Theory of Planned Behavior Analysis of Social Distancing During the COVID-19 Pandemic: Focusing on the Intention-Behavior Gap

The mediating role of health literacy in the relationship between self-care and planned behavior against Covid-19

BACKGROUND

Planned behaviors and self-care against the coronavirus are two important factor in controlling its spread and self-care behaviors depend on the level of health literacy. This research was conducted to determine the mediating role of health literacy in the relationship between elements of planned behavior and self-care in dealing with the Covid-19.

METHODS

In this descriptive-analytical quantitative study, the sample size was calculated using Cochrane's formula and considering a p-value of 0.51, α = 0.05, and d = 0.05, and 313 students were selected based on stratified and random method. To gather data and assess various aspects of variables, a questionnaires were utilized, focusing on health literacy, self-car and planned behavior. The relationship between the variables was examined by SPSS version 26 and via descriptive statistics, including the mean and standard deviation, and inferential statistics such as Pearson's correlation coefficient (P = 0.05), path analysis, and determining the standard coefficients between self-care and planned behavior, mediated by the indicators of the health literacy.

RESULTS

A significant difference was found between the level of health literacy of women and men. The comparison of the mean health literacy and self-care behavior in terms of other variables did not show any significant difference. Meanwhile, the comparison of health status control behaviors, hand washing, and mask use did not show any significant difference between the two groups. A positive and significant correlation was found between self-care behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention. The relationship of health literacy and psychological variables of attitude, subjective norms, and perceived behavioral control with self-care against COVID-19 was significant.

CONCLUSION

The direct and significant impact of health literacy on individuals' self-care behaviors against the coronavirus was not observed. However, health literacy did have a significant effect on subjective norms. This finding is important because subjective norms significantly influenced individuals' behavioral intention, which in turn had a significant effect on self-care behaviors against the coronavirus. Thus, health literacy played a mediating role in this relationship. Furthermore, attitude emerged as the strongest predictor of behavioral intention, exerting a direct effect. Conversely, perceived behavioral control did not directly and significantly affect students' self-care behaviors.

Nurses' intention to care of COVID-19 patients in hospitals dedicated to infectious disease in South Korea: application of the theory of planned behavior and verification of the moderating effect of ethical nursing competence

BACKGROUND

The theory of planned behavior is a conceptual framework of recent studies to identify and explain nurses' intentions to care for patients with emerging infectious diseases. However, correlations between behavioral intentions and variables that explain them have been inconsistent in previous studies. The influence of new variables might be considered in this case. This study aimed to determine moderating effects of ethical nursing competence on nurses' intention to care for COVID-19 patients in hospitals dedicated to infectious diseases based on the theory of planned behavior.

METHODS

A cross-sectional survey was conducted. Data on intention to care for COVID-19 patients, perceived behavioral control, attitude toward the behavior, subjective norm, and ethical nursing competence were obtained from 190 nurses in three hospitals dedicated to infectious diseases in South Korea. The moderating effect of ethical nursing competence was analyzed using model I of PROCESS Macro.

ETHICAL CONSIDERATIONS

This study was approved by the Institutional Review Board of Ulsan University Hospital, South Korea. Written informed consent was obtained from each subject.

RESULTS

The ethical nursing competence was a significant moderator in the relation between perceived behavioral control and the intention to care (B = 0.36, t = 2.16, p = 0.032). Ethical nursing competence did not have a significant interaction with attitude toward behavior or subjective norm.

CONCLUSIONS

This study showed that the higher the ethical nursing competence level, the greater the effect of perceived behavioral control on nurses' intention to care for COVID-19 patients. Promoting ethical nursing competence is necessary for nurses who would take care of patients at the frontline of the infectious disease pandemic. Nursing managers should include ethical nursing competence in the assessment of nurses' competence and design educational programs to enhance ethical nursing competence for efficient nursing staffing during a pandemic.

Factors Affecting Adherence to Social Distancing among Adults Aged 19-44 Years: Insights from a Nationwide Survey during COVID-19 Pandemic

Background and Objectives: Before COVID-19 vaccinations became available, adhering to non-pharmaceutical interventions (NPIs), like social distancing (SD), wearing masks, and hand hygiene, were crucial to mitigating viral spread. Many studies reported that younger individuals were more reluctant to follow these measures compared with older ones. We hypothesized that it would be worthwhile to find factors that influenced SD compliance among young people during the pre-vaccination phase of a pandemic. Materials and Methods: We analyzed data of adults aged 19-44 from the 2020 South Korean Community Health Survey and compared socio-demographic, health-related behavioral, and psychological factors between compliant and non-compliant cohorts. Results: A total of 59,943 participants were enrolled and we found that older age groups (30-39 and 40-44) and safety concerns (such as viral infection, virus-related death, economic damage, and transmitting virus to vulnerable people) were significantly associated with adherence to SD. Conversely, participants who were not living with a spouse, were unable to stay at home despite symptoms, smoked, drank, and had a negative attitude toward government policy statistically correlated with non-compliance. Conclusions: In times when NPIs were the primary defense against the pandemic, it is essential to identify factors that positively or negatively affect individual compliance with them, especially among young people. Using a large-scale, well-designed national survey, we could gain insights into the early recognition of risk factors for non-compliance and appropriate follow-up interventions (i.e., education campaigns, clear communication of public guidelines, and implementation of guidelines), which will help people to avoid suffering from other waves of future infectious diseases.

Extending the theory of planned behavior to envisage social distancing behavior in containing the COVID-19 outbreak

The study investigates the antecedents that influence social distancing behavior during the COVID-19 outbreak and develops a hypothetical model integrating additional pertinent variables into the classic theory of planned behavior (TPB) to grasp the social distancing behavior accurately. The extended model was investigated employing structural equation modeling using the data collected through Snowball Technology from 331 respondents. The results unearth significant influences of all the predictor variables on their outcome variables. Surprisingly, the supportive government strategy has no crucial impact on perceived behavioral control toward social distancing. Furthermore, the study reports no trivial difference between young and old and high-low income groups on the intention-actual social distancing. The study outlines policy interventions to prevent mass transmission of the COVID-19 catastrophe. Lastly, limitations are specified to open up novel insights for future researchers.

