Examining persuasive message type to encourage staying at home during the COVID-19 pandemic and social lockdown: A randomized controlled study in Japan

Identifying factors improving the intention to use antibiotics appropriately in children and adults using protection motivation theory

Objective

This study aimed to employ hypothetical models based on the protection motivation theory (PMT) to identify factors that improve the intention to use antibiotics appropriately (intention) among individuals who take antibiotics or administer them to their children.

Methods

Adult Japanese participants, including 600 parents who administer antibiotics to children aged <14 years and 600 adults who take them, completed an online survey. Structural equation modeling (SEM) was conducted on hypothetical models representing intention using 19 questions based on PMT. If the hypothesized model did not fit, SEM was repeated to search for a new model.

Results

The hypothesized models did not fit. Two factors were extracted from SEM: "understanding the risk of antimicrobial resistance" and "excessive expectation of antibiotics." In adults, SEM revealed that "excessive expectation of antibiotics" (β = -0.50, p < 0.001) negatively influenced intention; in children, "excessive expectation of antibiotics" (β = -0.52, p < 0.001) negatively influenced intention, while "understanding the risk of antimicrobial resistance" (β = 0.22, p < 0.001) positively influenced intention.

Conclusion

Factors influencing intention varied between adult and pediatric antibiotic use.

Innovation

Awareness activities for appropriate antibiotic use should be tailored to population characteristics.

Inclusive Crisis Communication in a Pandemic Context: A Rapid Review

Background: Crisis communication might not reach non-native speakers or persons with low literacy levels, a low socio-economic status, and/or an auditory or visual impairments as easily as it would reach other citizens. The aim of this rapid review was to synthesize the evidence on strategies used to improve inclusive pandemic-related crisis communication in terms of form, channel, and outreach. Methods: After a comprehensive search and a rigorous screening and quality assessment exercise, twelve comparative studies were selected for inclusion in this review. Data were analyzed and represented by means of a structured reporting of available effects using narrative tables. Results: The findings indicate that a higher message frequency (on any channel) may lead to a lower recall rate, audio-visual productions and tailored messages prove to be valuable under certain conditions, and primary healthcare practitioners appear to be the most trusted source of information for most groups of citizens. Trust levels were higher for citizens who were notified in advance of potential exceptions to the rule in the effect of preventive and curative measures promoted. Conclusions: This review contributes to combatting information inequality by providing evidence on how to remove the sensorial, linguistic, cultural, and textual barriers experienced by minorities and other underserved target audiences in COVID-19-related governmental crisis communication in response to the societal, health-related costs of ineffective communication outreach.

Effective health communication depends on the interaction of message source and content: two experiments on adherence to COVID-19 measures in Türkiye

OBJECTIVE

Following the COVID-19 outbreak, authorities recommended preventive measures to reduce infection rates. However, adherence to calls varied between individuals and across cultures. To determine the characteristics of effective health communication, we investigated three key features: message source, content, and audience.

METHODS

Using a pre-test and two experiments, we tested how message content (emphasizing personal or social benefit), audience (individual differences), message source (scientists or state officials), and their interaction influence adherence to preventive measures. Using fliers advocating preventive measures, Experiment 1 investigated the effects of message content and examined the moderator role of individual differences. Experiment 2 presented the messages using news articles and manipulated sources.

RESULTS

Study 1 found decreasing adherence over time, with no significant impact from message content or individual differences. Study 2 found messages emphasizing 'protect yourself' and 'protect your country' to increase intentions for adherence to preventive measures. It also revealed an interaction between message source and content whereby messages emphasizing personal benefit were more effective when they came from healthcare professionals than from state officials. However, message source and content did not affect vaccination intentions or donations for vaccine research.

CONCLUSION

Effective health communication requires simultaneous consideration of message source and content.

