Applying social norms interventions to increase adherence to COVID-19 prevention and control guidelines

Analyzing the use of non-pharmaceutical personal protective measures through self-interest and social optimum for the control of an emerging disease

Non-pharmaceutical personal protective (NPP) measures such as face masks use, and hand and respiratory hygiene can be effective measures for mitigating the spread of aerosol/airborne diseases, such as COVID-19, in the absence of vaccination or treatment. However, the usage of such measures is constrained by their inherent perceived cost and effectiveness for reducing transmission risk. To understand the complex interaction of disease dynamics and individuals decision whether to adopt NPP or not, we incorporate evolutionary game theory into an epidemic model such as COVID-19. To compare how self-interested NPP use differs from social optimum, we also investigated optional control from a central planner's perspective. We use Pontryagin's maximum principle to identify the population-level NPP uptake that minimizes disease incidence by incurring the minimum costs. The evolutionary behavior model shows that NPP uptake increases at lower perceived costs of NPP, higher transmission risk, shorter duration of NPP use, higher effectiveness of NPP, and shorter duration of disease-induced immunity. Though social optimum NPP usage is generally more effective in reducing disease incidence than self-interested usage, our analysis identifies conditions under which both strategies get closer. Our model provides new insights for public health in mitigating a disease outbreak through NPP.

Looking beyond vaccines: Cultural tightness-looseness moderates the relationship between immunization coverage and disease prevention vigilance

Advancements in vaccination technologies mitigate disease transmission risks but may inadvertently suppress the behavioral immune system, an evolved disease avoidance mechanism. Applying behavioral immune system theory and utilizing robust big data analytics, we examined associations between rising vaccination coverage and government policies, public mobility, and online information seeking regarding disease precautions. We tested whether cultural tightness-looseness moderates the relationship between mass immunization and disease prevention vigilance. Comprehensive time series analyses were conducted using American data (Study 1) and international data (Study 2), employing transfer function modeling, cross-correlation function analysis, and meta-regression analysis. Across both the US and global analyses, as vaccination rates rose over time, government COVID-19 restrictions significantly relaxed, community mobility increased, and online searches for prevention information declined. The relationship between higher vaccination rates and lower disease prevention vigilance was stronger in culturally looser contexts. Results provide initial evidence that mass immunization may be associated with attenuated sensitivity and enhanced flexibility of disease avoidance psychology and actions. However, cultural tightness-looseness significantly moderates this relationship, with tighter cultures displaying sustained vigilance amidst immunization upticks. These findings offer valuable perspectives to inform nuanced policymaking and public health strategies that balance prudent precautions against undue alarm when expanding vaccine coverage worldwide.

Factors associated with intention of HIV testing among Asian American men: a path analysis

Research has pointed to myriad cultural and socio-psychological factors associated with HIV testing, such as acculturation, social norms about HIV testing, masculinity, homonegativity, and constructs from the Theory of Planned Behavior. However, the interrelationships of these factors on the intentions of HIV testing among the population of Asian American men remains unknown. A dataset of 425 Asian American men in the U.S., collected online with convenience sampling method during 2020-2021, was analyzed to test a conceptual framework that aimed to fill this gap. Results from a path model with two endogenous variables (homonegativity and HIV testing intention) indicated that perceived social norms about HIV testing, attitude about HIV testing, and perceived HIV risk had directandindirect relationships with the intentions of HIV testing in the study population. However, social norms about HIV testing and perceived HIV risk showed stronger direct effects (standardized estimates = 0.37 and 0.34, respectively, p-value < 0.001). Additionally, we found that the relationships of these factors with HIV testing intention were also mediated by homonegativity. Findings from this study advance our understanding of pathways of associations between a host of cultural and socio-psychological factors with HIV testing intention among an understudied population - Asian American men. Our results will help inform the development of future intervention programs to increase HIV testing in this population.

Closing the Gap: How Psychological Distance Influences Willingness to Engage in Risky COVID Behavior

Pandemics, and other risk-related contexts, require dynamic changes in behavior as situations develop. Human behavior is influenced by both explicit (cognitive) and implicit (intuitive) factors. In this study, we used psychological distance as a lens to understand what influences our decision-making with regard to risk in the context of COVID-19. This study was based on the rationale that our relational needs are more concrete to us than the risk of the virus. First, we explored the impact of social-psychological distance on participants' risk perceptions and behavioral willingness. As hypothesized, we found that close social relationships of agents promoted willingness to engage in risky behavior. In the second phase, we tested an intervention designed to increase the concreteness of information about virus transmission as a mechanism to mitigate the bias of social influence. We found that the concreteness intervention resulted in significantly reduced willingness to engage in risky behavior. As such, communications aimed at changing the behavior of citizens during times of increased risk or danger should consider conceptually concrete messaging when communicating complex risk, and hence may provide a valuable tool in promoting health-related behavior.