COVID-19 and child education outcomes in Southern Ghana

This study analyses the effects of the COVID-19 pandemic on child education outcomes by providing evidence on the gendered dimension, determinants and coping measures of informal households in Southern Ghana. We rely on a face-to-face interview undertaken in January 2022 (i.e., approximately 2 years after the beginning of the pandemic) involving 761 students across basic and secondary schools from 10 metropolitan, municipality and district assemblies (MMDAs) in the Greater Accra region of Ghana. We document several disruptions to child education outcomes such as learning practices, school attendance, class participation and academic performance. The results also showed that per child education expenditure incurred due to the COVID-19 pandemic by the informal households was GHS305 (US$ 49). Additionally, we assess the correlates of the negative effects on academic performance and COVID-19 related education expenditure as a result of coping measures. Our results from Ordinary Least Squares (OLS) show strong association between participation in online classes, age of students, ownership of television and district of residence on COVID-19 related education expenditure. Results from Logit models show that self-reported negative effects of COVID-19 pandemic on academic performance are affected by gender and age of student, distance to market and location of residence. Interestingly, we also found considerable gendered heterogeneity for the predictors of the COVID-19 pandemic on child education outcomes. We conclude that the COVID-19 pandemic and the associated countermeasures had negative effects on child education outcomes, and that informal households incurred considerable costs in attempting to address the associated education challenges in Southern Ghana. The findings have implications on the design and implementation of educational policies and programs to address the long-term effects of the COVID-19 pandemic on child education outcomes in developing countries.

Does Intention Strength Moderate the Intention-Health Behavior Relationship for Covid-19 Protection Behaviors?

BACKGROUND AND PURPOSE

The present research tests whether intention strength moderates intention-health behavior relations and the extent to which this is accounted for by the moderating effects of intention stability, goal priority, and goal conflict.

METHODS

In a prospective multi-behavior study, a representative sample of UK adults (N = 503) completed measures of past behavior, intention, intention strength, goal priority, and goal conflict in relation to eight Covid-19 protection behaviors at time 1. Intention and self-reported behavior were assessed at time 2 (2 months later). Intention stability was assessed over 2 months.

RESULTS

Intention strength was a significant moderator of the intention-behavior relationship (controlling for past behavior). Controlling for the moderating effects of intention stability attenuated the moderating effect of intention strength, while also controlling for the moderating effects of goal priority and goal conflict reduced the moderating effects of intention strength to nonsignificance.

CONCLUSIONS

The present findings indicate that intention strength is a significant moderator of the intention-health behavior relationship. They also suggest that the moderating effect of intention strength is explained by effects on intention stability, goal priority, and goal conflict. Tests of interventions to manipulate intention strength as a means to strengthen intention stability and intention-behavior relations are warranted.

Context Matters: Patterns in Physical Distancing Behavior Across Situations and Over Time During the Covid-19 Pandemic in the Netherlands

BACKGROUND

Physical distancing is an effective preventative measure during respiratory infectious disease outbreaks. Prior studies on distancing behaviors have largely ignored context characteristics (physical, social) and time.

PURPOSE

We investigated patterns in physical distancing over time and across situations, as well as sociodemographic variation herein.

METHODS

We employed data from five rounds of a cohort study conducted throughout the pandemic by the Dutch public health institute (RIVM; N ≈ 50.000 per round). We conducted Latent Class Analyses to investigate patterns of physical distancing in a range of situations, followed by regression models to investigate associations between distancing behavior and sociodemographic and context characteristics.

RESULTS

Participants differed in their general tendency to adhere to distancing guidelines across situations, but there were also substantial differences in distancing behavior between situations, particularly at work, with friends and family and outdoors. Distancing at work was strongly associated with work environment characteristics. Younger age groups reported less distancing behavior, particularly with close relations (friends or family) and at work. In periods when the pandemic situation was most severe, people adhered more strongly to distancing guidelines and age differences were most pronounced during these periods.

CONCLUSIONS

Physical and social context matters for physical distancing, highlighting the importance of developing strategies for pandemic preparedness that improve opportunities for physical distancing (e.g., reducing crowding, one-way traffic) and accommodate young people to safely meet even in times of high pandemic severity and lockdowns. Future studies should account for the physical and social context in which distancing behavior is observed.

A planned behavior theory-based explanatory model of protective behavior against COVID-19, with an age perspective

In this study, an explanatory model of protective behaviors against COVID-19 transmission based on the theory of planned behavior is tested using a sample of 904 individuals by adding two relevant variables in the COVID-19 context: skepticism and responsibility toward COVID-19 transmission. Responsibility and the intention to behave in a protective way act as mediators in predicting protective behaviors. The model is invariant between younger and older people, although some path differences were found: the perception that individuals have about the extent to which their reference group adopts protective behaviors directly influences individual protective behavior for younger but not older people, for whom subjective social norms were only indirect predictors of such behavior. Additionally, the rates in all the variables showed that the group under 35 took more risks in the context of protective behaviors against COVID-19: they exhibited more skepticism, lower behavioral control, perceived fewer positive social norms regarding protective behaviors, felt less responsible for spreading the disease, had less intention to behave in a protective way, and finally adopted fewer protective behaviors. Developers of intervention strategies and campaigns should contemplate such variables and focus on differences according to age.

