Trust in Science, Perceived Vulnerability to Disease, and Adherence to Pharmacological and Non-pharmacological COVID-19 Recommendations

Beyond misinformation: developing a public health prevention framework for managing information ecosystems

The COVID-19 pandemic has highlighted how infodemics (defined as an overabundance of information, including misinformation and disinformation) pose a threat to public health and could hinder individuals from making informed health decisions. Although public health authorities and other stakeholders have implemented measures for managing infodemics, existing frameworks for infodemic management have been primarily focused on responding to acute health emergencies rather than integrated in routine service delivery. We review the evidence and propose a framework for infodemic management that encompasses upstream strategies and provides guidance on identifying different interventions, informed by the four levels of prevention in public health: primary, secondary, tertiary, and primordial prevention. On the basis of a narrative review of 54 documents (peer-reviewed and grey literature published from 1961 to 2023), we present examples of interventions that belong to each level of prevention. Adopting this framework requires proactive prevention and response through managing information ecosystems, beyond reacting to misinformation or disinformation.

Predicting the intention to receive the COVID-19 booster vaccine based on the health belief model

COVID-19 vaccine boosters are recommended because the protection provided by previous doses eventually decreases, posing a threat to immunity. Some people, however, remain hesitant or unwilling to get vaccinated. The present study sought to investigate factors associated with the intention to receive the COVID-19 booster vaccine based on (1) the constructs of the Health Belief Model, and (2) trust in healthcare workers and science. A sample of 165 adults with two doses of the COVID-19 vaccine were recruited using convenience sampling. Data was collected using an online survey from November 2021 to January 2022. The survey included questions about participants' socio-demographic details, health beliefs, trust, history of COVID-19 vaccination, and the intention to receive a third dose of the COVID-19 vaccine. Ordinal logistic regression analysis showed that higher perceived benefits, severity, and trust in healthcare workers, and lower perceived barriers predicted higher willingness to get a third dose of the vaccine whereas perceived susceptibility and trust in science did not. Understanding the factors and health beliefs that underlie vaccine hesitancy are vital when developing effective interventions with the aim of increasing uptake of COVID-19 booster vaccines.

The Role of Anxiety and Prosocial Behaviors on Adherence Behaviors to Prevent COVID-19 in University Students in the United States: Cross-Sectional Study

Background

In situations of acute stress, individuals may engage in prosocial behaviors or risk-taking self-oriented behaviors. The COVID-19 pandemic created large stress-promoting conditions that impacted individuals' decisions to adhere to COVID-19 preventative behaviors.

objectives

The study aimed to examine the relationship between anxiety during the pandemic and adherence behaviors to prevent the spread of COVID-19, and the moderating influence of prosocial behaviors. We hypothesized that individuals with high anxiety during COVID-19 would adhere more to preventive COVID-19 behaviors than ones with low anxiety and that this relationship would be stronger in those individuals with higher prosocial behaviors.

Methods

A web-based survey was administered through the SONA web-based participant tool of the psychology department of a university in the Northeastern United States. A final sample of 54 undergraduate students completed web-based questionnaires during the second wave of the COVID-19 pandemic, from January to May 2021, which included demographic measures and surveys on prosocial behaviors, anxiety, and COVID-19 preventive behaviors. Moderation analyses were conducted using PROCESS in SPSS.

Results

Participants reported high levels of trait and state anxiety symptoms, most of them meeting or exceeding the cutoff criteria to be clinically meaningful (state anxiety: 47/54, 87%; trait anxiety: 38/44, 86%), and over 50% highly adhered to the COVID-19 preventive behaviors of wearing a face mask, using hand sanitizer, handwashing, coughing/sneezing into their elbow or a tissue, self-quarantining, maintaining social distance, avoiding social gatherings, and avoiding nonessential travel. No significant associations were observed between prosocial behavior, anxiety types, and adherence to COVID-19 preventive behaviors. However, when moderation analyses were conducted between anxiety types and adherence to COVID-19 preventive behaviors, results demonstrated a statistically significant interaction of public prosocial behavior with state anxiety (β=-.17, t53=-2.60; P=.01), predicting engagement in COVID-19 preventative behaviors. At high levels of anxiety, low levels of prosocial public behaviors were associated with higher engagement in COVID-19 preventative behaviors. In contrast, high levels of public prosocial behavior were associated with low engagement in COVID-19 preventative behaviors at higher levels of anxiety.

Conclusions

These results provide information that can aid in the creation of interventions that could increase adherence to COVID-19 preventative behaviors (Reviewed by the Plan P #PeerRef Community).

Path analysis of perceived disease vulnerability, COVID-19 fear, and lower vaccine hesitancy within the context of protection motivation theory