Compliance with COVID-19 Physical Distancing Mandates in Oman: The Role of Health Literacy and Internal Health Locus of Control

BACKGROUND

Research indicates that the effectiveness of coronavirus disease 2019 (COVID-19) physical distancing mandates is influenced by several individual factors, including health literacy; internal health locus of control (IHLOC), the belief that physical distancing can reduce COVID-19 risk; social norms; self-efficacy; and perceptions of the benefits and barriers associated with distancing. However, further investigation is needed to understand the links between these factors and compliance intentions.

OBJECTIVE

This study investigates the mechanism linking these factors with the intentions to comply with physical distancing mandates.

METHODS

A total of 759 participants (Mean age = 29.13, standard deviation [SD] = 8.33; 68.5% women) were surveyed online from September 2020 to October 2020. Data were analyzed using ANOVA (analysis of variance) and structural equation modeling.

KEY RESULTS

Health literacy was associated with more perceived benefits (β = .175, p = .001), greater self-efficacy (β = .193, p < .001), and less perceived barriers (β = -.391, p < .001). IHLOC was significantly associated with greater perceived benefits (β = .156, p = .007) and self-efficacy (β = .294, p < .001). Family descriptive norms were significantly associated with fewer perceived barriers (β = -.276, p < .001), while injunctive norms were associated with more perceived benefits (β = .202, p = .001) and higher self-efficacy (β = .299, p < .001). Intentions to adhere to physical distancing mandates were significantly associated with past compliance (β = .427, p < .001) and perceived barriers (β = -.205, p < .001) and benefits (β = .295, p < .001). Post-hoc mediation analyses revealed several small yet significant indirect effects, highlighting the complex pathways shaping adherence intentions.

CONCLUSIONS

This study identifies how health literacy, IHLOC, social norms, perceived benefits and barriers, and self-efficacy intricately shape intentions to comply with physical distancing mandates. These findings offer valuable implications for public health policy and interventions. [HLRP: Health Literacy Research and Practice. 2024;8(2):e69-e78.].

Political Party Collective Norms, Perceived Norms, and Mask Wearing Behavior: A Test of the Theory of Normative Social Behavior

The theory of normative social behavior (TNSB) postulates that people are influenced by others' behaviors, which they observe from messages and experience. In addition to focusing on perceived (i.e., descriptive and injunctive) norms, the TNSB was expanded to include collective norms, which represent what people actually do. Testing this expanded theoretical model, the current study examined whether two types of collective norms - collective political norms and collective regional norms - interacted with descriptive norms to influence pandemic mask wearing behavior expectations among U.S. adults (N = 444). The interaction was statistically significant for collective political norms (β = -.74, p = .009) but not collective regional norms (β = -.16, p = .85). Specifically, descriptive norms were related to increased mask wearing expectation for all values of political party collective norms, but the effects were stronger when political party collective norms were low (i.e., low mask wearing behavior was normative). The findings support the inclusion of collective norms in the TNSB, clarify the relationships among different types of norms, and provide insights for norms-based interventions.

Predicting the use of a COVID-19 contact tracing application: A study across two points of measurements

Contact tracing mobile applications (apps) were important in combating the COVID-19 pandemic. Most previous studies predicting contact tracing app use were cross-sectional and not theory-based. This study aimed at contributing to a better understanding of app use intentions and app use by applying an extended version of the protection motivation theory across two measurement points while accounting for the development of the pandemic. A total of N = 1525 participants from Switzerland (Mage = 53.70, SD = 18.73; 47% female; n = 270 completed both assessments) reported on risk perceptions, response efficacy, self-efficacy, social norms, trust in government, trust in the healthcare system, active search of COVID-19-related information, intentions for and actual (self-reported) app use. Analyses included country-specific incidences and death toll. Increases in response-efficacy, self-efficacy, trust in government, and the active search of COVID-19-related information predicted increased app-use intentions. Increases in self-efficacy, intentions, and the active search of COVID-19-related information predicted increased self-reported app use. Risk perceptions, incidence, and death toll were unrelated to both outcomes. Across an aggravation of the pandemic situation, intentions for and app use were primarily related to response-efficacy, self-efficacy, trust in government, and the active search of COVID-19-related information.

Predicting adherence to COVID-19 preventive measures among South Korean adults aged 40 to 69 Years using the expanded health empowerment model

The public health environment in South Korea is advancing toward the late stages of the COVID-19 pandemic. However, there is limited knowledge about the extent of individuals' compliance with preventive measures during this transitional period and the potential predictors that determine such compliance behaviors. In this study, we employed the expanded health empowerment model to investigate factors associated with COVID-19 preventive behaviors among Korean adults in late 2022. Our theoretical framework integrates the knowledge-attitude-behavior model with the health belief model to conceptualize health empowerment underlying the formation of preventive behaviors. We collected data from 1100 Korean adults aged 40-69 years through an online survey conducted in October 2022. Participants responded to questions about their knowledge of COVID-19, attitudes towards the disease, adherence to preventive measures, infection history, and sociodemographic characteristics. Structural equation modeling was employed to assess the relationships between knowledge, attitudes, and preventive behaviors related to COVID-19. Results showed that attitudes toward the disease predict adherence to preventive behaviors. We also found that COVID-19 knowledge partially determined the attitudes toward the disease. However, COVID-19 knowledge was not directly associated with adherence to preventive behaviors. Additionally, the associations between knowledge, attitudes, and preventive behaviors did not differ between infected and never-infected individuals. Overall, this study finds empirical support for the expanded health empowerment model, which connects knowledge to preventive behaviors through positive attitudes toward the disease, while underscoring the limited role of infection history in this association. These findings can help policymakers understand individual responses to public health guidelines in the late pandemic era and develop policies to mitigate further transmission of COVID-19.