The Role of Awareness of Age-Related Change in the Longitudinal Association between Pain and Physical Activity

We examined how physical pain impacts the developmental construct of Awareness of Age-Related Change (AARC-gains and AARC-losses) and, in turn, how AARC mediates and moderates the association between pain and subsequent physical activity. We used longitudinal data from 434 participants of the UK PROTECT Study (mean age = 65.5 years; SD = 6.94 years). We found that pain in 2019 predicted higher AARC-losses (β = .07; p = .036) and less physical activity (β = -.13; p-value = .001) in 2020. Additionally, we found that AARC-losses partially mediated, but did not moderate, the association of pain in 2019 and physical activity in 2020. AARC-losses may explain physical inactivity in middle-aged and older adults experiencing pain. Incorporating developmental constructs such as AARC into theories and empirical studies on pain and pain management may be necessary to more fully capture people's responses to pain.

Social isolation in COVID-19: a comparative study between Korea and Vietnam

Amidst the ongoing COVID-19 pandemic, social isolation has become a pressing issue worldwide, deeply affecting individuals' mental and physical well-being. This study introduces a theoretical model to understand the factors influencing social isolation in the context of this global health crisis. We employed a survey methodology, collecting data from Korean and Vietnamese university students through a Google survey form. The theoretical model was evaluated using structural equation modeling (SEM), and multi-group analysis (MGA) was used to assess differences between the Korean and Vietnamese student groups. The investigation centered on affective risk perception, cognitive risk perception, social distancing attitude, social distancing intention, and demographic factors like age and gender. Our findings revealed that affective and cognitive risk perceptions have significant positive impacts on attitudes toward social distancing. Furthermore, attitudes towards social distancing were found to significantly influence social distancing intentions. Interestingly, social distancing intention was found to have a significant positive correlation with social isolation. Lastly, demographic factors such as gender and age were found to be significant factors influencing social isolation. Specifically, gender had a positive association, while age showed a negative correlation with social isolation. Moreover, our MGA results showed that the relationship between social distancing intention and social isolation significantly differed between the Korean and Vietnamese student groups, indicating potential cultural or societal influences on this relationship. Such understanding could inform policies and strategies aimed at mitigating the adverse effects of social isolation in the wake of global health crises.

Personal protective behaviors in response to COVID-19: a longitudinal application of protection motivation theory

Introduction

Disease outbreaks are expected to occur more frequently and spread more rapidly in the age of globalization. Personal protective behaviors strongly affect infection and death rates worldwide. It is therefore of prime importance to better understand which factors predict personal protective behaviors during a pandemic. Protection motivation theory (PMT) proposes that people's motivation to protect themselves is based on two appraisal processes: threat appraisal and coping appraisal. Building on PMT, this longitudinal study aimed to predict personal protective behaviors in response to COVID-19, including hand hygiene, physical distancing, and mask wearing.

Method

In the first wave of the study (November, 2020), the two appraisal processes as specified in PMT as well as intentions to perform protective behaviors were assessed in a representative sample of German adults (N = 328). In the second wave of this study, which was conducted one month later, the frequency of protective behaviors was measured. Structural equation modeling was used to test whether threat and coping appraisal predicted intentions and protective behaviors.

Results

Response rate for the second wave was high (87%). For all three behaviors, self-efficacy predicted intentions and also indirectly behavior (i.e., mediated via intentions). Furthermore, exploratory tests of alternative theoretical models suggested that both self-efficacy and costs have direct effects (i.e., independent from their relationship with intentions) on performed behavior.

Conclusion

To support individuals to engage in protective behaviors during a pandemic, it is important to reduce barriers to action and to foster individuals' self-efficacy.

Socio-psychological factors associated with anticipated stigma toward COVID-19: a cross-sectional study in Japan

BACKGROUND

The stigmatization against COVID-19 has become a public issue. However, it remains unknown which individual factor contributes to anticipated stigma formation. This study explored socio-psychological factors associated with anticipated stigma toward coronavirus disease 2019 (COVID-19).

METHODS

We obtained cross-sectional data regarding 1,638 middle-aged community residents (mean age, 48.5 years) from a population-based survey in metropolitan Tokyo, Japan during the third wave of the COVID-19 pandemic, when a regional public health emergency had been declared in December 2020 and January 2021. We hypothesized that perceived risk of infection, normative beliefs about preventive behaviors, and past experiences of stigmatization unrelated to COVID-19 would be associated with anticipated stigma. Modified Poisson regression was conducted to examine associations after adjustments for demographic and socioeconomic statuses.

RESULTS

Higher perceived risk (adjusted prevalence ratio [APR] = 1.17; 95% confidence interval [CI, 1.08-1.27]), past experiences of stigmatization (APR = 1.09; 95% CI [1.00-1.19]), and higher normative beliefs about preventive behaviors (APR = 1.18; 95% CI [1.11-1.26]) were independently associated with anticipated stigma.

CONCLUSIONS

These results suggest that intervention messages to increase risk perception and normative beliefs to enhance protective behaviors may have the unintended effect of increasing anticipated stigma in the context of the COVID-19 pandemic.

[Evaluation of the Dunning Kruger effect in relation to vaccination: a study of messages on the social network LinkedIn.]

OBJECTIVE

The Dunning-Kruger effect refers to an excess of confidence regarding one's abilities and knowledge; trust leads to transmitting information in an assertive manner, regardless of its validity or veracity, of experts, but of great impact on public opinion. This study evaluated the existence of the Dunning-Kruger effect in messages related to vaccination against COVID-19 on LinkedIn.

METHODS

448 messages were evaluated and the authors' knowledge and training on the subject were related. In the statistical treatment, the Chi-square test was performed to determine if there is a significant association between the variables, establishing the level of significance at P<0.05. These procedures were carried out using SPSS statistical software.

