Descriptive Norms and Prototypes Predict COVID-19 Prevention Cognitions and Behaviors in the United States: Applying the Prototype Willingness Model to Pandemic Mitigation

Injunctive social norms and perceived message tailoring are associated with health information seeking

Social norms messages may promote information seeking, especially when the norms refer to a group with which a person identifies. We hypothesized that tailored social norms messages would increase COVID-19 testing willingness and intentions. College students (n = 203, 75% female, 87% White) were randomly assigned to one of four conditions in a 2 (Descriptive norms: Relevant vs. Irrelevant to COVID-19 testing) x 2 (Tailoring: Specific vs. General group information) experimental design. Participants reported COVID-19 testing willingness and intentions, perceived injunctive norms, and identification and connectedness with the group in the message. Although neither the norm nor tailoring manipulation worked as intended, participants who perceived greater message tailoring and injunctive norms reported greater willingness and intentions, with no effect of perceived descriptive norms on either outcome. Tailored messages as well as messages promoting injunctive norms may promote information seeking across health contexts, thereby enabling more informed decisions.

A comparison of anxiety levels before and during the COVID-19 pandemic

The COVID-19 Pandemic upended the lives of nearly everyone worldwide, and recent studies have reported higher rates of anxiety, depression, and other mental health problems. Using a repeated crosssectional design, the current study compares anxiety levels from a representative sample of college students prior-to and during the COVID-19 Pandemic. Additionally, differences in anxiety prior to and following U.S. approval for use of the Pfizer-BioNTtech COVID-19 vaccine were also compared. Findings indicate that state-anxiety levels did not differ significantly prior to and during the Pandemic as well as before the vaccine and during and after the vaccine (M = 43.01, 44.10, 44.77, respectively). Surprisingly, trait anxiety levels were significantly higher during the Pandemic than before (p = .003), and anxiety levels trend down after the approval of the vaccine, but not significantly (M = 45.10, 48.85, 47.58, respectively). Future research should continue to investigate and compare anxiety levels during the COVID-19 Pandemic.

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.

Association between health anxiety dimensions and preventive behaviors during the COVID-19 pandemic among Japanese healthcare workers

Objective

Health anxiety (HA), defined as excessive worry about having a serious medical condition, may affect preventive behaviors during the coronavirus disease 2019 (COVID-19) pandemic. We examined the distinct role of two dimensions of HA-perceived likelihood (probability dimension) and awfulness of illness (awfulness dimension)-in self-protection, as reflected in preventive behaviors during the pandemic.

Methods

Participants comprised 657 healthcare workers. Data were collected between February 24 and 26, 2021. The Short Health Anxiety Inventory determined the HA dimensions. Adherence to the government's recommendations for COVID-19 preventive behaviors was self-rated. An independent association between each HA dimension and participants' adherence to the recommendations was examined using multivariable regression.

Results

Within the analyzed sample of 560 subjects, severe HA was observed in 9.1 %. The more the participants felt awful, the less frequently they engaged in the recommended preventive behaviors (adjusted odds ratio = 0.993, 95 % confidence interval: 0.989, 0.998, p = 0.003) regardless of their profession, working position, psychological distress, sleep disturbance, and current physical diseases. However, the probability dimension was not associated with their preventive behaviors.

Conclusion

The awfulness dimension of HA could be a more sensitive marker of preventive behaviors than the probability dimension. Paying particular attention to the awfulness dimension may help optimize self-protection strategies during the COVID-19 pandemic. A two-dimensional understanding of HA may be useful for the maintenance of the healthcare system and public health as well as healthcare workers' own health.

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.

The interplay between cognitive and affective risks in predicting COVID-19 precautions: a longitudinal representative study of Americans

OBJECTIVE

Cognitive risk figures prominently in models predicting health behaviors, but affective risk is also important. We examined the interplay between cognitive risk (personal likelihood of COVID-19 infection or death) and affective risk (worry about COVID-19) in predicting COVID-19 precautionary behaviors. We also examined how outbreak severity bias (overestimation of the severity of COVID-19 in one's community) predicted these outcomes.

DESIGN

In a representative sample of U.S. adults (N = 738; M_age = 46.8; 52% women; 78% white), participants who had not had COVID-19 took two online surveys two weeks apart in April 2020.

MAIN OUTCOME MEASURES

We assessed cognitive risk, affective risk, and outbreak severity bias at baseline and at follow-up two precaution variables: prevention behaviors (e.g. social distancing) and behavioral willingness (e.g. vaccinations).

RESULTS

Overall, affective risk better predicted precautions than cognitive risk. Moreover, overestimating the severity of the outbreak predicted more affective risk (but not cognitive risk) and in turn more precautions. Additional analyses showed that when affective risk was lower (as opposed to higher) greater cognitive risk and outbreak severity bias both predicted more precautions.

CONCLUSION

These findings illustrate the importance of affective risk and outbreak severity bias in understanding COVID-19 precautionary behavior.