COVID-19 vaccinations have demonstrated effectiveness in reducing severe infections. However, vaccine hesitancy posed a major public health hurdle to combat the COVID-19 pandemic. Online spread of vaccine conspiracy beliefs generated unwarranted mistrust and resistance to vaccines. While numerous studies have explored the factors influencing vaccine hesitancy, there remains a lack of comprehensive understanding regarding the interplay between perceived disease vulnerability, COVID-19 fear, and vaccine hesitancy. Protection motivation theory posits citizens will evaluate perceived threats and take actions to mitigate potential harm. With a large U.S. sample, path analysis demonstrated individuals' perceived disease vulnerability was associated with lower vaccine hesitancy. Greater perceived disease vulnerability was associated with higher COVID-19 fear. Greater COVID-19 fear was associated with lower vaccine hesitancy. Greater vaccine conspiracy beliefs associated with higher vaccine hesitancy. However, in the presence of perceived vulnerability to disease, vaccine conspiracy beliefs associated with higher fear of COVID-19 and thereby lower vaccine hesitancy. We found under circumstances of higher perceived vulnerability to disease and fear of COVID-19, vaccine conspiratorial believers were less vaccine hesitant. We discuss how public health messaging can highlight personal risks to contracting COVID-19 to appeal to those who self-identify as disease prone, but may have reservations about vaccines because of misinformation. Successfully combating diseases entails reaching and gaining cooperation from misbelievers because misinformation is expected to continue in the digital age. By understand individual differences to vaccine hesitancy, it can help increase vaccinations and prevent severe illnesses in the post COVID-19 pandemic era.

An empirical evaluation of technology acceptance model for Artificial Intelligence in E-commerce

Artificial Intelligence (AI) has become essential to Electronic-Commerce technology over the past decades. Its fast growth has changed the way consumers do online shopping. Using the Technology Acceptance Model (TAM) as a theoretical framework, this research examines how AI can be made more effective and profitable in e-commerce and how entrepreneurs can make AI technology to assist in achieving their business goals. In this regard, an online survey was conducted from the online purchasers of e-commerce firms. The Partial Least Square (PLS) Smart was used to examine the data. The broadly used TAM was identified as an appropriate hypothetical model for studying the acceptance of AI technology in e-commerce. The findings of this study show that Subjective Norms positively impact Perceived Usefulness (PU) and Pursued Ease of Use (PEU), trust has a positive effect on PEU, and PEU positively impacts PU and attitudes toward use. Similarly, PU also has a positive effect on attitudes toward use and intention to use. Furthermore, the findings do not support the impact of Trust on PU and attitudes towards behavioural intention to use. Lastly, behavioural intention to use positively impacted the actual use of AI technology. This study adds theoretical and practical knowledge for adopting the TAM model in the E-commerce sector. It helps entrepreneurs to implement the TAM model in their business to use AI in a better and more appropriate way.

Determining factors affecting the user's intention to disclose privacy in online health communities: a dual-calculus model

Background

As a new type of medical service application for doctor-patient interaction, online health communities (OHCs) have alleviated the imbalance between the supply and demand of medical resources in different regions and the problems of "difficult and expensive access to medical care", but also raised the concern of patients about the risk of disclosure of their health privacy information.

Methods

In this study, a dual-calculus model was developed to explore users' motivation and decision-making mechanism in disclosing privacy information in OHCs by combining risk calculus and privacy calculus theories.

Results

In OHCs, users' trust in physicians and applications is a prerequisite for their willingness to disclose health information. Meanwhile, during the privacy calculation, users' perceived benefits in OHCs had a positive effect on both trust in doctors and trust in applications, while perceived risks had a negative effect on both trusts in doctors and trust in applications. Furthermore, in the risk calculation, the perceived threat assessment in OHCs had a significant positive effect on perceived risk, while the response assessment had a significant negative effect on perceived risk, and the effect of users' trust in physicians far exceeded the effect of trust in applications. Finally, users' trust in physicians/applications is a mediating effect between perceived benefits/risks and privacy disclosure intentions.

Conclusion

We combine risk calculus and privacy calculus theories to construct a dual-calculus model, which divides trust into trust in physicians and trust in applications, in order to explore the intrinsic motivation and decision-making mechanism of users' participation in privacy disclosure in OHCs. On the one hand, this theoretically compensates for the fact that privacy computing often underestimates perceived risk, complements the research on trust in OHCs, and reveals the influencing factors and decision transmission mechanisms of user privacy disclosure in OHCs. On the other hand, it also provides guidance for developing reasonable privacy policies and health information protection mechanisms for platform developers of OHCs.

Trust in science and belief in misinformation mediate the effects of political orientation on vaccine hesitancy and intention to be vaccinated

In previous studies, anti-vaccination attitudes have been attributed either to far-right voters or to both far-left and far-right voters. The present study investigated the associations of political orientation with vaccine hesitancy and intention to be vaccinated against COVID-19, and the potential mediating roles of trust in science and belief in misinformation. A total of 750 Italian respondents completed an online questionnaire in the period between the second and the third wave of COVID-19 (from 9th March to 9th May 2021). The results showed that political orientation had both direct and indirect associations with vaccine hesitancy and vaccine intention, mediated by trust in science and belief in misinformation. Specifically, right-wing adherents were less trustful of scientists and believed in COVID-19-related misinformation more than left-wing adherents, and these two factors accounted for their higher vaccine hesitancy and reduced willingness to receive an anti-COVID-19 vaccination. Our findings are in line with the predictions of the mindsponge theory and suggest that communicative campaigns aimed at improving the rates of vaccine acceptance in right-wing adherents should be specifically focused on enhancing trust in science and reducing belief in misinformation.

