Factors associated with preventive behaviors of COVID-19 among adolescents: Applying the health belief model

Information and health literacy policies during pandemics: A narrative review

BACKGROUND

The COVID-19 pandemic has compelled governments globally to formulate policies addressing the unique needs of their populations. These policies are critical in disseminating accurate information and enhancing health literacy during crises.

OBJECTIVE

This narrative review aims to identify and assess effective information and health literacy policies implemented during pandemics.

METHODS

A comprehensive literature search was performed across five electronic information sources (PubMed, Science Direct, ProQuest, Emerald Insight, Scopus), supplemented by Google Scholar. The analysis employed Walt and Gilson's health policy triangle framework to categorize and evaluate the findings.

RESULTS

The review revealed that the policies could be grouped into several key categories: educational programs, laws and regulations, knowledge sharing, national programs, and different information sources. The development of these policies involved multifaceted processes influenced by political, scientific, economic, cultural and social factors, as well as the involvement of multiple stakeholders.

CONCLUSIONS

This review offers significant insights and actionable recommendations for policymakers and stakeholders. By understanding the dimensions and components of effective information and health literacy policies, stakeholders can better prepare for and respond to future pandemics and similar health crises.

COVID-19 vaccination uptake in remote areas-Evidence from a panel survey in Bangladesh

BACKGROUND

Vaccination has proven to be an essential strategy in combating the COVID-19 pandemic. This study aims to discern the factors influencing both the intentions for and actual behavior regarding COVID-19 vaccination among remote, rural populations in Bangladesh.

METHODS

The study utilized panel survey data comprising 1,698 randomly selected household heads. These are predominantly illiterate, of Muslim religion, middle-aged, and male, with agriculture or day labor as primary income source. They reside in 36 locations distributed along the whole 250 km length of the Jamuna River in Bangladesh. Data collection occurred through face-to-face and telephone interviews conducted between September 2021 and October 2022. Descriptive statistics and Ordinary Least Squares regression models were employed to assess influence factors for COVID-19 vaccination intentions and uptake. The analyses considered the constructs of the Health Belief Model alongside sociodemographic characteristics such as gender, age, religion, education, and income source.

RESULTS

Survey respondents showed a notably high willingness to receive the COVID-19 vaccine promptly upon its availability. However, the effectiveness of the Health Belief Model in elucidating COVID-19 vaccination uptake was limited, except for its availability component. Older individuals, those with higher levels of education, and individuals employed in government or formal sector occupations were prompt in receiving the COVID-19 vaccine as it became available. Gender, religion, and the presence of dependents in the household did not exert a significant influence on vaccination uptake.

CONCLUSIONS

The results indicate that a strong willingness to receive the COVID-19 vaccine correlated with an increased likelihood of vaccine uptake once it was available. These findings suggest that a widespread distribution of COVID-19 vaccines to low-income and remote areas could have served as a vital strategy in mitigating the COVID-19 pandemic.

Structural equation modeling analysis of health belief model-based determinants of COVID-19 preventive behavior of academic staff: a cross-sectional study

INTRODUCTION

Despite COVID-19 being highly contagious and spreading to several countries, the university community has overlooked prevention measures. For more than five decades, the Health Belief Model (HBM) has been a widely used conceptual framework in health behavior. structural equation modeling(SEM) analysis is an advanced statistical method capable of rectifying failures of the basic models and showing complex relations Thus this study aimed to determine the magnitude of COVID-19 prevention behavior and identify its associated factors using HBM and SEM analysis.

METHOD

An institutional-based cross-sectional study was conducted among academic staff of the University of Gondar in Ethiopia from April 10 to May 10/2021. Daniel Soper's sample size calculator was used to determine the sample size. Proportional allocation to each campus followed by a simple random sampling technique was employed to select study subjects. A pre-tested, structured questionnaire was used to collect the data. Structural equation modeling analysis was employed to show the relationship between health belief model constructs and their effect on preventive behavior.

RESULT

A total of 602 academic staff participated. The magnitude of good COVID-19 preventive behavior was 24.8%. The HBM explained 55% of the variance in preventive behavior. Perceived barriers (β = -0.37, p < 0.05), self-efficacy (β = 0.32, p < 0.05), perceived susceptibility (β = 0.23, p < 0.05), and perceived benefit (β = 0.16, p < 0.05) were the direct significant predictors of COVID 19 prevention behavior.

CONCLUSION

only a quarter of the academic staff have good COVID-19 preventive behavior. The HBM explained a great amount of variance in preventive behavior and Perceived barriers, benefits, susceptibility, and self-efficacy significantly associated with prevention behavior. Carefully planned intervention that considers those significant perceptions should be designed and implemented to raise COVID-19 prevention behavior.

Factors affecting cancer screening perception in Turkish women: the role of health literacy

It is suggested that individuals with limited health literacy have less awareness about cancer and screening methods. However, there is a paucity of evidence regarding the relationship between cancer screening perception and health literacy levels among women. This study investigates the determinants of cancer screening perceptions in Turkish women, with a particular emphasis on the influence of health literacy. Employing a cross-sectional design, the study involved 428 women aged 18-69. Data were collected via online questionnaires. Hierarchical regression analysis was utilized to assess the effects of distinct variables on cancer screening perceptions. Exploratory and confirmatory factor analyses were employed to validate and ensure reliability. The results indicated that the constructed hierarchical regression model explicated around 10% of the variance in cancer screening perceptions. Among the various factors examined, health literacy emerged as the most potent predictor of screening perceptions. Individuals possessing higher health literacy demonstrated more favorable attitudes toward cancer screening. Additionally, age surfaced as another notable determinant, with advanced age correlating positively with awareness and receptiveness to screening. This research reveals the pivotal role of health literacy in shaping how Turkish women perceive cancer screening. While a few factors have an impact, the study highlights the urgent need to elevate health literacy levels to foster heightened awareness and engagement in cancer screening programs. The study's findings offer valuable guidance for devising targeted interventions to address disparities in cancer screening perception and participation, particularly among women in low- to middle-income countries such as Turkey.

Adding COVID to cancer: does cancer status influence COVID-19 infection preventive behaviors?

Introduction

A better understanding of how to promote disease mitigation and prevention behaviors among vulnerable populations, such as cancer survivors, is needed. This study aimed to determine patterns of and factors associated with COVID-19-related preventive behaviors among cancer survivors and assess whether the COVID-19 preventive behaviors of cancer survivors differ from the general population.

Methods

In June 2020, an online survey of adults (N = 897) assessed predictors of COVID-19-related preventive behaviors, including socio-demographics, COVID-19 beliefs and perceptions (Health Belief Model [HBM] variables), and cancer statuses (cancer survivors currently in treatment, cancer survivors not currently in treatment, and individuals with no history of cancer). An average score of respondent engagement in eight preventive behaviors was calculated. Differences in HBM variables and preventive behaviors by cancer status were assessed using ANCOVAs. Hierarchical multiple regression analyzed associations among socio-demographics, HBM constructs, cancer statuses, and engagement in COVID-19 preventive behaviors.

Results

Participants reported engaging in 3.5 (SD = 0.6) preventive behaviors. Cancer survivors not in treatment engaged in preventive behaviors significantly less than the comparison group. In the final adjusted model, after adding COVID-19 beliefs and perceptions, cancer status was no longer significant. All HBM constructs except perceived susceptibility were significant predictors of preventive behaviors.

Conclusions

COVID-19 beliefs and perceptions were more robust predictors preventive behaviors than cancer status. Nonetheless, public health organizations and practitioners should communicate the risk and severity of infection among cancer survivors and emphasize the need to engage in protective behaviors for COVID-19 and other infectious diseases with this vulnerable population.

Evaluation of Pregnant Woman's Perception of COVID-19 Based on the Health Belief Model in Isfahan

Background

Coronavirus Disease (COVID-19) is a viral disease that has become an international public health concern. Thus, the present study aimed to evaluate pregnant women's perception of COVID-19 based on the health belief model in Isfahan.

