Exploring the predictors of health-protective behavior during the COVID-19 pandemic: A multi-country comparison

Assessing acceptability of the fourth dose against COVID-19 among Chinese adults: A population-based survey

Coronavirus disease 2019 (COVID-19) has wreaked havoc across the globe for approximately three years. Vaccination is a key factor to ending this pandemic, but its protective effect diminishes over time. A second booster dose at the right time is needed. To explore the willingness to receive the fourth dose of the COVID-19 vaccine and its influencing factors, we commenced a national, cross-sectional and anonymous survey in mainland China among people aged 18 and above from October 24 to November 7, 2022. A total of 3,224 respondents were eventually included. The acceptance rate of the fourth dose was 81.1% (95% CI: 79.8-82.5%), while it was 72.6% (95% CI: 71.1-74.2%) for a heterologous booster. Confidence in current domestic situation and the effectiveness of previous vaccinations, and uncertainty about extra protection were the main reasons for vaccine hesitancy. Perceived benefit (aOR = 1.29, 95% CI: 1.159-1.40) and cues to action (aOR = 1.73, 95% CI: 1.60-1.88) were positively associated with the vaccine acceptance, whereas perceived barriers (aOR = 0.78, 95% CI: 0.72-0.84) and self-efficacy (aOR = 0.79, 95% CI: 0.71-0.89) were both negatively associated with it. Additionally, sex, age, COVID-19 vaccination history, time for social media, and satisfaction with the government's response to COVID-19 were also factors affecting vaccination intention. Factors influencing the intention of heterologous booster were similar to the above results. It is of profound theoretical and practical significance to clarify the population's willingness to vaccinate in advance and explore the relevant influencing factors for the subsequent development and promotion of the fourth-dose vaccination strategies.

Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model

BACKGROUND

While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors.

OBJECTIVE

This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic.

METHODS

This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used.

RESULTS

A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action.

CONCLUSIONS

This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement.

People in Tight Cultures and Tight Situations Wear Masks More: Evidence From Three Large-Scale Studies in China

Studies have found large differences in masks use during the pandemic. We found evidence that cultural tightness explains mask use differences and this association was more robust in tight situations like subways. In Study 1, we observed 23,551 people's actual mask use in public places around China. People wore masks more in tight situations; however, differences did not extend to outdoor streets and public parks, where norms are looser. We replicated this finding using a data from 15,985 people across China. Finally, in a preregistered study we observed mask use with the removal of COVID-19 restrictions, people still wore masks more in tight situations like subways than in loose situations of parks. These findings suggest that norm tightness has a lasting association with people's health-protective behaviors, especially in tight situations. It provides insight into how different cultures might respond with future pandemics and in what situations people adopt health-protective behaviors.

A machine learning approach to predict self-protecting behaviors during the early wave of the COVID-19 pandemic

Using a unique harmonized real-time data set from the COME-HERE longitudinal survey that covers five European countries (France, Germany, Italy, Spain, and Sweden) and applying a non-parametric machine learning model, this paper identifies the main individual and macro-level predictors of self-protecting behaviors against the coronavirus disease 2019 (COVID-19) during the first wave of the pandemic. Exploiting the interpretability of a Random Forest algorithm via Shapely values, we find that a higher regional incidence of COVID-19 triggers higher levels of self-protective behavior, as does a stricter government policy response. The level of individual knowledge about the pandemic, confidence in institutions, and population density also ranks high among the factors that predict self-protecting behaviors. We also identify a steep socioeconomic gradient with lower levels of self-protecting behaviors being associated with lower income and poor housing conditions. Among socio-demographic factors, gender, marital status, age, and region of residence are the main determinants of self-protective measures.

Vaccine Uptake to Prevent Meningitis and Encephalitis in Shanghai, China

Multiple vaccines may prevent meningitis and encephalitis (M/E). In China, the meningococcal vaccine and Japanese encephalitis vaccine (JEV) have been included in the expanded program of immunization (EPI). The pneumococcal vaccine, Haemophilus influenzae type b (Hib) vaccine, rotavirus vaccine, and enterovirus 71 (EV-71) vaccine are non-EPI vaccines and are self-paid. We aim to investigate the uptake of these M/E vaccines in children and the related knowledge and health beliefs among family caregivers. A total of 1011 family caregivers with children aged 1-6 years in Shanghai, China were included in the study. The uptake of the pneumococcal vaccine, Hib-containing vaccine, rotavirus vaccine, and EV-71 vaccine remained at 44.0-48.1% in children, compared with the higher uptake of the meningococcal vaccine (88.8%) and JEV (87.1%). Moreover, family caregivers had limited knowledge on the M/E pathogens and possible vaccines. Their health beliefs were moderate to high. Then, a health belief model (HBM) and a structural equation model were established. The uptake of four non-EPI vaccines was significantly influenced by family income (β = 0.159), knowledge (β = 0.354), self-efficacy (β = 0.584), and perceived susceptibility (β = 0.212) within an HBM. Therefore, it warrants further improving the uptake rate for these non-EPI vaccines to prevent potential M/E in children. A specific health promotion may empower the caregivers' decision-making on childhood vaccination.

