Factors influencing health behaviours during the coronavirus disease 2019 outbreak in China: an extended information-motivation-behaviour skills model

Empowering adult patients with diabetes for health educators' role within their family members: A cross-sectional study

BACKGROUND

Patient engagement as partners in diabetes prevention for family members/close relatives is a novel and underexplored approach. This paper aims to assess patients' willingness and confidence in their ability to succeed as health educators for their family members and investigate the influencing factors.

METHODS

A cross-sectional descriptive study was conducted between January 2023 and April 2023. A newly developed and validated self-reported questionnaire, based on the Health Belief Model (HBM) and previous research, was administered to a convenient sample of 134 adult participants diagnosed with diabetes. These participants sought care at primary healthcare clinics at King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs in Riyadh and Jeddah (MNGHA). The data was examined using statistical methods including descriptive analysis, ANOVA, Tukey's HSD (Honestly Significant Difference) Post Hoc tests, and Pearson's correlation coefficients.

RESULTS

The majority of participants expressed a willingness to assume the role of health educators for their family members (n = 117, 87.31%) and reported a high level of willingness and confidence, as indicated by self-efficacy scores ranging from 12.00 to 25.00, with a mean of 21.12 (SD = 2.76). Participants' willingness to be health educators exhibited positive correlations with their perceptions of diabetes severity and susceptibility (r = .433, p < .01), perceived benefits and barriers (r = .451, p < .01), cues to action (r = .520, p < .01), self-efficacy (r = .789, p < .01), and the total score of the questionnaire (r = .640, p < .01).

CONCLUSIONS

The majority of participants expressed their willingness to assume the role of health educators for their family members, and a significant portion reported confidence in their capacity to accomplish this objective. Healthcare providers should emphasize the importance of equipping patients with the skills and knowledge necessary to effectively convey health messages and serve as health educators within their communities. This expansion of the approach holds the potential to have a significant impact on public health strategies for diabetes prevention.

A Dangerous Curve: Impact of the COVID-19 Pandemic on Brace Treatment in Adolescent Idiopathic Scoliosis

STUDY DESIGN

Observational Cohort study.

OBJECTIVES

We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression.

METHODS

We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi2 were used for comparison.

RESULTS

152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5°±8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery.

CONCLUSION

The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates.

LEVEL OF EVIDENCE

III.

Promoting foot self-care in type 2 diabetes mellitus patients receiving hemodialysis based on the information-motivation-behavioral skills model

This study develops and verifies the use of the foot self-care behavioral model in patients with type 2 diabetes mellitus (T2DM) receiving hemodialysis (HD) based on the information-motivation-behavioral skills model. Data were collected between June and August 2021 from 156 outpatients with type 2 diabetes who were receiving regular HD. A structured questionnaire and electronic medical records were used to collect demographic and disease-related data along with Foot Care Knowledge Questionnaires, third version of Diabetes Attitude Scale, Multidimensional Scale of Perceived Social Support, Foot Care Confidence Scale, and Foot Self-care Behavior Scale. Age, diabetic foot care knowledge, social support, and foot care self-efficacy had a direct effect on foot self-care behavior. Foot care self-efficacy had a mediating effect on foot care knowledge, diabetes-related attitudes, social support, and foot self-care behavior. The information-motivation-behavioral skills model was suitable as a foot self-care behavioral model for patients with T2DM receiving HD. Additionally, these findings suggest that it is crucial to improve foot self-care behavior through increased foot care knowledge, diabetes-related attitudes, and social support, which could contribute to enhancing foot care self-efficacy.

Media exposure, trustworthiness of sources and the health information literacy knowledge gap: a study in China

Health information literacy (HIL), as an essential part of the wellbeing of citizens, is a crucial indicator used to measure a country's primary public health level. The present study collected 1051 samples in southern China to examine the factors predicting HIL. The results showed that males, those less educated, and older adults had lower HIL. Television exposure, unofficial Internet exposure, trust in government and trust in doctors and medical institutions were positively associated with HIL. In contrast, newspapers, radio exposure and trust in web celebrities were negatively associated with HIL. Official Internet media exposure helps to bridge the HIL knowledge gap generated by differences in education level, while trust in celebrities-especially web celebrities-could widen the HIL knowledge gap. This study extends the knowledge gap theory in health communication in the Chinese context and provides pathways for future health interventions.

Cervical cancer screening and vaccination: knowledge, awareness, and attitude of female staff in a Nigerian University

BACKGROUND

Poor knowledge and awareness of cervical cancer screening and vaccination are significant barriers to effective cervical cancer prevention in developing countries. Knowledge of cervical cancer and vaccination against cervical cancer remains low in Nigeria. The purpose of this study was to assess the knowledge, awareness, and attitude of female staff of Afe Babalola University towards cervical cancer screening and vaccinations.

METHODS

This study was a cross-sectional study conducted using a semi-structured questionnaire among female staff of Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria. The workers' knowledge and awareness were assessed using yes and no questions while the attitude was assessed using Likert scale questions. The workers' knowledge was ranked as good (≥ 50%) and poor (< 50%) while attitude was ranked as positive (≥ 50%) and negative (< 50%). The relationship between demographics, attitude and knowledge of cervical cancer screening and vaccination was carried out using the Chi-square test. Analyses were conducted using SPSS software version 20.

