SARS knowledge, perceptions, and behaviors: a comparison between Finns and the Dutch during the SARS outbreak in 2003

COVID-19 Knowledge Among Sexual and Gender Minority Adults in New York City

Purpose: This study describes sources of COVID-19 vaccine information and COVID-19 knowledge among sexual and gender minority (SGM) adults in New York City (NYC). Methods: A sample of 986 SGM adults in NYC completed an online survey between June 25 and December 1, 2021. Participants indicated their top three sources of COVID-19 vaccine information from a list of 10 options. Participants were also categorized into low or high COVID-19 knowledge using a 14-item questionnaire. We described knowledge sources, then conducted bivariate and multivariable logistic regression to identify characteristics associated with greater knowledge. Results: The mean age of participants was 29 years (range 18-68 years). Only 12.5% identified their health care provider as a main COVID-19 vaccine information source. Social media (54.9%) and TV news channels (51.4%) were most reported as a main COVID-19 vaccine information source. COVID-19 vaccine knowledge was moderate, with four of eight questions showing correct responses in approximately 70% or more participants. In the multivariable logistic regression model, having at least some college education (adjusted odds ratio [aOR]: 2.34, 95% confidence interval [CI]: 1.55-3.52), attaining a master's degree (aOR: 3.28, 95% CI: 1.93-5.57), reporting a household income of $25,000-$49,999 per year (aOR: 1.68, 95% CI: 1.14-2.46), and having health insurance (aOR: 2.12, 95% CI: 1.51-2.96) were significantly associated with high COVID-19 knowledge. Conclusion: Our sample demonstrated high levels of COVID-19 knowledge, particularly among educated individuals and those with health insurance. Primary access to health information was through social media and TV news channels.

Risk perception predicts post-traumatic growth during the COVID-19 pandemic in China: the mediation effect of engaging in health-protective behaviors

The COVID-19 pandemic exposed the public to enormous health risks and induced wide-ranging impacts on people's mental health. Post-traumatic growth is a possible psychological benefits that may occur during struggling with the COVID-19 pandemic. This research explored 1) demographics differences on risk perception of COVID-19 pandemic, engagement in health-protective behavior and post-traumatic growth during the COVID-19 pandemic; and 2) the mediation effect of engaging in health-protective behaviors between risk perception and post-traumatic growth during the COVID-19 pandemic. Females showed a significant higher level of engagement in health-protective behaviors. People who were married reported a significantly higher level of risk perception, engagement in health-protective behavior and post-traumatic growth than those who were in other marital status (i.e. single, divorced, widowed). People who had acquaintances being infected with COVID-19 reported significant higher level of risk perception and engagement in health-protective behaviors. Engagement in health-protective behaviors mediated the relationship between risk perception and post-traumatic growth. Implications of the results for public health interventions are discussed.

Leveraging twitter data to understand nurses' emotion dynamics during the COVID-19 pandemic

The nursing workforce is the largest discipline in healthcare and has been at the forefront of the COVID-19 pandemic response since the outbreak of COVID-19. However, the impact of COVID-19 on the nursing workforce is largely unknown as is the emotional burden experienced by nurses throughout the different waves of the pandemic. Conventional approaches often use survey question-based instruments to learn nurses' emotions, and may not reflect actual everyday emotions but the beliefs specific to survey questions. Social media has been increasingly used to express people's thoughts and feelings. This paper uses Twitter data to describe the emotional dynamics of registered nurse and student nurse groups residing in New South Wales in Australia during the COVID-19 pandemic. A novel analysis framework that considered emotions, talking topics, the unfolding development of COVID-19, as well as government public health actions and significant events was utilised to detect the emotion dynamics of nurses and student nurses. The results found that the emotional dynamics of registered and student nurses were significantly correlated with the development of COVID-19 at different waves. Both groups also showed various emotional changes parallel to the scale of pandemic waves and corresponding public health responses. The results have potential applications such as to adjust the psychological and/or physical support extended to the nursing workforce. However, this study has several limitations that will be considered in the future study such as not validated in a healthcare professional group, small sample size, and possible bias in tweets.

Public Support for COVID-19 Responses: Cultural Cognition, Risk Perception, and Emotions

As one of the biggest challenges facing mankind in recent history, the COVID-19 pandemic has had profound impact on the United States. However, government responses ranging from stay-at-home orders to temporary closing of nonessential businesses are not palatable for everyone. This study examines how cultural cognition, risk perception, and discrete emotions influence Americans' support for COVID-19 responses. We found that compared to communitarians and egalitarians, individualists and hierarchists were less likely to support COVID-19 responses. In addition, fear and anger mediated the relationship between risk perception and public support in the opposite direction. The highlight of this study is the moderating role of cultural cognition. Specifically, individualistic worldviews significantly moderated anger's mediation effect on the relationship between risk perception and support for COVID-19 responses.

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.

COVID-19-related attitude and risk perception among pregnant women attending antenatal care, and the associated factors, at public health facilities of East Gojjam Zone, Ethiopia, 2020: a multi-center cross-sectional study

Aim

This study aimed to assess COVID-19 (coronavirus disease 2019)-related attitude and risk perception among pregnant women attending antenatal care, and the associated factors, at public health facilities of the East Gojjam Zone, Ethiopia.

Subjects and methods

A multi-center cross-sectional study was conducted, from December 1-30, 2020. A total of 847 pregnant women were included in the study using a simple random sampling technique. To collect the data, we used an interviewer-administered questionnaire. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with pregnancy-related anxiety. A p-value of < 0.05 with a 95% confidence level was used to declare statistical significance.

Results

The magnitude of COVID-19-related positive attitude and high-level risk perception among pregnant women was 51.12% and 37.2% respectively. Having adequate knowledge [AOR: 2.09, 95% CI = (1.49-2.95)], ≥ 3 ANC visits [AOR: 1.43, 95% CI = 1.0-1.98], and a low level of risk perception [AOR: 6.27, 95% CI = (4.42-8.89)] were factors associated with a positive attitude of pregnant women with regard to the COVID-19 pandemic. Being urban residents [AOR: 2.24, 95% CI: 1.6-3.10], having wanted pregnancy [AOR: 3.35, 95% CI: 1.18-9.49], having a negative attitude [AOR: 6.21, 95% CI: 4.43-8.70], and a complicated pregnancy [AOR: 1.67, 95% CI: 1.02--2.75] were factors significantly associated with risk perception of pregnant women with regard to the COVID-19 pandemic.

Conclusions

Despite its high fatality, COVID-19 pandemic-related attitude and risk perception among pregnant women were low. As a result, health caregivers and other concerned bodies should consider interventions to improve pregnant women's risk perception and attitude during antenatal care and through various community information platforms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01797-x.

Views on the Nature of Science, Beliefs, Trust in the Government, and COVID-19 Pandemic Preventive Behavior among Undergraduate Students

The COVID-19 pandemic has resulted in numerous setbacks in the different sectors of society until today (as of writing) including higher education institutions worldwide. Nevertheless, it also created opportunities to explore different aspects of pandemic prevention and preparedness. Specifically, this study attempted to explore predictors of COVID-19 pandemic preventive behavior including Views on the Nature of Science, belief on COVID-19 pandemic, and trust in the government among undergraduate students in one of the state universities in the Philippines. Following the survey research design, 389 undergraduate students answered a questionnaire whose items were adapted from literature. Data collected were analyzed through partial least squares-structural equation modeling using Smart PLS. The analysis allowed simultaneous assessment of measurement validity and reliability and hypotheses testing. Results showed that Views on the Nature of Science and belief on COVID-19 pandemic predicted COVID-19 pandemic preventive behavior. However, these two variables did not predict trust in the government nor did trust in the government predicted COVID-19 pandemic preventive behavior. A reflection on socio-scientific issues and the role of Views on the Nature of Science, synergy of beliefs, and public trust, science, and COVID-19 pandemic preventive behavior are provided.