Why People Stayed Home During the COVID-19 Pandemic: Implications for Health Communication Across Four Countries

Staying at home substantially reduces the spread of COVID-19. Moreover, understanding why people stayed at home by addressing its social cognitive determinants can help create more effective communication to change behaviors. This study analyzed this outcome through an extended model of the theory of planned behavior based on risk perception and personal norms in four countries: the United States, Japan, Brazil, and Taiwan. 1,196 individuals participated in this study through a questionnaire focused on planned behavior, moral norms, and risk perception. The data showed that intention and perceived behavioral control influenced behavior significantly, while attitude, injunctive norms, perceived behavioral control, personal norms, and risk perception influenced intention. With multigroup analysis and ANOVA, we verified significant differences in the estimates and mean scores across cultures, revealing the need for scholars to analyze outcomes based on geography and local political culture. Given that health communications played a key role in managing the pandemic, this study clarifies the social cognitive determinants of staying at home and how the local political culture can impact their influence. Thus, we provide an evidence-based prescription for focused communications.

Linking Cultural Tightness, Components of Norm Activation and COVID-19 Preventive Behaviors among University Students: Evidence from Beijing, China

The ongoing COVID-19 pandemic has imposed greater challenges and more stringent requirements on higher education institutions (HEIs). However, limited empirical research has been devoted to identifying external and internal factors that may promote individual preventive behaviors during the COVID-19 pandemic within the higher education context. This study proposed and examined an extended norm activation model (NAM) concerning the relationships among cultural tightness, original NAM components, and COVID-19 preventive behaviors. An online survey was conducted with a sample of 3693 university students from 18 universities in Beijing, China. The results showed that cultural tightness was positively associated with respondents' COVID-19 preventive behaviors. Three original NAM variables, namely, awareness of consequences, the ascription of responsibility, and personal norms, played a chain mediating role in the relationship between cultural tightness and COVID-19 preventive behaviors. Theoretical and practical implications regarding the findings of this study and suggestions for future research are discussed.

Co-occurrence of urban heat and the COVID-19: Impacts, drivers, methods, and implications for the post-pandemic era

Cities, the main place of human settlements, are under various mega challenges such as climate change, population increase, economic growth, urbanization, and pandemic diseases, and such challenges are mostly interlinked. Urban heat, due to heatwaves and heat islands, is the combined effect of climate change and urbanization. The COVID-19 is found to be a critical intervention of urban heat. However, the interrelationship between COVID-19 and urban heat has not been fully understood, constraining urban planning and design actions for improving the resilience to the dual impacts of heat and the pandemic. To close this research gap, this paper conducted a review on the co-occurrence of urban heat and the COVID-19 pandemic for a better understanding of their synergies, conflicts or trade-offs. The research involves a systematic review of urban temperature anomalies, variations in air pollutant concentrations, unbalanced energy development, and thermal health risks during the pandemic lockdown. In addition, this paper further explored data sources and analytical methods adopted to screen and identify the interventions of COVID-19 to urban heat. Overall, this paper is of significance for understanding the impact of COVID-19 on urban heat and provides a reference for coping with urban heat and the pandemic simultaneously. The world is witnessing the co-existence of heat and the pandemic, even in the post-pandemic era. This study can enlighten city managers, planners, the public, and researchers to collaborate for constructing a robust and resilient urban system for dealing with more than one challenges.

Descriptive, injunctive, or the synergy of both? Experimenting normative information on behavioral changes under the COVID-19 pandemic

Backgrounds

The effectiveness of citizens' behavioral changes to prevent the spread of SARS-CoV-2, such as avoiding large social events, relies on science communication from policymakers and collective action among peer citizens. Extant studies recognize the potential effects of information stimuli on citizens' behavioral changes, including what epidemiological experts request (injunctive information) and what surrounding people behave (descriptive information). Yet, they have insufficiently assessed the co-occurrence and possible interaction of multiple information stimuli.

Methods

1,819 Japanese citizens aged 18 or over were recruited for an experimental survey during March 1-3, 2021 and asked their views on a hypothetical wedding attendance in Japan while being exposed to randomly assigned normative information stimuli. Their willingness to attend a wedding asked before and after the intervention was measured. Infection risk perception was also asked as a mediating variable.