RESULTS

A total of 200 staff consented to participate in the study out of which 64% were married with mean age 32.81 ± 8.164 years. Majority (60.5%) of the participants knew the causes of cervical cancer while 7.5% strongly agreed that they do not see the need for cervical screening. Majority (63.5%) of the participants showed good knowledge while 46% had a positive attitude towards cervical cancer screening and vaccination.

CONCLUSIONS

The study participants showed good knowledge and awareness but poor attitude towards cervical cancer screening and vaccinations. Interventions and continuous education are needed to improve the population's attitude and eliminate misconceptions.

Community behavioral change and management of COVID-19 Pandemic: Evidence from Indonesia

Objectives

This study aims to investigate the effect of information and motivation on behavioral change related to the COVID-19 pandemic management in Indonesia. It also examines the role of behavioral skills in mediating the information-behavioral change relationship and the motivation-behavioral change relationship.

Method

This study employs the partial least squares structural equation modeling (PLS-SEM) to test the research hypotheses. Using the online survey method to collect data, 845 responses were obtained from several main islands of Indonesia.

Results

The results of the study show that information and motivation positively influence people's behavior changes. Behavioral skills mediate the influence of information and motivation on behavioral change. This study contributes to the development of the information-motivation-behavior model (IMB-Model). It also provides additional knowledge on pandemic management in the research setting of Indonesia as a country that has complex characteristics in terms of religion and belief, demography, culture, economy, and politics.

Conclusions

This study concludes that the success of Indonesia in dealing with the pandemic greatly depends on the success of changing the community behavior. Providing reliable and consistent information enhances people's motivation to build their behavioral skills. With increased behavioral skills, people have changed their behavior in fighting against COVID-19 by obeying health protocols, participating in vaccination programs, and practicing a healthier lifestyle.

Knowledge, attitudes and practice regarding environmental friendly disinfectants for household use among residents of China in the post-pandemic period

Background

A sharp rise in household consumption of disinfectants triggered by COVID-19 pandemic has generated tremendous environmental burden and risks of disinfectant emissions in the post-pandemic period. To address this emerging challenge, replacing highly hazardous disinfectants with more environmental friendly alternatives has been accepted as an inherently effective solution to environment issues posed by disinfectant emerging contaminants. However, no study has yet been done to explore the potential customers' attitudes and the market prospect of environmental friendly disinfectants until now.

Methods

This cross-sectional questionnaire-based survey was conducted from January to March, 2022, among resident volunteers in China, to explore the practices, knowledge and attitudes of the public regarding environmental friendly disinfectants for household use.

Results

Among a total of 1,861 Chinese residents finally included in the analyses, 18% agreed or strongly agreed that they paid special attention to the environmental certification label on the product, and only bought the environmental certified disinfectant products; 16% and 10% were using environmental friendly disinfectants for hand sanitization and environmental disinfection, respectively. The mean self-assessed and actual knowledge scores were 2.42 ± 1.74 and 2.12 ± 1.97, respectively, out of a total of 5. Participants having good practices of consuming environmental friendly disinfectants achieved higher knowledge scores. Residents' overall attitudes toward the development, consumption and application of environmental friendly disinfectants were very positive. "Possible conflict between disinfection effectiveness and environmental factor of disinfectants in a context of severe COVID-19 pandemic" was considered as the most important barrier jeopardizing the participants' usage intention for environmental friendly disinfectants.

Conclusions

These data suggested most residents of China had a positive attitude, poor knowledge and practices toward environmental friendly disinfectants. More should be done to enhance the residents' environmental knowledge levels about disinfectants, and to further develop and promote disinfectant products with both excellent disinfection activity and environmentally friendly attributes.

Practices, Knowledge, and Attitudes of Chinese University Students Toward Traditional Chinese Herbal Medicine for the Control of COVID-19

BACKGROUND

The application of traditional Chinese herbal medicine has been officially recommended and strongly promoted in China as an important complement to conventional prevention and treatment for COVID-19. Capturing the practices, knowledge and attitudes of young adult population toward using Chinese herbs for COVID-19 is important for understanding the future of Chinese herbal medicine over the coming decades.

METHODS

This cross-sectional questionnaire-based study was conducted from May to June, 2022, among 313 student volunteers in Wuhan University of Science and Technology, a provincial comprehensive university in China.

RESULTS

Results showed that only 18% of students had used Chinese herbs to prevent COVID-19. The main information sources were social media, the students' family members, relatives, friends, etc. as well as the healthcare professionals. However, most students only sometimes paid close attention to related reports and news articles in social media. Clear pharmacological and toxicological properties of herbs were considered by 43% students as the most important factor to promote their own application of Chinese herbs to fight COVID-19. The mean knowledge score was 1.64 out of 5. Students' overall attitudes toward application of Chinese herbal medicine to fight COVID-19 were very positive.

CONCLUSION

These data suggests most university young adults had a positive attitude but lack of practices and knowledge towards traditional Chinese herbal medicine for COVID-19 control.