Effect of digital messages from health professionals on COVID-19-related outcomes: A systematic review of randomized controlled trials

Effectiveness of health professionals' messages via digital tools on COVID-19-related outcomes remains unknown. In this systematic review, we examined this issue by searching randomized controlled trials in six databases until August, 2022 (PROSPERO, CRD 42022350788). Risk of bias was assessed using revised Cochrane risk-of-bias tool. Primary outcomes were COVID-19 infections, preventive behaviors, and factors that support behavioral change. Seven trials with 16 reports (some reported two or more outcomes) were included. One trial showed that physician videos distributed by Facebook ads significantly reduced COVID-19 infections. Five of 6 reports showed that interventions can promote non-pharmaceutical preventive behaviors, vaccination, or information-seeking behaviors and half of the results were significant. Interventions improved the factors that support behavioral change. 14 reports had some concerns of bias risk and 2 had high risk of bias. Our findings suggest that digital messages by health professionals may help reduce COVID-19 infections through promoting behavioral change.

Association between trust in COVID-19 information sources and engaging in infection prevention behaviors in Japan: A longitudinal study

OBJECTIVE

We examined changes in people's trust in information sources in Japan during the COVID-19 pandemic over the course of 1 year and investigated longitudinal associations between trust in such sources and engaging in infection prevention behaviors.

METHODS

We conducted a longitudinal survey of Japanese populations under a declared state of emergency at two time points, August 2020 and August 2021. We surveyed sociodemographic data, seven Trust in COVID-19 information sources and six COVID-19 preventive behaviors.

RESULTS

In all, 784 participants completed the two surveys. Physicians were the most consistently trusted information source over the 1-year period. We identified three preventive behaviors that were positively associated with trust in physicians as an information source (social distancing, wearing masks, and washing hands with soap), four preventive behaviors that were positively associated with trusting infected patients (social distancing, using ventilation, wearing masks, and using hand sanitizer), and one preventative behavior that was negatively associated with trust in government (avoiding closed spaces).

CONCLUSION

In the ongoing pandemic, information from physicians and patients may encourage people to engage in long-term preventive behaviors.

PRACTICE IMPLICATIONS

Physicians and patients should be promoted as trusted and behavior influencing sources of information during the pandemic.

The Early Warning Mechanism of Public Health Emergencies Through Whistleblowing: A Perspective Based on Considering the Uncertainty of Risk Perception

Purpose

During the early warning period of public health emergencies, the information released by whistleblowers on the risk posed by the given event can reduce uncertainty in the public's risk perception and help governments take timely actions to contain the large-scale dissemination of risk. The purpose of this study is to give full play to whistleblowers and draw attention to the risk events, forming a pluralistic model of the risk governance during the early warning period of public health emergencies.

Methods

We construct an evolutionary game model of the early warning of public health emergencies through whistleblowing that involves the government, whistleblowers, and the public, discussing the mechanism of interaction between these subjects under the uncertainty of risk perception. Furthermore, we use numerical simulations to analyze the influence of changes in the relevant parameters on the evolutionary trajectory of the subjects' behaviors.

Results

The results of the research are obtained by numerical simulation of the evolutionary game model. The results show that the public's cooperation with the government encourages the latter to take a positive guidance strategy. Increasing the reward for whistleblowers within an acceptable cost, strengthening the propaganda of the mechanism and the higher level of risk perception of the government and whistleblowers will promote whistleblowers' vocalization actively. When the government's reward for whistleblowers is lower, the whistleblowers choose negative vocalization with the improvement of the public's risk perception. If there is no mandatory guidance from the government at this point, the public is prone to passively cooperating with the government owing to a lack of risk-related information.

Conclusion

Establishing an early warning mechanism through whistleblowing is important for containing risk in the early warning period of public health emergencies. Building the whistleblowing mechanism in daily work can improve the effectiveness of the mechanism and enhance the public's risk perception better when the public health emergencies arise.

Influence of diverse kinds of persuasive messages on intention to stay home during COVID-19 pandemic: Moderating role of media type