Results

Findings suggest the constant supremacy of descriptive information and no synergistic effects in the interaction of multiple information stimuli. We also report that the effects of injunctive and descriptive information vary according to participants' risk perception, age, and trust in experts.

Conclusion

Our experimental test enables a systematic assessment of multiple normative information and confirms the primacy of descriptive information as the main driver of behavioral change. Communication by medical experts has limitations but is still effective in specific categories of the population.

A longitudinal study of vaccine hesitancy attitudes and social influence as predictors of COVID-19 vaccine uptake in the US

Background

In many countries with high levels of COVID-19 vaccine access, uptake remains a major issue. We examined prospective predictors of COVID-19 vaccine uptake in a United States longitudinal study.

Methods

An online longitudinal study on COVID-19 and well-being assessed vaccine hesitancy attitudes, social norms, and uptake among 444 respondents who had completed both survey waves in March and June 2021.

Results

The mean sample age was 41, with 55% female, 71% white, 13% Black, and 6% Latinx. In March 2021, 14% had received at least one COVID-19 vaccine dose. By June 2021, 64% reported receiving at least one dose. In prospectively assessing predictors of vaccine uptake, we found strong correlations among five different vaccine hesitancy questions. In multivariable logistic regression models, family and friends discouraging vaccination (adjusted odds ratios [aOR] = .26, 95% CI = .07, .98), not knowing whom to believe about vaccine safety (aOR = .51, 95% CI = .27, .95), and concerns that shortcuts were taken with vaccine development (aOR = .43, 95% CI = .23, .81) were all independent predictors of lower vaccine uptake. Political conservatism, gender, education, and income were also independent predictors of reduced uptake. Vaccine hesitancy items were also modeled as a scale, and the scale was found to be strongly predictive of vaccine uptake.

Conclusions

The findings highlight the importance of social norm interventions and suggest general and specific vaccine hesitancy attitudes, especially trust, should be considered in developing vaccine uptake programs.

The Companion Pandemic to COVID-19: The Use of Informal Practices to Access Public Healthcare Services in the European Union

Objectives: The objective of this paper is to evaluate the use of informal payments and personal connections to gain preferential access to public health services during the COVID-19 pandemic and to propose effective policy measures for tackling this phenomenon.

Methods: Using data from 25,744 patients in the European Union, six different scenarios are analyzed in relation to making informal payments and/or relying on personal connections to access public healthcare services. To evaluate the propensity to engage in informal practices in healthcare, probit regressions with sample selection and predicted probabilities are used. Robustness checks are also performed to test the reliability of the findings.

Results: For each scenario, a statistically significant association is revealed between the propensity to make informal payments and/or rely on personal connections and the asymmetry between the formal rules and the patients’ personal norms and trust in public authorities.

Conclusion: To tackle informal practices in healthcare, policy measures are required to reduce the asymmetry between the formal rules and personal norms by raising trust in public authorities.

COVID-19 messages in sponsored social media posts: The positive impact of influencer-brand fit and prior parasocial interaction

This study explores the dissemination potential of a COVID-19 message embedded in a sponsored social media post. The moderating role of prior parasocial interaction and influencer-brand fit were considered. 365 respondents participated in the study. A 3 (control, congruent, incongruent brand) × 2 (control, COVID-19 message) between-subject online experiment was designed and executed. Data were analyzed using a mediated moderation model. Results indicated that the three-way interaction of the COVID-19 message, brand presence and prior parasocial interaction affected the perceived influencer credibility, attitudes towards the social media post, and the behavioral engagement with the post. When the COVID-19 message was included in the post, increased prior parasocial interaction intensified the positive effect of influencer-brand fit on influencer credibility, which in turn resulted in a more positive attitude towards the post, and a higher behavioral engagement. Theoretical and practical implications were discussed.

Understanding Health Information Behaviors of Migrant Domestic Workers during the COVID-19 Pandemic

Migrant domestic workers (MDWs) in Hong Kong remain vulnerable during the COVID-19 pandemic. Obtaining accurate information is essential for MDWs as it helps them understand their predicament and protect themselves. Therefore, this study delves into the MDWs' health literacy by scrutinizing how they acquire, verify, and respond to pandemic-related information. Semi-structured interviews were conducted with 32 Indonesian MDWs, recruited through purposive and snowball sampling. The data were examined using a constant comparative approach in grounded theory. The findings reveal that the participants engaged in information seeking and scanning to obtain health crisis information, mainly through their friends, family members, and community organizations. The participants also verified the information using their judgment or by consulting other actors, such as local organizations and media outlets. The messages they obtained informed the means to protect themselves, which motivated them to adopt preventive measures. However, some also engaged in maladaptive coping, such as taking ineffective preventive actions. The participants also disseminated health crisis information throughout their social circle. This study concluded that MDWs performed four health information behaviors during the pandemic, namely information acquisition, authentication, sharing, and adoption of preventive measures. However, their information practices may change at different stages of the pandemic.