Follow or not? Descriptive norms and public health compliance: Mediating role of risk perception and moderating effect of behavioral visibility

In a pandemic context, public health events are receiving unprecedented attention, and identifying ways to enhance individual public health compliance behaviors has become an urgent practical problem. Considering that individual decisions are susceptible to group members' behaviors and that descriptive norms provide social information about the typical behaviors of others, we focused on the effects of the properties and reference groups of descriptive norms on public health compliance behaviors. We also investigated the mechanism with risk perception as a mediator and the applicable condition with behavioral visibility as a moderator. Through a 2 × 2 × 2 between-subject survey experiment with 529 subjects, we demonstrated that (1) compared with the negative norm, the positive norm was more effective in promoting public health compliance behaviors; (2) compared with the distal group norm, the proximal group norm more significantly promoted public health compliance behaviors; (3) the effect of the property of descriptive norms on public health compliance behaviors was weakened in the treatment of the proximal group norm; (4) risk perception partially mediated the association between the property of descriptive norms and public health compliance behaviors and fully mediated the effect of the interaction of the property and the reference group of descriptive norms on public health compliance behaviors; in the treatment of the negative-proximal group norm, individuals perceived more risk, thus effectively nudging their public health compliance behaviors; (5) compared with low-visibility behaviors, public health compliance behaviors were significantly stronger for high-visibility behaviors; (6) the property of descriptive norms had a weaker effect on public health compliance behaviors for low-visibility behaviors. In terms of theoretical significance, we refined the study of descriptive norms to promote the application of behavioral public policy. Moreover, the new model of public health compliance behaviors constructed in this study explains the mechanism and applicable conditions of public health compliance behaviors. In practical terms, this study has implications for designing intervention programs to nudge public health compliance behaviors.

Social-contextual factors interact with masculinity to influence college men's HPV vaccination intentions: The role of descriptive norms, prototypes, and physician gender

Men’s low HPV vaccination uptake and HPV-related disease incidence are public health issues; gendered social–contextual factors likely play a role. In Study 1, college men (N = 130; M_age = 19.55; white = 58.1%) reported their social cognitions (male-referent descriptive norms and prototypes), self-reliance masculinity ideology, and vaccination intentions. In Study 2, college men (N = 106; M_age = 19.32; white = 61.3%) were randomly assigned to receive HPV vaccination information from a man or woman physician-avatar. Descriptive norms and favorable prototypes (bs ≥ .337; ps ≤ .016) were associated with higher HPV vaccination intentions. Men with higher self-reliance masculinity had higher HPV vaccination intentions with a man physician and when they perceived greater vaccination among men (ps ≤ .035). Men with higher self-reliance masculinity are more sensitive to gendered social–contextual effects in HPV vaccination decision-making. Gendered social–contextual factors should be integrated into public health interventions to increase college men’s HPV vaccination uptake.

Infection preventive behaviors and its association with perceived threat and perceived social factors during the COVID-19 pandemic in South Korea: 2020 community health survey

BACKGROUND

This study examined why some individuals have not properly performed health prevention behavior during the coronavirus disease 2019 (COVID-19) pandemic. We used data from a community health survey conducted by public health centers in South Korea to identify factors affecting COVID-19 prevention behavior in urban and rural areas. Also, we examined whether individual-level demographic, socio-psychological, and structural variables affected COVID-19 prevention behavior by referring to a model explaining individuals' health prevention behavior. In particular, the study is significant as not many other measures were suggested besides compliance with personal quarantine rules during the early phase of the pandemic in 2020. We hope that the results of this study will be considered in further analysis of infection preventive behavior and in future health crises.

METHODS

Probability proportional and systematic sampling were used to collect data in 2020 from 229,269 individuals. After exclusion, the valid data from 141,902 adults (86,163 urban and 44,739 rural) were analyzed. We performed t-tests and analyses of variance to ascertain the differences in COVID-19 preventive behaviors according to demographic characteristics, and a post-hoc analysis was conducted using Scheffé's test. Factors that affected participants' COVID-19 preventive behaviors were analyzed using multiple regression analyses.

RESULTS

The variables significantly influencing COVID-19 preventive behaviors in urban areas were age, gender, living with two or more people, educational level, monthly household income, working status, influenza vaccination, daily life stress, and perceived threat. In rural areas, age, gender, living with two or more people, education level, influenza vaccination, daily life stress, perceived threat, and perceived social factors were significantly associated with increased COVID-19 preventive behaviors.

CONCLUSIONS

Several demographic characteristics were associated with urban and rural residents' COVID-19-related preventive behaviors. A different approach is needed for the two regions in future policy. Future studies should aim to improve the power of the model and include other factors that may be related to COVID-19 preventive behavior.

The relationship between COVID-19-related prevention cognition and healthy lifestyle behaviors among university students: Mediated by e-health literacy and self-efficacy

BACKGROUND

At present, few studies have explored the mediating effect of e-Health literacy and self-efficacy on prevention cognition and healthy lifestyle behaviors during the normalization stage of COVID-19 prevention and control. This study aimed to determine the associations among COVID-19-related prevention cognition, self-efficacy, e-Health literacy, and healthy lifestyle behaviors at university students.

METHODS

By using a stratified cluster random sampling method, 971 students from five universities were recruited between May and August 2021 in Guangzhou, China. We collected participants' demographic characteristics, and assessed self-efficacy, COVID-19-related prevention cognition, e-Health literacy, and healthy lifestyle behaviors. A structural equation model was used for mediation analysis.

RESULTS

The overall mean value of healthy lifestyle behaviors of college students was 0.307 (SD 0.389). Between COVID-19-related prevention cognition, e-Health literacy, self-efficacy, and healthy lifestyle behaviors (r = 0.132-0.505, P < 0.01) were a significant positive correlation. The COVID-19-related prevention cognition had a direct and positive predictive effect on healthy lifestyle behaviors, with a direct effect value of 0.136. e-Health literacy and self-efficacy played both an independent mediating and serial-multiple mediating roles in the association between COVID-19-related prevention cognition and healthy lifestyle behaviors, and the indirect effect values were 0.043, 0.020 and 0.035, respectively.

CONCLUSIONS

The results showed that the emphasis on improving college students' prevention cognition, supplemented by improving e-Health literacy and self-efficacy, could improve college students' healthy lifestyle behaviors.

LIMITATIONS

This study was a cross-sectional investigation with no causal relationship between variables.

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.