Intention to Vaccinate against COVID-19 among Young Adults: The Role of Conspiratorial Thinking

The anti-scientific and anti-vaccine movements gained momentum amidst the health and socio-economic crisis brought about by the COVID-19 pandemic. These widespread pseudoscientific beliefs and the endorsement of conspiracy theories likely contributed to the COVID-19 vaccine hesitancy. The aim of this study was to explore which variables best differentiated between groups of vaccinated (n = 289), vaccine-hesitant (n = 106), and vaccine-refusing (n = 146) young adults. The study was conducted online at the beginning of the mass vaccination campaign in Croatia when the vaccine just became available for younger and non-vulnerable members of the general population. The demographic variables, COVID-19 anxiety, and conspiratorial thinking regarding COVID-19 were entered into the discriminant analysis. The function explaining 89.2% of the group differences, mostly between the vaccinated and vaccine-refusing, was largely defined by conspiratorial thinking regarding COVID-19 (0.852), followed by variables with substantially less discriminative power, including COVID-19 anxiety (0.423; lower in the vaccine-refusing group), political orientation (0.486; vaccine-refusing leaning less to the left), financial and educational status (0.435 and 0.304, respectively; both lower in the vaccine-refusing group), and religiosity (0.301; higher in the vaccine-refusing group). These results confirm that among young adults, the decision to vaccinate against COVID-19 might be heavily influenced by one's proclivity to engage in conspiratorial thinking.

Using normative language when describing scientific findings: Randomized controlled trial of effects on trust and credibility (Preprint)

BACKGROUND

Scientists often make cognitive claims (eg, the results of their work) and normative claims (eg, what should be done based on those results). Yet, these types of statements contain very different information and implications. This randomized controlled trial sought to characterize the granular effects of using normative language in science communication.

OBJECTIVE

Our study examined whether viewing a social media post containing scientific claims about face masks for COVID-19 using both normative and cognitive language (intervention arm) would reduce perceptions of trust and credibility in science and scientists compared with an identical post using only cognitive language (control arm). We also examined whether effects were mediated by political orientation.

METHODS

This was a 2-arm, parallel group, randomized controlled trial. We aimed to recruit 1500 US adults (age 18+) from the Prolific platform who were representative of the US population census by cross sections of age, race/ethnicity, and gender. Participants were randomly assigned to view 1 of 2 images of a social media post about face masks to prevent COVID-19. The control image described the results of a real study (cognitive language), and the intervention image was identical, but also included recommendations from the same study about what people should do based on the results (normative language). Primary outcomes were trust in science and scientists (21-item scale) and 4 individual items related to trust and credibility; 9 additional covariates (eg, sociodemographics, political orientation) were measured and included in analyses.

RESULTS

From September 4, 2022, to September 6, 2022, 1526 individuals completed the study. For the sample as a whole (eg, without interaction terms), there was no evidence that a single exposure to normative language affected perceptions of trust or credibility in science or scientists. When including the interaction term (study arm × political orientation), there was some evidence of differential effects, such that individuals with liberal political orientation were more likely to trust scientific information from the social media post's author if the post included normative language, and political conservatives were more likely to trust scientific information from the post's author if the post included only cognitive language (β=0.05, 95% CI 0.00 to 0.10; P=.04).

CONCLUSIONS

This study does not support the authors' original hypotheses that single exposures to normative language can reduce perceptions of trust or credibility in science or scientists for all people. However, the secondary preregistered analyses indicate the possibility that political orientation may differentially mediate the effect of normative and cognitive language from scientists on people's perceptions. We do not submit this paper as definitive evidence thereof but do believe that there is sufficient evidence to support additional research into this topic, which may have implications for effective scientific communication.

TRIAL REGISTRATION

OSF Registries osf.io/kb3yh; https://osf.io/kb3yh.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/41747.

Both trust in, and polarization of trust in, relevant sciences have increased through the COVID-19 pandemic

While attempts to promote acceptance of well-evidenced science have historically focused on increasing scientific knowledge, it is now thought that for acceptance of science, trust in, rather than simply knowledge of, science is foundational. Here we employ the COVID-19 pandemic as a natural experiment on trust modulation as it has enabled unprecedented exposure of science. We ask whether trust in science has on the average altered, whether trust has changed the same way for all and, if people have responded differently, what predicts these differences? We 1) categorize the nature of self-reported change in trust in "scientists" in a random sample of over 2000 UK adults after the introduction of the first COVID vaccines, 2) ask whether any reported change is likely to be real through consideration of both a negative control and through experiment, and 3) address what predicts change in trust considering sex, educational attainment, religiosity, political attitude, age and pre-pandemic reported trust. We find that many more (33%) report increased trust towards "scientists" than report decreased trust (7%), effects of this magnitude not being seen in negative controls. Only age and prior degree of trust predict change in trust, the older population increasing trust more. The prior degree of trust effect is such that those who say they did not trust science prior to the pandemic are more likely to report becoming less trusting, indicative of both trust polarization and a backfire effect. Since change in trust is predictive of willingness to have a COVID-19 vaccine, it is likely that these changes have public health consequences.

The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic

BACKGROUND

The Perceived Vulnerability to Disease Questionnaire (PVDQ) measures beliefs associated with personal susceptibility to infectious diseases and behaviors or perceptions in the presence of potential risk of pathogen transmission. Given the onset of the Severe Acute Respiratory Syndrome Coronavirus 2 global pandemic, otherwise known as the COVID-19 pandemic, the construct being measured may function differently based on affective, behavioral, and cognitive changes along with the need to change norms and lifestyles in a global context. The present study aims to test the psychometric properties and the gender invariance of the Italian adaptation of the PVDQ to confirm that the scale can be used with Italian-speaking people, and that it functions effectively during a pandemic.

METHODS

A total of 509 participants filled out an online questionnaire including the Italian version of the I-PVDQ (I-PVDQ) and several measures of psychological constructs. Reliability and factor analyses (single and multigroup) were conducted. Bayesian correlation tests and Bayesian independent sample t-tests were used to assess the validity of I-PVDQ.