This study highlights the influence of diverse kinds of persuasive messages on intention to stay home during COVID-19 pandemic. The COVID-19 pandemic is believed to be the top modern societal challenge necessitating extensive collective action and collaboration. The statistical population included Iranian individuals by answering our online survey questionnaires at diverse phases of the COVID-19 pandemic. 406 completed questionnaires were gathered and analyzed. Note that, according to the official reports, Iran encountered COVID-19 disease since February 19, 2020. Data collection was started on July 18, 2020 (at the beginning of second wave of COVID-19 in Iran) and lasted until October 30, 2020. Various social network platforms including Instagram, WhatsApp, Facebook and Telegram were used for distribution of the questionnaires. According to the results, perceived severity and perceived self-efficacy had an insignificant direct influence on intention to stay home. From another perspective, perceived vulnerability (β = 0.261, CI = 0.059; 0.242]) and perceived response efficacy (β = 0.502, CI = 0.347; 0.656]) positively and significantly affected the intention to stay home. Moreover, no significant difference was found between these two kinds of media messages in research sample. Our findings showed that “perceived response efficacy” has the highest importance score of 0.502; if the perceived response efficacy performance is boosted by one unit point by individuals during COVID-19 pandemic, its overall intention to stay home will increase by 0.502. Besides, our results showed that lowest performance (78.104) is associated with perceived vulnerability highlighting an excellent opportunity for improvement in this area.

Social cognition theories and behavior change in COVID-19: A conceptual review

The COVID-19 pandemic has had unprecedented health, economic, and social consequences worldwide. Although contact reductions and wearing face coverings have reduced infection rates, and vaccines have reduced illness severity, emergence of new variants of the coronavirus that causes COVID-19, and the shift from pandemic to endemic patterns of infection, highlights the importance of ongoing preventive behavior adherence to manage future outbreaks. Research applying social cognition theories may assist in explaining variance in these behaviors and inform the development of efficacious behavior change interventions to promote adherence. In the present article, we summarize research applying these theories to identify modifiable determinants of COVID-19 preventive behaviors and the mechanisms involved, and their utility in informing interventions. We identify limitations of these applications (e.g., overreliance on correlational data, lack of long-term behavioral follow-up), and suggest how they can be addressed. We demonstrate the virtue of augmenting theories with additional constructs (e.g., moral norms, anticipated regret) and processes (e.g., multiple action phases, automatic processes) to provide comprehensive, parsimonious behavioral explanations. We also outline how the theories contribute to testing mechanisms of action of behavioral interventions. Finally, we recommend future studies applying these theories to inform and test interventions to promote COVID-19 preventive behavior adherence.

Encouraging COVID-19 vaccination via an evolutionary theoretical approach: A randomized controlled study in Japan

OBJECTIVE

We aimed to examine the effect of a message that target the fundamental human motive of kin care on COVID-19 vaccination recommendations among participants with young children, based on an evolutionary theoretical approach.

METHODS

Participants with young children (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care, or that targeted the fundamental motive of disease avoidance, or a control message. Intention to receive COVID-19 vaccination was assessed both before and after reading the messages. A one-way ANOVA with Tukey's or Games-Howell test was conducted.

RESULTS

An intervention message targeting the fundamental motive of kin care and disease avoidance significantly increased intention of vaccination versus a control message (p < 0.001, respectively).

CONCLUSION

The evolutionary theoretical approach that focuses on fundamental human motives has the potential to extend the communication strategy for COVID-19 vaccination recommendations.

PRACTICE IMPLICATIONS

Health professionals should deliver messages that target the fundamental motive of kin care as well as messages about the susceptibility and severity of COVID-19 and vaccine efficacy (e.g., "Get vaccinated against COVID-19 for your child's sake, because if you are infected, you will be unable to care for your child.").

Encouragement of cervical cancer screening via an evolutionary theoretical approach: A randomized controlled study in Japan

The introduction of an evolutionary perspective into public health research has received attention in recent years. We aimed to examine the effects of messages that target the fundamental human motive of kin care (i.e., childbirth and parenting) on cervical cancer screening recommendations, based on an evolutionary theoretical approach. A randomized controlled study was conducted in Japan. Female participants (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care (recommending cervical cancer screening for future childbearing), or that targeted the fundamental motive of disease avoidance, or a control message. Intention to obtain cervical cancer screening was assessed both before and after reading the messages. A one-way ANOVA with Tukey's or Games-Howell test was conducted. Each of the intervention message targeting the fundamental motive of kin care and of the message targeting disease avoidance significantly increased intention to obtain cervical cancer screening versus a control message (M = 0.76 vs. M = 0.17, p < 0.001; M = 0.74 vs. M = 0.17, p < 0.001, respectively). A message that targeted the fundamental motive of kin care was as effective as one targeting the fundamental motive of disease avoidance. Health professionals should add messages that target the fundamental motive of kin care to their repertoire to encourage cervical cancer screening among women who wish future childbirth and parenting (e.g., "Delayed detection of cervical cancer may prevent your future childbirth and parenting. So let's obtain cervical cancer screening regularly for your future childbirth and parenting.").

Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction

BACKGROUND

It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior.

METHODS

A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death.

RESULTS

There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic.

CONCLUSION

During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.

The relationship between new PCR positive cases and going out in public during the COVID-19 epidemic in Japan

The suppression of the first wave of COVID-19 in Japan is assumedly attributed to people's increased risk perception after acquiring information from the government and media reports. In this study, going out in public amidst the spread of COVID-19 infections was investigated by examining new polymerase chain reaction (PCR) positive cases of COVID-19 and its relationship to four indicators of people going out in public (the people flow, the index of web searches for going outside, the number of times people browse restaurants, and the number of hotel guests, from the Regional Economic and Social Analysis System (V-RESAS). Two waves of COVID-19 infections were examined using cross-correlation analysis. In the first wave, all four indicators of going out changed to be opposite the change in new PCR positive cases, showing a lag period of -1 to +6 weeks. In the second wave, the same relationship was only observed for the index of web searches for going outside, and two indicators showed the positive lag period of +6 to +12 weeks after the change in new PCR positive cases. Moreover, each indicator in the second wave changed differently compared to the first wave. The complexity of people's behaviors around going out increased in the second wave, when policies and campaigns were implemented and people's attitudes were thought to have changed. In conclusion, the results suggest that policies may have influenced people's mobility, rather than the number of new PCR positive cases.

From warning messages to preparedness behavior: The role of risk perception and information interaction in the Covid-19 pandemic

During infectious disease outbreaks, early warning is crucial to prevent and control the further spread of the disease. While the different waves of the Covid-19 pandemic have demonstrated the need for continued compliance, little is known about the impact of warning messages and risk perception on individual behavior in public health emergencies. To address this gap, this paper uses data from the second wave of Covid-19 in China to analyse how warning information influences preventive behavior through four categories risk perception and information interaction. Drawing on the protective action decision model (PADM) and the social amplification of risk framework (SARF), risk warning information (content, channel, and type), risk perception (threat perception, hazard- and resource-related preparedness behavior perception and stakeholder perception), information interaction, and preparedness behavior intention are integrated into a comprehensive model. To test our model, we run a survey with 724 residents in Northern China. The results show that hazard-related preparedness behavior perception and stakeholder perception act as mediators between warning and preventive action. Stakeholder perception had much stronger mediating effects than the hazard-related attributes. In addition, information interaction is effective in increasing all categories risk perception, stimulating public response, while functioning as a mediator for warning. The risk warning information content, channel, and type are identified as key drivers of risk perception. The research found that information channel was more related to different risk perception than other characteristics. Overall, these associations in our model explain core mechanisms behind compliance and allow policy-makers to gain new insights into preventive risk communication in public health emergencies.

The Effect of Exposure to "Exemption" Video Advertisements for Functional Foods: A Randomized Control Study in Japan

Previous content analysis of video advertisements for functional foods identified "Exemption" advertisements. "Exemption" advertisements may imply to the audiences that "By taking functional foods, I can adopt unhealthy behaviors or I don't have to adopt healthy behaviors". In the context of Compensatory Health Beliefs (CHBs), this study refers to these beliefs as functional foods related to CHBs (FF-CHBs). This study aimed to assess the effects of exposure to "Exemption" advertisements for fat-reduction functional foods on audiences. The main hypothesis is exposure to "Exemption" video advertisements increases participants' FF-CHBs. Participants (n  =  788) were randomly assigned to an intervention group that viewed three video advertisements or a control group and answered online self-administered questionnaires. Intervention videos were three videos with the highest number of views per month from among the "Exemption" video advertisements. Control videos were about how to brew green tea. FF-CHBs was assessed before and after the intervention. The intervention group showed significantly greater FF-CHBs after intervention (mean = 2.37 vs. 2.11, p < 0.001, η2 = 0.026) compared with the control group. "Exemption" functional foods video advertisements increased FF-CHBs that can lead to adopting unhealthy behaviors and avoiding healthy behaviors. The content of these functional foods video advertisements should be improved to promote public health.