The Influencing Factors of HIV-Preventive Behavior Based on Health Belief Model among HIV-Negative MSMs in Western China: A Structural Equation Modeling Analysis

(1) Background: Men who have sex with other men (MSMs) are at high risk of being infected by the human immunodeficiency virus (HIV) in western China. Pre-exposure prophylaxis (PrEP) is an efficient way to prevent HIV transmission. However, adherence is the most vital determinant factor affecting PrEP effectiveness. We conducted a study based on the Health Belief Model to explore factors that predict adherence to PrEP among a cohort of 689 MSMs in western China. (2) Methods: We assessed perceived susceptibility, severity, benefits, barriers, self-efficacy, cues to action, and HIV-preventive behavior through a cross-sectional survey. (3) Results: PrEP self-efficacy was directly associated with PrEP behaviors (β = 0.221, p < 0.001), cues to action were directly associated with PrEP behaviors (β = 0.112, p < 0.001), perceived benefits were directly associated with PrEP behaviors (β = 0.101, p < 0.001), and perceived susceptibility was directly associated with PrEP behaviors (β = 0.117, p = 0.043). (4) Conclusion: Medication self-efficacy, perceived susceptibility, and cue to action structures are predictors of the MSMs’ HIV-preventive behavior in western China. These results will provide theoretical plans for promoting PrEP adherence in MSMs.

Exploring the drivers of COVID-19 protective behaviors among Singaporean tourists to Indonesia using travel bubbles

This study investigats the relationships among positive emotions, perceived threats, protection motivation, coronavirus disease 2019 (COVID-19) vaccination intentions, quarantine-free travel intentions and COVID-19 protective behaviors in the context of quarantine-free travel. Data were collected from Singaporean tourists in Batam and Bintan of Indonesia using travel bubbles. A total of 387 respondents completed the questionnaires. The findings can help tourism managers create and implement market-driven service initiatives to increase positive emotions, protection motivation, and intentions to take quarantine-free travel and decrease perceived threats in order to enable tourists to have accurate COVID-19 protective behaviors.

The role of e-health literacy and some cognitive factors in adopting protective behaviors of COVID-19 in Khalkhal residents

Background

Several vaccines have recently been generated and are being utilized to prevent COVID-19 mortality. Although the disease is causing many fatalities worldwide, preventative practices should be prioritized, even if vaccines are available. Therefore, this study aimed to identify the role of e-health literacy and some cognitive factors in adopting protective behaviors against COVID-19 in Khalkhal residents.

Methods

In the present cross-sectional study we recruited 380 people aged 18–65 according to cluster sampling from September 2021 to December 2021 in Khalkhal County, Iran. Reliable and validated tools were applied to data collection, including the eHealth Literacy Scale (eHEALS) in Persian and the Cognitive factors assessment questionnaire based on the Health Belief Model (HBM). Data were analyzed using Chi-square, one-way ANOVA, independent samples t-test, and bivariate correlation. The predictors were also determined using hierarchical linear regression analysis.

Results

The average age of the participants was 35.26 ± 11.51 years. The regression analysis implied that gender (p-value = 0.032), education level (p-value = 0.001), occupational status (p-value = 0.002), income (p-value = 0.001), and marriage (p-value = 0.001) had statistically significant associations with e-HL. Additionally, education level (p-value = 0.001), occupational status (p-value = 0.001), income (p-value = 0.001), and marriage (p-value = 0.002) revealed statistically significant associations with COVID-19 preventive behaviors. Approximately 16.5% of the variation in the COVID-19 protective behaviors is explained by the cognitive factors and the demographic variables. Overall, demographic, cognitive, and e-HL variables were able to explain roughly 35.5% of the variation in COVID-19 protective behaviors. Furthermore, self-efficacy was the strongest predictor of protective behaviors (β = 0.214).

Conclusions

HBM constructs successfully predicted the role of e-health literacy and some cognitive factors in adopting COVID-19 protective behaviors. People with high socioeconomic levels were better at e-health literacy and COVID-19 protective behaviors during the pandemic. Moreover, applying approaches to adopting COVID-19 protective behaviors is essential, especially in low socioeconomic status (SES) groups.

Prescription for COVID-19 by non-medical professionals during the pandemic in Colombia: a cross-sectional study

Background:

The COVID-19 pandemic has led to an increase in the behavior of self-medication (SM). Given the massive release of misleading information during the pandemic, some pharmacies recommend drugs such as ivermectin, azithromycin, and hydroxychloroquine that are not useful for preventing or treating COVID-19 and could expose patients to unnecessary adverse drug reactions (ADRs), drug-drug interactions (DDIs), disease masking, and antibiotic resistance.

Rationale:

SM with drugs advertised for COVID-19 can have consequences, and people should be aware of approved uses, potential contraindications, and ADRs. Thus, the aim of this study was to know the drug therapies including natural products and homeopathic drugs offered by Colombian pharmaceutical establishments for the prevention and treatment of COVID-19, as well as the information provided on the safe use of the product.