RESULTS

448 messages were analyzed. Of these, 153 reflected very high certainty, 115 medium certainty, 107 low certainty and 73 reflected doubts. The group that issued the most messages with absolute certainty (41.8%) was the group with minimal knowledge about COVID-19. Of this group without knowledge on the subject, only 7.1% expressed messages without expressing certainty. The group with very high knowledge on the subject was more likely to reflect uncertainty, communicating 15.7% of the messages with absolute certainty and 37.1% with zero certainty.

CONCLUSIONS

It is obtained that those people with less knowledge express their messages more assertively and present less acceptance of the COVID-19 vaccine in their speeches. The presence of the Dunning-Kruger effect in relation to COVID-19 vaccination is demonstrated.

Exploring the influence of behavioural, normative and control beliefs on intentions to adhere to public health guidelines during the COVID-19 pandemic: a qualitative interview based study

BACKGROUND

Perceived severity and susceptibility of disease are predictors of individual behaviour during health crises. Little is known about how individual beliefs influence intentions to adhere to public health guidelines during periods of health crises, and how access to and consumption of information influence these intentions. This study investigated behavioural beliefs, normative beliefs, and control beliefs, and their influence on behavioural intentions to adhere to public health guidelines during the COVID-19 pandemic.

METHODS

Participants were recruited from a related COVID-19 study conducted by our team, and through snowball sampling in subsequent. Using a maximum variation sampling technique, we recruited a diverse group of participants representing six major regions in Canada. Participants took part in one-on-one semi-structured interviews from February 2021 to May 2021. Data were analyzed independently in duplicate by thematic analysis. The Theory of Planned Behaviour (TPB) was the conceptual framework used to organize dominant themes.

RESULTS

We conducted a total of 60 individual interviews (137 eligible individuals contacted, 43.8% response rate) and identified six themes organized according to the three constructs of behavioural, normative and control beliefs as described in the TPB: (1) Behavioural: My "New Normal," Individual Rights and Perceived Pandemic Severity, Fatigue with COVID-19, (2) Normative: COVID-19 Collective, (3) Control: Practicality of Public Health Guidelines, and (6) Conflicting Public Health Messages. Most (n = 43, 71.7%) participants perceived individuals in their geographic community to be following public health guidelines adequately. Several participants (n = 15, 25.0%) commented on the unequal impact of restrictions based on socioeconomic factors (i.e., class, race, age).

CONCLUSION

Individual perceptions of risk, loss of control, access to resources (i.e., childcare), and societal expectations, shaped intentions to engage in disease preventative behaviours (i.e., social distancing) during the COVID-19 pandemic.

Adolescents' social and moral reasoning about COVID-19 public health behaviors

Examining the forms of social and moral reasoning adolescents use is important for understanding youth engagement with public health guidelines. The present work examined adolescents' perceptions of social norms and associated reasoning in the COVID-19 context. Participants (n = 127, M age = 17.00, SD = 0.71) negatively evaluated other teenagers who broke COVID-19 guidelines and reasoned about harm reduction to justify breaking these rules, but also recognised the importance of protecting mental health as one reason to spend time with friends counter to these rules. Further, adolescents reported that they were more likely to engage in public health behaviors compared to their peers or the average teenager, suggesting a social norm of lower engagement with these guidelines. Together, this evidence documents the importance of considering social norms and moral reasoning in framing communication efforts that target adolescents' adherence to public health guidelines.

Impact of adverse events during community-wide mass drug administration for soil-transmitted helminths on subsequent participation-a Theory of Planned Behaviour analysis

BACKGROUND

Experiencing adverse events (AEs) during mass drug administration (MDA) could affect participation in future MDAs. This study aims to understand the potential influence of AEs during a community-wide MDA (cMDA) trial for soil-transmitted helminths (STH) in India on intention to participate in future cMDAs.

METHODS

This study was conducted using a multi-method quantitative and qualitative approach among 74 participants who experienced an AE during STH cMDA and the 12 participants who subsequently refused cMDA treatment of the ongoing DeWorm3 trial. Path analysis and thematic analysis guided by the Theory of Planned Behaviour, was used.

PRINCIPAL FINDINGS

Among 74 individuals who reported an AE, 12% refused treatment in the cMDA immediately subsequent to their AE and 4% refused in all subsequent cMDAs. Of these 74 individuals, 59 (80%) completed a survey and eight participated in in-depth interviews. A positive attitude towards deworming and perceived ability to participate in cMDA (perceived behavioural control) were significant predictors of intention to participate in cMDA (p<0.05). A positive attitude towards cMDA was associated with caste (χ2 = 3.83, P = 0.05), particularly among the scheduled caste/scheduled tribe (SC/ST) (62%). Perceived behavioural control in cMDA participation was associated with occupation (χ2 = 5.02, P<0.05), with higher perceived control among those engaged in skilled occupations (78%). Intention to participate in subsequent cMDAs was associated with caste and family type (χ2 = 3.83, P = 0.05 and χ2 = 7.50, P<0.05 respectively) and was higher among SC/ST (62%) and those with extended families (67%). In-depth interviews demonstrated that perceived severe AEs may lead to treatment refusal in future, particularly if children were affected.

CONCLUSIONS

Intention to participate in future STH cMDAs was associated with caste (SC/ST) and family type (extended families). Therefore, community mobilization messages about potential AEs and their management may need to intentionally target non-SC/ST households, nuclear families, and those engaged in unskilled occupations to increase cMDA participation given the possibility of AEs occurring.

TRIAL REGISTRATION

NCT03014167, ClinicalTrials.gov.