RESULTS

Exploratory factor analysis supported the two-factor structure of the I-PVDQ, and factor loadings loaded appropriately onto perceived infectability (PI) and germ aversion (GA). In terms of invariance, the scale showed configural, metric, scalar, and strict invariance across genders. Decisive evidence in favor of correlation with the measure of COVID-19 related fears for both PI and GA was found. There was strong evidence for observed correlations with COVID-19 related constructs such as intolerance to uncertainty, psychological inflexibility, resilience, stress, and anxiety. Women showed higher GA than men, while there were no gender differences in PI.

CONCLUSIONS

Taken together, these results suggest that the I-PVDQ confirms the psychometric properties of the original version and that can be used to detect PVD when it is affected by environmental circumstances since its functioning is preserved during a pandemic.

The distinct associations of ingroup attachment and glorification with responses to the coronavirus pandemic: Evidence from a multilevel investigation in 21 countries

While public health crises such as the coronavirus pandemic transcend national borders, practical efforts to combat them are often instantiated at the national level. Thus, national group identities may play key roles in shaping compliance with and support for preventative measures (e.g., hygiene and lockdowns). Using data from 25,159 participants across representative samples from 21 nations, we investigated how different modalities of ingroup identification (attachment and glorification) are linked with reactions to the coronavirus pandemic (compliance and support for lockdown restrictions). We also examined the extent to which the associations of attachment and glorification with responses to the coronavirus pandemic are mediated through trust in information about the coronavirus pandemic from scientific and government sources. Multilevel models suggested that attachment, but not glorification, was associated with increased trust in science and compliance with federal COVID-19 guidelines. However, while both attachment and glorification were associated with trust in government and support for lockdown restrictions, glorification was more strongly associated with trust in government information than attachment. These results suggest that both attachment and glorification can be useful for promoting public health, although glorification's role, while potentially stronger, is restricted to pathways through trust in government information.

Using Moralization as a Persuasion Strategy in Public Health Messages: A Cross-Sectional, Experimental Study on Vaping

Using moralization in anti-vaping public health messages as a persuasion strategy was recently recommended to address the current vaping epidemic. However, previous findings indicated this could lead to moralized attitudes in the general population, which can be very difficult to change and could severely affect social cohesion and distort risk perception. Since the safety and efficiency of using electronic cigarettes as smoking cessation devices are still being investigated, we conducted a cross-sectional, experimental study on a convenience sample of 612 Romanian never vapers, never smokers to assess how exposure to moralizing public health messages about vaping might influence their trust in future scientific results about this topic. Participants were randomized into six groups according to the type of message ("moral," "immoral," "neutral") and the type of effects of vaping on smokers' health, documented in a future fictitious study ("health benefits," "health risks"). Results showed that the type of message moderated trust in future scientific results after controlling for participants' general trust in science. When vaping was framed as immoral, trust in future scientific results showing health benefits was decreased, and vice versa. Implications are discussed for using moralization strategically in public health messaging to curtail or promote certain health behaviors.

Using normative language when describing scientific findings: Study protocol for a randomized, controlled trial of effects on trust and credibility

Background

Trust in science and scientists has received renewed attention because of the “infodemic” occurring alongside COVID-19. A robust evidence basis shows that such trust is associated with belief in misinformation and willingness to engage in public and personal health behaviors. At the same time, trust and the associated construct of credibility are complex meta-cognitive concepts that often are oversimplified in quantitative research. The discussion of research often includes both normative language (what one ought to do based on a study’s findings) and cognitive language (what a study found), but these types of claims are very different, since normative claims make assumptions about people’s interests. Thus, this paper presents a protocol for a large randomized controlled trial to experimentally test whether some of the variability in trust in science and scientists and perceived message credibility is attributable to the use of normative language when sharing study findings in contrast to the use of cognitive language alone.

Objective

The objective of this trial will be to examine if reading normative and cognitive claims about a scientific study, compared to cognitive claims alone, results in lower trust in science and scientists as well as lower perceived credibility of the scientist who conducted the study, perceived credibility of the research, trust in the scientific information on the post, and trust in scientific information coming from the author of the post.

Methods

We will conduct a randomized controlled trial consisting of 2 parallel groups and a 1:1 allocation ratio. A sample of 1500 adults aged ≥18 years who represent the overall US population distribution by gender, race/ethnicity, and age will randomly be assigned to either an “intervention” arm (normative and cognitive claims) or a control arm (cognitive claims alone). In each arm, participants will view and verify their understanding of an ecologically valid claim or set of claims (ie, from a highly cited, published research study) designed to look like a social media post. Outcomes will be trust in science and scientists, the perceived credibility of the scientist who conducted the study, the perceived credibility of the research, trust in the scientific information on the post, and trust in scientific information coming from the author of the post. Analyses will incorporate 9 covariates.

Results

This study will be conducted without using any external funding mechanisms.

Conclusions

If there is a measurable effect attributable to the inclusion of normative language when writing about scientific findings, it should generate discussion about how such findings are presented and disseminated.

Trial Registration

Open Science Framework n7yfc; https://osf.io/n7yfc

International Registered Report Identifier (IRRID)

PRR1-10.2196/41747

Excess suicides in Brazil: Inequalities according to age groups and regions during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has already claimed more than six million direct deaths. Low-and middle-income countries, such Brazil, were severely hit, not only due to direct effects on mortality, but also for its indirect effects on other causes of deaths.