Experience of nature and times of silence as a resource to cope with the COVID-19 pandemic and their effects on psychological wellbeing-Findings from a continuous cross-sectional survey in Germany

Background

The COVID-19 pandemic with its lockdowns affected social relations and mental health conditions of people worldwide. We aimed to analyze the relevance of nature and times of silence as resources to cope with the pandemic. Of interest were how experiences of nature and times of silence are related to the perception of wondering awe and gratitude and psychological wellbeing and how these have changed during the different phases of the pandemic. Finally, we asked whether Nature/Silence would mediate the link between Awe/Gratitude and wellbeing.

Methods

A cross-sectional survey with standardized questionnaires (i.e., PCQ, GrAw-7, BMLSS-10, WHO-5) enrolling participants during the different phases of the COVID-19 pandemic was conducted. The total sample of 5,155 participants from Germany consisted of 65% women and 34% men, with a mean age of 45.0 ± 14.0 years.

Results

Directly after the first lockdown, Nature/Silence and Awe/Gratitude scores were high and decreased along with wellbeing with the onset of the second lockdown in winter 2020, while perceived burden constantly increased. Nature/Silence was rated lowest by people with reduced wellbeing (eta2 = 0.058) and feeling lonely or socially isolated (eta2 = 0.042). Predictor analyses revealed that wellbeing as a dependent variable was predicted best by corona-related perception of burden, Awe/Gratitude, reflection of life, and Nature/Silence and further by perceived changes in terms of relationships and spirituality (R2 = 0.55). In mediation analyses, Awe/Gratitude proved to be a significant predictor for Nature/Silence (β = 0.55, p< 0.0001) and wellbeing (β = 0.05, p < 0.0001). The mediation analysis explained 37% of the variability in the data. The direct influence of Awe/Gratitude on wellbeing was estimated as β = 0.09 (p < 0.0001), and the mediation effect of Nature/Silence on the link between Awe/Gratitude and wellbeing was significant, too (β = 0.03, p < 0.0001), explaining 25% of the total effect.

Conclusion

Nature/Silence and Awe/Gratitude were used as relevant resources during the pandemic, although they cannot fully buffer the negative effects of the social restrictions that resulted in decreases in wellbeing and increases in perceived burden. Perception of nature as a sensitizer of positive experiences particularly during difficult phases of life could be trained to stabilize wellbeing and thus to contribute to public health.

Having a prevention regulatory focus longitudinally predicted distress and health‐protective behaviours during the COVID‐19 pandemic

People focussed on prevention (vs. promotion) are motivated by safety and are less inclined to take risks. We tested if having a prevention (vs. promotion) focus before the COVID-19 pandemic outbreak predicted threat perceptions and health outcomes throughout the pandemic. Participants (N = 161) took part in a longitudinal study. Measures were assessed before the pandemic was declared (on November 2019, T1) and after a global pandemic was declared (on June 2020, T2). Participants who were more focussed on prevention prior to the onset of the pandemic (at T1) perceived greater risk and were more worried about contracting COVID-19, and engaged in more preventive behaviours during the pandemic (at T2). They also reported less anxiety and felt healthier later on (at T2). Exploratory analyses revealed that enacting preventive behaviours helped people cope with pandemic-related anxiety. Being motivated by security and enacting preventive behaviours seems to have helped people reduce anxiety over risk even during the pandemic.

The role of risk perception, risk communication, and demographic factors in COVID-19 preventive behaviors: an online survey in Iran

Objectives

This study investigated preventive behaviors toward coronavirus disease 2019 (COVID-19) and related factors in a Kurdish Iranian sample.

Methods

This online survey was conducted among the population aged 18 and above in Kermanshah Province, in western Iran, in April 2020. Samples were invited and recruited through social media. Data were collected using a questionnaire consisting of 4 sections (questions on demographic variables, risk perception, risk communication, and COVID-19 preventive behaviors) and analyzed using Stata ver. 8.

Results

The Pearson correlation test showed that risk communication was significantly correlated with COVID-19 preventive behaviors (r=0.320, p<0.01). In the final model, where the explanatory power increased with the entry of the risk communication variable, the variables explained a total of 14% of variance in COVID-19 preventive behaviors. Sex (β=−0.482), risk perception (β=0.047), and risk communication (β=0.662) were significant determinants.

Conclusion

Risk communication and risk perception related to COVID-19, as well as being a woman, were determinants of COVID-19 preventive behaviors.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Influence factors analysis of COVID-19 Prevention behavior of chinese Citizens: a path analysis based on the hypothetical model

BACKGROUND

Under the outbreak of Coronavirus disease 2019 (COVID-19), a structural equation model was established to determine the causality of important factors that affect Chinese citizens' COVID-19 prevention behavior.

METHODS

The survey in Qingdao covered several communities in 10 districts and used the method of cluster random sampling. The research instrument used in this study is a self-compiled Chinese version of the questionnaire. Of the 1215 questionnaires, 1188 were included in our analysis. We use the rank sum test, which is a non-parametric test, to test the influence of citizens'basic sociodemographic variables on prevention behavior, and the rank correlation test to analyze the influencing factors of prevention behavior. IBM AMOS 24.0 was used for path analysis, including estimating regression coefficients and evaluating the statistical fits of the structural model, to further explore the causal relationships between variables.