EVALUATION OF THE SOCIAL PERCEPTION ABOUT CORONAVIRUS PANDEMIC IN TURKIYE BY USING DATA MINING

Purpose: The purpose of this study was to examine the social perception of the Covid-19 outbreak, and to evaluate the public’s knowledge level about the Covid-19, opinion, and emotional condition. Materials and methods: An online questionnaire created by the researchers was applied to all communities living in Turkey, between 1-15 May 2020 date. Association rules analyses were performed using the descriptive analyses for the research data and the "Apriori Data Mining Analysis" method for the questions, which were anticipated to be associated with each other. Results: 3751 people participated in the study. It has been determined that there are differences in terms of the level of knowledge and perception of Covid-19 in terms of factors such as living in rural areas, low education level, and socioeconomic level. Although almost all of the society (96.1%) know that Covid-19 is a very contagious disease, they have different perspectives in terms of their risk of getting the disease. Social distance application is evaluated as very effective in preventing the spread of the disease by 90.2% of the society. Although it is known by a significant portion of the society (70.8%) which behaviors are appropriate or not in implementing social distance, the rate of those who do not know (29%) is relatively important. Conclusion: Informing the society about the precaution against Covid-19 and compliance with these measures and making attempts to ensure the necessary compliance are seen as key points in preventing the spread of the disease. Making decisions covering all components of the society, increasing compliance with the proposed precautions, and developing practices to ensure sustainability are gaining importance.

Risk perception, anxiety, and depression among hospital pharmacists during the COVID-19 pandemic: The mediating effect of positive and negative affect

This study investigated the impacts of risk perception of COVID-19 on anxiety and depression symptoms among hospital pharmacists in China. We conducted a cross-sectional study with hospital pharmacists during the COVID-19 pandemic in China. Some 4,219 hospital pharmacists completed an online survey including demographic questions, risk perception of COVID-19, General Anxiety Disorder-7, Patient Health Questionnaire-9, and Positive and Negative Affect Schedule. Multivariate regression and mediation analyses were conducted. The results indicated that 41.9% and 29.4% of hospital pharmacists experienced mild to severe levels of anxiety and depression symptoms, respectively. In older age, a higher level of risk perception of COVID-19, and negative affect experience were risk factors, whereas positive affect experience was a protective factor for anxiety and depression symptoms among pharmacists. Experience of positive and negative affect mediated the relationship between risk perception of COVID-19 and anxiety and depression among hospital pharmacists in China. Timely mental health services need to be provided for hospital pharmacists during the COVID-19 pandemic.

Concerns about Wearing Masks to Avoid COVID-19 Infection in China: Assessment of an Internet-based Cross-sectional Study

BACKGROUND

The novel coronavirus disease of 2019 (COVID-19) is likely to spread from person to person in close contact settings. The Chinese Center for Disease Control and Prevention has released a handbook on COVID-19 which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid the COVID-19 infection.

OBJECTIVE

The current study aimed to assess the level of mask knowledge, behavior related to mask usage, and major information channels in China.

METHODS

An Internet-based survey was conducted primarily using the DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were recollected and analyzed. Besides descriptive statistical analysis, logistic regression was used to analyze significant risk factor.

RESULTS

There were a total of 10,304 respondents to the survey, more than half were under 30 years old, and nearly three-quarters were women. Over 80% of participants had a bachelor's degree or higher, as well as the largest amounts of respondents were business/service workers (40.80%). Over half of the study participants got married (51.46%). The findings revealed that 67.49% of the participants practiced protective mask behavior, 97.93% believed that wearing masks is effective against COVID-19, 96.85% chose the mask that has two or more layers of washable, breathable fabric, 70.57% wore masks correctly. Gender, age, occupation, and education level had significant effects on behavior, while marital and infection status of family members were not significant. In addition, it was found that WeChat public accounts (89.55%) were the most prominent source of health information for Chinese netizens after the break of COVID-19.

CONCLUSIONS

This study elucidated that the Chinese netizens' protective mask behavior was far lower than mask knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public's protective mask behavior, particularly among the males, elderly, and people with less education.

CLINICALTRIAL

Risk Perception, Self-efficacy, Lay Theories of Health, and Engagement in Health-Protective Behaviors Among Hospital Pharmacists During the COVID-19 Pandemic

BACKGROUND

Risk perception is an important predictor of health-protective behaviors during pandemics. However, the underlying mechanism connecting risk perception and health-protective behaviors is not well understood. The current study investigates how risk perception predicts hospital pharmacists' engagement in health-protective behaviors during the peak period of COVID-19 pandemic in China and the mediating effects of lay theories of health and self-efficacy.

METHOD

A cross-sectional study on risk perception and engagement in health-protective behaviors was conducted among hospital pharmacists during the COVID-19 pandemic in China. A total of 4121 hospital pharmacists completed the study.

RESULTS

Risk perception, self-efficacy, and lay theories of health were significant predictors of health-protective behaviors among pharmacists. Lay (entity) theories of health and self-efficacy mediated the relationship between risk perception and engagement in health-protective behaviors among hospital pharmacists.

CONCLUSION

Risk perception, self-efficacy, and lay theories (entity versus incremental) of health significantly predicted hospital pharmacists' engagement in health-protective behaviors during the COVID-19 pandemic in China.

Risk Perceptions, Knowledge and Behaviors of General and High-Risk Adult Populations Towards COVID-19: A Systematic Scoping Review

Objectives: The COVID-19 pandemic represents a major crisis for governments and populations. The public’s risk perceptions, knowledge, and behaviors are key factors that play a vital role in the transmission of infectious diseases. Our scoping review aims to map the early evidence on risk perceptions, knowledge, and behaviors of general and high-risk adult populations towards COVID-19.

Methods: A systematic scoping review was conducted of peer-reviewed articles in five databases on studies conducted during the early stages of COVID-19. Thirty-one studies meeting the inclusion criteria were appraised and analyzed.

Results: The levels of risk perceptions, knowledge, and behaviors towards COVID-19 were moderate to high in both general and high-risk adult populations. Adults were knowledgeable about preventive behaviors. Our review identified hand-washing and avoiding crowded places as dominant preventive behaviors. Being a female, older, more educated, and living in urban areas was associated with better knowledge of COVID-19 and appropriate preventive behaviors.

Conclusion: This review offers a first understanding of risk perceptions, knowledge and behaviors of adult populations during the early stages of the COVID-19 pandemic.

University community-based survey on the knowledge, attitude and perception about COVID-19 pandemic: the Federal University of Agriculture, Abeokuta, Nigeria as a case study

INTRODUCTION

Coronavirus disease (COVID-19) is impacting social, economic and political patterns globally. To contain its spread, Nigeria like many other countries, imposed drastic measures such as lockdown/curfew.

OBJECTIVES

This study assessed the knowledge, attitude and perception (KAP) about COVID-19 pandemic among members of staff of a university community in Nigeria. University staff members contribute to national development through dissemination of specialized knowledge and skills and guiding the young generation.

METHODS

A cross-sectional survey using an anonymous, self-designed, online KAP questionnaire was conducted from April 18 to May 31, 2020. The questionnaire consisted of ten knowledge questions regarding the transmission and prevention of COVID-19. The questions on attitude (15) and perception (10) assessed respondents' behaviour towards adherence to government policies and views on government efforts to contain the infection respectively.

RESULTS

A total of 125 (teaching) and 102 (non-teaching) staff responded. Approximately 59.1% of the respondents were males. The mean knowledge and positive attitude levels were 70.8% (SD ± 9.6%) and 83.1% (SD ± 13.07 %) respectively. Significant differences in the knowledge mean scores were observed for demographic categories such as educational qualification (p = 0.001), staff work category (p ≤ 0.000), work background (p ≤ 0.000), and type of lockdown (p = 0.027). Most of the respondents (85.3%) opined that COVID-19 was a biological weapon and viewed the lockdown as necessary (81.5%). However, they thought that the Nigerian government was not doing enough to mitigate COVID-19 spread.

CONCLUSIONS

The perception of COVID-19 in the university community bear implications across public health initiatives, compliance with precautionary behaviour and bilateral relations with foreign nations.

Psychosomatic Symptoms and Neuroticism following COVID-19: The Role of Online Aggression toward a Stigmatized Group

The present study investigated the effect of interpersonal mistreatment on the perpetrators' mental health. We proposed that the threat of COVID-19 will increase people's mental health problems through their on-line aggression toward stigmatized groups accused of spreading the disease and that there might be potential gender differences in such effects. We tested our predictions among a sample of U.S. residents (Study 1) and a large sample of Chinese residents living out of Hubei province (Study 2) during a heightened period of concern about COVID-19, February 2020. Specifically, we measured U.S. residents' on-line aggressive behaviors toward Chinese people (Study 1) and Chinese non-Hubei residents' on-line aggressive behaviors toward Hubei residents (Study 2) as well as their neuroticism (Study 1) and mental health states (Study 2). In line with our predictions, both studies showed that perceived infection of COVID-19 can induce on-line aggression toward stigmatized groups, thereby increasing people's mental health problems. Moreover, the relationship between COVID-19 vulnerability, on-line aggression, and psychosomatic symptoms was more prominent in men than in women. These results offer insights into people's responses toward COVID-19 and add to the understanding of people's mental and physical health during the epidemic stage of contagious diseases.

Knowledge, attitudes, and preventive practices toward the COVID-19 pandemic: an online survey among Bangladeshi residents

AIM

The novel coronavirus (SARS-CoV-2) has rapidly infected people worldwide, leading to a massive public reaction. Peoples' knowledge, attitudes, and practices (KAP) toward COVID-19 are the most important for the control and prevention of the infectious disease pandemic. This study aimed to assess the knowledge, attitude, and preventive practices (KAP) toward the COVID-19 among Bangladeshi residents during the lockdown situation.

SUBJECTS AND METHODS

An online-based cross-sectional survey was conducted among 1765 Bangladeshi adults through the social media networks of the authors.

RESULTS

The respondents were older than 18 years, with an average age of 24.88 years (SD 6.30). Approximately 15% of our participants received online training. The mean knowledge score was 14.49 (SD 1.8, range 0-17), and the overall correct response rate on this knowledge test was 85%. Approximately 67.2% scored well (above the mean 4.5, range 1-5) regarding the practices. To avoid the infection, 96.6% wore masks outside the home, and 98.7% washed their hands with soap when they came back. COVID-19 knowledge score was significantly associated with a lower odds of (OR 0.87, 95% CI 0.79-0.92) negative attitudes. Again, the awareness score was associated with a lower likelihood of (OR 0.94, 95% CI 0.87-0.98) poor practices.

CONCLUSION

Online health education programs focusing on young people, housewives, and people with less education may potentially improve the attitudes and practices to control the COVID-19 pandemic in the long term in such a low-resource setting.

Who Is the Most Vulnerable to Anxiety at the Beginning of the COVID-19 Outbreak in China? A Cross-Sectional Nationwide Survey

(1) Background: The COVID-19 pandemic has not only changed people’s health behavior, but also induced a psychological reaction among the public. Research data is needed to develop scientific evidence-driven strategies to reduce adverse mental health effects. The aims of this study are to evaluate the anxiety reaction of Chinese people and the related determinants during the earliest phase of the COVID-19 outbreak in China. Evidence from this survey will contribute to a targeted reference on how to deliver psychological counseling service in the face of outbreaks. (2) Methods: A cross-sectional, population-based online survey was conducted from 28 January to 5 February 2020 using an open online questionnaire for people aged 18 years or above, residing in China and abroad. The socio-demographic information of the respondents was collected, and anxiety scores were calculated. A direct standardization method was used to standardize anxiety scores and a general linear model was used to identify associations between some factors (e.g., sex, age, education, etc.) and anxiety scores. (3) Results: A total of 10,946 eligible participants were recruited in this study, with a completion rate of 98.16% (10,946/11,151). The average anxiety score was 6.46 ± 4.12 (total score = 15); women (6.86 ± 4.11) scored higher than men (5.67 ± 4.04). The age variable was inversely and significantly associated with the anxiety score (β = −2.12, 95% CI: −2.47–−1.78). People possessing higher education (β = 1.15, 95% CI: 0.88–1.41) or a higher awareness of cognitive risk (β = 4.89, 95% CI: 4.33–5.46) reported higher levels of anxiety. There was a close association between poor subjective health and anxiety status (β = 2.83, 95% CI: 2.58–3.09). With the increase of confidence, the anxiety of the population exhibited a gradual decline (β = −2.45, 95% CI: −2.77–−2.13). (4) Conclusion: Most people were vulnerable to anxiety during the earliest phase of the COVID-19 outbreak in China. Younger women, individuals with high education, people with high cognitive risk and subjective poor health were vulnerable to anxiety during the epidemic. In addition, increasing confidence in resisting this pandemic is a protective determinant for individuals to develop anxiety. The findings suggest that policymakers adopt psychosocial interventions to reduce anxiety during the pandemic.

COVID-19 knowledge, risk perception, and information sources among Chinese population

BACKGROUND

Measures for effective control of the coronavirus disease 2019 (COVID-19) pandemic include identifying the causal organisms, applying appropriate therapies, and developing vaccines, as well as improving understanding among the general public.

AIM

To evaluate the knowledge, awareness, perception, and response of the general public to COVID-19 in China.

METHODS

A detailed questionnaire comprising 47 questions designed in both English and Chinese was developed. The survey was conducted via WeChat, a multipurpose messaging, social media, and mobile payment app that is widely used by the Chinese population. In total, 1006 participants responded, and most of them were from different provinces of mainland China.

RESULTS

Overall, this comprehensive survey revealed that the general public in China is highly aware of the basic information concerning COVID-19 and its precautions. Interestingly, more respondents (99.3%) were aware of the term severe acute respiratory syndrome (SARS) than COVID-19 (97.2%) and Middle East respiratory syndrome (MERS) (73.4%). Among them, 2.4%, 1.6%, and 0.9% said that they or their family members or friends were affected by COVID-19, SARS, and MERS, respectively. The majority of the respondents (91.2%) indicated that knowledge about COVID-19 was received mainly from WeChat, followed by TV (89%), friends (76.1%), and QQ (a Chinese instant messaging software service) (57.7%).

CONCLUSION

The general public in China is highly aware of COVID-19 and the necessary precautions. Unexpectedly, 2.8% of the participants were unaware of the current epidemic. The remaining information gaps highlight the necessity of further enhancing awareness and preparedness.

Implicit theories of health, consideration of future consequences, and engagement in health protective behaviors during the COVID-19 pandemic in China

This research investigated how implicit theories of health and consideration of future consequences influence people's engagement in health-protective behaviors during the COVID-19 pandemic in China. Three hundred and ninety Chinese completed the study during the peak period of COVID-19 pandemic in China. Gender, education level, implicit theories of health, and consideration of future consequences were significant predictors of people's engagement in health-protective behaviors. Consideration of future consequences mediated the effect of implicit (incremental) theories of health on people's engagement in health-protective behaviors. Implications of the current research for promoting engagement in health-protective behaviors during pandemics of infectious diseases and directions for future research are discussed.

Knowledge, beliefs, mental health, substance use, and behaviors related to the COVID-19 pandemic among US adults: a national online survey

Aim

Given the need for data to inform public health messaging to mitigate the COVID-19 pandemic, this national survey sought to assess the state of COVID-19-related knowledge, beliefs, mental health, substance use changes, and behaviors among a sample of U.S. adults.

Subject and methods

In the period March 20–30, 2020, we collected data on COVID-19-related knowledge, awareness and adoption of preventive practices, depression and anxiety (Patient Health Questionnaire-4), stress (Impact of Event Scale-6), pessimism, and tobacco and alcohol use. Differences between age groups (18–39 years, 40–59 years and ≥ 60 years) were tested using Pearson’s chi-squared tests or ANOVAs; associations between drinking and smoking and depression, anxiety, and stress were tested using adjusted logistic regression models.

Results

Approximately half of the sample (N_Total = 6391) were 50–69 years old and 58% were female. COVID-19 knowledge (mean = 12.0; SD = 1.2) and protective practice awareness (mean = 9.1; SD = 0.8) were high. Among respondents, 44% had a score consistent with depression and anxiety (PHQ-4 score ≥ 6), and 52% reported high stress scores (≥ median of 1.33). COVID-19-related anxiety and depression were associated with increased drinking (AOR = 1.79; 95% CI = 1.49, 2.15) and smoking (AOR = 2.17; 95% CI = 1.64, 2.88). High stress scores were also associated with increased drinking (AOR = 1.80; 95% CI = 1.49, 2.17, p < 0.001) and smoking (AOR = 1.75; 95% CI = 1.31, 2.33).

Conclusions

In spite of high knowledge levels, important gaps were identified. High prevalence of poor mental health outcomes and associated increases in drinking and smoking warrant ongoing risk communications tailoring to effectively disseminate information and expanding psychosocial services, particularly via telehealth, to mitigate the negative mental health impact of COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-021-01564-4.

The outbreak of coronavirus disease in China: Risk perceptions, knowledge, and information sources among prenatal and postnatal women

BACKGROUND

The COVID-19 pandemic has created anxiety among members of the public, including all women over the childbirth continuum, who are considered to be at a greater risk of contracting most infectious diseases. Understanding the perspectives of health care consumers on COVID-19 will play a crucial role in the development of effective risk communication strategies. This study aimed to examine COVID-19-related risk perceptions, knowledge, and information sources among prenatal and postnatal Chinese women during the initial phase of the COVID-19 pandemic.

METHODS

A cross-sectional survey design was adopted, and a four-section online questionnaire was used to collect data. Using a social media platform, the online survey was administered to 161 participants during the outbreak of COVID-19 in Nanjing, China, in February 2020.

RESULTS

The participants perceived their risk of contracting and dying from COVID-19 to be lower than their risk of contracting influenza, however many of them were worried that they might contract COVID-19. The participants demonstrated adequate knowledge about COVID-19. The three major sources from which they obtained information about COVID-19 were doctors, nurses/midwives, and the television, and they placed a high level of confidence in these sources. There was no significant relationship between the perceived risk of contracting COVID-19 and knowledge about this disease.

CONCLUSION

The present findings offer valuable insights to healthcare professionals, including midwives, who serve on the frontline and provide care to pregnant women. Although the participants were adequately knowledgeable about COVID-19, they had misunderstood some of the recommendations of the World Health Organisation.

Mental Health and Psychological Responses During the Coronavirus Disease 2019 Epidemic: A Comparison Between Wuhan and Other Areas in China

OBJECTIVE

This study aimed to compare the mental health and psychological responses in Wuhan, a severely affected area, and other areas of China during the coronavirus disease 2019 (COVID-19) epidemic.

METHODS

This cross-sectional study was conducted on February 10-20, 2020. A set of online questionnaires was used to measure mental health and responses. A total of 1397 participants from Wuhan (age, 36.4 ± 10.7 years; male, 36.1%) and 2794 age- and sex-matched participants from other areas of China (age, 35.9 ± 9.9 years; male, 39.0%) were recruited.

RESULTS

Compared with their counterparts, participants from Wuhan had a significantly higher prevalence of any mental health problems (46.6% versus 32.2%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.65-2.17), anxiety (15.2% versus 6.2%; adjusted OR = 2.65, 95% CI = 2.14-3.29), depression (18.3% versus 9.7%; adjusted OR = 2.11, 95% CI = 1.74-2.54), suicidal ideation (10.5% versus 7.1%; adjusted OR = 1.60, 95% CI = 1.28-2.02), and insomnia (38.6% versus 27.6%; adjusted OR = 1.70, 95% CI = 1.48-1.96). Participants from Wuhan had a slightly higher rate of help-seeking behavior (7.1% versus 4.2%; adjusted OR = 1.76, 95% CI = 1.12-2.77) but similar rate of treatment (3.5% versus 2.7%; adjusted OR = 1.23, 95% CI = 0.68-2.24) for mental problems than did their counterparts. In addition, compared with their counterparts, participants from Wuhan gave higher proportions of responses regarding "fearful" (52% versus 36%, p < .001), "discrimination against COVID-19 cases" (64% versus 58%, p = .006), "strictly comply with preventive behaviors" (98.7% versus 96%, p = .003), and "fewer living and medical supplies" (<2 weeks: 62% versus 57%, p = .015).

CONCLUSIONS

The COVID-19 epidemic has raised enormous challenges regarding public mental health and psychological responses, especially in the highly affected Wuhan area. The present findings provide important information for developing appropriate strategies for the prevention and management of mental health problems during COVID-19 and other epidemics.

The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19-Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey

BACKGROUND

The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people's mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19.

OBJECTIVE

The objectives of this study were to (1) examine the regional differences in mental health and COVID-19-related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19-related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19-related worry, attention to news, and stress.

METHODS

A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19-related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19-related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19-related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects.

RESULTS

The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19-related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001).

CONCLUSIONS

Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic.

Changing trends of mental and behavioral responses and associations during the COVID-19 epidemic in China: a panel study

This prospective observational study examined changing trends in mental and behavioral responses, and their association with perceived risk, severity, self-efficacy and isolation status during the Chinese COVID-19 epidemic. There were five waves of interviews. Descriptive statistics and non-parametric test methods were used for data analysis. Participants numbered 150 for the linkable baseline survey and 102 completed all 5 survey waves and were included in the analysis. Mental stress, emotional status and lifestyle manifested a statistically significant downwards trend across the total period of this panel study. The number of reported new confirmed patients perceived high risk and perceived severity were positively associated with mental stress, emotional status and lifestyle. Self-efficacy was negatively associated with each type of mental and behavioral response. The more time people were confined to their home, the more serious the emotional and lifestyle problems. Dose-response relationships were noted between the number of reported new confirmed patients and mental stress, emotional status and lifestyle during the five observation points. This study yielded new information about mental and behavioral responses among Chinese people during the COVID-19 epidemic. Policy changes and health education are essential for minimizing the adverse health effects of these responses.

Prosociality and hoarding amid the COVID-19 pandemic: A tale of four countries

The COVID‐19 pandemic is an unprecedented public health crisis that poses a challenge to humanity. Drawing on the stress and coping literature, we argue that people around the world alleviate their anxiety and stress induced by the pandemic through both prosocial and ‘self‐interested’ hoarding behaviours. This cross‐cultural survey study examined the pushing (threat perception) and pulling (moral identity) factors that predicted prosocial acts and hoarding, and subsequently psychological well‐being. Data were collected from 9 April to 14 May 2020 from 251 participants in the United Kingdom (UK), 268 in the United States (US), 197 in Germany (DE), and 200 in Hong Kong (HK). Whereas threat perception was associated positively with both prosocial acts and hoarding, benevolent moral identity was associated positively with the former but not the latter behaviour. We also observed cross‐cultural differences, such that both effects were stronger in more individualistic (UK, US) countries than less individualistic (HK, DE) ones. The findings shed light on the prosocial vs. self‐interested behavioural responses of people in different cultures towards the same pandemic crisis.

COVID-19-Induced Anxiety and Associated Factors Among Urban Residents in West Shewa Zone, Central Ethiopia, 2020

BACKGROUND

The COVID-19 pandemic affects the public overall psychological status including anxiety. Assessing the perceived risk and preventive behaviors and COVID-19-induced anxiety of every individual is crucial to be more effective in handling the outbreak.

PURPOSE

This study intends to determine the status of perceived risk, preventive behavior, and induced anxiety regarding COVID-19 among urban residents in Ethiopia.

METHODS

In this research a population-based, cross-sectional design was employed among 801 urban residents in West Shewa Zone, Ethiopia from June to October 2020. COVID-19 Induced Anxiety Scale (CIAS) was used, with CIAS score ≥80% taken as having anxiety. A Preventive Behavior towards COVID-19 Scale (PBCS) was used to measure the level of protective behavior. The data were gathered using CS Entry and analyzed with SPSS version 23.0. Basic descriptive analysis was conducted, and binary logistic regression analysis was carried out to determine the predictors associated with anxiety.

RESULTS

Most of the study population, 716 (89.4%), had moderate risk perception, and around 497 (62.0%) of them had moderate preventive behavior against the pandemic. The proportion of COVID-19-induced anxiety disorder was found to be 18.1%. The identified predictors associated with COVID-induced anxiety were: being widowed (AOR=3.5; 95% CI: 1.7-7.6), lacking formal education (AOR=1.9; 95% CI: 1.3-3.3), having history of psychoactive substance use (AOR=3.0; 95% CI: 1.6-5.8), high protective behavior (AOR=2.2; 95% CI:1.5-3.3), low perceived risk (OR=3.7; 95% CI: 1.5-12.4), and family history of mental illness (AOR=1.6; 95% CI:0.7-3.8).

CONCLUSION AND RECOMMENDATION

COVID-19-induced anxiety prevalence was 18.1%. Risk perception regarding COVID was moderate. However, only 38.0% of the population had high preventive behavior against the pandemic. Hence, it is important to provide the continuous public health education necessary to promote preventive measures and minimize risky behaviors. Basic psychosocial help should be also provided for individuals suffering with COVID-19-induced anxiety.

Health literacy in the general population in the context of epidemic or pandemic coronavirus outbreak situations: Rapid scoping review

OBJECTIVE

The aim of this rapid scoping review, for which only studies from the general population were considered, was to describe the extent of existing research on HL in the context of previous coronavirus outbreaks (SARS-CoV-1, MERS-CoV and SARS-CoV-2).

METHODS

We searched major databases and included publications of quantitative and qualitative studies in English and German on any type of research on the functional, critical and communicative domains of HL conducted in the context of the three outbreaks in the general population. We extracted and tabulated relevant data and narratively reported where and when the study was conducted, the design and method used, and how HL was measured.

RESULTS

72 studies were included. Three investigated HL or explicitly referred to the concept of HL, 14 were guided by health behaviour theory. We did not find any study designed to develop or psychometrically evaluate pandemic/epidemic HL instruments, or relate pandemic/epidemic or general HL to a pandemic/epidemic outcome, or any controlled intervention study. Type of assessment of the domains of HL varied widely.

CONCLUSION

Theory-driven observational studies and interventions, examining whether pandemic-related HL can be improved are needed.

PRACTICE IMPLICATIONS

The development and validation of instruments that measure pandemic-related HL is desirable.

COVID-19 in Bangladesh: measuring differences in individual precautionary behaviors among young adults

Aim

The novel coronavirus disease 2019 (COVID-19) is present in Bangladesh, and various control measures have been taken to flatten the epidemic curve. Due to the current demographic distribution in Bangladesh, young adults comprise almost one-third of the total population of the country. Therefore, their precautionary behavior is very important to ensure the success of preventive policies. This exploratory study examined the differences in the adoption of precautionary behaviors among young adults, and estimated and compared the predictors of precautionary behavior adoption among young adults living in the capital city Dhaka and a nearby district, Tangail.

Subject and methods

A total of 350 respondents from each district participated in the study. ANOVA and two-sample t-tests were utilized to detect differences in precautionary behavior across demographic groups of young adults, and quantile regression modeling was used to find the predictors of adopting precautionary behaviors and to compare these predictors between the two districts.

Results

Individuals who had a postgraduate education and had good mental health tended to show better precautionary behaviors in Dhaka. Female respondents from Tangail who had no psychological distress took precautionary behaviors more often than their male counterparts. However, no significant differences in the adoption of precautionary behaviors to prevent COVID-19 among young adults were found between the two districts. Better self-control ability, higher education and good mental health emerged as factors that significantly shaped the precautionary behaviors of young adults in this study.

Conclusion

Having better knowledge did not ensure better adoption of precautionary behaviors among the participants. In effect, the government's strong intervention to keep people maintaining social distance and a strict lockdown in severely affected areas are probable immediate solutions.

Impact of Perceived Severity of COVID-19 (SARS-COV-2) on Mental Health of University Students of Pakistan: The Mediating Role of Muslim Religiosity

Background: Perceived severity of COVID-19 (SARS-COV-2) is known to be associated with mental health of people in general and health professionals in particular in Western societies. However, its association with the mental health of students in Pakistan, which is predominantly a Muslim society, remains unclear so far. Moreover, the role of Muslim religiosity for such an association has not yet been investigated. We aimed to examine the association and report findings on the impact of perceived severity on mental health with a sample of students from all five provinces of Pakistan. Methods: We did a cross-sectional online survey from 1,525 Pakistani students in March 2020 using standardized measurement tools. We then determined the prevalence of perceived severity among students and its impact on their mental health. The strength of associations between these variables was estimated using generalized linear models, with appropriate distribution and link functions. Structural equation modeling through SmartPLS (3.0) software was utilized to analyze the results. Findings: The perceived severity of COVID-19 is significantly associated with mental health of Pakistani students, whereas Muslim religiosity is a strong mediator between perceived severity and mental health of Pakistani students. Conclusions: Though the perceived severity of COVID-19 is associated with mental health, this relationship can be better explained by the role of Muslim religiosity. When tested individually, the perceived severity accounted for only 18% variance in mental health that increased up to 57% by the mediating role of Muslim religiosity. This difference clearly indicates the mediating role of Muslim religiosity in the association between perceived severity and mental health for Pakistani students.

Risk perception, knowledge, information sources and emotional states among COVID-19 patients in Wuhan, China

BACKGROUND

The rapidly evolving COVID-19 pandemic has become a global health crisis. Several factors influencing risk perception have been identified, including knowledge of the disease, information sources, and emotional states. Prior studies on COVID-19-related risk perception primarily focused on the general public, with little data available on COVID-19 patients.

PURPOSE

To investigate COVID-19 patients' risk perception, knowledge of the disease, information sources, and emotional states in the epicenter, Wuhan, during the COVID-19 outbreak in China.

METHODS

Data were collected online using self-administered electronic questionnaire developed with reference to previous relevant studies and publications by the World Health Organization.

FINDINGS

A higher level of perceived risk was found in relation to COVID-19 as compared to other potential health threats. Knowledge gaps existed regarding transmission and prevention of COVID-19. Additionally, risk perception was negatively related to knowledge and positively related to depressive states. Moreover, social media was a primary source for COVID-19 information, whereas the most trusted sources were health professionals.

DISCUSSION

Realistic perception of risk should be encouraged considering both physical and mental health while developing relevant strategies. Furthermore, risk communication needs to be specifically tailored for various target groups, such as the elderly and mentally vulnerable individuals, with the adoption of popular media platforms.

The relationship between government trust and preventive behaviors during the COVID-19 pandemic in China: Exploring the roles of knowledge and negative emotion

Government trust is known to be associated with preventive practices during pandemics, but few studies have explored the roles of knowledge and negative emotion in conditioning the relationship between trust and preventive behaviors. The aim of this study was to explore the roles of knowledge and negative emotion in conditioning the relationship between trust and preventive measures during the COVID-19 pandemic in China. Data from a cross-sectional survey of 3000 Chinese adults [mean (SD) age 36.93 (12.11) years; 52.4% male], conducted using quota-sampling method (March 2-2020 to March 23-2020), were analyzed. Overall, respondents performed recommended preventive measures more frequently (3.21 out of 4) than excessive preventive measures (2.11 out of 4). Government trust was positively associated with both officially recommended (b = 0.12; 95%CI = 0.18, 0.25) and excessive preventive behaviors (b = 0.07; 95%CI = 0.03, 0.10). The positive relationship between trust and excessive preventive behaviors was found to be statistically significant only among those with low levels of COVID-19 knowledge. Officially recommended preventive behavior is most likely to happen when there is a combination of high levels of government trust and low levels of negative emotion. Therefore, government trust increases both official and excessive (sometimes unscientific) preventive behaviors. Interventions shall aim to enhance people's COVID-19 knowledge and to reduce negative emotions.

COVID-19 Knowledge, Risk Perception, and Precautionary Behavior Among Nigerians: A Moderated Mediation Approach

The novel coronavirus has not only brought along disruptions to daily socio-economic activities, but sickness and deaths due to its high contagion. With no widely acceptable pharmaceutical cure, the best form of prevention may be precautionary measures which will guide against infections and curb the spread of the disease. This study explored the relationship between COVID-19 knowledge, risk perception, and precautionary behavior among Nigerians. The study also sought to determine whether this relationship differed for men and women. A web-based cross-sectional design approach was used to recruit 1,554 participants (mean age = 27.43, SD = 9.75; 42.7% females) from all geopolitical zones in Nigeria, through social media platforms using a snowball sampling technique. Participants responded to web-based survey forms comprising demographic questions and adapted versions of the Ebola knowledge scale, SARS risk perception scale, and precautionary behavior scale. Moderated mediation analysis of the data showed that risk perception mediated the association between COVID-19 knowledge and precautionary behavior and this indirect effect was in turn moderated by gender. Results indicate that having adequate knowledge of COVID-19 was linked to higher involvement in precautionary behavior through risk perception for females but not for males. It was also noted that awareness campaigns and psychological intervention strategies on COVID-19 related activities may be particularly important for males more than females. Drawing from the health belief model, we recommend that COVID-19 awareness campaigns should target raising more awareness of the risks associated with the infection to make individuals engage more in precautionary behaviors.

COVID-19 precautionary behavior: the Israeli case in the initial stage of the outbreak

Background

The lay public’s behavioral responses during a virus spread, such as the COVID-19, play an important role in bringing the outbreak under control, and provide insights into development of risk communication messages to the public. Therefore, this study aimed to explore the association between knowledge about COVID-19, perceived susceptibility, emotional reactions and precautionary behavior among the Israeli lay public at the beginning of the COVID-19 outbreak.

Method

A cross-sectional study was conducted among 1407 participants, aged 18 + .

Participants completed measures of knowledge about COVID-19, perceived susceptibility, emotional reactions, precautionary behavior, and socio-demographic questionnaires. A hierarchical regression model was calculated with precautionary behavior as the dependent variable.

Results

Findings indicated that precautionary behavior was higher for females, older participants, participants with higher levels of knowledge about COVID-19, and participants with greater negative emotional reactions. A negative curvilinear relationship was found between perceived susceptibility and precautionary behavior, so that the latter was highest for participants with moderate perceived susceptibility. All interaction terms were non-significant.

Conclusions

Findings suggest that in order to enhance precautionary behavior in the initial stage of a virus outbreak, it is recommended to pay attention to the public’s knowledge about the virus, perceived susceptibility and emotional reactions. Although negative feelings about the virus may motivate preventive behavior, it is important to address these feelings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09818-8.

Concerns About Information Regarding COVID-19 on the Internet: Cross-Sectional Study

Background

Since the outbreak of COVID-19, the Chinese government and the Chinese Center for Disease Control and Prevention have released COVID-19–related information to the public through various channels to raise their concern level of the pandemic, increase their knowledge of disease prevention, and ensure the uptake of proper preventive practices.

Objective

Our objectives were to determine Chinese netizens’ concerns related to COVID-19 and the relationship between their concerns and information on the internet. We also aimed to elucidate the association between individuals’ levels of concern, knowledge, and behaviors related to COVID-19.

Methods

The questionnaire, which consisted of 15 closed-ended questions, was designed to investigate Chinese netizens’ knowledge about COVID-19. The self-selection online survey method of nonprobability sampling was used to recruit participants through Dingxiangyisheng WeChat (a public, medical, and health service platform in China) accounts. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data.

Results

In total, 10,304 respondents were surveyed on the internet (response rate=1.75%; 10,304/590,000). Nearly all (n=9803, 95.30%) participants were concerned about “confirmed cases” of COVID-19, and 87.70% (n=9036) received information about the outbreak through social media websites. There were significant differences in participants’ concerns by sex (P=.02), age (P<.001), educational attainment (P=.001), and occupation (P<.001). All knowledge questions and preventive practices were associated with concerns about COVID-19. The results of the multivariate logistic regression indicated that participants’ sex, educational attainment, occupation and employment status, knowledge acquisition, and concern level were significantly associated with the practice of proper preventive behaviors.

Conclusions

This study elucidated Chinese netizens’ concerns, information sources, and preventive behaviors related to the COVID-19 pandemic. Sex, educational attainment, occupation and employment status, knowledge acquisition, and level of concern were key factors associated with proper preventive behaviors. This offers a theoretical basis for the government to provide targeted disease prevention and control information to the public.

Risk perception and precautionary health behavior toward COVID-19 among health professionals working in selected public university hospitals in Ethiopia

OBJECTIVE

This study was designed to determine risk perception and precautionary health behavior toward coronavirus disease (COVID-19) among health professionals working in selected public university hospitals of Ethiopia.

METHODS

A web-based cross-sectional survey was used with health professionals working in selected public university hospitals of Ethiopia. A structured survey questionnaire consisted of socio-demographic, risk perception, and behavioral response items were used. The survey questions were designed on Google form. All academic and clinical staff invited to participate in the online survey, which was carried out from May 1-14, 2020. Data analysis was done using the Statistical Package for Social Sciences version 24. Descriptive statistics computed and the result is presented by tables and figures.

RESULTS

A total of 273 health professionals participated in this study. The mean (± SD) age of participants was 31.03 ± 5.11. Study participants' overall mean score of perceived risk was 23.59 ± 4.75. The study participants' mean score of perceived vulnerability (4.01 ± 1.17) was higher than the human immunodeficiency virus, common cold, malaria, and tuberculosis. Regarding precautionary health behavior, the lowest mean score is for wearing gloves 1.82 ± 1.15.

CONCLUSION

Participants mean score of perceived vulnerability of coronavirus disease was higher than some of the prevalent infectious disease in the area. Almost all participants applied recommended protective measures to the acceptable level, except for wearing mask and gloves. Therefore, there is a need to further intensification of more effective ways to support health professionals' adherence to major precautionary measure is important.

Chinese public's knowledge, perceived severity, and perceived controllability of COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour: a national survey

BACKGROUND

The outbreak of the coronavirus disease-19 (COVID-19) has caused enormous stress among the public in China. Intellectual input from various aspects is needed to fight against COVID-19, including understanding of the public's emotion and behaviour and their antecedents from the psychological perspectives. Drawing upon the cognitive appraisal theory, this study examined three cognitive appraisals (i.e., perceived severity, perceived controllability, and knowledge of COVID-19) and their associations with a wide range of emotional and behavioural outcomes among the Chinese public.

METHODS

Participants were 4607 citizens (age range: 17-90 years, Mage = 23.71 years) from 31 provinces in China and they took part in a cross-sectional survey online.

RESULTS

The results showed that the public's emotional and behavioural reactions were slightly affected by the outbreak of COVID-19. Moreover, the public had limited participation in the events regarding COVID-19 but actively engaged in precautionary behaviour. In addition, results of structural equation model with latent variables revealed that the three appraisals were differentially related to the outcome variables (i.e., negative emotion, positive emotion, sleep problems, aggression, substance use, mobile phone use, social participation, and precautionary behaviour).

CONCLUSIONS

The findings highlight the utility of cognitive appraisal, as a core process of coping stress, in explaining the public's emotion and behaviour in the encounter of public health concern. Practically, the findings facilitate the government and practitioners to design and deliver targeted intervention programs to the public.

Chinese public's knowledge, perceived severity, and perceived controllability of COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour: a national survey

BACKGROUND

The outbreak of the coronavirus disease-19 (COVID-19) has caused enormous stress among the public in China. Intellectual input from various aspects is needed to fight against COVID-19, including understanding of the public's emotion and behaviour and their antecedents from the psychological perspectives. Drawing upon the cognitive appraisal theory, this study examined three cognitive appraisals (i.e., perceived severity, perceived controllability, and knowledge of COVID-19) and their associations with a wide range of emotional and behavioural outcomes among the Chinese public.

METHODS

Participants were 4607 citizens (age range: 17-90 years, Mage = 23.71 years) from 31 provinces in China and they took part in a cross-sectional survey online.

RESULTS

The results showed that the public's emotional and behavioural reactions were slightly affected by the outbreak of COVID-19. Moreover, the public had limited participation in the events regarding COVID-19 but actively engaged in precautionary behaviour. In addition, results of structural equation model with latent variables revealed that the three appraisals were differentially related to the outcome variables (i.e., negative emotion, positive emotion, sleep problems, aggression, substance use, mobile phone use, social participation, and precautionary behaviour).

CONCLUSIONS

The findings highlight the utility of cognitive appraisal, as a core process of coping stress, in explaining the public's emotion and behaviour in the encounter of public health concern. Practically, the findings facilitate the government and practitioners to design and deliver targeted intervention programs to the public.

The impact of comprehension of disease-related information and perceptions regarding effects and controllability on protective and social solidarity behaviors with regard to COVID-19

Aim

The main theme in health behavior theories is that risk perception goes hand in hand with knowledge of the disease, perceived effects, and perceived controllability of the disease. This study aims to investigate the impact of all those variables on protective and social solidarity behaviors concerning COVID-19.

Subject and methods

This cross-sectional study was conducted in the early stages of the outbreak in Turkey. Data were collected between April 1 and April 6, 2020, via an online survey. The reliability of the scales was tested. Exploratory factor analysis was used to examine construct validity. SEM analysis was employed to determine the model.

Results

SEM analysis indicates that fit indices (χ2 = 4.108 df = 2; χ2/df = 2.05; RMSEA = 0.04; CFI = 0.99; GFI = 0.99; PCLOSE = 0.545) were good model fits. The structural analysis indicated that the comprehensibility of information, perceived effects and controllability of the disease, and social solidarity had a statistically significant direct positive effect on protective behavior (β = 0.133, p < 0.001; β = 0.399, p < 0.001; β = 0.084, p < 0.001; β = 0.171, p < 0.001, respectively).

Conclusion

A health behavior model in the literature was evaluated with the data for a society facing a pandemic risk, and it was shown that the data fit the model perfectly. The study has revealed that understanding the information about COVID-19 increases social solidarity. Most importantly, it is concluded that social solidarity increases society’s protective behaviors. Participants did not find COVID-19-related information to be comprehensible. Despite disease uncertainty in the early stage of the pandemic, participants had a high perception of the severity of COVID-19.

Anxiety levels, precautionary behaviours and public perceptions during the early phase of the COVID-19 outbreak in China: a population-based cross-sectional survey

OBJECTIVE

To investigate psychological and behavioural responses to COVID-19 among the Chinese general population.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based mobile phone survey between 1 February and 10 February 2020 via random digit dialling. A total of 1011 adult residents in Wuhan (n=510), the epicentre and quarantined city, and Shanghai (n=501) were interviewed. Proportional quota sampling and poststratification weighting were used. Multivariable logistic regression models were used to investigate perception factors associated with the public responses.

PRIMARY OUTCOME MEASURES

We measured anxiety levels using the 7-item Generalised Anxiety Disorder Scale (GAD-7) and asked respondents to report their precautionary behaviours before and during the outbreak.

RESULTS

The prevalence of moderate or severe anxiety was significantly higher (p<0.001) in Wuhan (32.8%) than Shanghai (20.5%). Around 79.6%-88.2% residents reported always wearing a face mask when they went out and washing hands immediately when they returned home, with no discernible difference across cities. Only 35.5%-37.0% of residents reported a handwashing duration above 40 s as recommended by the WHO. The strongest predictor of moderate or severe anxiety was perceived harm of the disease (OR 1.8, 95% CI 1.5 to 2.1), followed by confusion about information reliability (OR 1.7, 95% CI 1.5 to 1.9). None of the examined perception factors were associated with odds of handwashing duration above 40 s.

CONCLUSIONS

Prevalence of moderate or severe anxiety and strict personal precautionary behaviours was generally high, regardless of the quarantine status. Our results support efforts for handwashing education programmes with a focus on hygiene procedures in China and timely dissemination of reliable information.

Anxiety levels, precautionary behaviours and public perceptions during the early phase of the COVID-19 outbreak in China: a population-based cross-sectional survey

OBJECTIVE

To investigate psychological and behavioural responses to COVID-19 among the Chinese general population.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based mobile phone survey between 1 February and 10 February 2020 via random digit dialling. A total of 1011 adult residents in Wuhan (n=510), the epicentre and quarantined city, and Shanghai (n=501) were interviewed. Proportional quota sampling and poststratification weighting were used. Multivariable logistic regression models were used to investigate perception factors associated with the public responses.

PRIMARY OUTCOME MEASURES

We measured anxiety levels using the 7-item Generalised Anxiety Disorder Scale (GAD-7) and asked respondents to report their precautionary behaviours before and during the outbreak.

RESULTS

The prevalence of moderate or severe anxiety was significantly higher (p<0.001) in Wuhan (32.8%) than Shanghai (20.5%). Around 79.6%-88.2% residents reported always wearing a face mask when they went out and washing hands immediately when they returned home, with no discernible difference across cities. Only 35.5%-37.0% of residents reported a handwashing duration above 40 s as recommended by the WHO. The strongest predictor of moderate or severe anxiety was perceived harm of the disease (OR 1.8, 95% CI 1.5 to 2.1), followed by confusion about information reliability (OR 1.7, 95% CI 1.5 to 1.9). None of the examined perception factors were associated with odds of handwashing duration above 40 s.

CONCLUSIONS

Prevalence of moderate or severe anxiety and strict personal precautionary behaviours was generally high, regardless of the quarantine status. Our results support efforts for handwashing education programmes with a focus on hygiene procedures in China and timely dissemination of reliable information.

Measuring Italian citizens' engagement in the first wave of the COVID-19 pandemic containment measures: A cross-sectional study

BACKGROUND

In January 2020, the coronavirus disease 2019 (COVID-19) started to spread in Italy. The Italian government adopted urgent measures to slow its spread. Enforcing compliance with such measures is crucial in order to enhance their effectiveness. Engaging citizens in the COVID-19 preventive process is urgent today both in Italy and around the world. However, to the best of our knowledge, no previous studies have investigated the role of health engagement in predicting citizens' compliance with health emergency containment measures.

METHOD

An online survey was administered between February 28 and March 4, 2020 on a representative sample of 1000 Italians. The questionnaire included a measure of health engagement (Patient Health Engagement Scale), a 5-item Likert scale ranging from 1 to 7, resulting in 4 positions that describe the psychological readiness to be active in one's own health management, and a series of ad hoc items intended to measure citizens' perceived susceptibility and severity of the disease, orientation towards health management, trust in institutional bodies, health habits and food consumption. To investigate the relationship between health engagement and these variables, ANOVA analysis, logistic regression and contingency tables with Pearson's chi-squared analysis have been carried out.

RESULTS

Less engaged people show higher levels of perceived susceptibility to the virus and severity of the disease; they are less trustful of scientific and healthcare authorities, they feel less self-effective in managing their own health-both in normal conditions and under stress-and are less prone to cooperate with healthcare professionals. Low levels of health engagement also are associated with a change in the usual purchase behavior.

CONCLUSIONS

The Patient Health Engagement model (PHE) provides a useful framework for understanding how people will respond to health threats such as pandemics. Therefore, intervention studies should focus on raising their levels of engagement to increase the effectiveness of educational initiatives intended to promote preventive behaviors.

Evaluation of Risk Perception of COVID-19 Disease: A Community-Based Participatory Study

OBJECTIVE

How people behave in a crisis depends on their understanding and evaluation of risk and vulnerability. Therefore, this study was conducted to investigate the Iranians' risk perception of coronavirus disease (COVID-19).

METHODS

An online survey was applied, which resulted in the collection of information on demographics, the 5 dimensions of risk perception (cognitive, political, social, cultural, and emotional), and trust in the government among the Iranian users of social networks. Data were analyzed by descriptive and analytical tests of SPSS (IBM Corp, Armonk, NY) software, and confirmatory factor analysis of Amos software.

RESULTS

A total of 364 persons from 20 provinces completed the questionnaire during February 25 to March 2, 2020. More than 80% of the participants believed that negligence and lack of close supervision of the authorities have led to the spread of COVID-19. The mean (SD) risk perception was 58.77 (± 10.11), indicating the medium level of risk perception of people. The second-order confirmatory factor analysis also indicated that cultural dimension had the highest positive correlation (0.96), emotional dimension had the highest negative correlation (-0.65), and social dimension had the least correlation with the risk perception model (0.08).

CONCLUSION

Iranians' risk perception of the COVID-19 outbreak is not optimal, and it seems necessary to improve it.

Latent profiles of the comorbidity of the symptoms for posttraumatic stress disorder and generalized anxiety disorder among children and adolescents who are susceptible to COVID-19

The present study aims to examine the comorbidity patterns of the symptoms (intrusion and avoidance) for posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) and the role of perceived threat and courtesy stigma in distinguishing specific patterns of the symptoms for PTSD and GAD among children and adolescents who are susceptible to coronavirus disease 2019 (COVID-19) in Hubei, China. A total of 1172 (683 female and 489 male) children and adolescents aged 8-18 years were involved in completing the measurements of PTSD, GAD, perceived threat of COVID-19, and COVID-19-related courtesy stigma. The Latent Profile Analysis identified the three profiles of the symptoms for PTSD and GAD which were labeled as Moderate PTSD, Mild Comorbidity, and Severe Comorbidity. The scores of the symptoms for PTSD, GAD, perceived threat, and stigma were different among the three profiles. The risk factors (i.e., perceived threat and stigma) that are related to comorbidity patterns were examined through a three-step method. The possibility of entry into the Severe Comorbidity Profile increased with increasing perceived threat and stigma. The mental health care interventions for children and adolescents who are susceptible to COVID-19 can be developed to reduce perceived threat and stigma.

Psychological and Behavioral Responses to the COVID-19 Pandemic in Greece

OBJECTIVE

Fear of COVID-19 was associated with more severe depressive and anxiety symptoms. This study aimed to explore COVID-19-related fear, depressive and anxiety symptoms, social responsibility, and behavioral responses during the COVID-19 pandemic in Greece.

METHOD

A cross-sectional study was conducted from April 10 to April 13, 2020. Members of the Greek general population completed anonymously an online survey, distributed through the social media. Among the 3,700 adult respondents, 3,029 fulfilled inclusion criteria. The survey included sociodemographic questions, questions exploring potential risk factors for increased fear of COVID-19, questions about the employment of safety and checking behaviors, and questions about compliance with public health guidelines. In addition, four psychometric scales were used, the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), and Steele's Social Responsibility Motivation scale. Multivariate General Linear Models (GLM) were used to depict significant differences among dependent variables (FCV-19S, PHQ-9, GAD-7) and independent variables (potential risk factors, safety and checking behaviors, compliance with guidelines). The relationship between the FCV-19S total score and influencing factors was quantified by linear regression analysis.

RESULTS

Several participants reported high levels of COVID-19-related fear (35.7%) and moderate to severe depressive symptoms (22.8%), while a significant proportion reported moderate to severe anxiety symptoms (77.4%). Women scored altogether significantly higher than men. Respondents under the age of 30 reported less fear and depressive symptoms and showed the least social responsibility. Based on GLM, a significant other's COVID-19 illness, being on psychiatric medication, employment of safety and checking behaviors, and compliance with guidelines were associated with higher COVID-19-related fear. Linear regression analysis revealed that gender, age, depressive, and anxiety symptoms modified levels of COVID-19-related fear.

CONCLUSIONS

Greater behavioral responses to the pandemic, that is, excessive employment of safety/checking behaviors and greater compliance with guidelines, were shown to amplify fear, potentially due to increased contamination awareness. In addition, female gender, older age, and more severe anxiety symptoms were related with higher COVID-19-related fear. Describing and weighing carefully the psychosocial and behavioral impact of the pandemic will enable the implementation of both supportive and preventive interventions.

Public perspectives on protective measures during the COVID-19 pandemic in the Netherlands, Germany and Italy: A survey study

BACKGROUND

The extent to which people implement government-issued protective measures is critical in preventing further spread of coronavirus disease 2019 (COVID-19) caused by coronavirus SARS-CoV-2. Our study aimed to describe the public belief in the effectiveness of protective measures, the reported implementation of these measures, and to identify communication channels used to acquire information on COVID-19 in European countries during the early stage of the pandemic.

METHODS AND FINDINGS

An online survey available in multiple languages was disseminated starting on March 19th, 2020. After five days, we computed descriptive statistics for countries with more than 500 respondents. Each day, we assessed enacted community containment measures by stage of stringency (I-IV). In total, 9,796 adults responded, of whom 8,611 resided in the Netherlands (stage III), 604 in Germany (stage III), and 581 in Italy (stage IV). To explore possible dynamics as containment strategies intensified, we also included 1,365 responses submitted during the following week. Participants indicated support for governmental measures related to avoiding social gatherings, selective closure of public places, and hand hygiene and respiratory measures (range for all measures: 95.0%-99.7%). Respondents from the Netherlands less frequently considered a complete social lockdown effective (59.2%), compared to respondents in Germany (76.6%) or Italy (87.2%). Italian residents applied enforced social distancing measures more frequently (range: 90.2%-99.3%, German and Dutch residents: 67.5%-97.0%) and self-initiated hygienic and social distancing behaviors (range: 36.3%-96.6%, German and Dutch residents: 28.3%-95.7%). Respondents reported being sufficiently informed about the outbreak and behaviors to avoid infection (range: 90.2%-91.1%). Information channels most commonly reported included television newspapers, official health websites, and social media. One week later, we observed no major differences in submitted responses.

CONCLUSIONS

During the early stage of the COVID-19 pandemic, belief in the effectiveness of protective measures among survey respondents from three European countries was high and participants reported feeling sufficiently informed. In March 2020, implementation of measures differed between countries and were highest among respondents from Italy, who were subjected to the most stringent lockdown measures and greatest COVID-19 burden in Europe during this period.

Self-Control Moderates the Association Between Perceived Severity of Coronavirus Disease 2019 (COVID-19) and Mental Health Problems Among the Chinese Public

Coronavirus disease 2019 (COVID-19) has caused thousands of deaths in China. Prior research suggests that individuals' perceived severity of COVID-19 is related to a range of negative emotional and behavioral reactions among the Chinese public. However, scant research has examined the underlying mechanisms. Drawing upon the risk-resilience model, this study proposes that self-control, as a resilient factor, would potentially moderate the association between perceived severity of COVID-19 and mental health problems. Data from a national survey was used to examine this idea. Participants were 4607 citizens from 31 regions in China (Mage = 23.71 years, 72.5% female) who completed a national survey at the beginning of February 2020. Results of hierarchical regression showed that after controlling for a number of demographic variables, perceived severity of COVID-19 and self-control were positively and negatively related to mental health problems, respectively. More importantly, self-control moderated the "perceived severity of COVID-19-mental health problems" association, with this link attenuating as the levels of self-control increased. These findings suggest that compared to those with high self-control, individuals with low self-control are more vulnerable and are more in need of psychological aids to maintain mental health in the encounter of the COVID-19 outbreak. Practically, enhancing individuals' self-control ability might be a promising way to improve individuals' mental health during the early period of the COVID-19 outbreak.

Self-Control Moderates the Association Between Perceived Severity of Coronavirus Disease 2019 (COVID-19) and Mental Health Problems Among the Chinese Public

Coronavirus disease 2019 (COVID-19) has caused thousands of deaths in China. Prior research suggests that individuals' perceived severity of COVID-19 is related to a range of negative emotional and behavioral reactions among the Chinese public. However, scant research has examined the underlying mechanisms. Drawing upon the risk-resilience model, this study proposes that self-control, as a resilient factor, would potentially moderate the association between perceived severity of COVID-19 and mental health problems. Data from a national survey was used to examine this idea. Participants were 4607 citizens from 31 regions in China (M_age = 23.71 years, 72.5% female) who completed a national survey at the beginning of February 2020. Results of hierarchical regression showed that after controlling for a number of demographic variables, perceived severity of COVID-19 and self-control were positively and negatively related to mental health problems, respectively. More importantly, self-control moderated the "perceived severity of COVID-19-mental health problems" association, with this link attenuating as the levels of self-control increased. These findings suggest that compared to those with high self-control, individuals with low self-control are more vulnerable and are more in need of psychological aids to maintain mental health in the encounter of the COVID-19 outbreak. Practically, enhancing individuals' self-control ability might be a promising way to improve individuals' mental health during the early period of the COVID-19 outbreak.

The North American Layman's Understanding of COVID-19: Are We Doing Enough?

Background: In the absence of an effective vaccine, public health policies are aimed at awareness, and education of the general public in order to contain the quickly spreading COVID-19 pandemic. Most of the recommended precautionary measures are dependent on human behaviors and therefore their effectiveness largely depends on peoples' perception and attitudes toward the disease. This study aimed to assess the level of knowledge, risk perception, and precautionary measures taken in response to COVID-19 in North America. Methods: In this cross-sectional observational study, an online survey targeted to North Americans focused on the public's knowledge of COVID-19, risk perception, and precautionary behaviors taken in response to this pandemic. Descriptive analyses were performed for the whole population and the subgroup analyses contrasted the differences between Americans and Canadians. Results: The cohort comprised 1,264 relatively young participants with an average age of 28.6 ± 9.8 years. The vast majority (>90%) were knowledgeable about COVID-19. Regarding risk perception, about a quarter assumed to be at less risk to contract the disease, and 42.8% considered themselves to be less contagious than others. While the vast majority avoided performing risky behaviors, only a small proportion (13.2%) wore a face mask-which is in line with the public health recommendations of the two countries at the time of data collection. Overall, a larger proportion of Canadian participants (55.8%) were satisfied with the performance of their national public health in response to the current pandemic, compared to their American counterparts (12.2%). Discussion: Data regarding the public's knowledge of COVID-19, risk perception, and behaviors in response to this pandemic is limited. The results of this study highlight that this relatively young and educated sample of North Americans had a high level of knowledge about COVID-19 and a large proportion of them were taking the precautionary measures against this pandemic. However, a significant number of individuals believe to be at less risk of contracting the disease compared to the general population. Educating the public that no one is safe from this disease, could play a role in further limiting risky behaviors and ultimately facilitating disease containment.