Materials and Methods

This cross-sectional study includes 100 pregnant women selected by random sampling. Data were collected using an online questionnaire on the Porsline website. This questionnaire examines the knowledge and structures of the health belief model, including perceived susceptibility and severity, perceived barriers and benefits, and self-efficacy regarding the prevention of COVID-19. Data were analyzed using analytical tests such as independent t-test and Pearson's correlation coefficient. The significance level was considered to be <0.05.

Results

The results showed that the knowledge of COVID-19 and preventative methods was at a reasonable level among most women (77%). Also, there was a significant correlation between education and self-efficacy. Based on the findings, the mean score of knowledge (F1,99 = 0.116, p = 0.04) and the mean score of perceived susceptibility (F1,99 = 0.02, p < 0.001) of mothers who were pregnant for the first time were significantly higher than mothers who were pregnant for the second time or more.

Conclusions

The perceived severity and susceptibility scores were higher than other constructs, indicating women's proper understanding of the risks of COVID-19. However, half of them stated that they do not go to receive services, and this issue can have adverse consequences. The researchers recommend planning to improve other model constructs, such as self-efficacy, for improving women's performance in receiving care.

Preventive behaviors of COVID-19 in the Iranian adult population during the pandemic: Integrated effect of the health belief model and the planned behavior intention using causal path analysis

Background

This study aimed to investigate the integration of the health belief model (HBM) and the theory of intention to plan preventive behavior for COVID-19 during the pandemic.

Methods

In a cross-sectional study, a sample of 480 adult participants from different outpatient clinics were recruited in the study. The participant responded by self-report; the health belief model (HBM) scale, preventive behavior scale, subjective norms scale, the intention of planned behavior scale, and perceived control behavior scale were measured. The hypothesized causal path models were examined using SEM analysis.

Results

The HBM had significant effects on perceived behavior control (β=0.60, P=0.001), the intended preventive behavior (β=0.32, P=0.001), and subjective norm (β=0.53, P=0.001). Subsequently, the intention of preventive behavior (β==0.39, P=0.001) and subjective norms (β=0.27, P=0.001) significantly affected the performance of preventive behaviors. The estimated fitting criteria showed that the hypothesized model fits relatively well.

Conclusion

The health belief model with the integration of subjective norms, perceived control behavior and mediation by the intention of planned behavior in a pathway relationship explains well the preventive behavior of COVID-19. The findings present a deeper understanding of how integrating HBM and intended planned behavior enhances people's preventive behavior against COVID-19.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Application of Protection Motivation Theory to COVID-19 vaccination among a predominantly Hispanic sample of adolescents

Despite the efficacy and widespread availability of COVID-19 vaccines, vaccine uptake has been relatively low in U.S. Hispanic communities, especially among adolescents. This study examined vaccination status among 444 high school students in predominantly Hispanic neighborhoods of Los Angeles County, California in May-June 2022 (mean age = 15.74 years, 55% female, 93% Hispanic). Guided by Protection Motivation Theory, we hypothesized that the odds of being fully vaccinated (at least 2 vaccine doses) would be significantly associated with higher levels of perceived severity, perceived vulnerability, response efficacy, and self-efficacy. 79% of the respondents were fully vaccinated. Binary logistic regression analyses found that response efficacy (belief in the effectiveness of the COVID-19 vaccine) and self-efficacy to get vaccinated were significantly associated with the likelihood of being fully vaccinated. Perceived severity of COVID-19 and perceived vulnerability to COVID-19 were not associated with the likelihood of being fully vaccinated. Results indicate that health communications are needed to convince Hispanic adolescents and their parents that the COVID-19 vaccine is effective, and outreach efforts are needed to remove barriers to vaccination among this population.

School Attendance Decisions for Children With Medical Complexity During COVID-19

OBJECTIVE

School attendance by children with medical complexity (CMC) may be influenced by parent perceptions of their child's risk for coronavirus disease 2019 (COVID-19). The authors of this study aimed to quantify in-person school attendance and identify attendance predictors.

METHODS

From June to August 2021, surveys were collected from English- and Spanish-speaking parents of children aged 5 to 17 years with ≥1 complex chronic condition who received care at an academic tertiary children's hospital in the Midwestern United States and who attended school prepandemic. The outcome, in-person attendance, was defined dichotomously as any in-person attendance versus none. We evaluated parent-perceived school attendance benefits, barriers, motivation, and cues, COVID-19 severity and susceptibility using survey items derived from the health belief model (HBM). Latent HBM constructs were estimated with exploratory factor analysis. Associations between the outcome and the HBM were evaluated with multivariable logistic regression and structural equation models.

RESULTS

Among 1330 families (response rate 45%), 19% of CMC were not attending in-person school. Few demographic and clinical variables predicted school attendance. In adjusted models, family-perceived barriers, motivation, and cues predicted in-person attendance, whereas benefits, susceptibility, and severity did not. The predicted probability (95% confidence interval) of attendance ranged from 80% (70% to 87%) for high perceived barriers to 99% (95% to 99%) for low perceived barriers. Younger age (P <.01) and previous COVID-19 infection (P = .02) also predicted school attendance.

CONCLUSIONS

Overall, 1 in 5 CMC did not attend school at the end of the 2020 to 2021 academic year. Family perceptions of schools' mitigation policies and encouragement of attendance may be promising avenues to address this disparity.

Determination of factors influencing young adults' intention to have COVID-19 vaccine in the Philippines: An integration of Health Belief Model and the Theory of Planned Behavior

Objectives

The COVID-19 pandemic continues to increase around the world and businesses and markets across the world significantly decreased. The purpose of this study was to determine the factors that affect the intention to be vaccinated for the COVID-19 vaccine among young Filipino adults by integrating the Health Belief Model and Extended Theory of Planned Behavior.

Study design

A cross-sectional study design was utilized.

Methods

Factors such as understanding of the COVID-19 vaccine, self-efficacy, cues to action, perceived barriers, perceived benefits, perceived side effects, perceived behavioral control, attitude, subjective norm, and intention to be vaccinated were analyzed by utilizing Structural Equation Modeling (SEM).

Results

With 865 young Filipino adults who answered a self-administered survey, it was seen that Understanding of the COVID-19 vaccine has the highest direct significant effect on cues to action, followed by perceived barriers, and perceived benefits. Interestingly, the primary factor was Understanding COVID-19 vaccines which had an indirect significant effect on the intention to get vaccinated. This is because knowing what the vaccine is for, its effects, and the application would lead to the acceptance of the COVID-19 vaccine. Moreover, the impact of being known to have the COVID-19 vaccine would lead to the intention to get vaccinated.

Conclusions

The findings of this study can be utilized especially by the government in developing strategies for encouraging people to take the COVID-19 vaccine. Finally, the model construct of the study can be applied to explore more factors that can affect the intention to be vaccinated with the COVID-19 vaccine and other vaccines people worldwide.

Exploring the Moderating Effect of Positive and Negative Word-of-Mouth on the Relationship between Health Belief Model and the Willingness to Receive COVID-19 Vaccine

This study indicates that the positive and negative effects of word-of-mouth (WOM) have an impact and moderating effect on vaccine uptake willingness, which is important to exploring the factors that affect vaccine uptake. We further analyzed the differences in the impact relationship between variables through questionnaire research. Based on the Health Belief Model (HBM) widely used to explore global health issues, this study focuses on Taiwanese residents and uses a questionnaire survey method. Furthermore, this study investigates the impact of various factors in the HBM on the willingness to receive the COVID-19 vaccine when faced with positive and negative word-of-mouth evaluations from the perspective of vaccine recipients, as well as whether WOM evaluations have an interference effect, along with the differences between variables. Practical recommendations are provided based on the research results, which can serve as a reference for future vaccine promotion programs and health promotion. By improving the national vaccination rate and achieving herd immunity, we aim to increase the persuasiveness of word-of-mouth on public healthcare decision-making. We also hope to provide a basis for health promotion and encourage people to make informed decisions about vaccination.