COVID-19 Study on Scientific Articles in Health Communication: A Science Mapping Analysis in Web of Science

The COVID-19 pandemic continues to cause a collapse in the health systems and econo-mies of many countries around the world, after 2 years of struggle and with the number of cases still growing exponentially. Health communication has become as essential and necessary for control of the pandemic as epidemiology. This bibliometric analysis identifies existing contributions, jointly studying health communication and the pandemic in scientific journals indexed. A systematic search of the Web of Science was performed, using keywords related to COVID-19 and health communication. Data extracted included the type of study, journal, number of citations, number of authors, country of publication, and study content. As the number of scientific investigations has grown, it is necessary to delve into the areas in which the most impactful publications have been generated. The results show that the scientific community has been quick to react by generating an extraordinary volume of publications. This review provides a comprehensive mapping of contributions to date, showing how research approaches have evolved in parallel with the pandemic. In 2020, concepts related to mental health, mass communication, misinformation and communication risk were more used. In 2021, vaccination, infodemic, risk perception, social distancing and telemedicine were the most prevalent keywords. By highlighting the main topics, authors, manuscripts and journals since the origin of COVID-19, the authors hope to disseminate information that can help researchers to identify subsisting knowledge gaps and a number of future research opportunities.

Consumer Motivations for Adopting Omnichannel Retailing: A Safety-Driven Perspective in the Context of COVID-19

This study aims to understand the influence of COVID-19 on consumers' fears and self-protection motivations. Furthermore, the study seeks to understand the effects of these fears and motivations on consumers' intentions to use omnichannel retailing. A modified theoretical model is proposed by integrating protection motivation theory (PMT) and extending the extended parallel process model (E-EPPM). A total of 398 valid questionnaires are collected and used for further structural equation modeling analysis. The results suggest that the perceived severity, perceived vulnerability, and health anxiety positively impact perceived fears surrounding COVID-19. Furthermore, it is found that perceived fear, self-efficacy, and response efficacy will affect the protection motivation of consumers and ultimately contribute to their behavioral intention to use omnichannel retailing. The findings theoretically enrich the research on COVID-19, PMT, and E-EPPM and empirically provide managerial implications for omnichannel retail service providers.

COVID-19 Pandemic: Effect on Confidence Levels of Portuguese Towards People of Different Professions

BACKGROUND

The COVID-19 pandemic is emerging in a world where science is highly developed. Nevertheless, science is not the only resource that people resort to when they have difficulties. In this pandemic context, some professions became more relevant, including front-line professionals, such as medical doctors and nurses, and those who may have an indirect role. The aim of this study is to understand whether there is a strengthening of people's confidence, in politicians, journalists, science-based activities, and in more mystical dimensions.

METHODS

A cross-sectional study was carried out to understand the levels of confidence of the Portuguese population in several professional groups, measured in two pandemic moments. Participants were recruited to participate in the study through online platforms. The sample was randomly collected from the Portuguese population. The sample was composed of 1455 Portuguese people with a mean age of 44 years, and 1080 were female.

RESULTS

We found high levels of confidence in medical doctors and nurses, as well as in other health professions, science, and education. We detected the opposite trend for politicians and journalists. Measured in two pandemic moments, we found confidence levels in these professionals were lower in September than in July with statistical significance differences [(politicians (t = 3.15, p = 0.00); journalists (t = 2.49, p = 0.01)].

CONCLUSION

It is important to improve a joint action between politicians, journalists, health and science professionals to communicate measures to increase confidence from people. There is a need for the engagement of the population in the adoption of protective measures and contribute to easier control in pandemic situations.

Emphasize personal health benefits to boost COVID-19 vaccination rates

The rapid development of COVID-19 vaccines is a tremendous scientific response to the current global pandemic. However, vaccines per se do not save lives and restart economies. Their success depends on the number of people getting vaccinated. We used a survey experiment to examine the impact on vaccine intentions of a variety of public health messages identified as particularly promising: three messages that emphasize different benefits from the vaccines (personal health, the health of others, and the recovery of local and national economies) and one message that emphasizes vaccine safety. Because people will likely be exposed to multiple messages in the real world, we also examined the effect of these messages in combination. Based on a nationally quota representative sample of 3,048 adults in the United States, our findings suggest that several forms of public messages can increase vaccine intentions, but messaging that emphasizes personal health benefits had the largest impact.