AIMS

The objective of this study was to estimate the excess suicides in Brazil and evaluate patterns within and between its regions during the COVID-19 pandemic in 2020.

METHOD

The observed suicides are gathered from the mortality information system of the Brazilian Ministry of Health. The estimates of expected suicides, according to sex, age group, bimonthly period and region, were reached through quasi-Poisson generalized additive models, with adjustment for overdispersion. The analyses were performed in R software, version 3.6.1 and RStudio, version 1.2.1335.

RESULTS

From March 2020 to December 2020, 10,409 suicides were observed in Brazil, resulting in an overall decrease of 13%, in comparison to the expected rate for the period. There were excess suicides of 26% in men from the Northern region in the 60 years and more age group, as well as in women from the Northern region in the 30 to 59 years age group in two consecutive bimonthly periods. Excess suicides of 40% was also observed in women in the 60 years and more age group from the Northeastern region.

CONCLUSIONS

Despite the overall decrease in suicides in Brazil over the period assessed, substantial excess suicides were observed in different age groups and sexes from the Northern and Northeastern regions of the country, which are regions that are historically more prone to health and socioeconomic inequalities.

The converging influence of social, economic and psychological factors on public responsiveness to the COVID-19 pandemic in South Africa

Background

This study assessed the influence of social, economic, and psychological factors on South African’s responsiveness to the COVID-19 pandemic. Although the South African government responded quickly to manage the pandemic, the strict lockdown placed a significant burden on the population. Understanding the converging influence of social, economic, and psychological factors on the population’s responsiveness is important for improving people’s cooperation in controlling COVID-19 and for supporting individuals and communities during the ongoing and future pandemics.

Methods

Using data collected from a national telephonic survey (December 2020 to March 2021), we assessed whether selected social, economic and psychological factors were related to: 1) adoption of COVID-19 behavioural measures (hand hygiene, wearing of face masks, and physical distancing), and 2) adherence to government restrictions on movement.

Results

South Africans were highly responsive to the pandemic with respondents generally reporting that they very often engaged in the protective behaviours and often to very often adhered to government restriction on movement. However, those from the white population group; with a higher education; living in uncrowded households; who perceived less vulnerability to contracting COVID-19; supported the measures; trusted the scientists; thought the measures by government were implemented fairly and fairly enforced by the police; felt more anxious, sad, hopeless, isolated, angry or had trouble sleeping; inclined to engage in coping behaviour, were more likely to adopt COVID-19 protective behaviours. Furthermore, females, those with a lower education, those less likely to have experienced poverty since the beginning of lockdown; who perceived greater vulnerability to COVID-19, trusted government, and were more supportive of the behavioural measures were more likely to adhere to the restrictions of movement.

Conclusions

Strengthening the South African population’s responsiveness to the pandemic requires supporting those living in poor socioeconomic circumstances, promoting trust in the scientific evidence, and ensuring that the measures by government are perceived to be fairly implemented and fairly enforced by the police. Due to the impact on livelihoods, restrictions of movement should only be considered if necessary, and this will require trust and confidence in government and strategies to support those experiencing financial hardship.

“I Did My Own Research”: Overconfidence, (Dis)trust in Science, and Endorsement of Conspiracy Theories

Epistemically suspect beliefs, such as endorsement of conspiracy theories or pseudoscientific claims, are widespread even among highly educated individuals. The phenomenon of conspiratorial thinking is not new, yet the COVID-19 pandemic, causing a global health crisis of an unprecedented scale, facilitated the emergence and rapid spread of some rather radical health-related pseudoscientific fallacies. Numerous correlates of the tendency to endorse conspiracy theories have already been addressed. However, many of them are not subject to an intervention. In this study, we have tested a model that includes predictors ranging from stable characteristics such as demographics (gender, age, education, and size of the place of residence), less stable general traits such as conservatism and overconfidence in one’s own reasoning abilities, to relatively changeable worldviews such as trust in science. A hierarchical regression analysis (N = 859 participants) showed that included predictors explained a total of 46% of the variance of believing in COVID-19 conspiracy theories, with only gender, overconfidence, and trust in science yielding significance. Trust in science was the strongest predictor, implying that campaigns aimed at enhancing public trust in both science as a process, and scientists as individuals conducting it, might contribute to the reduction in susceptibility to pseudoscientific claims. Furthermore, overconfidence in one’s own reasoning abilities was negatively correlated with an objective measure of reasoning (syllogisms test) and positively correlated with the endorsement of conspiracy theories, indicating that the so-called Dunning-Kruger effect plays a role in pseudoscientific conspiratorial thinking regarding COVID-19.

Affective States During the First Wave of the COVID-19 Pandemic: Progression of Intensity and Relation With Public Health Compliance Behavior

The COVID-19 pandemic was expected to cause intense affective reactions. This situation provided a unique opportunity to examine the characteristics and correlates of emotions in a real-world context with great significance. Our study aimed to describe the progression of positive and negative affective states during the pandemic, and to investigate which affective states predicted compliance with public health measures. We undertook a survey of affective states in the province of Quebec at the beginning, the peak, and the aftermath of the first wave of the COVID-19 pandemic. We recruited 530 responders; 154 responded to all three surveys. We used self-report scales to measure affective states and compliance with public health measures. We then computed separate linear regressions for the three phases of our study, with compliance with health measures as the dependent variable. Affective states were generally most intense at the beginning of the pandemic. Fear-related pandemic-related affective states reliably predicted compliance with public health measures in the three phases of our study. Positively valenced affective states related to the societal response also contributed predictive value, but only at the peak of the first wave.

Perceived Vulnerability to Disease and the Relationship with Teacher Satisfaction in South Africa during COVID-19: The Serial Role of Burnout, Role Conflict, and Ambiguity

Teachers’ work roles and responsibilities have changed dramatically because of the COVID-19 pandemic. These unprecedented changes have the potential to generate role stress and burnout and reduce teachers’ job satisfaction. This study investigated the serial relationship between perceived vulnerability to disease, role stress, burnout, and teaching satisfaction. It was hypothesised that individuals who perceive themselves to be at high risk of contracting COVID-19 would report high role conflict and ambiguity in the workplace, which would in turn lead to high levels of burnout and low satisfaction with teaching. Participants were schoolteachers (N = 355) who completed the Perceived Vulnerability to Disease Questionnaire, the Role Orientation Questionnaire, the Maslach Burnout Inventory, and the Teaching Satisfaction Scale. Path analysis confirmed that perceived vulnerability to disease was associated with role conflict and ambiguity, which was in turn associated with emotional exhaustion, depersonalisation, and low teaching satisfaction. Teachers who appraised themselves as being more vulnerable to contracting COVID-19 experienced greater role stress, which was associated with high levels of burnout and low teaching satisfaction. This study highlights that threat appraisals related to contracting COVID-19 represent an additional job demand and this needs to be matched by job resources that can facilitate coping.

[Changes in the pattern of COVID-19 hospitalizations and deaths after substantial vaccination of the elderly in Manaus, Amazonas State, Brazil]

The impact of COVID-19 vaccination in the elderly has received relatively little attention, particularly in a scenario predominated by the gamma variant. The aim of this study was to assess vaccination coverage and its relationship to changes in the pattern of COVID-19 hospitalizations and deaths in the elderly in Manaus, Amazonas State, Brazil. This was an ecological study with Brazilian Ministry of Health data on hospitalizations and deaths, assessing vaccination coverage based on a two-dose regimen, in addition to two vaccination regimens associated with a significant protective effect, one partial (35 days or more after the first dose of the Oxford/AstraZeneca vaccine) and the other complete (14 days or more after the second dose of the Sinovac-CoronaVac vaccine). Based on the date of initial symptoms, patterns of COVID-19 hospitalizations and deaths were assessed comparatively in elderly 60-69 years and 70 years or more in two groups of Epidemiological Weeks (EW) in 2020 (unvaccinated) and 2021 (vaccinated). Hospitalization and death rates were estimated with Poisson regression. In the groups 60-69 and 70 years or more, vaccination coverage rates were 41.8% and 54.8%, as well as 53.5% and 90.1%, in the EW groups 18-20/2021 and 21-23/2021, respectively. Both EW groups in 2021 showed a substantial change in the patterns of COVID-19 hospitalizations and deaths, with an increase in the risk of hospitalization and death in unvaccinated younger individuals and an important reduction in vaccinated elderly, especially those 60-69 years of age, besides overall reductions of 62% (95%CI: 52-69) and 63% (95%CI: 43-75) in hospitalization and death rates, respectively. Our results emphasize the importance of mass vaccination, especially during an epidemic such as in Manaus, marked by high circulation of the gamma variant.

Acceptance and Factors Influencing Acceptance of COVID-19 Vaccine in a Romanian Population

COVID-19 vaccination has been recognized as one of the most effective ways to overcome the current SARS-CoV-2 pandemic. However, the success of this effort relies on national vaccination programmes. In May 2021, we surveyed 1552 people from Romania to determine acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 39.2% of participants reported that they were vaccinated and 25.6% desired vaccination; nonetheless, 29.5% expressed opposition to vaccination. Concerning vaccination refusal, the top justification given by respondents is that the vaccine is insufficiently safe and there is a risk of serious side effects (84.4%). A higher rate of vaccination refusal was observed among female gender, younger age, and lower educational level. Refusal was also associated with unemployment, being in a relationship, and having a decrease in income during the pandemic. People who are constantly informed by specialized medical staff have a statistically significant higher vaccination rate, while people who choose to get information from friends, family, and co-workers have the strongest intention of avoiding the vaccine. Current levels of vaccine are insufficient to achieve herd immunity of 67%. It is mandatory to understand the aspects that define and establish confidence and to craft nationwide interventions appropriately.

Predictors of the Intention to Be Vaccinated against COVID-19 in a Sample of Italian Respondents at the Start of the Immunization Campaign

COVID-19 vaccines are the most promising means of limiting the pandemic. The present study aims at determining the roles of several psychological variables in predicting vaccination intention in Italy. An online questionnaire was disseminated between 9 March and 9 May 2021. The sample included 971 participants. Results showed that most of the participants were willing to vaccinate. Acceptance rates were correlated with age, marital status, and area of residence. Intention to be vaccinated was positively correlated with perceived risk, pro-sociality, fear of COVID-19, use of preventive behaviors, and trust in government, in science, and in medical professionals. Intention to be vaccinated was negatively associated with belief in misinformation. The degree of acceptance is likely to be a result of the campaign tailored to address people’s negative attitudes towards vaccines. Trust in government and trust in science were among the strongest psychological predictors of vaccination intention. Fear of COVID-19, but not perceived risk, was associated with increased vaccine uptake, suggesting that the affective component of risk perception was more important than the cognitive component in predicting participants’ behaviors. Belief in misinformation was associated with reduced vaccination intention. Future studies will take into consideration these variables, to better understand the multifaceted process underlying vaccination intention.