Determinants of observing health protocols related to preventing COVID-19 in adult women: A qualitative study in Iran

Background

The best way to prevent COVID-19 is to observe health protocols. Therefore, identifying the reasons of following these protocols in order to plan and make intervention seems necessary. Therefore, the purpose of this study was to identify the determinants of observing health protocols related to prevention of COVID-19 among the Iranian adult women with a qualitative approach.

Method

In this qualitative study, the conventional content analysis approach was used. saturation was obtained after face-to-face semi-structured interviews with 38 women from Kermanshah who were selected through purposeful sampling and snowball sampling. Guba and Lincoln criteria were used for the strength of the research and Graneheim and Lundman method was used for its analysis.

Results

After analyzing the interviews, 5 categories, 12 subcategories and 110 initial codes were obtained. Categories and sub-categories were: 1- Individual factors (personality traits, health literacy about COVID-19); 2- Perceived risk having underlying disease in oneself and family, history of getting COVID-19 and death in close relatives; 3- Fear of the destructive consequences of the disease (concern about the economic consequences of getting the disease, concern about the treatment process); 4- Social and cultural factors (social monitoring, religious insight, ability to properly manage social interactions, impressionability from important others); 5- Environmental factors (supportive living environment, access to health and anti-infective materials).

Conclusion

Increasing the adherence of adult women to health instructions related to COVID-19 requires interventions at different levels of individual, environmental and social, and without accurate knowledge of the customs and culture of a society effective interventions cannot be established.

Escaping the Reality of the Pandemic: The Role of Hopelessness and Dissociation in COVID-19 Denialism

Background: Denialism of coronavirus disease 2019 (COVID-19) severely affected governments’ attempts to contain the spread of the virus. Indeed, groups of deniers showed scepticism and misinformation toward the causes of the virus, leading to less adherence to official guidelines and vaccination campaigns. The present study aimed to investigate the sociodemographic and psychological factors associated with COVID-19 denialism, expressed in the forms of scepticism, nonadherence to guidelines, and negative attitudes toward vaccination. Methods: Four hundred and sixty-one volunteers completed an online survey composed of the Beck Hopelessness Scale, the Dissociative Experiences Scale-II, the Sense of Community Index, and a questionnaire about COVID-19 denialism. Results: The multiple regression analyses showed that higher age and a lower level of education were positive predictors of COVID-19 denialism. Furthermore, the structural equation model showed that hopelessness positively predicted dissociation and negatively predicted the sense of community. In turn, only dissociation was found to positively predict COVID-19 denialism. Conclusions: The findings of the present study suggested that hopelessness could exacerbate a defensive dissociative response that could be associated with greater COVID-19 denialism. Moreover, older and less educated people showed a greater propensity to engage in COVID-19 denialism.

Predictors of COVID-19 Vaccine Intention: Evidence from Chile, Mexico, and Colombia

(1) Background: Although the evidence is consistent that vaccines for COVID-19 effectively prevent severe illness or death, the rapid development of vaccines has led to increased beliefs about possible negative consequences and conspiracy theories about the vaccine. Several factors influence whether or not people decide to be vaccinated. Some studies suggest that our perception of what significant others do and think influences our behavior. (2) Methods: This study evaluates the predictive role of beliefs about negative consequences of the COVID-19 vaccine, conspiracy beliefs about this vaccine, and social influence on the intention to vaccinate against COVID-19 in three Latin American and Caribbean countries: Chile, Mexico, and Colombia. Using convenience sampling, 2075 adults from Chile (48.3%), Mexico (27.6%), and Colombia (24.6%) participated by answering an online questionnaire with variables of interest. (3) Results: Despite the differences between countries, the results showed that the proposed model is invariant and explains between 56–66% of the COVID-19 vaccination intent. Specifically, controlling for age, socioeconomic status, political orientation, and educational level, we found that beliefs about the negative consequences of the COVID-19 vaccine were the main predictor followed by social influence. Beliefs in conspiracy theories did not predict vaccination intention (4) Conclusions: Considering these variables in campaigns to boost vaccination intention is discussed.

Exploring the relationships between rule-governed behavior and adherence to guidelines aiming to reduce the spread of COVID-19

Research demonstrates that socially mediated consequences impact adherence to health mandates during pandemics. However, no published research has examined whether adherence varies based on the extent to which an individual relies on arbitrary social approval (i.e., displays generalized pliance). The present study explored the relationships between adherence to COVID-19 public health measures, two types of rule-following (pliance and tracking), and perceived peer behavior in a sample of adults (n = 288). Findings revealed that adherence was negatively correlated with generalized pliance and tracking was unrelated to adherence. Pliance did not moderate the relationship between peer adherence and individual adherence. Findings are discussed with reference to the need to develop easily adaptable and context sensitive measures of types of rule-following, in addition to a measure of social tracking.