How compliance with behavioural measures during the initial phase of a pandemic develops over time: A longitudinal COVID-19 study

In this longitudinal research, we adopt a complexity approach to examine the temporal dynamics of variables related to compliance with behavioural measures during the COVID-19 pandemic. Dutch participants (N = 2399) completed surveys with COVID-19-related variables five times over a period of 10 weeks (23 April-30 June 2020). With these data, we estimated within-person COVID-19 attitude networks containing a broad set of psychological variables and their relations. These networks display variables' predictive effects over time between measurements and contemporaneous effects during measurements. Results show (1) bidirectional effects between multiple variables relevant for compliance, forming potential feedback loops, and (2) a positive reinforcing structure between compliance, support for behavioural measures, involvement in the pandemic and vaccination intention. These results can explain why levels of these variables decreased throughout the course of the study. The reinforcing structure points towards potentially amplifying effects of interventions on these variables and might inform processes of polarization. We conclude that adopting a complexity approach might contribute to understanding protective behaviour in the initial phase of pandemics by combining different theoretical models and modelling bidirectional effects between variables. Future research could build upon this research by studying causality with interventions and including additional variables in the networks.

Predicting Compliance with Sanitary Behaviors among Students in Higher Education During the Second COVID-19 Wave: The Role of Health Anxiety and Risk Perception

To limit the spread of COVID-19, public authorities have recommended sanitary behaviors such as handwashing, mask-wearing, physical distancing, and social distancing. We recruited a large sample of higher education students in Belgium (N = 3201-3441) to investigate the role of sociodemographic variables, mental health, previous COVID-19 infections, academic involvement, and risk perception on adherence to these sanitary behaviors. This cross-sectional study took place during the second COVID-19 wave in Belgium, between February and March 2021. Analyses showed that living alone, being female, later in the academic curriculum, having higher general and health anxiety, higher academic involvement, and higher risk perception were positively associated with adherence to the four aforementioned sanitary behaviors. Conversely, previous infection with COVID-19 and having been quarantined were negative predictors. Our results show a set of predictors highly similar for the four sanitary behaviors. We discuss potential initiatives to increase adherence to sanitary behaviors in this group of highly educated youngsters.

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.

Drivers of young adults' voluntary compliance with COVID-19 protective measures: results from a multi-method study

BACKGROUND

With the easing of governmental COVID-19 restrictions, promoting voluntary public compliance with protective measures becomes essential for the pandemic evolution. A highly relevant target group for such health promotion are adolescents and young adults since they showed a strong decline in compliance throughout the pandemic. Building on an extended version of the Theory of Planned Behavior, this article investigates drivers of young people's intentions to engage in voluntary COVID-19 measures in phases of re-opening.

METHODS

We conducted a sequential multi-method study among 14- to 29-year-olds in Germany: (1) a semi-standardized online survey (N = 88) to examine underlying beliefs and (2) a standardized online survey (N = 979) to identify influencing factors of compliance. The pre-study addressed the respondents' perceptions about wearing a mask, social distancing, and avoiding crowded locations (open-ended questions). Responses for all protective measures were aggregated to identify general behavioral, normative, and control beliefs about COVID-19 protective measures. In order to gain generalizable insights into the factors determining voluntary compliance intentions in younger adults, we conceptualized the model constructs in the subsequent standardized online survey as formative measures based on their underlying beliefs. PLS-SEM was used to examine the effects of attitudes, subjective norms, perceived behavioral control, risk perceptions, and knowledge on young people's intentions to comply (main study). Furthermore, a multi-group analysis was conducted to investigate differences between compliers and non-compliers.

RESULTS

The pre-study revealed that young people's instrumental attitudes not only cover reasons of protection but also aspects of self-presentation (e.g., being a role model). The main study showed that besides knowledge and perceived severity of illness, instrumental attitude is the strongest predictor of intention to comply. The influence is even stronger in the group of non-compliers.

CONCLUSION

This article highlights the importance of theory-based campaign planning and provides practical guidance to health communicators on how to increase voluntary compliance with COVID-19 protective measures in adolescents and young adults. The findings demonstrate the great potential of combining the Theory of Planned Behavior with risk perception and knowledge to gain deeper insights into the feelings and thoughts of younger target groups during a health crisis.

Visiting crowded places during the COVID-19 pandemic. A panel study among adult Norwegians

Non-pharmaceutical interventions, including promotion of social distancing, have been applied extensively in managing the COVID-19 pandemic. Understanding cognitive and psychological factors regulating precautionary behavior is important for future management. The present study examines the importance of selected factors as predictors of having visited or intended to visit crowded places. Six online questionnaire-based waves of data collection were conducted in April-October 2020 in a Norwegian panel (≥18 years). Sample size at Wave 1 was 1,400. In the present study, "Visited or intended to visit crowded places" for different types of locations were the dependent variables. Predictors included the following categories of items: Perceived response effectiveness, Self-efficacy, Vulnerability, Facilitating factors and Barriers. Data were analyzed with frequency and percentage distributions, descriptives, correlations, principal components analysis, negative binomial-, binary logistic-, and multiple linear regression, and cross-lagged panel models. Analyses of dimensionality revealed that a distinction had to be made between Grocery stores, a location visited by most, and locations visited by few (e.g., "Pub," "Restaurants," "Sports event"). We merged the latter set of variables into a countscore denoted as "Crowded places." On the predictor side, 25 items were reduced to eight meanscores. Analyses of data from Wave 1 revealed a rather strong prediction of "Crowded places" and weaker associations with "Supermarket or other store for food." Across waves, in multiple negative binomial regression models, three meanscore predictors turned out to be consistently associated with "Crowded places." These include "Response effectiveness of individual action," "Self-efficacy with regard to avoiding people," and "Barriers." In a prospective cross-lagged model, a combined Response effectiveness and Self-efficacy score (Cognition) predicted behavior ("Visited or intended to visit crowded places") prospectively and vice versa. The results of this study suggest some potential to reduce people's visits to crowded locations during the pandemic through health education and behavior change approaches that focus on strengthening individuals' perceived response effectiveness and self-efficacy.