Observation of covid-19 safety protocols by persons with chronic health conditions in Ghana: The influence of health belief model

Covid-19 has brought distortion to health delivery globally and made it challenging to seek healthcare, but persons with chronic health conditions who require continuous medical attention have suffered the most as all attention at the medical front was directed to covid-19 related issues. The study explores how the five primary constructs of the health belief model were used to drive adherence to covid-19 preventive protocols among persons with chronic health conditions in Ghana. A quantitative technique was used for data collection and analyses. SPSS version 21 and AMOS version 21 were used to analyze data. Hierarchical regression from SPSS were used to examine the influences of health belief model constructs on chronic patients' adherence to covid-19 preventive protocols. The study's finding indicates that perceived susceptibility, severity, and self-efficacy influence adherence to covid-19 protocols among persons with chronic conditions. While perceived benefits and perceived barriers though they have negative and positive influences on adherence, they were not statistically significant. Perceived self-efficacy has a negative influence on the perceived barrier and a positive influence on perceived benefit. Gender has positive influence on Perceived susceptibility. The study's outcome indicated that persons with chronic health conditions need special arrangements to ease their access to healthcare during outbreaks. Hence, public health professionals need to educate chronic patients on how to practice the covid-19 preventive protocols and support them with covid-19 preventive materials to increase their self-efficacy to adhere to covid-19 protocols.

The relationships of perceived susceptibility, perceived severity, and subjective norms with COVID-19 preventive behaviors: a secondary data analysis comparing adolescents and emerging adults in South Korea

PURPOSE

Based on the health belief model and theory of planned behavior, this study investigated how age group (adolescence and emerging adulthood) moderated the relative effects of perceived susceptibility, perceived severity, and subjective norms on preventive behavior against coronavirus disease 2019 (COVID-19).

METHODS

This secondary data analysis utilized data from adolescents (n=272) and emerging adults (n=239). Hierarchical multiple regression analysis was performed to test the moderating effect of age group on the relationships among variables.

RESULTS

Higher perceived susceptibility (β=.21, p<.001), perceived severity (β=.14, p=.002), subjective norms (friends) (β=.26, p<.001), subjective norms (parents) (β=.44, p<.001), and subjective norms (schools) (β=.28, p<.001) enhanced COVID-19 preventive behaviors. Moderated regression analysis showed that subjective norms (friends and school) impacted preventive behavior in adolescents more than in emerging adults.

CONCLUSION

Given the need to increase perceived susceptibility and severity among adolescents and emerging adults, these findings provide baseline data for designing effective COVID-19 prevention interventions that consider the developmental characteristics of different age groups. Interventions by health centers at universities can strengthen COVID-19 preventive behavior among emerging adults. As adolescents are influenced by friends, their peer roles must be strengthened to enhance adherence to COVID-19 preventive guidelines.

Effects of Cognitive Appraisals on Perceived Self-Efficacy and Distress during the COVID-19 Lockdown: An Empirical Analysis Based on Structural Equation Modeling

During the COVID-19 lockdown, individuals and households had to responsibly manage the difficulties and problems caused by the restrictions on their mobility, such as the interruptions to work schedules, insecure food supplies, and the procurement of services and health care. The perceptions of risk as well as the fear of disease were strongly linked to worry, defined as a sequence of thoughts that evoke negative emotions and elevated levels of anxiety and distress. This study evaluated how different cognitive appraisals of an individual's sources of worry could influence their perceived self-efficacy and directly or indirectly moderate their perceived general distress. A sample of 544 participants completed a survey that included questions based on the generalized self-efficacy scale, the sources of concern during the epidemic, the cognitive appraisal scale in emergency, and perceived discomfort. Subsequently, a structural-equation-modeling (SEM) analysis was performed to test the moderating role of cognitive appraisals and perceived self-efficacy on participants' overall distress during a lockdown. Overall, the model reported acceptable fit values and confirmed the hypotheses of the study. An individual's worries activated either a dysfunctional threat appraisal, which prompted a fear-and-closure response that then increased their overall state of distress; or two other functional appraisals (i.e., adaptive or supportive) that contributed to significantly improving the individual's self-efficacy. Higher self-efficacy was shown to be associated with lower levels of perceived distress. For the purposes of prevention and distress containment, it would be appropriate to promote psycho-educational interventions that promote the adoption of appraisal strategies that are functional and beneficial for perceived self-efficacy.

Personal infection prevention behaviors and campaign to encourage travel during COVID-19: A cross-sectional study

Introduction

The Go To Travel campaign in Japan was launched to subsidize travel and accommodation costs for tourists through vouchers that could be used at domestic destinations. Infection prevention behavior can lead to refraining from travel owing to infection concerns; conversely, taking preventive action can promote travel. There is a lack of information about the association between infection prevention behaviors and desire to travel. During a pandemic of infection, there is the difficult challenge of balancing the promotion of infection prevention behavior with economic revitalization. Thus, we examined the relationship between personal infection prevention behaviors and using Go To Travel.

Methods

We conducted a cross-sectional study of 26,637 workers who responded to a large-scale questionnaire survey about COVID-19 in Japan. We built multilevel logistic regression models adjusted for confounders to assess the association between each personal infection prevention behavior and using Go To Travel. We analyzed the seven infection prevention behavior individually: wearing a mask when among other people; disinfecting hands with alcohol before going indoors; washing hands after using the toilet; gargling upon returning home; opening a window to ventilate a room; carrying an alcohol sanitizer; and disinfecting hands after touching objects outside.

Results

Among the 26,637 participants, 7,959 (30%) used Go To Travel. For "wearing a mask in the presence of others" and "washing hands after using the toilet," the majority of respondents answered "almost always: 86.5 and 85.6% respectively. Action "carrying alcohol disinfectant" was the least implemented, with 36.9% of respondents saying "almost never." Two of the seven preventive behaviors ("disinfecting hands with alcohol before going indoors" and "carrying alcohol disinfectant") were positively related to using Go To Travel, that is, the more of these actions they took, the more they used Go To Travel (p for trend <0.001).

Conclusions

To balance pandemic preparedness with economic preparedness, it is also necessary to promote travel when the infection situation is calm. However, since human mobility can be a factor that exacerbates the infection situation, it is necessary to promote more infection prevention behaviors among individuals. We confirmed that Go To Travel users were basically doing a good infection prevention behaviors, but they tended not to wash their hands after touching things or carry alcohol sanitizer. It is necessary to encourage these measures to be taken when traveling.

Vaccine hesitancy and the willingness to recommend the COVID-19 vaccine to children in a rural country on the United States-Mexico border

Introduction

As of October 26, 2022, only 9% of children in the United States aged 6 months to 4 years have received at least one dose of COVID-19 vaccine despite FDA approval since June 17, 2022. Rates are better yet still low for children aged 5 to 11 years as nearly 30% were fully vaccinated as of August 23, 2022. Vaccine hesitancy among adults is one of the major factors affecting low vaccine uptake rates in children against COVID-19, yet most studies examining vaccine hesitancy have targeted school-age and adolescent children.

Methods

With the aim of assessing the willingness to recommend the COVID-19 vaccination to children under 5 years compared to children 5 to 12 years of age, a county-wide survey was conducted between January 11 and March 7, 2022, among adults on the United States-Mexico border.

Results

Among the 765 responses, 72.5% were female and 42.3% were Latinx. The most significant factor associated with likelihood to recommend the COVID-19 vaccine to children less than 5 years and 5-12 years of age was adult vaccination status. Ordinal logistic regression also indicated that ethnicity, primary language, being a parent, previous COVID-19 infection, and concern about getting COVID-19 in the future were significantly associated with likelihood of COVID-19 vaccine recommendation to children < 5 years and 5-12 years old.

Discussion

This study found high consistency among respondents in their willingness to vaccinate children aged < 5 years compared with children aged 5-12 years. Our findings support public health strategies that target adult vaccinations as an avenue to improve childhood vaccinations for young children.

Application of behavioral change theory and models on COVID-19 preventive behaviors, worldwide: A systematic review

Objective:

This systematic review aimed to assess the global application of behavioral change theory and models on COVID-19 preventive behaviors.

Methods:

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Databases such as PubMed/MIDLINE, Web of Science, Scopus, EMB ASE, World Health Organization libraries, and Google Scholar were used to search all published articles in the area of application of behavioral change theory and model on COVID-19 preventive behavior until October 1, 2022. Studies published in another language other than English were excluded. Two independent reviewers did the article selection and quality check. A third reviewer asked if any disagreement were found.