Health authorities' health risk communication with the public during pandemics: a rapid scoping review

BACKGROUND

Responses from the H1N1 swine flu pandemic and the recent COVID-19 coronavirus pandemic provide an opportunity for insight into the role of health authorities' ways of communicating health risk information to the public. We aimed to synthesise the existing evidence regarding different modes of communication used by health authorities in health risk communication with the public during a pandemic.

METHODS

We conducted a rapid scoping review. MEDLINE and EMBASE were searched for publications in English from January 2009 through October 2020, covering both the full H1N1 pandemic and the response phase during the COVID-19 pandemic. The search resulted in 1440 records, of which 48 studies met our eligibility criteria.

RESULTS

The present review identified studies across a broad interdisciplinary field of health risk communication. The majority focused on the H1N1 pandemic and the COVID-19 pandemic. A content analysis of the studies identified three categories for modes of communication: i) communication channels, ii) source credibility and iii) how the message is communicated. The identified studies on social media focused mainly on content and engagement, while studies on the effect of the use of social media and self-protective behaviour were lacking. Studies on the modes of communication that take the diversity of receivers in the field into account are lacking. A limited number of studies of health authorities' use of graphic and audio-visual means were identified, yet these did not consider/evaluate creative communication choices.

CONCLUSION

Experimental studies that investigate the effect of health authorities' videos and messages on social media platforms and self-protective behaviour are needed. More studies are needed across the fields of health risk communication and media studies, including visual communication, web design, video and digital marketing, at a time when online digital communication is central to reaching the public.

Analysis of Policies Based on the Multi-Fuzzy Regression Discontinuity, in Terms of the Number of Deaths in the Coronavirus Epidemic

It has been a year since the outbreak of the coronavirus epidemic 2019 (COVID-19). In the face of the global epidemic, governments in all countries have taken different prevention measures, such as social isolation, mandatory health protection, and the closure of schools and workplaces. The situation of the epidemic has clearly varied from country to country. In this context, research on the impact of policies for the control of the spread of the global epidemic is of great significance. In this paper, we examined data from a sample of 212 countries between 31 December 2019, and 21 May 2020, using multi-fuzzy regression discontinuity. We found that developed countries had relatively low sensitivity to the policy stringency index; however, policy control measures had a significant effect on epidemic control. In addition, the trend analysis showed that the corresponding management and control came into play only after the policy stringency index reached 50 or the policy management reached level II, and the robustness was optimal at this time. Therefore, the governments in all countries should realize that epidemic prevention and control are of great importance. They can strengthen policy stringency to control the spread of the epidemic, considering their national conditions in terms of the economy and health system.

Predictors of Staying at Home during the COVID-19 Pandemic and Social Lockdown based on Protection Motivation Theory: A Cross-Sectional Study in Japan

During the COVID-19 pandemic, a social lockdown should be put in place and individuals should stay at home. Behavioral change is the only way to prevent the pandemic and overwhelmed healthcare systems until vaccines are available. We aimed to examine the psychological factors that predict staying at home during the COVID-19 pandemic and social lockdown. A total of 1980 participants in Japan completed a survey for this study from 9 to 11 May 2020, when the state of emergency covered all prefectures in the country. Self-reported behavior in terms of staying at home, the perceived severity of the pandemic, vulnerability to the pandemic, response efficacy, and self-efficacy based on protection motivation theory were assessed. Multiple regression analysis showed that perceived severity (standardized β = 0.11, p < 0.001) and self-efficacy (standardized β = 0.32, p < 0.001) significantly predicted greater levels of staying at home, after controlling for socio-demographics. However, perceived vulnerability and response efficacy did not. To encourage people to stay at home during the pandemic and social lockdown, increasing the perceived severity of infection by COVID-19 and self-efficacy in terms of exercising restraint with respect to going out may consequently encourage people to stay at home.