Social cognitive predictors of vaccination status, uptake and mitigation behaviors in the Canadian COVID-19 Experiences survey

Emerging infectious diseases like COVID-19 will remain a concern for the foreseeable future, and determinants of vaccination and other mitigation behaviors are therefore critical to understand. Using data from the first two waves of the Canadian COVID-19 Experiences Survey (CCES; N = 1,958; 66.56 % female), we examined social cognitive predictors of vaccination status, transition to acceptance and mitigation behaviors in a population-representative sample. Findings indicated that all social cognitive variables were strong predictors of mitigation behavior performance at each wave, particularly among unvaccinated individuals. Among those who were vaccine hesitant at baseline, most social cognitive variables predicted transition to fully vaccinated status at follow-up. After controlling for demographic factors and geographic region, greater odds of transitioning from unvaccinated at CCES Wave 1 to fully vaccinated at CCES Wave 2 was predicted most strongly by a perception that one's valued peers were taking up the vaccine (e.g., dynamic norms (OR = 2.13 (CI: 1.54,2.93)), perceived effectiveness of the vaccine (OR = 3.71 (CI: 2.43,5.66)), favorable attitudes toward the vaccine (OR = 2.80 (CI: 1.99,3.95)), greater perceived severity of COVID-19 (OR = 2.02 (CI: 1.42,2.86)), and stronger behavioral intention to become vaccinated (OR = 2.99 (CI: 2.16,4.14)). As a group, social cognitive variables improved prediction of COVID-19 mitigation behaviors (masking, distancing, hand hygiene) by a factor of 5 compared to demographic factors, and improved prediction of vaccination status by a factor of nearly 20. Social cognitive processes appear to be important leverage points for health communications to encourage COVID-19 vaccination and other mitigation behaviors, particularly among initially hesitant members of the general population.

Acceptance of Social Networking Sites by Older People before and after COVID-19 Confinement: A Repeated Cross-Sectional Study in Chile, Using the Theory of Planned Behaviour (TPB)

This study aims to examine the capacity of the Theory of Planned Behaviour (TPB) to explain the intention to use social networking sites by older people in two time periods, before and after confinement due to the COVID-19 epidemic, as well as the evolution of effects (paths) over time of TPB's determinants. Based on interviews from samples of 384 and 383 elderly Chilean adults collected before and after confinement, the evolution of the effects (paths) was analysed using the TPB model applying the PLS-SEM technique. The intention to use social networks and its association with three factors were evaluated: attitude toward the behaviour, subjective norms, and perceived control over the behaviour. The model explains the intention to use social networks by 27% before confinement, increasing its magnitude to 50% after confinement. After the period of confinement, their attitudes become more significant, their perceptions of control become less important, and social pressures remain permanent in predicting the behaviour. In conclusion, better access and greater use of social networks by older people during the lockdown period increased the predictive strength of the attitude towards these technologies.

Psychosocial Determinants of Hand Hygiene, Facemask Wearing, and Physical Distancing During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

BACKGROUND

Hand hygiene, facemask wearing, and physical distancing play a crucial role in the prevention of the COVID-19 pandemic. Identifying the key psychosocial determinants of these precautionary behaviors contributes to effective intervention and policymaking for COVID-19 and future pandemics.

PURPOSE

This study aimed to systematically review and meta-analyze available evidence on psychosocial determinants of the general population's practice of three precautionary behaviors, based on the Risk, Attitudes, Norms, Abilities, and Self-regulation (RANAS) framework.

METHODS

Literature was identified by searching seven databases and relevant review papers. Observational and experimental studies targeting the general population (≥18 years) published between January 2020 to September 2021 were included. Pooled effect sizes were calculated with the inverse-variance method using random-effects models.

RESULTS

A total of 51 studies (64 samples) were included in the qualitative synthesis, of which 30 studies (42 samples) were included in the meta-analysis. RANAS-based constructs including knowledge, pros attitudes, and perceived norms were identified as significant determinants of all three behaviors in the meta-analysis. Perceived susceptibility and cons attitudes showed no significant associations with any behaviors. Perceived severity, perceived control, self-efficacy, and behavioral intention were significantly associated with one or two behaviors. Country (western vs. eastern hemispheres) significantly moderated the effects of certain risk and ability factors.

CONCLUSIONS

More research is needed with respect to the intention-behavior relationship, self-regulatory and reflexive factors of precautionary behaviors, as well as the exploration of the potential moderating effect of sociodemographic factors.

Assessment of the Importance of COVID-19 Prevention Measures and Their Applicability in the Daily Life of Pregnant Women and Mothers of Infants

Abstract. The COVID-19 pandemic has posed significant challenges to (expectant) mothers of infants in terms of family health protection. To meet these challenges in a health literate manner, COVID-19 protective measures must be considered important and must also be implemented appropriately in everyday life. To this end, N = 343 (expectant) mothers of infants indicated (a) how important they considered 21 COVID-19 infection prevention measures, and (b) how well they succeeded in implementing them in their daily life (20 measures). We performed data analysis using exploratory factor analysis for ordinal data and latent class analysis. One- and two-dimensional models (CFI = .960 / .978; SRMR = .053 / .039) proved to appropriately explain maternal importance ratings. The items on successfully applying COVID-19 measures in daily life can be modeled by the 5 factors hygiene measures, contact with other people, public transportation, staying at home, and checking infection status (CFI = 0.977; SRMR = .036). Six latent classes can be distinguished. Despite the largest class (39 %), classes are characterized by selective or general applicability problems. Classes reporting problems in the applicability of the measures rated them as generally less important (η = .582). Assessing and modelling importance and applicability of COVID-19 prevention measures allows for a psychometrically sound description of subjective perceptions and behaviors that are crucial for health literate practice in maternal daily life.