Result:

Seventeen thousand four hundred thirty-six total articles were retrieved from all sources after the removal of duplicated articles and those not evaluating the outcome of interest were excluded. Finally, 82 articles done using behavioral change theory and model on COVID-19 preventive behaviors were included. The health belief model (HBM) and theory of planned behavior (TPB) were most commonly used in COVID-19 preventive behaviors. The constructs of most behavioral theories and models were significantly associated with COVID-19 preventive behaviors such as hand washing, face mask use, vaccine uptake, social isolation, self-quarantine, social distance, and use of sanitizers.

Conclusion:

This systematic review summarizes comprehensive evidence on the application of behavioral change theory and model on COVID-19 preventive behaviors globally. A total of seven behavioral change theories and models were included. The HBM and TPBs were most commonly used for COVID-19 preventive behaviors. Therefore, the application of behavioral change theory and models is recommended for developing behavioral change interventional strategies.

The predictors of COVID-19 preventive health behaviors among adolescents: the role of health belief model and health literacy

Aim

The present study aimed to evaluate the predictive role of the Health Belief Model (HBM) constructs and health literacy (HL) in shaping the coronavirus disease 2019 (COVID-19) preventive health behaviors (PHBs) among adolescents.

Methods

This cross-sectional study was conducted with 503 adolescent girls and boys, randomly selected via cluster sampling. For this purpose, the data were collected online through four research tools, including the demographic-clinical characteristics information questionnaire, the COVID-19 PHB Scale based on HBM, and the Health Literacy Scale for COVID-19. The data analysis was then performed by regression analysis along with the structural equation modeling (SEM), considering the significance level of 0.05.

Results

The regression analysis results demonstrated that following the one-unit increase in the values of self-efficacy and cues to action, the COVID-19 PHBs elevated by 0.063 and 0.078 units, respectively. In addition, the COVID-19 PHBs subsided by 0.018 with the rise in the value of perceived barriers (P < 0.001). According to the path analysis, the direct path from the COVID-19-related HL to the COVID-19 PHBs (B = 0.097, β = 0.087, 95% confidence interval [CI] = 0.005 to 0.189) was significant. Furthermore, the indirect path from the COVID-19-related HL to the COVID-19 PHBs through perceived susceptibility (B = 0.017, β = 0.015, 95% CI = 0.001 to 0.032), perceived barriers (B = 0.029, β = 0.026, 95% CI = 0.004 to 0.055), self-efficacy (B = 0.094, β = 0.084, 95% CI = 0.031 to 0.156), and cues to action (B = 0.153, β = 0.137, 95% CI = 0.092 to 0.215) was significant.

Conclusion

In keeping with the study results, it is essential to take some effective measures to boost the HBM constructs and HL among adolescents to improve their PHBs during pandemics such as COVID-19.

COVID-19 self-protective practices and associated factors among secondary school students in Jimma town, Jimma, Oromia, Southwest Ethiopia

Background

Since there is limited evidence regarding COVID-19 self-protective practices among school students, this study assessed COVID-19 self-protective practices and associated factors among secondary school students.

Methods

A school-based cross-sectional study was conducted in Jimma town, Oromia regional state, Southwest Ethiopia from 25 May 2021 to 10 June 2021. The total sample size was 634, and students were randomly selected from public and private secondary schools. A self-administered questionnaire was used for data collection. The data were entered into Epidata 3.1 and analyzed using SPSS 21.0 software. Descriptive statistics, such as proportion and mean, were computed to describe the findings. The composite index was computed for each dimension. A linear regression analysis was used to identify the predictors of self-protective practice. A local polynomial smoothing graph was done using Stata 12 software to visualize the relationship between a significant variable and an outcome variable.

Results

A total of 576 respondents participated in this study, which made a response rate of 90.85%. The mean score for overall knowledge was 31.40 (SD ±8.65). Knowledge about COVID-19 symptoms and preventive practices had a mean score of 23.93 and 45.96, respectively. The mean scores for perceived vulnerability, severity, benefits, barriers, self-efficacy, and school support were 26.37, 33.21, 43.13, 16.15, 33.38, and 25.45, respectively. The mean score for self-protective practice was 28.38 (SD ±11.04). As perceived benefit (AOR = 0.199, p = 0.000, 95% CI: 0.094-0.304), perceived school support (AOR = 0.125, p = 0.009, 95% CI: 0.032-0.218), and self-efficacy (AOR = 0.186, p = 0.000, 95% CI: 0.102-0.270) increased, COVID-19 self-protective practices also increased and vice versa. However, age (AOR = -0.873, p = 0.006, 95% CI = -1.495, -0.251), perceived vulnerability (AOR = -0.107, p = 0.021; 95% CI = -0.199, -0.016), and maternal educational status (no formal education) (AOR = -5.395, p = 0.000, 95% CI = -7.712 to 3.077) had negatively associated with self-protective practices.

Conclusion

COVID-19 self-protective practice is unsatisfactory. Perceived benefit, perceived school support, and self-efficacy are positively associated with it. However, students' age, perceived vulnerability, and maternal educational status (no formal education) were negatively associated with COVID-19 self-protective measures among secondary school students. The findings underscore that there is a need to conduct risk communications among students. Similarly, awareness creation intervention should target mothers with no formal education.

Factors Influencing Preventive Behaviors for COVID-19 in Undergraduate Nursing Students: A Cross-Sectional Descriptive Study

PURPOSE

This study aimed to determine how undergraduate nursing students' knowledge and health beliefs affected their COVID-19-related infection-prevention behaviors.

METHODS

This study used a descriptive survey. A total of 188 undergraduate nursing students from two universities in South Korea participated in this study. The data were collected from June 2020 to August 2020. Factors influencing infection-prevention behaviors were identified using multiple regression analysis.

RESULTS

The participants' mean knowledge level regarding COVID-19 was 84.05 ± 11.78 out of 100. The average health belief score was 2.80 ± 0.32 points out of 5. COVID-19-related preventive health behaviors were correlated with experiences of searching for COVID-19 information (r = .22, p < .01), perceived severity (r = .24, p < .01), perceived benefits (r = .29, p < .01), cues to action (r = .30, p < .01), knowledge (r = .27, p < .01), and perceived barriers (r = -.19, p < .05). Factors that significantly affected COVID-19-related preventive health behaviors were the participants' years of study, experiences regarding COVID-19 prevention education, perceived severity, perceived barriers, and cues to action.

CONCLUSION

COVID-19-related preventive health behaviors are promoted by increasing awareness about the disease and promoting COVID-19 education in nursing curriculums.

The effect of educational intervention based on the self-efficacy theory of high school students in adopting preventive behaviors of COVID-19

BACKGROUND

The COVID-19 pandemic has become a major problem for education systems. This study was conducted to investigate the effect of educational intervention based on the self-efficacy theory of high-school students in adopting preventive behaviors of COVID-19.

MATERIAL AND METHODS

This quasi-experimental study was performed on Hazrat Zahra and Shahed high-school students in Jahrom (southern Iran) in 2021. In total, 160 students (80 each in the intervention group and the control group) were selected by multistage random sampling. Data collection tools included a demographic information questionnaire and self-efficacy in adopting preventive behaviors from COVID-19 researcher-made questionnaire. Questionnaires were completed by all participants before and 3 months after the educational intervention. The educational intervention was performed for 6 weeks by using an educational program based on Bandura self-efficacy theory. The intervention was performed during 12 sessions of face-to-face training in the classroom (two 1-h sessions per week), distributing educational packages and sending educational videos through cyberspace. Data were analyzed using Chi-square test, independent t test, paired t test, and linear regression.

RESULTS

After the educational intervention, a significant difference was observed in the intervention group before and after the educational intervention (P = 0.018) and between the intervention and the control groups (P = 0.001) in the self-efficacy in adopting preventive behaviors from COVID-19 score. Also, the average self-efficacy score of students increased with an increase in parental education level and a history of COVID-19 in family members.

CONCLUSION

Educational intervention based on self-efficacy theory was shown as an effective method to improve students' self-efficacy in adopting preventive behaviors from COVID-19.