Risk perceptions and COVID-19 protective behaviors: A two-wave longitudinal study of epidemic and post-epidemic periods

We investigated how perceived risk and protective behaviors changed as the coronavirus epidemic progressed. A longitudinal sample of 538 people responded to a COVID-19 risk perception questionnaire during the outbreak and post-epidemic periods. Using Structural Equation Modeling (SEM), we examined the mean level change of selected constructs and differences in their relationships. We tested a risk perception pathway in which affective attitude, informed by experience, shaped risk perceptions and protective behaviors. The model also postulated a social pathway in which cultural worldviews, like individualism and hierarchy, predicted risk perceptions and protective behaviors through social norms. Latent mean difference analyses revealed a decrease in social distancing behaviors and an increase in hygiene-cleanliness, corresponding to a reduction in risk perceptions and social norms and a rise in direct and indirect experience, while affective attitude remained substantially stable. Cross-sectional and longitudinal path analyses showed that affective risk perception, primarily informed by affective attitude, and social norms promoted behavior consistency regardless of epidemic contingencies. Instead, analytic risk perceptions were linked to protective behaviors only during the outbreak. Although risk perceptions dropped over time, analytic risk perceptions dropped more steeply than affective risk perceptions. Our findings supported the distinction between affective and deliberative processes in risk perception, reinforcing the view that affective reactions are needed to deploy analytic processes. Our study also supports the claim that perceived social norms are essential to understanding cultural worldview-related protective behaviors variability.

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.

Mask-wearing intentions on airplanes during COVID-19 - Application of theory of planned behavior model

The COVID-19 pandemic has devastated the air transport industry, forcing airlines to take measures to ensure the safety of passengers and crewmembers. Among the many protective measures, mask mandate onboard the airplane is an important one, but travelers' mask-wearing intentions during flight remain uninvestigated especially in the US where mask use is a topic of on-going debate. This study focused on the mask use of airline passengers when they fly during COVID-19, using the theory of planned behavior (TPB) model to examine the relationship between nine predicting factors and the mask-wearing intention in the aircraft cabin. A survey instrument was developed to collect data from 1124 air travelers on Amazon Mechanical Turk (MTurk), and the data was statistically analyzed using structural equation modeling and logistic regression. Results showed that attitude, descriptive norms, risk avoidance, and information seeking significantly influenced the travelers' intention to wear a mask during flight in COVID-19. Group analysis further indicated that the four factors influenced mask-wearing intentions differently on young, middle-aged, and senior travelers. It was also found that demographic and travel characteristics including age, education, income, and travel frequency can be used to predict if the airline passenger was willing to pay a large amount to switch to airlines that adopted different mask policies during COVID-19. The findings of this study fill the research gap of air travelers' intentions to wear a mask when flying during a global pandemic and provide recommendations for mask-wearing policies to help the air transport industry recover from COVID-19.

An online advertising intervention to increase adherence to stay-at-home-orders during the COVID-19 pandemic: An efficacy trial monitoring individual-level mobility data

The COVID-19 pandemic has led public health departments to issue several orders and recommendations to reduce COVID-19-related morbidity and mortality. However, for various reasons, including lack of ability to sufficiently monitor and influence behavior change, adherence to these health orders and recommendations has been suboptimal. Starting April 29, 2020, during the initial stay-at-home orders issued by various state governors, we conducted an intervention that sent online website and mobile application advertisements to people's mobile phones to encourage them to adhere to stay-at-home orders. Adherence to stay-at-home orders was monitored using individual-level cell phone mobility data, from April 29, 2020 through May 10, 2020. Mobile devices across 5 regions in the United States were randomly-assigned to either receive advertisements from our research team advising them to stay at home to stay safe (intervention group) or standard advertisements from other advertisers (control group). Compared to control group devices that received only standard corporate advertisements (i.e., did not receive public health advertisements to stay at home), the (intervention group) devices that received public health advertisements to stay at home demonstrated objectively-measured increased adherence to stay at home (i.e., smaller radius of gyration, average travel distance, and larger stay-at-home ratios). Results suggest that 1) it is feasible to use mobility data to assess efficacy of an online advertising intervention, and 2) online advertisements are a potentially effective method for increasing adherence to government/public health stay-at-home orders.

"Responsible" or "Strange?" Differences in Face Mask Attitudes and Use Between Chinese and Non-East Asian Canadians During COVID-19's First Wave

Early in the COVID-19 pandemic, journalists and scholars noted differences between Asians and North Americans in their support for public mask use. These differences were primarily assumed to be due d to variations in ethnocultural norms and practices. To better ascertain people's motives for wearing masks and potential cultural differences in these rationales, this comparative, mixed-methods research examines Chinese and non-East Asian Canadians' mask use attitudes utilizing online group interviews (Study 1) and a nation-wide survey (Study 2) Study 1, conducted in the early stages of the pandemic, captured an ambivalent, yet evolving attitude toward public mask use among the non-East Asian Canadians, which differed from their Chinese counterparts who more uniformly perceived mask use favorably. Study 2, conducted 2 months later, suggests that both groups primarily wore masks for disease protection- and prevention-related reasons. However, age and education appeared to influence the mask wearing frequency of the non-East Asian Canadians, for whom public mask use was less prevalent and normative. The attitudinal differences in public mask use call for targeted strategies to support mask wearing for different ethnocultural groups, which may be achieved partially through enhancing interethnic understanding on the diversified use of and opinions about masks. The findings suggest that favorable social norms, along with evidence-based information campaigns involving personal appeals may encourage greater mask use by the non-East Asian population.