Trust in Institutions and the COVID-19 Threat: A Cross-Sectional Study on the Public Perception of Official Recommendations and of Othering in Switzerland

Objectives: To explore how perceived disease threat and trust in institutions relate to vaccination intent, perceived effectiveness of official recommendations, and to othering strategies. Methods: We conducted a cross-sectional survey of Swiss adults in July 2020. Outcome variables were vaccination intent, perceived effectiveness of official recommendations and othering strategies (labelling a given social group as responsible for the disease and distancing from it). Independent variables were perceived disease threat, trust in various institutions, perceived health-related measures, and sociodemographic variables. Linear and logistic regressions were performed. Results: The response rate was 20.2% (1518/7500). Perceived disease threat and trust in medical/scientific institutions were positively associated with vaccination intent and perceived effectiveness of official recommendations for coronavirus mitigation measures. Only disease threat was associated with a perception of effectiveness among othering strategies. Age and education levels were associated with vaccination intent. Conclusion: Reinforcing trust in medical/scientific institutions can help strengthen the perceived effectiveness of official recommendations and vaccination. It however does not prevent adherence to ineffective protecting measures such as othering strategies, where decreasing perceptions of epidemic threat appears to be more efficient.

Respiratory Infectious Diseases and Adherence to Nonpharmacological Interventions for Overcoming COVID-19 Pandemic: A Self-Reported Study

BACKGROUND

The aim of the study was to examine changes in the frequency of respiratory diseases during the COVID-19 pandemic and to correlate the changes with nonpharmacological interventions for overcoming the pandemic. In addition, the study explored the predictors of adherence to nonpharmacological interventions among the Jordanian public.

METHOD

The study is survey-based and self-reported, using convenient sampling. The study was conducted during October-November of 2021.

RESULTS

The study included 1714 participants. About one-quarter of participants reported decreases in the incidence of cold (21.9%), influenza (24.7%), respiratory infections other than cold and influenza (23.3%), tonsillitis (23.0%), and oral ulcers (23.5%). On the other hand, the majority reported no change in the incidence of the above infections (62.0-64.4%). Adherence of the sample to nonpharmacological interventions of COVID-19 was moderate. The percentages of people who always wear a mask, follow social distancing, and use sanitizing procedures were 47.1%, 37.8%, and 68.8% respectively. ANOVA test showed a significant correlation between the incidence of respiratory/oral infections and adherence to nonpharmacological interventions. The multiple regression test showed that people who followed COVID-19 news, have children, have a job, and being married were more adhered to nonpharmacological measures compared to others.

CONCLUSION

Implementation of nonpharmacological interventions used to overcome the COVID-19 pandemic can be applied to reduce other respiratory infections during their peak seasons.

Risk mitigation behaviors to prevent infection in the mitochondrial disease community during the COVID19 pandemic

Background

A challenge during the COVID-19 pandemic has been widespread adherence to risk-reducing behaviors. Individuals with mitochondrial disease (MtD) are special population with an increased risk of morbidity associated with infection.

Purpose

To measure risk mitigation behaviors (RMBs) in families affected by MtD and identify factors that may influence these behaviors.

Methods

An online questionnaire was distributed in April and June 2020. Individuals with MtD or their caregivers completed the survey.

Results

We received 529 eligible responses with n = 312 completing all questions for our multivariate regression model. The most common RMBs were increased hand washing (96%), social distancing (94%), and avoiding public gatherings (93%). Higher numbers of recent healthcare visits (b = 0.62, p < 0.05) and expressed fear of the MtD patient contracting COVID-19 (b = 0.92, p < 0.05) were associated with more RMBs. Living in a rural community (b = −0.99,p < 0.05) and a history of COVID-19 testing (b = −2.14,p < 0.01) were associated with fewer RMBs.

Conclusions

Our results suggest that during the COVID-19 pandemic, families affected by MtD have near universal adherence to basic RMBs. This may be motivated by fear of the severe morbidity associated with infection in MtD. Patients with frequent healthcare visits may be sicker and therefore take more precautions. Living in a rural community may also impact these behaviors. People who practice fewer RMBs may be more likely to seek testing. Our findings may generalize to other chronic diseases.

Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial

Background

Trust in science meaningfully contributes to our understanding of people’s belief in misinformation and their intentions to take actions to prevent COVID-19. However, no experimental research has sought to intervene on this variable to develop a scalable response to the COVID-19 infodemic.

Objective

Our study examined whether brief exposure to an infographic about the scientific process might increase trust in science and thereby affect belief in misinformation and intention to take preventive actions for COVID-19.

Methods

This two-arm, parallel-group, randomized controlled trial aimed to recruit a US representative sample of 1000 adults by age, race/ethnicity, and gender using the Prolific platform. Participants were randomly assigned to view either an intervention infographic about the scientific process or a control infographic. The intervention infographic was designed through a separate pilot study. Primary outcomes were trust in science, COVID-19 narrative belief profile, and COVID-19 preventive behavioral intentions. We also collected 12 covariates and incorporated them into all analyses. All outcomes were collected using web-based assessment.