RESULTS

The result showed that the score in the prevention behavior of all citizens is a median of 5 and a quartile spacing of 0.31. The final structural equation model showed that the external support for fighting the epidemic, the demand level of health information, the cognition of (COVID-19) and the negative emotions after the outbreak had direct effects on the COVID-19 prevention behavior, and that negative emotions and information needs served as mediating variables.

CONCLUSIONS

The study provided a basis for relevant departments to further adopt epidemic prevention and control strategies.

Dramatic increases in knowledge, attitudes and practices of COVID-19 observed among low-income households in the Philippines: A repeated cross-sectional study in 2020

Background

The COVID-19 pandemic has severely impacted populations globally, and knowledge, attitudes and practices (KAPs) surrounding the virus have necessarily evolved. This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization that runs the “Transform” poverty alleviation program. The main objective of this study was to describe the changes in COVID-19 KAPs among households experiencing extreme poverty in the Philippines over an 8-month period.

Methods

A KAP questionnaire was integrated into the household survey collected as part of ICM’s regular monitoring and evaluation of “Transform”. Data collection for the first survey was conducted between February 20 and March 13, 2020, and the second survey was conducted between November 12 and December 12, 2020. Frequencies and proportions were calculated to describe the respondents’ responses and the Kruskal-Wallis test was used to assess if there were significant differences in KAP identification between the two time points.

Results

We observed a distinct increase across all KAP domains. Over 90% of study participants were able to correctly identify COVID-19 transmission modes and preventive measures, and an even higher percentage reported adopting these measures. However, the intention to seek care from public hospitals for COVID-19 symptoms dropped from 43.6% to 28.4%, while reports of self-treatment using stored medicines or antibiotics increased. Trust in community members and local health authorities was correlated with higher knowledge and practice scores.

Conclusions

Our study results reflect the extraordinary speed of information dissemination and behaviour change globally over the course of the pandemic, but they also highlight the changes in KAP that show the additional challenges faced by populations experiencing poverty in the Philippines. Prioritization of reducing inequities in the implementation and adoption of the evolving public health measures will be integral as the pandemic continues.

Compliance with Standard Precaution and Its Relationship with Views on Infection Control and Prevention Policy among Chinese University Students during the COVID-19 Pandemic

Background: COVID-19 has placed tremendous pressure on the global public health system and has changed daily life. Aim: To examine the relationships between the perceived threat, perceived stress, coping responses and infection control practices towards the COVID-19 pandemic among university students in China. Methods: Using a cross-sectional survey, 4392 students were recruited from six universities in two regions of China. Methods: Data were collected via an online platform using self-reported questionnaires. Hierarchical multiple regression analyses were performed to predict the variables on COVID-19 infection control practices. Results: Pearson correlation coefficients showed a significant negative relationship between perceived stress and COVID-19 infection control practices. A significant positive relationship was observed between wishful thinking and empathetic responding, and infection control practices. Hierarchical multiple regression analyses revealed that gender, geographical location, perceived stress and emotion-focused and relationship-focused coping responses were predictors of COVID-19 infection control practices. Conclusions: The findings suggest that university students displayed moderate levels of stress, using wishful thinking and empathetic responses as coping strategies. Counselling services should therefore emphasise reassurance and empathy. Male university students tended to be less compliant with social distancing. Both counselling and public health measures should recognise the importance of gender differences. Nurses should integrate these findings into future health programme planning and interventions.

Psycho-behavioural factors influencing COVID-19 vaccine hesitancy among Korean adults: The moderating role of age

Aims

This study aimed to identify the psycho‐behavioural factors influencing coronavirus disease 2019 (COVID‐19) vaccine hesitancy among Korean adults. We examined the primary effects of eHealth literacy, social responsibility and self‐efficacy on COVID‐19 vaccine hesitancy using the information‐motivation‐behavioural skills (IMB) model. The moderating effect of age on the relationship between psycho‐behavioural factors and COVID‐19 vaccine hesitancy was also examined.

Design

The study used a cross‐sectional survey design.

Methods

An online survey was completed by 500 Korean adults (253 men and 247 women) aged 20–60 years. Data collection took place in May 2021. The constructed hypothetical model for eHealth literacy, social responsibility, self‐efficacy and age was evaluated using partial least squares structural equation modelling (PLS‐SEM).

Results

eHealth literacy, social responsibility and self‐efficacy had significant negative effects on COVID‐19 vaccine hesitancy. Age had a significant moderating effect on COVID‐19 vaccine hesitancy. The moderating effects of age on the relationship between eHealth literacy and COVID‐19 vaccine hesitancy and between social responsibility and COVID‐19 vaccine hesitancy enhanced the explanatory power by high effect size. The overall fitness of the hypothetical model was good. The standardized root mean square residual value was 0.007, which explained 18.5% of the COVID‐19 vaccine hesitancy.

Conclusion

To reduce COVID‐19 vaccine hesitancy among Korean adults, a strategic approach that considers age should be adopted to enhance eHealth literacy, social responsibility and self‐efficacy.

Impact

The findings of this study suggest that providing correct health information online related to the COVID‐19 vaccine is likely to be effective in decreasing COVID‐19 vaccine hesitancy in older individuals, whereas inspiring a sense of social responsibility is more likely to be effective in younger individuals. These strategic nursing interventions could contribute to improving COVID‐19 vaccination rates among Korean adults.