The Moderating Power of Impulsivity: A Systematic Literature Review Examining the Theory of Planned Behavior

The theory of planned behavior (TPB) states that behavioral intention is the best predictor of actual behavior change. However, intention explains only a portion of the variance in behavior. Of specific interest is the question of which moderating or mediating variables can be leveraged to aid health promotion interventions utilizing the tenets of behavioral economics (delay discounting and commitment contracts) in the intention–behavior pathway. Impulsivity has been postulated to fill this role and may be applied to multiple behaviors. We aim to determine if impulsivity moderates the association between intention and actual behavior in the TPB, to discover what other variables may moderate or mediate this association, and to apply the findings to future studies in the field of behavioral economics. To this end, a systematic review was conducted using the PubMed, PsychINFO, and Embase online databases. Eligible studies in peer-reviewed journals published prior to November 2021 were selected. Thirty-three studies were included in the final review, examining physical activity, diet, preventive health, mental health, addiction, and medication adherence behaviors. Three main concepts emerged: (1) impulsivity moderates the association between intention and behavior change; (2) self-efficacy moderates the association between intention and behavior change; and (3) planning and self-efficacy contribute to moderated mediation. This review demonstrates a gap in the literature regarding the application of the TPB to the intention–behavior pathway for health behaviors. Future studies in behavioral economics may leverage the variables of impulsivity, self-efficacy, and planning to predict follow-through in this area and to develop targeted change initiatives.

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

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

Does Temporal Stability Moderate Reasoned Action Approach Relations With Covid-19 Preventive Behaviors?

Background

Preventive behaviors continue to play an important role in reducing the spread of the SARS-CoV-2 virus.

Purpose

This study aimed to apply the reasoned action approach (RAA) to predict Covid-19 preventive intentions and behavior and to test whether temporal stability moderates relations between RAA constructs and behavior.

Methods

A representative sample of UK adults (N = 603) completed measures of RAA variables (i.e., experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy and intention) in relation to six Covid-19 preventive behaviors (i.e., wearing face coverings, social distancing, hand sanitizing, avoiding the three Cs [closed spaces, crowded places, and close contacts], cleaning surfaces, and coughing/sneezing etiquette) at baseline (December 2020) and after 1 month. Self-reported behavior was assessed at baseline and after 1 and 2 months.

Results

The RAA was predictive of Covid-19 preventive intentions at time 1 and time 2; instrumental attitudes, descriptive norms, and capability were the strongest predictors at each time point. The RAA also predicted subsequent behavior across time points with intention, descriptive norms, and capability the strongest/most consistent predictors. Temporal stability moderated a number of RAA–behavior relationships including those for intention, descriptive norms, and capability. In each case, the relationships became stronger as temporal stability increased.

Conclusions

Health cognitions as outlined in the RAA provide appropriate targets for interventions to promote Covid-19 preventive intentions and behavior. Moreover, given that continued performance of Covid-19 preventive behaviors is crucial for reducing transmission of the SARS-CoV-2 virus, the results highlight the need for consistent messaging from governments and public health organizations to promote positive intentions and maintain preventive behavior.

Intention to maintain and willingness to stop: Applying a dual-process model to understanding the maintenance of COVID-19 preventive behaviors

Preventive behaviors have played an essential role in coping with COVID-19 and may continue to exerting a crucial impact on pandemic control in the future. This study aimed to evaluate the effectiveness of social-cognitive factors on maintenance of COVID-19 preventive behaviors based on a dual-process model, which encompasses a reasoned path via the intention to maintain and a social reaction path via the willingness to stop. We collected a probability sample of 472 community-dwelling adults. Social-cognitive factors, behavioral tendencies, and preventive behaviors of COVID-19 were measured. The results supported that the dual-process framework could account for individual differences in preventive behaviors. Self-efficacy and response cost significantly explained the intention to maintain preventive behaviors, while favorability of risk image and subjective norm significantly explained the willingness to stop preventive behaviors. Our findings proposed strategies for promoting individuals' maintenance of preventive behaviors during a pandemic. The development of prevention policies may focus on two paths: strengthening the intended path by enhancing self-efficacy and decreasing response cost of preventive behaviors and monitoring and improving social influences, such as risk prototype and subjective norm, which can reduce the willingness to stop preventive behaviors.

What influences news learning and sharing on mobile platforms? An analysis of multi-level informational factors

Purpose

The purpose of the study is threefold: first, to identify what factors influence mobile users' willingness of news learning and sharing, second, to find out whether users' learning in the news platforms will affect their sharing behavior and third, to access the impact of sharing intention on actual sharing behavior on the mobile platform.

Design/methodology/approach

This study proposes an influence mechanism model for examining the relationship among the factors, news learning and news sharing. The proposed mechanism includes factors at three levels: personal, interpersonal and social level. To achieve this, researchers collected data from 474 mobile news users in China to test the hypotheses. The tools SPSS 26.0 and AMOS 23.0 were used to analysis the reliability, validity, model fits and structural equation modeling (SEM), respectively.

Findings

The findings indicate that news learning on the mobile platforms is affected by self-efficacy and self-enhancement. And news sharing intention is influenced by self-efficacy, interpersonal trust, interpersonal reciprocity, online community identity and social norms positively. News sharing intention has a significant effect on news sharing behavior, but news learning has an insignificant relationship with new sharing.

Originality/value

This study provides practical guidelines for mobile platform operators and news media managers by explicating the various factors of users' engagement on the news platforms. This paper also enriches the literature of news learning and news sharing on mobile by the integration of two theories: the social ecology theory and the interpersonal behavior theory.