Association between the Health Belief Model, Exercise, and Nutrition Behaviors during the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has affected our nation's health further than the infection it causes. Physical activity levels and dietary intake have suffered while individuals grapple with the changes in behavior to reduce viral transmission. With unique nuances regarding the access to physical activity and nutrition during the pandemic, the constructs of Health Belief Model (HBM) may present themselves differently in nutrition and exercise behaviors compared to precautions implemented to reduce viral transmission studied in previous research. The purpose of this study was to investigate the extent of exercise and nutritional behavior change during the COVID-19 pandemic and explain the reason for and extent of this change using HBM constructs (perceived susceptibility, severity, benefit of action, and barriers to action).

METHODS

This study used a cross-sectional design to collect 206 surveys. This survey collected information on self-reported exercise and nutrition changes during the pandemic and self-reported levels of the HBM constructs.

RESULTS

Findings showed individuals with medium or high exercise behavior change had greater odds of increased HBM score than individuals with little to no exercise behavior change (OR = 1.117, 95% CI: 1.020-1.223, SE: 0.0464, p = 0.0175). There was no association between nutritional behavior change and HBM score (OR = 1.011, 95% CI: 0.895-1.142, p = 08646).

CONCLUSION

Individuals who reported a more drastic change in either exercise had greater odds of increased feelings of perceived susceptibility and severity related to COVID-19 and decreased perceived benefits and increased barriers to exercise. This relationship was not found regarding nutrition behavior change. These results encourage public health practitioners to understand how an individual's perceived feelings about a threat may affect exercise and nutritional behaviors.

Predictors of Influenza Vaccination among Chinese Middle School Students Based on the Health Belief Model: A Mixed-Methods Study

Influenza vaccination rates among Chinese middle school students are low. This study aims to explore the influencing factors of vaccination among middle school students and promote vaccination. We conducted a mixed-methods study, integrating a questionnaire survey among 9145 middle school students in four cities in China and semi-structured interviews with 35 middle school students to understand their attitudes and perceptions toward vaccination based on the Health Belief Model. We found the overall vaccination rate was 38.2% (3493/9145), with students in Beijing, boarding at school, or senior high school showing higher values than their counterparts (p < 0.05). Multiple logistic regression results showed that non-boarding (OR = 0.46, 95%CI: 0.42−0.51) and perceived barriers (OR = 0.97, 95%CI: 0.96−0.98) were unfavorable factors for influenza vaccination, whereas perceived susceptibility (OR = 1.07, 95%CI: 1.05−1.08), perceived benefits (OR = 1.02, 95%CI: 1.01−1.04), cues to action (OR = 1.08, 95%CI: 1.05−1.11), and self-efficacy (OR = 1.04, 95%CI: 1.02−1.07) were facilitators. Qualitative results indicated that positive health beliefs, school, and the home environment contribute to vaccination. In conclusion, the influenza vaccination rate among middle school students remains low. The concerns about the safety and potential side effects of vaccines are the main barriers to vaccination, underscoring the need for strengthening communication, education, and information among students and their teachers/parents.

COVID-19 Vaccination Acceptance in the Context of the Health Belief Model: Comparative Cross-Sectional Study in Punjab, Pakistan

One of the models that could be used to understand the adoption of vaccine uptake is the Health Belief Model (HBM). The aim of this study is to assess the role of HBM constructs and Perceived Health Status (PHS) on the vaccination status of individuals and to understand the role of socio-demographic variables on HBM scoring. A comparative cross-sectional telephone survey was conducted among 1325 vaccinated (60.0%) and non-vaccinated (40.0%) individuals aged 40 years and above in July 2021 in Punjab province, Pakistan. A higher level of education was the strongest predictor of positive HBM. All constructs of HBM, PHS and cues-to-action were significant predictors of COVID-19 vaccination uptake, with perceived benefits as the strongest predictor. In order to expand the vaccination coverage, double-pronged interventions utilizing both information and communication technology and human resources should be designed that address each barrier perceived by individuals and understandably communicate the benefits of COVID-19 vaccination to the broader population.

Support for mask use as a COVID-19 public health measure among a large sample of Canadian secondary school students

BACKGROUND

Youth voice has been largely absent from deliberations regarding public health measures intended to prevent SARS-CoV-2 transmission, despite being one of the populations most impacted by school-based policies. To inform public health strategies and messages, we examined the level of student support of mask use in public spaces and school mask requirements, as well as factors associated with students' perspectives.

METHODS

We used cross-sectional survey data from 42,767 adolescents attending 133 Canadian secondary schools that participated in the COMPASS study during the 2020/2021 school year. Multinomial regression models assessed support for i) wearing a mask in indoor public spaces and ii) schools requiring students to wear masks, in association with COVID-19 knowledge, concerns, and perceived risk.

RESULTS

Wearing masks in indoor public spaces was supported by 81.9% of students; 8.7% were unsupportive and 9.4% were neutral/undecided. School mask requirements were supported by 67.8%, with 23.1% neutral and 9.1% unsupportive. More females supported mask wearing in public spaces (83.9% vs. 79.1%) and school mask requirements (70.8% vs. 63.5%) than males. Students had increased odds of supporting mask use in public spaces and school mask requirements if they reported concerns about their own or their family's health, had discussions regarding ways to prevent infection, perceived COVID-19 to be a risk to young people, and knew that signs are not always present in COVID-19 cases and that masks prevent SARS-CoV-2 transmission if someone coughs.

CONCLUSIONS

During the year following the beginning of the pandemic, most students supported the required use of masks in schools and wearing masks in indoor public spaces. Improving knowledge around the effectiveness of masks appears likely to have the largest impact on mask support in adolescent populations among the factors studied.

Associations between Psychological Variables, Knowledge, Attitudes, Risk Perceptions and Health Behaviours towards COVID-19 among Adolescents

There is currently little scientific evidence available that allows us to understand patterns of knowledge, risk perception, attitudes, and behaviours among adolescents in relation to COVID-19. This study aims to analyse the relationship between knowledge about COVID-19, risk perception, and psychological variables and the adherence to preventive measures among the adolescent population. It is a descriptive cross-sectional study, which included adolescents between the ages of 12 and 18 (n = 354). The questionnaire was sent to several secondary schools chosen by convenience sampling and following a non-probabilistic snowball sampling. Descriptive, univariate, and multivariate analyses were carried out in order to determine whether knowledge about COVID-19, risk perception, tolerance of frustration, planning and decision-making, family functionality, self-efficacy, self-esteem, and social skills are related to preventive measures. The adoption among adolescents of behaviours which protect them against COVID-19 depends on knowledge about the disease, the perception of the risk it poses to them, as well as their tolerance of frustration and planning and decision-making abilities. The relationship between the individual variables among adolescents with the adoption of behaviours which protect them against COVID-19 has been confirmed. The development of intervention and communication strategies that take the psychosocial situation of adolescents into account will help to increase the adoption of protective health behaviours in the context of a pandemic.

The health belief model's ability to predict COVID-19 preventive behavior: A systematic review

Objective

The health belief model specifies that individuals' perceptions about particular behavior can predict the performance of respective behavior. So far, the model has been used to explain why people did not follow COVID-19 preventive behavior. Although we are using it, to our best knowledge, its predictive ability in COVID-19 preventive behavior is unexplored. So, this review aimed to assess the model's predictive ability and identify the most frequently related construct.

Method

A systematic review was conducted to examine the predictive ability of health belief model in COVID-19 preventive behavior using research done all over the world. Preferred reporting items for systematic review and meta-analysis guidelines were used. Comprehensive literature was searched using databases such as PubMed, Google scholar, and African Online Journal to retrieve related articles. Descriptive analyses such as the proportion of studies that better explained COVID-19 prevention behavior and the significance ratio of each construct of the model were made.

Result

Overall, 1552 articles were retrieved using a search strategy and finally 32 articles fulfilling the inclusion criteria undergo the review. We found that in the majority (87.5%) of the studies health belief model has a good predictive ability of COVID-19-related behavior. Overall the explained variance for health belief model ranged from 6.5% to 90.1%. The perceived benefit was the most frequently significant predictor; highest significance ratio (96.7%) followed by self-efficacy, cues to action perceived barrier, susceptibility, and severity in decreasing order.