COVID-19 precautionary practices and associated factors among clients visiting a tertiary hospital, Addis Ababa, Ethiopia

Background

Despite efforts to contain the spread of COVID-19, Addis Ababa, the country’s COVID-19 epicenter, is experiencing a sharp increase in the number of cases and death rate. While poor public adherence to COVID-19 precautionary practices is evident, factors associated with it are not well studied. We aimed to assess the level of practice of COVID-19 precaution and associated factors.

Methods

This was a hospital-based cross-sectional study conducted from February 1^st to 15^th, 2021 at Saint Paul’s Hospital Millennium Medical College, a tertiary teaching hospital in Addis Ababa, Ethiopia. We used a structured questionnaire to conduct a face-to-face exit interview with clients visiting the hospital. Systematic random sampling was employed to recruit study participants. Binary and multivariable logistic regressions were implemented to examine factors associated with precautionary practices. Statistical significance was declared at p-value <0.05. The Crude odds ratio (COR) and Adjusted odds ratio (AOR) were reported with a 95% confidence interval.

Results

We analyzed data obtained from 262 participants. The mean age of participants was 36 (SD+12) years. The majority (207, 79%) of the study participants had a favorable attitude towards prevention and control measures of COVID-19. A little over half (116, 55.7%) of the respondents had a satisfactory level of practice of COVID-19 precautions. Living in an area with strict enforcement of COVID-19 precautionary measures [AOR: 2.25, 95% CI (1.22–4.15)], and having a favorable attitude of COVID-19 prevention [AOR: 4.88, 95% CI (2.08–11.68)] were significantly associated with satisfactory COVID-19 precautionary practices.

Conclusions

The level of practice of COVID-19 precaution was unsatisfactory. Favorable attitude and stricter enforcement of COVID-19 preventive measures might have contributed more to adherence to precautionary practices. The findings highlight the need for a public health education strategy targeted at improving attitudes of the community on COVID-19 focusing on the effectiveness of preventive measures.

What Prompted the Adoption of Self-Protective Behaviors in Response to COVID-19? Evidence From Women Living in the Rural Areas of Western China

Background

Self-protective behaviors, such as handwashing and mask-wearing, are effective to reduce the spread of coronavirus disease (COVID-19), but few studies have focused on women living in rural areas who bear the brunt of the impacts of the pandemic due to their economic and social vulnerabilities. This study explores what prompted the adoption of self-protective behaviors in response to COVID-19 among women living in rural areas of western China.

Methods

The study sample consisted of 1,524 women from 116 townships across 10 counties in rural western China. We collected data in May and August 2020 on women's socioeconomic characteristics, exposure to COVID-19-related information, psychological response to COVID-19, and adoption of self-protective behaviors. Structural equation modeling (SEM) analyses were conducted to analyze the relations among the variables.

Results

During the lockdown, 1,221 (80.12%) of the 1,524 women in the study sample reported wearing a mask every time when they went outside and 1,021 (66.99%) reported handwashing with soap every time after they came home. Perceived efficacy had the strongest association with self-protective behaviors (β = 0.38; p < 0.001). Receiving public health guidance (β = 0.18; p < 0.001) was indirectly associated with more self-protective behaviors via greater perceived efficacy. Higher socioeconomic status was also directly associated with increased adoption of self-protective behaviors (β = 0.24; p < 0.001). Other variables, such as receiving surveillance and risk information, communication channels, perceived risks, and fear, were indirectly associated with the adoption of self-protective behaviors with smaller effect sizes (all β were lower than 0.10).

Conclusions

Not all women were able to adopt self-protective behaviors, such as mask-wearing and handwashing, during the COVID-19 pandemic in western China. To further encourage behavioral changes in response to public health crises, the government should develop clear and actionable guidelines and adopt targeted health communication strategies to reach the most disadvantaged groups of society. These findings may inform tailored responses to COVID-19 in other low- and middle-income countries.

Antecedents of self-protective behavior during the COVID-19 pandemic in Bangladesh

CONTEXT

Self-protective behavior (SPB) plays a significant role in controlling the spread of infection of a pandemic like coronavirus disease (COVID-19). Little research has been conducted to examine critical factors influencing SPB, especially in a developing country like Bangladesh.

AIMS

This study aimed to develop and test a theoretical model based on the extended information-motivation-behavior (IMB) skills model to investigate factors associated with SPB among Bangladeshi people.

METHODS

An online, cross-sectional survey was conducted on Bangladesh citizens (18 years and older) from June 1 and July 31, 2020. A total of 459 responses were used to assess the proposed model's overall fit and test the hypothesized relationships among the model constructs.

STATISTICAL ANALYSIS USED

The data were analyzed using partial least squares structural equation modeling to identify relationships among model variables.

RESULTS

Health information-seeking behavior, health motivation, self-efficacy, and health consciousness (HC) (P < 0.05) had a significant impact on SPB among Bangladeshi people. The results identified the consequences of various degrees of HC on SPB in the COVID-19 outbreak.

CONCLUSIONS

This study confirms the IMB model's applicability for analyzing SPB among people in developing countries like Bangladesh. The findings of this study could guide policymakers to develop and implement targeted strategies to ensure timely and transparent information for motivating people to improve SPB during the COVID-19 and in case of a future outbreak of an epidemic.