A Latent Profile Analysis of COVID-19 Trusted Sources of Information among Racial and Ethnic Minorities in South Florida

By the spring of 2021, most of the adult U.S. population became eligible to receive a COVID-19 vaccine. Yet, by the summer of 2021, the vaccination rate stagnated. Given the immense impact COVID-19 has had on society and individuals, and the surge of new variant strains of the virus, it remains urgent to better understand barriers to vaccination, including the impact of variations in trusted sources of COVID-19 information. The goal of the present study was to conduct a cross-sectional, community-engaged, and person-centered study of trusted sources of COVID-19 information using latent profile analysis (LPA). The aims were to (1) identify the number and nature of profiles of trusted sources of COVID-19 information, and (2) determine whether the trust profiles were predictive of COVID-19 vaccination attitudes and various demographic categories. Participants included mostly racial and ethnic minority individuals (82.4%) recruited by various community-based agencies in South Florida. The LPA evidenced an optimal 3-class solution characterized by low (n = 80)-, medium (n = 147)-, and high (n = 52)-trust profiles, with high trust statistically significantly predictive of vaccination willingness. The profiles identified could be important targets for public health dissemination efforts to reduce vaccine hesitancy and increase COVID-19 vaccination uptake. The general level of trust in COVID-19 information sources was found to be an important factor in predicting COVID-19 vaccination willingness.

Developing a Behavior Change Framework for Pandemic Prevention and Control in Public Spaces in China

Preventive behavior, such as hand hygiene, facemask wearing, and social distancing, plays a vital role in containing the spread of viruses during pandemics. However, people in many parts of the world usually encounter difficulties adhering to this behavior due to various causes. Thus, this article aims to develop a research framework and propose design strategies to prompt individuals’ behavior change during pandemics. Initially, we integrated a literature review and a structured interview (n = 22) to ascertain the core factors impacting behavior change during pandemics. These factors were categorized into four aspects: perceptional factors (attitudes, subjective norms and perceived behavior control, risk perceptions); social factors (knowledge and information dissemination, governmental regulations); physical factors (tools and facilities and surveillance); and sociocultural factor (cultural contexts). Then, a theoretical framework with antecedents was developed to reveal behavior intention and formation process. After that, an empirical study was carried out to test the research framework through a questionnaire survey (n = 549). The research findings indicated that all derived factors could directly or indirectly affect individuals’ preventive behavior during pandemics. This article strives to provide valuable insights for different stakeholders when coping with pandemic situations.

COVID-19 Help-Seeking Behaviors: Application of the Theory of Planned Behavior

The novel coronavirus disease (COVID-19) is highly contagious. More than 247 million cases have been confirmed by the end of October 2021. Seeking help earlier may slow the spread of COVID-19 because it may help in early detection of infected cases, and it facilitate tracing those who were with close contact with infected cases. The purpose of this study is to identify participants’ intentions toward COVID-19 seeking help and the factors affecting their decision. This is a cross-sectional study. An online survey using Google Forms was used for data collection. Hierarchical multiple regression analysis was used to explain intentions to seek help for COVID-19. The concepts included in the Theory of Planned Behavior and COVID-19 knowledge were used as predictors. The sample included 780 participants, with an average age of 28.60±9.86 years old. Most of the sample were female (67.4%) and having a bachelor’s degree (72.7%). Participants showed high level of knowledge regarding COVID-19, 73% of the sample had a total knowledge score equal to or higher than 85%. Also, participants had high positive attitudes and high intentions to seek help for COVID-19. The four predictors: Attitudes towards COVID-19, subjective norm, perceived behavioral control, and COVID-19 knowledge significantly explained intentions to seek help. Participants had high intentions to seek help for COVID-19, which was related to having positive attitudes toward seeking help, high social approval, high perceived controllability, and high COVID-19 knowledge levels. Regular awareness campaigns during early stages of pandemics should be performed to improve attitudes and knowledge level, which may improve prevention measures, and promote help seeking behaviors. Consequently, this may facilitate early detection of cases, and slow the spread of pandemics.

The Theory of Planned Behavior during the COVID-19 pandemic: A comparison of health behaviors between Belgian and French residents

The COVID-19 pandemic presents a global crisis and authorities have encouraged the population to promote preventive health behaviors to slow the spread of the virus. While the literature on psychological factors influencing health behaviors during the COVID-19 is flourishing, there is a lack of cross-national research focusing on multiple health behaviors. The present study overcomes this limitation and affords a validation of the Theory of Planned Behavior (TPB) as a conceptual framework for explaining the adoption of handwashing and limitation of social contacts, two health behaviors that highly differ in their nature. Specifically, we compare TPB model on these two protective behaviors among people living in Belgium (N = 3744) and France (N = 1060) during the COVID-19 sanitary crisis. Data were collected from March 18 until April 19, 2020, which corresponds to the spring lockdown and the first peak of the pandemic in these countries. Results indicated that more positive attitudes, greater social norms, increased perceived control and higher intentions were related to higher adherence to handwashing and limitation of social contacts, for both Belgian and French residents. Ultimately, we argued that the TPB model tends to manifest similarly across countries in explaining health behaviors, when comparing handwashing and limitation of social contacts among individuals living in different national contexts.

The Role of Attitudes, Norms, and Efficacy on Shifting COVID-19 Vaccine Intentions: A Longitudinal Study of COVID-19 Vaccination Intentions in New Zealand

While public intentions to get a COVID-19 vaccine have been shifting around the world, few studies track factors that help us understand and improve COVID-19 vaccine uptake. This study focuses on identifying changing public intentions to get a COVID-19 vaccine in New Zealand, a country that has been largely successful in containing the pandemic but risks new outbreaks as less than 20% of the population is fully vaccinated by August 2021. Data on COVID-19 intentions were collected just after the vaccine approval and rollout targeting old-age groups in February 2021 and then before the general public rollout in May 2021 (n = 650, 60% reinterview response rate). Results show that intention to get a COVID-19 vaccine increased in three months and was the highest in the last one year. Consistent with the Theory of Planned Behaviour, attitudes and efficacy beliefs were significantly associated with COVID-19 vaccine intentions, in the cross-sectional as well as longitudinal analyses. Findings highlight the persisting influence of attitudes, efficacy beliefs, and past intentions on future decision-making process to get a COVID-19 vaccine. Future research opportunities to understand vaccine intentions and improve public vaccine uptake are highlighted.