Conclusion

Health belief model has a good predictive ability of COVID-19-related behavior in the majority of reviewed studies. The perceived benefit was the most frequently significant predictor of COVID-19-related behavior. Professionals who are in need can effectively use health belief model in planning and designing interventions to prevent and control the pandemic.

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

Background

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

Methods

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

Results

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

Conclusions

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

A systematic review and meta-analysis on the preventive behaviors in response to the COVID-19 pandemic among children and adolescents

Purpose

The purpose of this review was to synthesize the empirical evidence of relevant studies related to preventive behaviors in response to the COVID-19 pandemic among children and adolescents. Further to this, we aimed to identify the demographic, psychological, and social and environmental correlates of such behaviors.

Methods

Following PRISMA guidelines, eligible literature was identified by searching seven databases (PsycINFO, PubMed, MEDLINE, EMBASE, Cochrane Library, PROSPERO registry platform, and ClinicalTrials.gov website) and reference list of included studies and relevant review papers from 1^st Jan 2020 to 28^th Feb 2021. The standardized mean difference and correlation coefficients r were extracted to estimate the effect sizes. Analyses were conducted using R software.

Results

Of the 35,271 original papers, 23 eligible studies were included in the qualitative synthesis and all these studies were of moderate-to-high quality, of which 17 studies were further included into the quantitative analysis. Children and adolescents (6–20 yrs.) showed a poorer practice of COVID-19 preventive behaviors compared to younger adults (21–59 yrs.) with a small-to-medium effect size (SMD = -.25, 95%CI = -.41 to -.09). For the demographic correlates, children and adolescents’ COVID-19 preventive practice was found to be significantly associated with gender (r = .14, 95%CI = .10 to .18), while not with age (r = -.02, 95%CI = -.14 to .10). Narratively, knowledge was found to be consistently and significantly correlated. For the psychological correlates, small-to-medium overall effects were identified for the association with attitudes (r = .26, 95%CI = .21 to .31) and perceived severity (r = .16, 95%CI = .01 to .30). For the family and social correlates, a non-significant association was identified between family economic status and COVID-19 preventive behaviors (r = .004, 95%CI = -.12 to .12).

Conclusions

Interventions and relevant policies of promoting children and adolescent’s preventive measures should be a priority. Further, empirical studies identifying the demographic, psychological, and family and social correlates of children and adolescents’ preventive behaviors are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13585-z.

Unintended consequences of measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review

BACKGROUND

With the emergence of SARS-CoV-2 in late 2019, governments worldwide implemented a multitude of non-pharmaceutical interventions in order to control the spread of the virus. Most countries have implemented measures within the school setting in order to reopen schools or keep them open whilst aiming to contain the spread of SARS-CoV-2. For informed decision-making on implementation, adaptation, or suspension of such measures, it is not only crucial to evaluate their effectiveness with regard to SARS-CoV-2 transmission, but also to assess their unintended consequences.

OBJECTIVES

To comprehensively identify and map the evidence on the unintended health and societal consequences of school-based measures to prevent and control the spread of SARS-CoV-2. We aimed to generate a descriptive overview of the range of unintended (beneficial or harmful) consequences reported as well as the study designs that were employed to assess these outcomes. This review was designed to complement an existing Cochrane Review on the effectiveness of these measures by synthesising evidence on the implications of the broader system-level implications of school measures beyond their effects on SARS-CoV-2 transmission.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, four non-health databases, and two COVID-19 reference collections on 26 March 2021, together with reference checking, citation searching, and Google searches.

SELECTION CRITERIA

We included quantitative (including mathematical modelling), qualitative, and mixed-methods studies of any design that provided evidence on any unintended consequences of measures implemented in the school setting to contain the SARS-CoV-2 pandemic. Studies had to report on at least one unintended consequence, whether beneficial or harmful, of one or more relevant measures, as conceptualised in a logic model.  DATA COLLECTION AND ANALYSIS: We screened the titles/abstracts and subsequently full texts in duplicate, with any discrepancies between review authors resolved through discussion. One review author extracted data for all included studies, with a second review author reviewing the data extraction for accuracy. The evidence was summarised narratively and graphically across four prespecified intervention categories and six prespecified categories of unintended consequences; findings were described as deriving from quantitative, qualitative, or mixed-method studies.

MAIN RESULTS

Eighteen studies met our inclusion criteria. Of these, 13 used quantitative methods (3 experimental/quasi-experimental; 5 observational; 5 modelling); four used qualitative methods; and one used mixed methods. Studies looked at effects in different population groups, mainly in children and teachers. The identified interventions were assigned to four broad categories: 14 studies assessed measures to make contacts safer; four studies looked at measures to reduce contacts; six studies assessed surveillance and response measures; and one study examined multiple measures combined. Studies addressed a wide range of unintended consequences, most of them considered harmful. Eleven studies investigated educational consequences. Seven studies reported on psychosocial outcomes. Three studies each provided information on physical health and health behaviour outcomes beyond COVID-19 and environmental consequences. Two studies reported on socio-economic consequences, and no studies reported on equity and equality consequences.

AUTHORS' CONCLUSIONS

We identified a heterogeneous evidence base on unintended consequences of measures implemented in the school setting to prevent and control the spread of SARS-CoV-2, and summarised the available study data narratively and graphically. Primary research better focused on specific measures and various unintended outcomes is needed to fill knowledge gaps and give a broader picture of the diverse unintended consequences of school-based measures before a more thorough evidence synthesis is warranted. The most notable lack of evidence we found was regarding psychosocial, equity, and equality outcomes. We also found a lack of research on interventions that aim to reduce the opportunity for contacts. Additionally, study investigators should provide sufficient data on contextual factors and demographics in order to ensure analyses of such are feasible, thus assisting stakeholders in making appropriate, informed decisions for their specific circumstances.

Using the Health Belief Model to Predict Vaccination Intention Among COVID-19 Unvaccinated People in Thai Communities

Background

The coronavirus disease 2019 (COVID-19) pandemic has become one of the biggest challenges to individual health and the public health system worldwide. COVID-19 morbidity and mortality are increasing, impacting almost every country including Thailand. This study used the Health Belief Model (HBM) as a framework to examine the intention of unvaccinated people living in northern Thailand to receive COVID-19 vaccines.

Methods

This cross-sectional study was conducted during October and November 2021. A total of 1,024 participants who are currently living in four northern provinces of Thailand, Chiang Mai, Chiang Rai, Lamphun, and Phayao, were recruited to participate in the study. The questionnaire was developed using an HBM structure to obtain information about the perceived severity, perceived susceptibility, self-efficacy, perceived benefits and barriers, cues to action, and preventive behaviors relating to COVID-19 vaccination and the decision to become vaccinated. Multiple linear regression was used to analyze the data.

Results

The unvaccinated participants were an average of 44.45 ± 16.63 years of age and more than half were women (54.5%). The COVID-19 preventive behavior score used perceived severity (B = 0.26), self-efficacy (B = 0.51), perceived benefits and barriers (B = 0.11), and cues to action (B = 0.18) after adjusting for age, underlying disease, and body mass index (R² = 42.5%). The COVID-19 vaccination decision score was positively correlated with perceived severity (B = 0.13), perceived susceptibility (B = 0.25), perceived benefits and barriers (B = 0.21), and cues to action (B = 0.27) after adjusting for underlying disease (R² = 38.7%).

Discussion

The results demonstrated the usefulness of using the HBM structure to understand individual intention to receive a COVID-19 vaccine. Communities should consider a COVID-19 health campaign and programs that use the HBM model as a framework for altering perceptions and beliefs about the COVID-19 vaccine and improving vaccination rates among unvaccinated people in rural northern Thailand.