Social Media Images as an Emerging Tool to Monitor Adherence to COVID-19 Public Health Guidelines: Content Analysis

Background

Innovative surveillance methods are needed to assess adherence to COVID-19 recommendations, especially methods that can provide near real-time or highly geographically targeted data. Use of location-based social media image data (eg, Instagram images) is one possible approach that could be explored to address this problem.

Objective

We seek to evaluate whether publicly available near real-time social media images might be used to monitor COVID-19 health policy adherence.

Methods

We collected a sample of 43,487 Instagram images in New York from February 7 to April 11, 2020, from the following location hashtags: #Centralpark (n=20,937), #Brooklyn Bridge (n=14,875), and #Timesquare (n=7675). After manually reviewing images for accuracy, we counted and recorded the frequency of valid daily posts at each of these hashtag locations over time, as well as rated and counted whether the individuals in the pictures at these location hashtags were social distancing (ie, whether the individuals in the images appeared to be distanced from others vs next to or touching each other). We analyzed the number of images posted over time and the correlation between trends among hashtag locations.

Results

We found a statistically significant decline in the number of posts over time across all regions, with an approximate decline of 17% across each site (P<.001). We found a positive correlation between hashtags (#Centralpark and #Brooklynbridge: r=0.40; #BrooklynBridge and #Timesquare: r=0.41; and #Timesquare and #Centralpark: r=0.33; P<.001 for all correlations). The logistic regression analysis showed a mild statistically significant increase in the proportion of posts over time with people appearing to be social distancing at Central Park (P=.004) and Brooklyn Bridge (P=.02) but not for Times Square (P=.16).

Conclusions

Results suggest the potential of using location-based social media image data as a method for surveillance of COVID-19 health policy adherence. Future studies should further explore the implementation and ethical issues associated with this approach.

Observations and conversations: how communities learn about infection risk can impact the success of non-pharmaceutical interventions against epidemics

BACKGROUND

Individual behavioural decisions are responses to a person's perceived social norms that could be shaped by both their physical and social environment. In the context of the COVID-19 pandemic, these environments correspond to epidemiological risk from contacts and the social construction of risk by communication within networks of friends. Understanding the circumstances under which the influence of these different social networks can promote the acceptance of non-pharmaceutical interventions and consequently the adoption of protective behaviours is critical for guiding useful, practical public health messaging.

METHODS

We explore how information from both physical contact and social communication layers of a multiplex network can contribute to flattening the epidemic curve in a community. Connections in the physical contact layer represent opportunities for transmission, while connections in the communication layer represent social interactions through which individuals may gain information, e.g. messaging friends.

RESULTS

We show that maintaining focus on awareness of risk among each individual's physical contacts promotes the greatest reduction in disease spread, but only when an individual is aware of the symptoms of a non-trivial proportion of their physical contacts (~ ≥ 20%). Information from the social communication layer without was less useful when these connections matched less well with physical contacts and contributed little in combination with accurate information from physical contacts.

CONCLUSIONS

We conclude that maintaining social focus on local outbreak status will allow individuals to structure their perceived social norms appropriately and respond more rapidly when risk increases. Finding ways to relay accurate local information from trusted community leaders could improve mitigation even where more intrusive/costly strategies, such as contact-tracing, are not possible.

A Mediation Model on How Conspiracy Beliefs Concerning the Corona-Crisis Are Related to Corona-Related Behaviours

Background: The endorsement of Conspiracy Beliefs concerning corona (CBc) may make people reject information from the general media, leading them to not follow recommendations on prevention behaviours, getting tested, and getting vaccinated. The aim of the present study was to understand the relationship between CBc and engaging in these corona-related behaviours.

Method: Two samples of participants (N = 1,004 and N = 159) were recruited independently. Participants filled in a survey that assessed four indicators of the three behaviours, four general psychological determinants (e.g., the seriousness of COVID-19), five behaviour-specific psychological determinants (e.g., test reliability, vaccine effectiveness), and CBc.

Results: The explained variances of the different models with regard to the four indicators of behaviour ranged from 3.9 to 75%. Mediation analyses using Hayes PROCESS model 4 showed significant mediation by general determinants in both samples, and mediation by several behaviour-specific determinants in one sample.

Discussion: Conspiracy Beliefs concerning corona may lead to rejection of general media information, and this may lead to states of psychological determinants that do not stimulate to engage in prevention behaviours, testing, or vaccination. The present study shedS some light on how CBc could be related to corona-related behaviours.

