The Impact of the Fear of COVID-19 on Purchase Behavior of Dietary Supplements: Integration of the Theory of Planned Behavior and the Protection Motivation Theory

Score of fear of COVID-19 and physical activity level are related to the habitual consumption of dietary supplements

The measures implemented to contain the COVID-19 pandemic resulted in both behavioral and lifestyle changes. The "Changes in Lifestyle-Related Behavior" instrument was developed to assess lifestyle-related behaviors in the Indian population. However, considering current knowledge, this instrument was not adapted for the Brazilian population. In addition, the relationship between fear of COVID-19 and consumption of dietary supplements has not yet been evaluated. Thus, we aimed to investigate the relationship between the use of dietary supplements with lifestyle behavior and the fear of COVID-19, as well as assess the psychometric properties of the Brazilian version of the "Changes in Lifestyle-Related Behavior" instrument. An online questionnaire assessed sociodemographic, occupational, anthropometric, physical activity (International Physical Activity Questionnaire-short form), fear of COVID-19, and lifestyle behavior data from 416 Brazilian adults (237 females; 18-60y). Mann-Whitney, Chi-square test, exploratory, and confirmatory analyses were applied. Exploratory and confirmatory analyses showed a satisfactory adequacy level of the questionnaire (CMIN/DF = 2.689; Cronbach's α = 0.60) with 5 domains ('Bad eating behavior'; 'Healthy eating'; 'Sleep quality'; 'Interest in cooking'; 'Number of portions and meals'). Lower fear of COVID-19 scores and higher levels of physical activity were found in participants who reported previous dietary supplement intake during the pandemic; in addition, the group that did not ingest dietary supplements reported greater changes in stress and anxiety levels during the pandemic (p<0.05). The intake of dietary supplements before the pandemic was associated with greater energy expenditure and better coping with the fear of COVID-19 during the pandemic. Additionally, the Changes in Lifestyle-Related Behavior tool can be used to assess lifestyle-related variables during the pandemic.

Exploring the Dietary Supplement Use During COVID-19: Insights from Community Pharmacists, Pharmacy Staff, Academics, and Industry Experts

Introduction: The increased use of dietary supplements is a consequence of the coronavirus disease 2019 (COVID-19) pandemic. Although their efficacy has not been consistently proven, they have been perceived as a preventive tool against COVID-19. Less strict regulations and debates on their definitions in a regulatory framework raise concerns about safety issues. Apart from dietary supplement use, information demand has increased, and pharmacists have played a key role as accessible health professionals. This study aimed to reveal the opinions of community pharmacists, pharmacy staff, sector representatives, and academicians regarding the sale and use of dietary supplements during the COVID-19 pandemic. Methods: A qualitative study approach was followed, using grounded theory. Data were collected between September 2021 and July 2022, analyzed using MAXQDA 2020 software, and reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: After refining the open codes, two themes emerged: dietary supplements and the effects of the pandemic. It was found that increased dietary supplement use was rooted in COVID-19 fear, promotional activities, and social media influence. The interaction between consumers and the dietary supplement industry is bidirectional. Conclusions: Pharmacies, as access points for these products, played a crucial role in struggling with the effects of the pandemic. Although dietary supplements are considered safe, their potential for adverse reactions poses a public health risk. Flexible regulations, unregulated alternative advertising channels, and a lack of awareness of the safety of these products pose a challenge to public health. In this regard, all stakeholders should work to minimize the risks from undergraduate education to professional life.

Analysis of Actual Fitness Supplement Consumption among Health and Fitness Enthusiasts

With the rising popularity of fitness supplements, understanding the factors driving their consumption behaviors is crucial. This study investigated the actual consumption of fitness supplements utilizing the Theory of Planned Behavior (TPB), Health Belief Model (HBM), and the Theory of Effort Minimization in Physical Activity (TEMPA) frameworks. The TPB provided insights into how attitudes, subjective norms, and perceived behavioral control influence individuals' intentions to consume fitness supplements. Additionally, the HBM sheds light on perceived effectiveness, benefits, barriers, and health motivation related to supplement consumption. Integrating the TEMPA framework further investigated the role of effort minimization in physical activity contexts. Through an online questionnaire, data were collected from a sample of 250 fitness supplement-consuming respondents. SEM analysis revealed significant associations between behavioral intentions and attitudes, perceived behavioral control, health motivation, and controlled precursors. However, it was seen that subjective norms, perceived effectiveness, perceived benefits, and automatic precursors were deemed insignificant. The findings contribute to a comprehensive understanding of the factors shaping actual consumption behaviors, offering valuable implications for marketers, health professionals, and policymakers seeking to promote informed and responsible supplement use among health and fitness enthusiasts.

Does knowledge and concern regarding food supplement safety affect the behavioral intention of consumers? An experimental study on the theory of reasoned action

In recent years, health crises have led consumers to make more frequent purchases of food supplements. The global food supplement market, which reached $61.20 billion in 2020, is estimated to reach $163.12 billion by 2022 and $350.96 billion by 2032. However, many consumers still have concerns about the safety of food supplements. Within the scope of the research, firstly, the health consciousness (HC) level of food supplement consumers was determined. