The Role of Risk Perceptions and Affective Consequences in COVID-19 Protective Behaviors

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.

Association between the risk perception of contracting COVID-19 and sociodemographic characteristics in a Peruvian population

Background: The perception of risk regarding coronavirus disease 2019 (COVID-19) has been widely researched due to its association with the adoption of preventive measures. In addition, since the onset of vaccination, it has been reported that the population perceives a lower risk of getting infected. However, few studies have analyzed the factors associated with risk perception in low- and middle-income countries. The aim of this study was to determine the association between the risk perception of contracting COVID-19 and sociodemographic characteristics in Peruvian population. Methods: An analytical and cross-sectional study was conducted in four cities in Peru from October to December, 2021. The sample consisted of 821 individuals aged 18 years and older. A virtual questionnaire was used to collect sociodemographic data and assess the risk perception of contracting coronavirus based on the Health Belief Model. The process of back-translation, expert judgment, and reliability analysis using split-half correlation was conducted. Student's t-tests, analysis of variance with post hoc Tukey's test, and Spearman's correlation were employed. Results: Of the participants, 53.71% were women and 73.3% had a higher education level, 45.55% are self-employed, and 40.44% did not have a family member infected with COVID-19. The risk perception of COVID-19 infection was associated with participants' family antecedent of COVID-19 (p < 0.05). Regarding the factors analyzed, perceived susceptibility to COVID-19 was associated with age (p=0.002), occupation (p<0.05), and a history of COVID-19 (p<0.05), while the perceived benefits of adopting preventive measures against this disease were associated with educational level (p < 0.001). Conclusions: The risk perception of contracting COVID-19 was higher among whose had multiple infected relatives.. Furthermore, the perception of susceptibility and the perceived benefits of using preventive measures were associated with sociodemographic characteristics.

Risk perception and avoidance of preventive behavior on the COVID-19 among cancer patients

Background and Aims

Willingness to engage in preventive behaviors against coronavirus disease 2019 (COVID-19) depends on people's risk perception. This is especially important in cancer patients who are at risk of complications from the disease. Therefore, this study was conducted to investigate avoidance of COVID-19 preventive behavior of in cancer patients.

Methods

This cross-sectional analytical study was done with 200 cancer patients who were selected by convenience sampling method. The study was conducted in Imam Khomeini Hospital of Ardabil, Iran from July to August 2020. A researcher-made questionnaire was used to investigate the risk perception of cancer patients towards COVID-19 with seven subscales according to the Extended Parallel Process Model. Data were analyzed by SPSS 20 using Pearson correlation and linear regression tests.

Results

The mean and standard deviation of the age of 200 participants (including 109 men and 91 women) was 48 ± 17. Results showed that the response efficacy (12.6 ± 2.2) had the highest mean and defensive avoidance (8 ± 2.8) had the lowest mean score among EPPM constructs. Linear regression results showed that fear (β = 0.242, p > 0.001), and perceived severity (β = 0.191, p = 0.008) were significant predictors of defensive avoidance.

Conclusion

Perceived severity and fear were significant predictors of defensive avoidance, and providing accurate and reliable news and information can be effective in reducing fear and promoting preventive behaviors.

Gender differences in sense of coherence among university students during the COVID-19 pandemic in Turkey

Non-pharmaceutical interventions (NPIs) implemented to mitigate the COVID-19 pandemic halted everyday life in higher education along with social and psychological impacts. The objective of our study was to explore the factors related to sense of coherence (SoC) from a gender perspective among university students in Turkey. This is a cross-sectional survey conducted online with a convenience sampling method as part of the international COVID-Health Literacy (COVID-HL) Consortium. SoC was measured by a nine-item questionnaire that was adapted to the Turkish language, including socio-demographic information and health status, including psychological well-being, psychosomatic complaints, and future anxiety (FA). 1595 students from four universities, of whom 72% were female, participated in the study. Cronbach's alpha for the SoC scale was 0.75. Based on the median split of the individual scores, levels of SoC showed no statistically significant difference according to gender. Logistic regression analysis indicated that higher SoC was associated with medium and high subjective social status, studying in private universities, high psychological well-being, low FA, and none/one psychosomatic complaint. While results were similar among female students, type of university and psychological well-being showed no statistically significant association with SoC among males. Our results indicate that structural (subjective social status) and contextual (type of university) factors, along with gender-based variations, are associated with SoC among university students in Turkey.

Development and validation of a COVID-19 risk perception scale in Peru

OBJECTIVES.

Motivation for the study. Risk perception of COVID-19 is a construct that varies according to the characteristics of the population in each geographic area; however, there is no validated scale to measure this construct in the Peruvian population. Main findings. A COVID-19 risk perception scale composed of two dimensions (cognitive and emotional) was designed and validated using qualitative and quantitative techniques. Implications. Having a valid and reliable instrument will help identify the variation of risk perception of COVID-19 according to contextual and psychological factors in the Peruvian population. . To develop and validate a risk perception scale for COVID-19 (PR-COVID-19-PE) in the Peruvian population.

MATERIALS AND METHODS.

Psychometric cross-sectional study conducted in 2022. In phase 1, in order to design the scale, we carried out a theoretical review and a documentary review of scales, we also used focus groups as well as an expert panel. Phase 2 included expert judgment and a pilot test. A virtual survey was conducted among 678 Peruvian adults during phase 3. A confirmatory factor analysis was carried out as well. We used a correlational analysis (Pearson's r) with a valid risk perception scale and the COVID-19 fear scale to determine criterion validity.

RESULTS.

The PR-COVID-19-PE has two dimensions (cognitive and emotional) and showed good fit during construct validity (x2/gl=2.34, Comparative Fit Index=0.96, Tucker-Lewis Index=0.96, Root Mean Square Error of Approximation= 0.05 and Standardized Root Mean-Square=0.07) and optimal internal consistency (ώ=0.88). Likewise, the PR-COVID-19-PE showed correlation with another COVID-19 risk perception scale (r=0.70, p< 0.001) and a fear of COVID-19 scale (r=0.41, p<0.001). In addition, it presents metric and scalar invariance by both sex and educational level.

CONCLUSIONS.

The PR-COVID-19-PE scale showed adequate reliability and content, construct and criterion validity. It is an instrument that can measure COVID-19 risk perception in similar populations. However, further studies are required for different populations.

Risk perception of COVID-19 among college students in China: Latent profile analysis

Background

The outbreak of the new coronavirus-2019 (COVID-19) has had a significant impact on people's mental and physical health. Meanwhile, people's perceptions of risk may influence their emotional states and preventative behavior during an epidemic. Previous research have revealed the diversity and uniqueness of risk perception, and college students may have a different perspective on risk perception. The objective of this study was to describe the subtypes of risk perception for COVID-19 among college students in China, identify the subtypes' traits, and investigate their affecting variables.

Methods

College students from 10 Chinese provinces participated in a cross-sectional study (n = 2,000) that from January 16 to 30, 2022. The latent profiles and influencing factors for risk perception were investigated using latent profile analysis, one-way analysis of variance, and multinomial logistical regression.

Results

The sample group of this survey was 1,946 students, and the response rate was 97.3%. The best model was suggested to consist of three profiles: "neutral risk perception" (20.3%), "perception seriously without susceptible" (52.8%), and "low risk perception" (26.9%). Risk perception of COVID-19 was positively associated with attention to negation information (r = 0.372, p < 0.01), anxiety (r = 0.232, p < 0.01), and depression (r = 0.241, p < 0.01), and negatively associated with perceived social support (r = -0.151, p < 0.01). Logistic-regressions analyses mainly revealed that the risk perception of three profiles related to having chronic diseases (OR = 2.704, p < 0.01), medical major (OR = 0.595, p < 0.01; OR = 0.614, p < 0.05), without having COVID-19 confirmed cases around (OR = 0.539, p < 0.01), attention to negative information (OR = 1.073, p < 0.001; OR = 1.092, p < 0.001), and perceived social support (OR = 0.0.975, p < 0.01).

Conclusions

The level of risk perception for COVID-19 among Chinese college students was unsatisfactory, and the risk perception of COVID-19 had significant group characteristics and heterogeneity. Colleges and public health practitioners could have a theoretical and empirical basis to implement risk perception intervention efforts by identifying latent subgroups during the COVID-19 epidemic.

Public Risk Perception Attribution Model and Governance Path in COVID-19: A Perspective Based on Risk Information

Background

Risk perception is a key factor influencing the public’s behavioral response to major public health events. The research on public risk perception promotes the emergency management system to adapt to the needs of modern development. This article is based on a risk information perspective, using the COVID-19 event as an example. From the micro and macro perspectives, the influencing factors of public risk perception in major public health events in China are extracted, and the attribution model and index system of public risk perception are established.

Methods

In this paper, the five-level Likert scale is used to collect and measure the risk perception variable questionnaire through the combination of online and offline methods (a total of 550 questionnaires, the overall Alpha coefficient of the questionnaire is 0.955, and the KMO test coefficient t=0.941), and through independent samples t-test, correlation analysis, multiple regression analysis and other methods to draw relevant conclusions.

Results

The results showed that gender and age were significantly associated with risk perception (p<0.005), and education level was significantly negatively associated with risk perception (p <0 0.005). Risk information attention and risk perception were significantly positively correlated (p<0.005), media credibility was significantly positively correlated with risk perception (p<0.005), while risk information identification and media exposure had no significant interaction with risk perception (p=0.125, p=0.352).

Conclusion

Factors such as gender, age, education level, place of residence, media exposure, media credibility, risk information attention, and recognition lead to different levels of risk perception. This conclusion helps to provide a basis for relevant departments to conduct public risk management of major public health events based on differences in risk perceptions.

Disparity in Occupational Health Risk During the Pandemic: Potential Misestimation and Its Implications for Health Policies

OBJECTIVE

This study clarifies potential misestimation of occupational risk caused by the dichotomy of frontline essential and nonessential occupations in prior studies.

METHODS

The linear regression is used to investigate the occupational risk in terms of incidence rate, hospitalization, and mortality on community level during the pandemic.

RESULTS

Overall, frontline essential occupations were positively associated with incidence rate, hospitalization, and mortality (156.06, 18.47, and 3.49; P < 0.01). Among essential occupations, however, education, training, and library occupations were negatively associated with them, whereas transportation, protective service, food preparation, and serving occupations were insignificantly associated with them. Moreover, among nonessential occupations, building and grounds cleaning, construction, and extraction occupations were positively associated with them.

CONCLUSION

The dichotomy of frontline essential and nonessential occupations can bring overestimation and underestimation of occupational risk during the COVID-19 pandemic.

Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.

Increased Risk Perception, Distress Intolerance and Health Anxiety in Stricter Lockdowns: Self-Control as a Key Protective Factor in Early Response to the COVID-19 Pandemic

Studies provide evidence that distress, (health) anxiety, and depressive symptoms were high during the first weeks of COVID-19 lockdown restrictions, decreasing over time (possibly due to individuals’ protective psychological factors). Relations between different lockdown restrictions, mental health issues, and protective factors need to be explored, since even small lockdown effects might increase the risk of future mental health issues. We merged objective lockdown stringency data with individual data (N = 1001) to examine differences in lockdown effects in strict lockdown (Romania) and mild lockdown (Hungary) conditions between March and May 2020 on stressors and mental health symptoms, taking protective factors into account. The stricter lockdown in Romania revealed higher levels of perceived risk of infection, distress intolerance, and COVID-19 health anxiety. Protective psychological factors were not affected by the lockdown measures. Surpassing psychological flexibility and resilient coping, self-control proved to be the most promising protective factor. It is recommended that future research merge objective data with study data to investigate the effects of different COVID-19 lockdown measures on mental health and protective factors. Policy decisions should consider lockdown-dependent consequences of mental health issues. Intervention programs are suggested to mitigate mental health issues and to strengthen peoples’ protective psychological factors.

Associations of COVID-19 Risk Perception, eHealth Literacy, and Protective Behaviors Among Chinese College Students Following Vaccination: A Cross-Sectional Study

Background

In spite of strict regulation of coronavirus disease 2019 (COVID-19) preventive measures and containment in China, there are still confirmed cases sporadically occurring in many cities. College students live in groups and have active social activities so that it will trigger a serious public health event once an infection event occurs. Thus, identifying the status and related factors of protective behaviors among them after receiving vaccination will be crucial for epidemic control. This study aimed to gather information on the protective behaviors and to identify the associations of COVID-19 risk perception, eHealth literacy, and protective behaviors for Chinese college students following vaccination.

Methods

A cross-sectional survey of college students engaged in protective behaviors post vaccination was conducted using the COVID-19 risk perception scale, eHealth literacy scale, and protective behaviors following vaccination questionnaire in one of the groups. Multiple linear regression analysis was used to confirm the correlation among the COVID-19 risk perception, eHealth literacy, and protective behaviors for Chinese college students.

Results

A total of 5,641 Chinese college students were included. Male students comprised 59.01% with an average age of (21.39 ± 2.75) years and most students rating their health as very good (44.85%) or pretty good (46.98%). A smaller percentage (13.76%) believed that they would likely or most likely be infected with COVID-19 after getting vaccinated. In addition, more than 1 in 10 (10.35%) college students had ever suspected to suffer from post-vaccination reactions following the COVID-19 vaccination. The mean score of protective behaviors was 26.06 ± 3.97. Approximately one-third (30.42%) of the students always or often did not wear a mask when going out. Some college students (29.25%) did not maintain distance of at least 1 m from others in social situations. Older female college students who were in good health and perceived as being at a low risk of getting infected with COVID-19, and those never suspected to suffer from post-vaccination reactions expected to engage in post-vaccination protective measures. Those with a higher level of perceived risk, severe risk perception and eHealth literacy, and a lower level of unknown risk perception were more likely to engage in further protective behaviors after getting vaccinated.

Conclusions

Overall, the level of protective behaviors among the Chinese college students following vaccination could be improved, especially for male, younger college students in poor health. This study revealed the predictive effects of risk perception and eHealth literacy on protective behaviors, recommending that the negative and positive effects of risk perception should be balanced in epidemic risk management, and eHealth literacy promotion should also be emphasized for public health and social measures.

An Integrated Model of Compliance with COVID-19 Prescriptions: Instrumental, Normative, and Affective Factors Associated with Health-Protective Behaviors

Background

The efficacy of public measures for reducing the transmission of the COVID-19 infection relies on citizens’ voluntary adherence with prescribed actions. Drawing on prior literature about compliant behavior, this study aimed to identify factors associated with people engagement in health-protective behaviors by including a conjoint complement of instrumental/self-oriented, normative/community-based, and affective variables.

Method

A cross-sectional study involving a non-representative sample of 4045 Italian citizens was carried out during the first stage of the pandemic (April–May 2020). Variables associated with health-protective behaviors were perceived personal and societal concerns and perceived effectiveness of the institutional response to the outbreak (instrumental dimensions), and family and friends perceived norms and sense of community responsibility (normative dimensions). Two negative emotions (anxiety and fear) were included as mediators between personal and societal concerns and outcome behaviors.

Results

Results showed the importance of both self-interest and community-based factors. Indeed, self-interest concerns, family perceived norms, and sense of community responsibility were significant predictors of people’s decisions to engage in health-protective behaviors.

Conclusions

The research findings show that compliance with public health prescriptions is a multimodal phenomenon and integrating self-interest and community-based factors can offer a better understanding of people’s decision to engage in health-protective behaviors. Further, this study unveils that a shared sense of community is effective in encouraging adherence to recommended behaviors so as behavioral changes can be sustained by targeting the recommendations not only on risk minimization for oneself but also on the allocation of personal responsibility toward the belonging community.