Methods:

An observational, cross-sectional mystery shopping study was carried out to determine the pharmaceutical alternatives for the management of COVID-19 offered by pharmaceutical establishments (drugstores, pharmacies, homeopathic pharmacies, and nutritional supplements stores) in Colombia, and information related to the safe use of the product. The study included 482 pharmaceutical establishments from 16 Colombian departments. Data collection was done through telephone calls to each of the establishments following an interview protocol pretending to be a patient who presents symptoms related to COVID-19.

Results:

About 57.3% (276) of the establishments recommended a product for the treatment of COVID-19 infection, 66.6% (321) asked whether the caller had COVID-19 symptoms and what they are, and 44.2% (213) suggested taking a COVID-19 test. Of 59 drugs suggested by pharmacies, the most recommended were azithromycin, ivermectin, acetaminophen, ibuprofen, and ASA (aspirin). From the establishments that recommended a product, dosage was indicated in 85.5% (236) of the pharmaceutical establishments and 14.5% (40) of the establishments reported the most common adverse effects of this substance. About 9.4% (26) of the establishments reported possible interactions of the recommended drugs and substances with food, beverages, or supplements.Conclusion: Pharmaceutical establishments in Colombia seem to have significantly contributed to self-medication for COVID-19 in Colombia during the pandemic. This behavior is inappropriate, since the mild forms of the disease do not have a specific treatment.

Plain Language Summary

Self-medication induced by pharmaceutical establishments in Colombia during the COVID-19 pandemic

Background: The COVID-19 pandemic has led to an increase in the behavior of self-medication (SM). Given the massive release of misleading information during the pandemic, some pharmacies recommend drugs such as ivermectin, azithromycin, hydroxychloroquine among others, which are not useful for preventing or treating COVID-19 and could expose patients to unnecessary side effects and interactions with other medications. People should be aware of the approved and non-approved uses, and potential side effects of these drugs. Rationale: The aim of this study was to know the drugs, including natural products and homeopathic drugs, offered by Colombian pharmaceutical establishments for the prevention and treatment of COVID-19, as well as the information provided on the safe use of the product. Methods: The study was done using the mystery shopping method, collecting data through telephone calls to each of the establishments by a trained individual pretending to be a patient with COVID-19 symptoms. The study included 482 pharmaceutical establishments from 16 Colombian departments. Results: Of 59 drugs suggested by pharmacies, the most recommended were azithromycin, ivermectin, acetaminophen, ibuprofen, and aspirin. The recommended dose was indicated in 85.5% (236) of the pharmaceutical establishments, and 14.5% (40) of them reported the most common adverse effects of the recommended product. About 9.4% (26) of the establishments reported possible interactions of the recommended drugs and substances with food, beverages, or supplements. Conclusion: The majority of the pharmaceutical establishments included in the study promoted inadequate self-medication for COVID-19 in Colombia during the pandemic.

SARS-CoV-2 and other pathogenic microorganisms in the environment

The title of the Virtual Special Issue (VSI) "SARS-CoV-2 and other pathogenic microorganisms in the environment", clearly indicates a main focus not only on the virus causing the current pandemic, but also on other pathogenic microorganisms and their spatial and temporal dynamics in environmental compartments. Overall, the VSI has received more than 100 submissions relating to most of the possible fields connected to the pandemic, many of them of high scientific value. A rigorous peer-reviewing process has been carried out, with a panel of experts making a great work to evaluate that important number of submissions. As a result, those manuscripts reaching the highest scientific standards were selected for publication. We think that the papers included constitute a set of high-quality contributions, which should help to improve the overall scientific perspective regarding this crucial issue. In this piece, the Editors comment some issues on the papers accepted for publication, and include additional reflections.

Perceived severity, fear of retaliation, and suspect report intention of general public during COVID-19 pandemic: A moderated moderation analysis

Management of COVID-19 largely depends on the reporting of suspected or confirmed positive cases. This study examined public's suspect report intention during COVID-19 using and extending the theory of planned behavior by adding two incident-specific variables such as perceived severity of COVID-19 and fear of retaliation. Direct association of attitude, subjective norm, and perceived behavioral control with suspect report intention and moderating role of perceived severity of COVID-19 and fear of retaliation were probed. This study also investigated whether the moderation of perceived severity of COVID-19 (primary moderator) varies with different level of fear of retaliation (secondary moderator) using moderated moderation analysis. Analyzing data collected from 554 Indian citizens provides evidence that attitude, subjective norm, and perceived behavioral control were positively associated with suspect report intention. Perceived severity of COVID-19 and fear of retaliation negatively moderated such associations. When fear of retaliation was high, high perceived severity of COVID-19 did not positively moderate the association of attitude, subjective norm, and perceived behavioral control with suspect report intention. Perceived behavioral control was the most potent facilitator and fear of retaliation was the strongest inhibitor of suspect report intention. Understanding people's suspect report intention can assist in implementing awareness programs to encourage suspect report intention and stop the community spread of COVID-19.