Perception and preventive behavior during COVID-19 pandemic among urban residents in Banda Aceh, Indonesia: a cross-sectional study

BACKGROUND It is critical to evaluate the perception and preventive behavior of COVID-19 to formulate the optimal public health strategies for tackling the ongoing pandemic. This study aimed to enhance knowledge on the perception and preventive behavior toward COVID-19 among urban residents in Banda Aceh, Indonesia. METHODS A cross-sectional population-based survey was conducted from September to October 2020 using a structured questionnaire for the attendants of the six public health centers in Banda Aceh. Information about sociodemographic, perception, and preventive behavior toward COVID-19 were collected. The data were analyzed to find the association between the level of preventive behavior and covariates. RESULTS Among 1,067 respondents, 71.1% were female, 52.5% were aged between 40 and 60 years, 31.2% were university graduates, and >60% were unemployed with underlying diseases such as diabetes, hypertension, and cardiopulmonary diseases. The responses of each statement toward COVID-19 were varied. The multivariable model of covariates showed that females had good preventive behavior toward COVID-19 (adjusted OR: 1.849, 95% CI: 1.359–2.515). Urban residents in Banda Aceh with the underlying diseases had poor preventive behavior, while those with higher educational level and perception scores were more inclined to engage in good preventive behavior. CONCLUSIONS Most urban residents in Banda Aceh showed positive perception and propensity for adopting preventive measures. Health education is necessary for susceptible residents, such as males, less educated people, and people with underlying diseases. It should be stressed on specific practices and knowledge.

Adolescents' adoption of COVID-19 preventive measures during the first months of the pandemic: what led to early adoption?

INTRODUCTION

The objectives of this study were to explore the extent to which adolescents adopted COVID-19 preventive measures in the first few months of the pandemic and to understand their adoption by looking at interconnected adoption-related factors and determining the strength of these factors, particularly among subgroups not expected to be early adopters.

METHODS

Analyses focus on data collected during Spring 2020 from 29 eastern Quebec secondary schools that participated in the COMPASS study. Participants (n = 6052) self-reported their knowledge, perception of risk and preventive practices to do with the COVID-19 pandemic. Data were analyzed using structural equation models based on gender and anxiety level.

RESULTS

The majority of respondents reported adopting the recommended COVID-19 preventive measures. The results showed three paths leading to adolescents' adoption of these measures: pandemic knowledge; perception of risk related to COVID-19; and, in particular, discussions with relatives about preventive measures and what to do in case of infection.

CONCLUSIONS

While most of the adolescent participants in this study appeared to comply with COVID-19 preventive measures, factors such as discussions with relatives emerge as elements to foster in order to improve adolescents' adoption of preventive measures.

Risk Culture and COVID-19 Protective Behaviors: A Cross-Sectional Survey of Residents in China

The COVID-19 outbreak caused by the Severe Acute Respiratory Syndrome CoronaVirus type 2 (SARS-CoV-2) has spread across the world. However, our understanding of the public responses, in particular in adopting protective behaviors, has been limited. The current study aimed to determine the level of protective behaviors adopted by the residents in China and its association with their cultural attributes. A national cross-sectional online survey was conducted in mainland China from 4^th to 13^th August 2020. Protective behaviors were assessed as a summed score (ranging from 0 to 40) measured by ten items. The self-report tendency of study participants toward the four cultural attributes (individualism, egalitarianism, fatalism, hierarchy) was rated on a seven-point Likert scale. A total of 17651 respondents returned a valid questionnaire, representing 47.9% of those who accessed the online survey. Most (89.8%) respondents aged between 18 and 45 years in the age range of and 47.7% were male. High levels of protective behaviors (34.04 ± 5.78) were reported. The respondents had high scores in the cultural attributes of hierarchy (Median = 5) and egalitarianism (Median = 5), compared with low scores in individualism (Median = 1) and fatalism (Median = 1). High levels of protective behaviors were associated a higher tendency toward egalitarianism (AOR = 2.90, 95% CI 2.67–3.15) and hierarchy (AOR = 1.66, 95% CI 1.53–1.81) and a low tendency toward fatalism (AOR = 1.79, 95% CI 1.63–1.97) and individualism (AOR = 2.62, 95% CI 2.41–2.85). The cultural attributes explained 17.3% of the variations in the protective behavioral scores. In conclusion, the adoption of protective behaviors is associated a risk culture characterized by high levels of hierarchy and egalitarianism and low levels of individualism and fatalism. Government actions and communication strategies need to adapt to the cultural characteristics of their target audience.

Factors influencing job satisfaction among dentists during the new normal of the COVID-19 pandemic in Indonesia: A structural equation modeling approach

BACKGROUND

Dentistry is one of the highest risk occupations that face COVID-19, especially in countries that are severely affected by the pandemic, such as Indonesia.

OBJECTIVE

The purpose of the study was to determine factors influencing job satisfaction among dentists during the new normal of COVID-19 pandemic in Indonesia by utilizing the Structural Equation Modeling (SEM) approach.

METHODS

A total of 310 Indonesian dentists voluntary completed an online questionnaire, which contained 58 questions. Several latent variables such as perceived severity of COVID-19, staff cooperation and management commitment, personal protective equipment, job stress, working hours, income, and overall job satisfaction were analyzed simultaneously.

RESULTS

SEM revealed perceived severity of COVID-19 had significant effects on job stress (β:0.394, p = 0.025) and the utilization of personal protective equipment (β:0.757, p = 0.001). Subsequently, job stress (β:-0.286, p = 0.001), working hours (β:0.278, p = 0.018), income (β:0.273, p = 0.003), personal protective equipment (β:0.145, p = 0.038), and staff cooperation & management commitment (β:0.091, p = 0.002) were found to have significant effects on overall job satisfaction. In addition, management & staff cooperation was found to have a significant association with job stress reduction (β:-0.319, p = 0.003) which subsequently led to higher satisfaction.

CONCLUSIONS

The current study is one of the first that analyzed job satisfaction among dentists in Indonesia during the global COVID-19 pandemic. The integrated latent variables can be applied and extended to evaluate job satisfaction among dentists during the COVID-19 pandemic in other countries. Finally, this study contributed as a theoretical foundation for policymakers to enhance the job satisfaction of dentists during the COVID-19 pandemic.

Effect of Knowledge/Practice of COVID-19 Prevention Measures on Return-to-Work Concerns; Attitudes About the Efficacy of Traditional Chinese Medicine: Survey on Supermarket Staff in Huanggang, China

Objective: The objective of this study was to investigate how knowledge and practice of coronavirus disease 2019 (COVID-19) prevention measures affected concerns about returning to work among supermarket staff. Attitudes about the ability of traditional Chinese medicine (TCM) to prevent COVID-19 were also assessed.

Methods: A cross-sectional study was conducted in Huanggang, Hubei Province, China from April 23 to 25, 2020. Participants were invited to fill out an electronic questionnaire on their cell phones.

Results: The results showed that from 2,309 valid questionnaires, 61.5% of participants were concerned about resuming work. Major concerns included asymptomatic infection (85.01%) and employees gathering in the workplace (78.96%). Multivariate logistic regression indicated that the female gender, having school-aged children and pregnancy were risk factors for being concerned about resuming work, while good knowledge and practice of preventive measures were protective factors. Knowledge and practice of preventive measures were positively correlated. Among preventive measures, the highest percentage of participants knew about wearing masks and washing hands. Meanwhile, 65.8% of participants expressed confidence in the ability of TCM to prevent COVID-19, where 74 and 51.3% thought there was a need and a strong need, respectively, for preventive TCM-based products. Among them, 71.5% preferred oral granules. Regarding TCM as a COVID-19 preventative, most were interested in information about safety and efficacy.

Conclusion: These findings suggested that promoting knowledge and practices regarding COVID-19 prevention can help alleviate concerns about returning to work. Meanwhile, TCM can feasibly be accepted to diversify COVID-19 prevention methods.

Clinical Trial Registration:http://www.chictr.org.cn/, identifier: ChiCTR2000031955.

Health literacy predicts Covid-19 awareness and protective behaviours of university students

Background

Health literacy is expected to help individuals deal with the required infection control and knowledge to cope with the COVID‐19 pandemic.

Objectives

This study examined the impact of health literacy on Covid‐19 awareness and protective behaviours of university students in Pakistan.

Methods

An online questionnaire was used to collect data from students at three universities in Punjab. The approved questionnaire contained 12 statements related to HL, 21 items towards Covid‐19 awareness, and 11 statements related to protective behaviours, along with some demographic data. Data analysis used Pearson correlation and simple linear regression.

Results

Health literacy of university students positively predicted their Covid‐19 awareness and protective behaviours indicating that students with high health literacy were likely to be more aware of Covid‐19 and adopt health protective behaviours. There were gender and rural/urban differences.

Conclusions

The results demonstrated an urgent need for planning a needs‐based health literacy programme focusing specifically on Covid‐19 literacy in Pakistan. This research might help policy‐makers, NGOs, and health librarians devise suitable programme.

Adolescents' experiences of the information they received about the coronavirus (Covid-19) in Norway: a cross-sectional study

BACKGROUND

In the first months of the coronavirus (Covid-19) pandemic, many countries took radical prevention measures. Authorities had to communicate with the public regularly to explain and ensure compliance with these measures and promote safety. The information given by authorities was mainly developed for adults, but children and adolescents may have different needs when it comes to information. This study examined how adolescents perceived information about Covid-19 provided by the media and other sources, and about what topics adolescents reported they lacked information during the first months of the Covid-19 pandemic.

METHODS

Three hundred seventy-seven adolescents in 11th, 12th, and 13th grade in Norwegian upper secondary schools (67% girls) completed an online questionnaire. Analyses included descriptive statistics, in addition to Generalized Linear Mixed Models analyses to examine gender differences in adolescents' satisfaction with the information provided about Covid-19, to what extent the pandemic affected their everyday life, and to what extent they were concerned about becoming infected with Covid-19.

RESULTS

The results showed that the majority of adolescents used the internet as the main source of information about Covid-19, followed by (online) newspapers. About half (49%) reported that they were satisfied with the information available, while 39% were neither satisfied nor dissatisfied, and 12% were dissatisfied. Adolescents wanted more information about the school situation, as well as virus- and future-related topics. A total of 21% reported that they were concerned about becoming infected with Covid-19. There was no significant gender difference in overall satisfaction with the information provided about Covid-19. Girls reported being significantly more affected by the pandemic than boys, and that they were significantly more concerned than boys about becoming infected with Covid-19.

CONCLUSIONS

This survey provides important knowledge to professionals working with adolescents, as well as to authorities, about what information channels can be used to reach adolescents, and what information they lacked about the Covid-19 pandemic.

A survey of postpartum depression and health care needs among Chinese postpartum women during the pandemic of COVID-19

BACKGROUND

The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women.

AIM

To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic.

METHODS

In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis.

RESULTS

With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R² = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05).

CONCLUSIONS

Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25-34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.

Development and psychometric assessment of the public health emergency risk perception scale: Under the outbreak of COVID-19

OBJECTIVE

Correctly understanding and evaluating the level of public risk perception toward public health emergencies not only helps experts and decision-makers understand the public's preventative health behaviors to these emergencies but also enhances their risk information communication with the public. The aim of this study was to develop a risk perception scale for public health emergencies and test its validity and reliability during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Guided by the theoretical model of risk perception, an initial scale was generated through literature review, group meetings, resident interviews, and expert consultation. A pretest and item screening were then conducted to develop a formal risk perception scale for public health emergencies. Finally, the reliability and validity of the scale were validated through a questionnaire survey of 504 Chinese adults.

RESULTS

The final scale had 9 items. The content validity index of the scale was 0.968, and the content validity index of individual items ranged from 0.83 to 1.00. Three common factors, dread risk perception, severe risk perception, and unknown risk perception, were extracted for exploratory factor analysis, and together they explained 66.26% of the variance in the score. Confirmatory factor analysis showed that the model had a satisfactory fit, where χ 2/df = 1.384, the goodness-of-fit index (GFI) = 0.989, root mean square error of approximation (RMSEA) = 0.028, root mean square residual (RMR) = 0.018, comparative fit index (CFI) = 0.995, normed fit index (NFI) = 0.982, and non-normed fit index (NNFI) = 0.990. The correlations between dimensions ranged from 0.306 to 0.483 (P < 0.01). Cronbach's α was 0.793 for the total scale and ranged between 0.687 and 0.801 for the individual dimensions. The split-half coefficient was 0.861 for the total scale and ranged from 0.727 to 0.856 for induvial dimensions. The test-retest coefficient was 0.846 for the total scale and ranged from 0.843 to 0.868 for induvial dimensions.

CONCLUSION

The developed scale for the risk perception of public health emergencies showed acceptable levels of reliability and validity, suggesting that it is suitable for evaluating residents' risk perception of public health emergencies.

Factors affecting perceived effectiveness of COVID-19 prevention measures among Filipinos during Enhanced Community Quarantine in Luzon, Philippines: Integrating Protection Motivation Theory and extended Theory of Planned Behavior

OBJECTIVE

The current study integrated Protection Motivation Theory (PMT) and extended Theory of Planned Behavior (TPB) to evaluate factors affecting the perceived effectiveness of COVID-19 prevention measures among Filipinos during Enhanced Community Quarantine (ECQ) in Luzon, Philippines.

METHODS

A total of 649 Filipinos answered an online questionnaire, which contained 63 questions. Structural Equation Modeling (SEM) was utilized to derive the causal relationships of the latent variables construct.

RESULTS

SEM showed that understanding of COVID-19 had significant direct effects on perceived vulnerability and perceived severity. Also, perceived vulnerability and perceived severity had significant indirect effects on intention to follow. Intention to follow had significant direct effects on actual behavior and adapted behavior, which subsequently led to perceived effectiveness. Of note, an understanding of COVID-19 was found to have a significant indirect effect on perceived effectiveness.

CONCLUSIONS

The current study is one of the first studies to analyze factors affecting the perceived effectiveness of COVID-19 prevention measures during the global pandemic. It is proposed that the integrated PMT and extended TPB of this study can be applied and extended to evaluate the perceived effectiveness of COVID-19 measures in other countries that are currently dealing with COVID-19 pandemic.

Depression and Psychological-Behavioral Responses Among the General Public in China During the Early Stages of the COVID-19 Pandemic: Survey Study

Background

The COVID-19 pandemic has recently spread dramatically worldwide, raising considerable concerns and resulting in detrimental effects on the psychological health of people who are vulnerable to the disease. Therefore, assessment of depression in members of the general public and their psychological and behavioral responses is essential for the maintenance of health.

Objective

This study aimed to assess the prevalence of depression and the associated factors among the general public during the early stages of the COVID-19 pandemic in China.

Methods

A cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression.aA cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression.

Results

The prevalence of depression (PHQ-9 score ≥10) among the general public during the COVID-19 pandemic was 182/1342 (13.6%). Regression analysis indicated that feeling stressed, feeling helpless, persistently being worried even with support, never feeling clean after disinfecting, scrubbing hands and items repeatedly, hoarding food, medicine, or daily supplies, and being distracted from work or study were positively associated with depression, while social support and being calm were negatively associated with depression.

Conclusions

The general public suffered from high levels of depression during the early stages of the COVID-19 pandemic. Thus, COVID-19–related mood management and social support should be provided to attenuate depression in the general public.