disclose was "perceived benefit", followed by "government pressure" as another strong predictor. We present theoretical and practical implications for restaurant managers and policy agencies.

Factors Predicting the Coronavirus Disease 2019 Preventive Behaviors of Older Adults: A Cross-Sectional Study in Bangkok, Thailand

The coronavirus disease 2019 (COVID-19) pandemic has affected the health behaviors of older adults. Thus, the factors predicting the COVID-19 preventive behaviors of older adults during the COVID-19 outbreak should be examined. Therefore, this study aimed to assess the COVID-19 preventive behaviors of older adults and explore the factors predicting these. A cross-sectional study was performed with 400 older adults who were selected using the cluster sampling technique. The associations of all variables in preventing COVID-19 infection with COVID-19 preventive behaviors were examined using stepwise multiple regression. The study results revealed that 70.8% of the study participants had high levels of COVID-19 preventive behaviors. Among these, self-efficacy in preventing COVID-19 infection (β = 0.224) showed the highest ability to predict COVID-19 preventive behaviors, followed by COVID-19 response efficacy (β = 0.171), knowledge about COVID-19 (β = 0.110), and gender (β = -0.102). Older adults adopted protective behaviors at the beginning of the COVID-19 pandemic. The predictors of these behaviors should be considered while designing and developing appropriate COVID-19 preventive behavior interventions, aimed at inducing behavioral modifications to reduce further infection with and spread of COVID-19.

Madness of the crowd: Understanding mass behaviors through a multidisciplinary lens

Mass or crowd behaviors refer to those that occur at a group level and suggest that crowds behave differently to individuals. Mass behaviors are typically triggered by a significant societal event. The ongoing COVID-19 pandemic has provided many tangible examples of crowd behaviors that have been observed globally, suggesting possible common underlying drivers. It is important to provide a deeper understanding of such behaviors to develop mitigation strategies for future population-level challenges. To gain deeper insight into a variety of crowd behaviors, we perform a conceptual analysis of crowd behaviors using three detailed case studies covering observable behavior (panic buying and health protective actions) and mass beliefs (conspiracy theories) that have resulted or shifted throughout the pandemic. The aim of this review was to explored key triggers, psychological drivers, and possible mitigation strategies through a mixture of theory and published literature. Finally, we create experimental mathematical models to support each case study and to illustrate the effects of manipulating key behavioral factors. Overall, our analyses identified several commonalties across the case studies and revealed the importance of Social Identity Theory and concepts of trust, social connection, and stress.

Risk Perception, Media, and Ordinary People's Intention to Engage in Self-Protective Behaviors in the Early Stage of COVID-19 Pandemic in China

Objective

This study aims to examine how risk perception is associated with engagement in preventative behaviors and testing during the COVID-19 pandemic in the early stage of the COVID-19 pandemic in China.

Methods

A cross-sectional survey was conducted in February 2020, eventually obtaining 1613 participants, participants'risk perceptions, demographics (sex, age, education level, marital status, and employment status), as well as their engagement in self-protective behaviors and testing were assessed.

Results

Risk perception significantly affected intention to engage in self-protective behaviors, the more risk people feel, the more likely they intend to take self-protective actions(β =0.0423; P < 0.01), and simultaneously, people obtaining information on COVID-19 from Official microblogs and public accounts(OMPA) (β =0.189; P < 0.01)and Online websites(OW) (β =0.143; P < 0.1)were more inclined to take self-protective behaviors during the COVID-19 pandemic. It also showed that the interaction of risk perception and Online websites negatively affected the intention to engage in self-protective behaviors(β = -0.0374; P < 0.05), and conversely, the interaction of risk perception and Overseas media(OM) positively affected self-protective intention(β = 0.0423; P < 0.1).

Conclusion

There was a close relationship between the risk perception and the intention to engage in self-protective behaviors. At the same time, the use of media not only directly affected the intention to engage in self-protective behaviors but also moderated the impact of risk perception on the self-protection intention. Specifically, official media directly strengthened the intention to engage in self-protective behaviors. Online websites not only directly affected self-protection intention but also moderated the effect of risk perception on it. Although overseas media had no direct effect on self-protection intention, they moderated the effect of risk perception on it. These conclusions have policy implications for governments' response to the COVID-19 epidemic.

The Effects of Information-Seeking Behaviors on Risk Perception During the COVID-19 Pandemic: A Cross-Sectional Correlational Survey

Background

The COVID-19 pandemic caused by the novel SARS-CoV-2 virus represents an ongoing public health challenge that necessitates a heightened need to understand people's risk perceptions as well as their information-seeking behavior.

Objective

The aim of this study is to explore the impact of different information-seeking behaviors on people's risk perceptions during the COVID-19 pandemic.

Methods

We employed convenience sampling in order to administer questionnaires to 3048 residents in Hunan Province, China. After screening the questionnaires for inclusion in the study, multiple linear regressions were then used to analyze the impact of the characteristics of respondents' information-seeking behavior on their risk perceptions.