Peers for the fearless: Social norms facilitate preventive behaviour when individuals perceive low COVID-19 health risks

A strategy frequently adopted to contain the COVID-19 pandemic involves three non-pharmaceutical interventions that depend on high levels of compliance in society: maintaining physical distance from others, minimizing social contacts, and wearing a face mask. These measures require substantial changes in established practices of social interaction, raising the question of which factors motivate individuals to comply with these preventive behaviours. Using Austrian panel survey data from April 2020 to April 2021, we show that perceived health risks, social norms, and trust in political institutions stimulate people to engage in preventive behaviour. A moderation analysis shows that the effectiveness of social norms in facilitating preventive behaviour increases when people's perceptions of health risks decrease. No such moderation effect is observed for trust in political institutions. These results suggest that strong social norms play a crucial role in achieving high rates of preventive behaviour, especially when perceived levels of health risks are low.

Do predictors of adherence to pandemic guidelines change over time? A panel study of 22,000 UK adults during the COVID-19 pandemic

In the absence of a vaccine, governments have focused on behaviour change (e.g. social distancing and enhanced hygiene procedures) to tackle the COVID-19 pandemic. Existing research on the predictors of compliance with pandemic measures has often produced discrepant results. One explanation for this may be that the determinants of compliance are context specific. Understanding whether this is the case is important for designing public health messaging and for evaluating the generalisability of existing research. We used data from the UCL COVID-19 Social Study; a large weekly panel of UK adults from first five months of lockdown in the UK (n = 22,625). We tested whether the extent to which demographic, socio-economic position, personality traits, social and pro-social motivations, and the living environment predict compliance changed across the pandemic using multilevel regression modelling. Low compliance was strongly related to younger age and also to risk attitudes, empathic concern, and high income, among other factors. The size of some of these associations was larger in later months when less stringent lockdown and household mixing measures were in place. The results showed that compliance was lower and fell faster across some groups, suggesting the importance that public health communications adopt a plurality of messages to maximize broad adherence.

Viruses, Vaccines, and COVID-19: Explaining and Improving Risky Decision-making

Risky decision-making lies at the center of the COVID-19 pandemic and will determine future viral outbreaks. Therefore, a critical evaluation of major explanations of such decision-making is of acute practical importance. We review the underlying mechanisms and predictions offered by expectancy-value and dual-process theories. We then highlight how fuzzy-trace theory builds on these approaches and provides further insight into how knowledge, emotions, values, and metacognitive inhibition influence risky decision-making through its unique mental representational architecture (i.e., parallel verbatim and gist representations of information). We discuss how social values relate to decision-making according to fuzzy-trace theory, including how categorical gist representations cue core values. Although gist often supports health-promoting behaviors such as vaccination, social distancing, and mask-wearing, why this is not always the case as with status-quo gist is explained, and suggestions are offered for how to overcome the "battle for the gist" as it plays out in social media.

Generalized self-efficacy and compliance with health behaviours related to COVID-19 in the US

OBJECTIVE

Investigate the role of generalized self-efficacy (GSE) in compliance with COVID-19 health behaviours such as wearing masks and social distancing.

DESIGN

Two studies conducted online in the US: 312 adults in Study 1 and 253 adults in Study 2.

MAIN OUTCOME MEASURES

In Study 1, participants reported compliance with four health behaviours related to COVID-19: social distancing, hand washing, avoiding non-essential travel, and wearing masks. In Study 2, participants reported expected compliance with wearing masks when it was framed as a national requirement, a state requirement, or a recommendation.

RESULTS

In Study 1, GSE positively affected reported compliance with COVID-19 health behaviours. This result was mediated by the perception that these behaviours would offer enhanced control. Psychological reactance negatively affected reported compliance, while trust in science-based institutions and perceived threat from COVID-19 exerted positive effects. In Study 2, requiring (vs. recommending) masks led to higher willingness to comply with COVID-19 health behaviours. This was moderated by GSE, which significantly impacted compliance only when masks were required rather than recommended.

CONCLUSION

Higher GSE predicted increased compliance with health behaviours related to COVID-19, such as wearing masks. This effect was strongest when these behaviours were framed as required rather than recommended.

Would You Rather Be Safe or Free? Motivational and Behavioral Aspects in COVID-19 Mitigation

This work investigates the relationship between goals and mitigation behaviors during the COVID-19 pandemic in Italy. Study 1 (pilot) identified goals ascribed to following and violating mitigation-related indications. Study 2 investigated the structure of and link between COVID-related goals and behaviors in a large community sample (N = 995, 301 men). Our results showed substantial relationships between goals and behaviors. Goals were best described by a bi-dimensional structure (being safe vs. being free), whereas behaviors clustered into a three-component structure (hygiene, distancing, going out). Hierarchical multiple regressions demonstrated the incremental validity of goals in the prediction of behaviors. Network analysis suggested that goals imbued with social content were more directly related to both risky and preventive behaviors. Motivational aspects emerged as important contributors to the organization of behaviors in the context of the COVID-19 pandemic.