Results

From January 22, 2021 to January 24, 2021, 1017 participants completed the study. The intervention slightly improved trust in science (difference-in-difference 0.03, SE 0.01, t₁₀₀₀=2.16, P=.031). No direct intervention effect was observed on belief profile membership, but there was some evidence of an indirect intervention effect mediated by trust in science (adjusted odds ratio 1.06, SE 0.03, 95% CI 1.00-1.12, z=2.01, P=.045) on membership in the “scientific” profile compared with the others. No direct nor indirect effects on preventive behaviors were observed.

Conclusions

Briefly viewing an infographic about science appeared to cause a small aggregate increase in trust in science, which may have, in turn, reduced the believability of COVID-19 misinformation. The effect sizes were small but commensurate with our 60-second, highly scalable intervention approach. Researchers should study the potential for truthful messaging about how science works to serve as misinformation inoculation and test how best to do so.

Trial Registration

NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241

International Registered Report Identifier (IRRID)

RR2-10.2196/24383

Would Older Adults Perform Preventive Practices in the Post-COVID-19 Era? A Community-Based Cross-Sectional Survey in China

During the post-COVID-19 era, preventive practices, such as washing hands and wearing a mask, remain key measures for controlling the spread of infection for older adults. This study investigated the status of preventive practices among older adults and identified the related influencing factors. Participants who were ≥60 years old were recruited nationwide. Data were collected through self-designed questionnaires, including demographic variables, knowledge, perceived vulnerability, response efficacy, anxiety and preventive practices. Descriptive statistics and chi-square tests were performed. Hierarchical logistic regression was conducted to determine the predictors. A total of 2996 participants completed this study. Of them, 2358 (78.7%) participants reported washing hands regularly in the last two weeks, and 1699 (56.7%) always wore masks outside this year. Knowledge (hand washing: OR = 1.09, p < 0.01; mask wearing: OR = 1.17, p < 0.01) and response efficacy (hand washing: OR = 1.61, p < 0.01; mask wearing: OR = 1.70, p < 0.01) were positively associated with preventive practices, whereas perceived vulnerability had a negative effect (hand washing: OR = 0.54, p < 0.01; mask wearing: OR = 0.72, p < 0.01). Knowledge, response efficacy and perceived vulnerability were found to be significant predictors of the preventive practice among older adults in the post-COVID-19 era. This study provides new insights into preventive suggestions after the peak of the pandemic and also has significant implications in improving the life quality of older adults.

Differences in the Protection Motivation Theory Constructs between People with Various Latent Classes of Motivation for Vaccination and Preventive Behaviors against COVID-19 in Taiwan

The present study aimed to identify the distinct classes of motivations to get vaccinated and to adopt preventive behaviors against the coronavirus disease 2019 (COVID-19) among people in Taiwan and to examine the roles of Protection Motivation Theory (PMT) cognitive constructs in these unique classes of motivations to get vaccinated and to adopt preventive behaviors. We recruited 1047 participants by using a Facebook advertisement. Participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19, PMT constructs of threat appraisal (perceived severity and perceived vulnerability), and PMT constructs of coping appraisal (self-efficacy, response efficacy, response cost, knowledge, and previous vaccination for seasonal influenza) were determined. We analyzed participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19 by using latent profile analysis. The present study identified three latent classes, including the participants with high motivation for vaccination and preventive behaviors (the class of Both High), those with low motivation for vaccination and preventive behaviors (the class of Both Low), and those with high motivation for vaccination but low motivation for preventive behaviors (the class of High Vaccination but Low Preventive Behaviors). Compared with the participants in the class of Both High, participants in the class of Both Low had lower levels of perceived vulnerability, perceived severity, self-efficacy to have vaccination, response efficacy of vaccination, knowledge about vaccination, and previous vaccination for seasonal influenza; participants in the class of High Vaccination but Low Preventive Behaviors had lower levels of perceived vulnerability and perceived severity but higher levels of response cost of vaccination. We concluded that varieties of motivations, threat, and coping appraisals should be considered in intervention programs aiming to increase motivation to adopt recommended protective behaviors against COVID-19.

Who Believes in COVID-19 Conspiracy Theories in Croatia? Prevalence and Predictors of Conspiracy Beliefs

The COVID-19 pandemic has given rise to numerous new conspiracy theories related to the virus. This study aimed to investigate a range of individual predictors of beliefs in COVID-19 conspiracy theories that account for sociodemographic characteristics (age, gender, education, economic standard, the importance of religion, and political self-identification), distinctive motivational orientations (social dominance and authoritarianism), relevant social attitudes (sense of political powerlessness and trust in science and scientists), and perceived personal risk (perceived risk for self and family members, the concern of being infected, and the expected influence of pandemic on the economic standard of an individual). Participants were 1,060 adults recruited from the general public of Croatia. The sample was a probabilistic quota sample with gender, age, level of education, size of the dwelling, and region of the country as predetermined quotas. The regression model explained 42.2% of the individual differences in beliefs in COVID-19 conspiracy theories. Trust in science and scientists and political powerlessness were the strongest predictors, whereas fear of being infected had the weakest contribution in explaining the variance of the criterion. Additionally, results revealed that the relation of conventionalism (as a proxy of authoritarianism) with belief in COVID-19 conspiracies was mediated by trust in science and scientists. The relation between social dominance and belief in conspiracies was also partially mediated by trust in science. The results suggest that (re)building trust in science and lowering the sense of political helplessness might help in fighting potentially harmful false beliefs about the pandemic.