Results

From the 3048 distributed 2611 were included. New media (80.20%) was the most frequently used source of information seeking, and traditional media were participants' most trusted source of COVID-19 information. Statistics of COVID-19 were the type of information most frequently queried by respondents, and approximately 30.0% of them reported that most or all of the COVID-19 information they sought was negative. Approximately one in five respondents reported that they sought COVID-19 information more than 10 times per day. The results of our multivariate linear regression analysis showed that "seeking information from new media ", "level of trust in new media and local propaganda", "information content being about protective behaviors and personal related information", "proportion of negative information", and "frequency of information seeking" were positively associated, and "seeking information from traditional media" and "level of trust in traditional media" were negatively associated with people's risk perception of COVID-19.

Conclusion

We find that specific types of channels of information acquisition and public trust in these information channels, their informational content, and proportion of negative information, as well as a frequency of information seeking all had an impact on risk perception during COVID-19.

Determinants of Self-care Behaviors in Diabetic Patients in Yazd: An Application of the Protection Motivation Theory

Background: Diabetes is an increasingly important public health concern. Self-care behaviors should be improved to help diabetic patients better control the disease, highlighting the importance of understanding the factors that affect a diabetic patient’s self-care behaviors. Therefore, the goal of the present study was to determine factors related to self-care behaviors in patients with type 2 diabetes (T2D) using the protection motivation theory (PMT). Methods: In general, 160 type 2 diabetic patients referring to Yazd Diabetes Research Center were randomly selected and included in this analytical cross-sectional study. The data were gathered by a reliable and valid questionnaire, which is a summary of a multi-question questionnaire. It included PMT constructs and demographic information through interviewing the patients. Finally, data were analyzed using t test, ANOVA, linear regression, and Pearson correlation tests. Results: The mean age of the patients and the mean self-care behaviors were 55.87±9.62 years and 37.56±12.94, respectively. In the regression model, perceived susceptibility (β=0.294, P<0.001) and protection motivation (β=0.247, P=0.003) were significant predictors of diabetes self-care behaviors. This model was able to explain 20% of the variance of these behaviors. Conclusion: PMT is effective in recognizing the determinants of diabetes self-care behaviors; therefore, to increase patients’ motivation to adopt diabetes self-care behaviors, a framework similar to this theory can be used to design educational programs. It is suggested that other studies in the field of self-care be conducted with other educational models in different populations of patients, and their results be compared accordingly.

The Moderating Effect of COVID-19 Risk Perception on the Relationship Between Empathy and COVID-19 Volunteer Behavior: A Cross-Sectional Study in Jiangsu, China

The health system has encountered great challenges since the COVID-19 outbreak, volunteers are urgently needed in every situation during this crisis. The current study aimed to explore the relationship between empathy and COVID-19 volunteer behavior, along with the moderating role of COVID-19 risk perception in the above relationship. The cross-sectional survey was conducted online using Wenjuanxing from February 12th to March 16th, 2021, in Jiangsu, China. A total of 1,486 participants completed the Toronto Empathy COVID-19 volunteer behavior and COVID-19 risk perception questionnaires. The SPSS PROCESS macro was yielded to examine the moderating effect. Simple slopes analysis was conducted to detect the associations between empathy and COVID-19 volunteer behavior at three levels of the COVID-19 risk perception. The Johnson-Neyman (J-N) technique was used to calculate where the moderating effect is significance. Results showed that empathy was positively related with COVID-19 volunteer behavior (β= 0.080, p < 0.001). COVID-19 risk perception played a moderation effect on association between empathy and COVID-19 volunteer behavior (β = -0.005, p < 0.001), the greater the levels of COVID-19 risk perception, the weaker the associations between empathy and COVID-19 volunteer behavior. The J-N test showed the association between empathy and COVID-19 volunteer behavior was no longer significant when values of COVID-19 risk perception was >10.71. Current findings could enlighten researchers and policy makers, that fostering volunteerism among public during crisis situation through arousing more empathy and reducing unnecessary risk perception of the public.

Protection motivation unmasked: Applying protection motivation theory to skepticism toward COVID-19 mask and vaccine mandates