Internal and External Motivations and Risk Perception toward COVID-19 Vaccination in Adolescents in the U.S

The COVID-19 vaccine is widely available to adolescents in the U.S.; however, vaccine hesitancy poses a threat to full coverage. The literature shows that perceived risks and the presence or lack of motivators are determinants for vaccination decisions, yet research evidence from minors is scant. This study adopted the Protection Motivation framework to identify differences in these facilitators and compare the influence of internal and external motivators among American adolescents in COVID-19 vaccine uptake. A nationwide online survey analyzed 13−17-year-old teenagers’ COVID-19 beliefs as well as present or potential reasons for accepting the vaccine. Of the 439 participants, 21.18% were not and did not plan to get vaccinated. Another 52.39% had at least one dosage, of which over three-quarters were internally motivated (whereas those unvaccinated were more likely to be externally motivated, X2 = 4.117, p = 0.042). In unvaccinated individuals, older adolescents reported slightly more internal motivators than younger adolescents (t = −2.023, p = 0.046). Internal motivation was associated with higher risk perception (r2 = 0.06651, p = 0.001), but risk perception had a stronger relationship with vaccination status (r2 = 0.1816, p < 0.001), with vaccinated individuals showing higher risk perception than those unvaccinated (mean difference = 0.42 on a scale of 1−4; t = −3.603, p < 0.001); the risk perception difference was even greater between hesitant and non-hesitant participants (mean difference = 0.63; t = −0.892, p < 0.001). The relationship was moderated by perceived knowledge, where the difference in risk perception between vaccination status was only significant for those with low perceived knowledge (f = 10.59, p = 0.001). Increasing awareness of disease risks and stressing internal motivators may be key to improving uptake in young people. Future research could delve deeper into risk perception formation of adolescents and why and how it differs across populations.

Application of Health Belief Model for the assessment of COVID-19 preventive behavior and its determinants among students: A structural equation modeling analysis

BACKGROUND

COVID-19 is a new pandemic that poses a threat to people globally. In Ethiopia, where classrooms are limited, students are at higher risk for COVID-19 unless they take consistent preventative actions. However, there is a lack of evidence in the study area regarding student compliance with COVID-19 preventive behavior (CPB) and its predictors.

OBJECTIVE

This study aimed to assess CPB and its predictors among students based on the perspective of the Health Belief Model (HBM).

METHOD AND MATERIALS

A school-based cross-sectional survey was conducted from November to December 2020 to evaluate the determinants of CPB among high school students using a self-administered structured questionnaire. 370 participants were selected using stratified simple random sampling. Descriptive statistics were used to summarize data, and partial least squares structural equation modeling (PLS-SEM) analyses to evaluate the measurement and structural models proposed by the HBM and to identify associations between HBM variables. A T-value of > 1.96 with 95% CI and a P-value of < 0.05 were used to declare the statistical significance of path coefficients.

RESULT

A total of 370 students participated with a response rate of 92%. The median (interquartile range) age of the participants (51.9% females) was 18 (2) years. Only 97 (26.2%), 121 (32.7%), and 108 (29.2%) of the students had good practice in keeping physical distance, frequent hand washing, and facemask use respectively. The HBM explained 43% of the variance in CPB. Perceived barrier (β = - 0.15, p < 0.001) and self-efficacy (β = 0.51, p <0.001) were significant predictors of student compliance to CPB. Moreover, the measurement model demonstrated that the instrument had acceptable reliability and validity.

CONCLUSION AND RECOMMENDATIONS

COVID-19 prevention practice is quite low among students. HBM demonstrated adequate predictive utility in predicting CPBs among students, where perceived barriers and self-efficacy emerged as significant predictors of CPBs. According to the findings of this study, theory-based behavioral change interventions are urgently required for students to improve their prevention practice. Furthermore, these interventions will be effective if they are designed to remove barriers to CPBs and improve students' self-efficacy in taking preventive measures.

Testing the Effectiveness of the Health Belief Model in Predicting Preventive Behavior During the COVID-19 Pandemic: The Case of Romania and Italy

We use a cultural psychology approach to examine the relevance of the Health Belief Model (HBM) for predicting a variety of behaviors that had been recommended by health officials during the initial stages of the COVID-19 lockdown for containing the spread of the virus and not overburdening the health system in Europe. Our study is grounded in the assumption that health behavior is activated based on locally relevant perceptions of threats, susceptibility and benefits in engaging in protective behavior, which requires careful attention to how these perceptions might be structured and activated. We assess the validity of the HBM in two European countries that have been relatively understudied, using simultaneous measurements during acute periods of infection in Romania and Italy. An online questionnaire provided a total of (N = 1863) valid answers from both countries. First, to understand individual difference patterns within and across populations, we fit a General Linear Model in which endorsement was predicted by behavior, country, their interaction, and a random effect for participants. Second, we assess the effect of demographics and health beliefs on prevention behaviors by fitting a multi-group path model across countries, in which each behavior was predicted by the observed health belief variables and demographics. Health beliefs showed stronger relationships with the recommended behaviors than demographics. Confirming previously reported relationships, self-efficacy, perceived severity, and perceived benefits were consistently related to the greater adoption of individual behaviors, whereas greater perceived barriers were related to lower adoption of health behaviors. However, we also point to important location specific effects that suggest that local norms shape protective behavior in highly contextualized ways.

Knowledge, Attitudes, Risk Perceptions, and Practices of Spanish Adolescents Toward the COVID-19 Pandemic: Validation and Results of the Spanish Version of the Questionnaire

Background: Adolescence is a period with physical, psychological, biological, intellectual, and social changes in which there is usually little perception of risk. COVID-19 has generated constant situations of change and uncertainty worldwide. During the pandemic, the acquisition of preventive behaviors has been relevant. Various studies carried out with adults associate risk perception and the implementation of preventive behaviors with knowledge about the COVID-19 and with age, but there are not many studies with adolescents. Therefore, the objective is to validate, in Spanish, the questionnaire of the knowledge, attitudes, risk perceptions, and practices of adolescents toward the pandemic, and analyze it according to sociodemographic characteristics.

Method: This study was a descriptive cross-sectional study, which included adolescents between the ages of 12–18 (n = 354). First, a translation and a back-translation of the questionnaire were performed. The questionnaire was presented in several high schools chosen by convenience sampling and following a non-probabilistic snowball sampling. Reliability and validity analyses were then carried out and the relationships between the different sociodemographic variables (gender, place of residence, level of education, if the person was in a sentimental relationship, and financial aid) were analyzed.

Results: The reliability of the questionnaire is acceptable (ordinal alpha = 77%). Knowledge was higher in women, and in those with a higher level of education; and were lower in those who lived in smaller towns, as well as in those who had a member of their family receiving financial aid. In terms of attitudes and risk perceptions, younger adolescents had higher scores, and those who had a member of their family receiving financial aid, lower.

Conclusion: The questionnaire is a reliable tool in the Spanish adolescent population. Knowledge was influenced by gender, place of residence, level of education, and financial aid. Attitudes and risk perceptions were influenced by age and financial aid. For practices, no predictors were found. In general, adolescents scored lower on knowledge about COVID-19, but they scored higher on COVID-19 safety practices.

A multi-method analytical approach to predicting young adults' intention to invest in mHealth during the COVID-19 pandemic

Mobile-based health (mHealth) systems are proving to be a popular alternative to the traditional visits to healthcare providers. They can also be useful and effective in fighting the spread of infectious diseases, such as the COVID-19 pandemic. Even though young adults are the most prevalent mHealth user group, the relevant literature has overlooked their intention to invest in and use mHealth services. This study aims to investigate the predictors that influence young adults' intention to invest in mHealth (IINmH), particularly during the COVID-19 crisis, by designing a research methodology that incorporates both the health belief model (HBM) and the expectation-confirmation model (ECM). As an expansion of the integrated HBM-ECM model, this study proposes two additional predictors: mobile Internet speed and mobile Internet cost. A multi-method analytical approach, including partial least squares structural equation modelling (PLS-SEM), fuzzy-set qualitative comparative analysis (fsQCA), and machine learning (ML), was utilised together with a sample dataset of 558 respondents. The dataset-about young adults in Bangladesh with an experience of using mHealth-was obtained through a structured questionnaire to examine the complex causal relationships of the integrated model. The findings from PLS-SEM indicate that value-for-money, mobile Internet cost, health motivation, and confirmation of services all have a substantial impact on young adults' IINmH during the COVID-19 pandemic. At the same time, the fsQCA results indicate that a combination of predictors, instead of any individual predictor, had a significant impact on predicting IINmH. Among ML methods, the XGBoost classifier outperformed other classifiers in predicting the IINmH, which was then used to perform sensitivity analysis to determine the relevance of features. We expect this multi-method analytical approach to make a significant contribution to the mHealth domain as well as the broad information systems literature.

Face Mask Use Among Commercial Drivers During the COVID-19 Pandemic in Accra, Ghana

The paper contributes to unravelling the perceptions of urban commercial drivers regarding their vulnerability to catching the SARS-CoV-2 virus while at work. It further examines how the perception of vulnerability influences personal use of face masks by drivers, as well as on their insistence on appropriate masking behaviour by other persons on-board public transport. Overcrowding and unsanitary conditions in informal public transport in Africa could facilitate the spread of the corona virus. However, the use of face masks, among other enhanced mitigation measures significantly contain and minimize the spread of the virus. Primary data, obtained through surveys at five major public transport terminals in Accra, was analysed and interpreted using the Health Belief Model as an explanatory framework. Results indicate that most drivers have a high vulnerability perception to Covid-19. It further emerged that older drivers, in particular, consistently wore face masks and insisted on other persons in their commercial vehicles to follow suit. Socio-demographic factors, and the need to ensure one's personal safety and those of loved ones were critical determinants of face mask use among surveyed drivers. The study thus recommends that public awareness campaigns should strategically focus attention on the younger generation of drivers (i.e. 18-39 years) who perceived themselves to be immune to the SARS-CoV-2 virus. Also, the collaborative efforts of state and non-state actors, like the transport operator unions, must be further strengthened if the gains made so far against Covid-19 is to be sustained.

Predicting Public Adherence to COVID-19 Preventive Measures: A Cross-Sectional Study in Hong Kong

Objectives: To effectively control the spread of COVID-19, the public's adherence to relevant disease preventive measures (DPM) is critical. This study examined individuals' adherence to various DPM and identified facilitators and barriers to adherence in a community sample in Hong Kong. Methods: In this cross-sectional study, telephone surveys were conducted over December 2020 and January 2021. Participants provided responses on their adherence to DPM as well as other psychosocial and cognitive factors via the phone. Results: Of the sample of 1255 Chinese adults (aged >18 years, 53% women), 94.4% wore face masks in public areas; 88.4% avoided touching their eyes, nose, and mouth; 82.1% performed hand hygiene practices; 81.5% used alcohol-based hand rubs; 74.6% abided by social distancing; and 39.7% tested for COVID-19 on a voluntary basis. Perceived benefits, perceived barriers, self-efficacy, cues to action, perceived acceptability, and disruptions to daily life related to COVID-19 were associated with individuals' adherence to DPM. Conclusions: Adherence to DPM was strong in Hong Kong, and the adherence level could be predicted by various factors. It is vital to consider these factors in order to improve the public's adherence.

Factors related to preventive COVID-19 behaviors using health belief model among general population: a cross-sectional study in Iran

BACKGROUND

Coronavirus disease (COVID-19) pandemic has become one of the biggest challenges to global health and economy. The present study aimed to explore the factors related to preventive health behaviors during the COVID-19 pandemic in Khuzestan Province, South of Iran, using the Health Belief Model (HBM).

METHODS

The present cross-sectional study was conducted in the period between July 2020 and September 2020. A total of 1090 people from Khuzestan province participated in the study. The data collection method included a multistage cluster sampling method with a random selection of provincial of health centers. The questionnaire collected socio-demographic information and HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and COVID-19 preventive behaviors). Data were analyzed using ANOVA, t-test, hierarchical multiple linear regression, and SPSS version 22.

RESULTS

The mean age of the participants was 35.53 ± 11.53, more than half of them were female (61.6%) and married (65.3). The results showed that 27% of the variance in the COVID-19 preventive behaviors was explained by HBM constructs. The regression analysis indicated that female gender (β = 0.11), perceived benefits (β = 0.10), perceived barriers (β = - 0.18), external cues to action (β = 0.25), and internal cues to action (β = 0.12) were significantly associated with COVID-19 preventive behaviors (p < 0.05).

CONCLUSION

Designing an educational intervention on the basis of HBM might be considered as a framework for the correction of beliefs and adherence to COVID-19 behavior. Health information campaigns need to (1) emphasize the benefits of preventive behaviors including avoiding the likelihood of getting a chronic disease and complications of the disease, (2) highlight the tips and advice to overcome the barriers (3) provide cues to action by means of showing various reminders in social media (4) focusing on adoption of COVID-19-related preventive behaviors, especially among men.

Health Belief Associated with Adherence to Health Protocol in Preventing Coronavirus Diseases on Patients’ Family

BACKGROUND: Adherence with health protocols during the Coronavirus disease (COVID-19) pandemic is very important to prevent transmission. However, it is obtained that adherence with health protocols is still not optimal. The hospital environment is an area that is at high risk of transmission. AIM: The purpose of this study is to analyze the relationship between health belief and adherence with the health protocol in the patient’s family. METHODS: Quantitative research is correlated with a cross-sectional approach. The sample is the family of patients at the hospital, which was taken with simple random sampling technique as many as 100 people. Research variables include perceived susceptibility, perceived severity, perceived benefits, perceived barrier, self-efficacy, and adherence with health protocols. Data collection was using questionnaire instruments. Data analysis was using Fisher test with a significance level of 95%. RESULTS AND DISCUSSION: Fisher’s test results obtained data that there is a relationship between health belief in the dimensions of perceived susceptibility (p = 0.007), perceived severity (p = 0.027), perceived benefits (p = 0.003), perceived barriers (p = 0.021), and self-efficacy (p = 0.002) with adherence with health protocols in an effort to prevent the transmission of COVID-19. The patient’s family will be willing to implement health protocols if they have a high health belief in efforts to prevent the transmission of COVID-19. This health belief includes the belief that COVID-19 disease is easily contagious and serious; adherence will provide benefits for health. CONCLUSION: Health beliefs are significantly related to adherence with health protocols in the prevention of COVID-19 transmission in the patient’s family.

Adherence to preventive behaviors among college students during COVID-19 pandemic in China: The role of health beliefs and COVID-19 stressors

Before herd immunity is reached, preventive practices still play an important role in controlling the COVID-19 pandemic. Adherence to preventive behaviors could be determined by individuals' health beliefs, which would be influenced by antecedent factors such as previous exposure to pandemic stressors. Applying the health belief model (HBM), this study aims to examine the mediation association among COVID-19 stressors, HBM constructs, and preventive behaviors. Longitudinal data were collected from 1225 Chinese college students using web-based surveys at wave 1 (w1; between January 31 and February 11, 2020) and wave 2 (w2; between March 20 and April 3, 2020). Participants reported their COVID-19 stressors (w1), five HBM constructs (w2), and preventive behaviors (w1 and w2). Paired t-tests suggested that social distancing and self-quarantine behaviors decreased while precautionary behaviors increased from w1 to w2. Path analysis indicated that two HBM constructs (perceived barriers and self-efficacy) mediated the association between COVID-19 stressors and precautionary behaviors. These findings suggested that tailored prevention intervention for college students should attend to perceived barriers and self-efficacy. Individuals who exposed to multiple pandemic stressors merit particular attention and intervention should account for their early pandemic stress experiences.

The Moderating Effects of Perceived Severity on the Generational Gap in Preventive Behaviors during the COVID-19 Pandemic in the U.S

During the COVID-19 pandemic, older adults appear to be more susceptible to the coronavirus disease. Although the health stakes are higher for older adults, individuals of all ages should adopt preventive measures to contain the human-to-human transmission of the virus. This study conducted a national online survey of 1843 adults at the early stage of the COVID-19 pandemic in the U.S. to examine age disparities in preventive behaviors against the virus. The results show that older generations, motivated by a higher perceived severity of the disease, were more likely to take the precautionary actions recommended by the U.S. Centers for Disease Control and Prevention (CDC) than younger generations. This thus suggests that persuasive health messages addressing the severity of COVID-19 might reduce the generational gap and promote preventive behaviors among young people, to protect themselves and the elderly.