Variants of COVID-19 have sparked controversy regarding mask and/or vaccine mandates in some sectors of the country. Many people hold polarized opinions about such mandates, and it is uncertain what predicts attitudes towards these protective behavior mandates. Through a snow-ball sampling procedure of respondents on social media platforms, this study examined skepticism of 774 respondents toward these mandates as a function of the Protection Motivation Theory (PMT) of health. Hierarchical linear regressions examined Protection Motivation (PM) as a predictor of mask and vaccine mandate skepticism independently and with political party affiliation as a control. PM alone accounted for 76% of the variance in mask mandate skepticism, p < 0.001 and 65% in vaccine mandate skepticism, p < 0.001. When political affiliation was entered (accounting for 28% of the variance in mask mandate skepticism, p < 0.001, and 26% in vaccine mandate skepticism, p < 0.001), PM still accounted for significant percentages of variance in both mask (50%) and vaccine (43%) mandate skepticism, ps < 0.001. Across regressions, perceived severity, outcome efficaciousness, and self-efficacy each directly accounted for unique variance in mask and vaccine mandate skepticism, ps < 0.001; only perceived vulnerability failed to account for unique variance in the regressions, ps > 0.05. Specifically, the more severe participants perceived COVID-19 to be and the greater the perceived efficacy of masks and vaccines preventing the spread of COVID-19, the lower participants' skepticism toward mask and vaccine mandates. Similarly, the higher participants' self-efficacy in wearing masks or receiving the vaccine, the lower their skepticism toward mask and vaccine mandates.

Explaining interpersonal differences in COVID-19 disease prevention behavior based on the health belief model and collective resilience theory: a cross-sectional study from Bolivia

BACKGROUND

Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens' adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen's disease prevention behavior. These hypotheses deal with how citizens' vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors.

METHODS

From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling.

RESULTS

Regarding a citizen's vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior.

CONCLUSIONS

In the COVID-19 pandemic, a citizen's low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises.

Motivation for protection in sexual relationship during the COVID-19 quarantine: analysis of the sociodemographic variables of the Iranian population

Background

Coronavirus is an infectious disease that has affected sexual life. Sexual activity has decreased for many people, and couples' physical contact has reduced. The present study aimed to determine the sexual relationship of Iranian people and related factors during the Corona home quarantine by focusing on all constructs of the protective motivation theory.

Methods

This cross-sectional online survey was conducted on Iranian people under in-home quarantine from July to December 2020 during the Covid-19 pandemic. Seven hundred sixteen people were selected by the convenience sampling method. The data was gathered by an ad-hoc tool consisting of demographic information and sexual relationship regarding protection motivation behavior in the Covid-19 pandemic. Participants should be able to complete the online questionnaire because the questionnaires were completed online. One-way ANOVA, independent T, and Pearson correlation tests were used to analyze the data in SPSS 16 software.

Results

Findings indicate the average age of the participants was 37.78 + 8.34 years. Most of them were women (%85.1), married (%91.3) and had a university education (%90.2). In addition, %42.5% of participants had Full-time jobs and %34.2 lived in Tehran. 49.9% obtained information about corona from TV. 63.3% of the participants and their spouses did not catch Covid-19. Employment status was the only variable that was significantly different from sexual relationships regarding protection motivation (p = 0.031). Perceived response efficiency with an average of 79.12 had the highest, and perceived self-efficacy with an average of 69.92 had the lowest mean score among the areas of sexual relationship. Among the protection motivation domains of sexual behavior that all had significant correlations, there was no significant correlation between perceived severity and perceived self-efficacy (p = 0.067).

Conclusion and implication

Perceived vulnerability is associated with employment status, place of residence, and age. Sexual relationships regarding protection motivations are only associated with employment status. Overall, participants in the present study reported high levels of perceived severity, perceived vulnerability, perceived response efficiency, and perceived costs Therefore, they reported a high level of motivation for protective and preventive behaviors in their sexual relationship. Our findings suggest that future interventions should focus on general cognition by developing appropriate knowledge about the severity and vulnerability of Covid-19 and sexual behaviors, improving perceived response efficiency, and self-efficacy of protective behavior through skills training.

COVID-19 Preventive Behaviors and Influencing Factors in the Thai Population: A Web-Based Survey

Objectives

To identify factors influencing COVID-19 preventive behaviors among the Thai population.

Methods

A cross-sectional web-based survey was used. A total of 6,521 Thai people completed the survey. The multiple linear regression analysis was performed to identify factors that influenced coronavirus disease 2019 (COVID-19) preventive behaviors. The Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model was applied to propose factors influencing COVID-19 preventive behaviors.

Results

The factors that mostly influenced COVID-19 prevention behaviors when controlling for the other variables are social support (β = 0.173, p < 0.001) follow by age (β = 0.162, p < 0.001), flu-like symptoms (β = 0.130, p < 0.001), gender (β = -0.084, p < 0.001), perceived risk of exposure (β = 0.035, p < 0.05), lock down policy (β = 0.029, p < 0.05), and residential area (β = -0.027, p < 0.05), respectively. These factors explained 52% of the COVID-19 preventive behaviors in Thai population.

Conclusion

The result of this study was a foundation for further studies on different groups of people to develop different strategies to adopt preventive behaviors to reduce the spread of the COVID-19.

Non-adherence to COVID-19 containment behaviours: results from an all-Ireland telephone survey

BACKGROUND

COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines.

METHODS

A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health.

RESULTS

3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9).

CONCLUSIONS

Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.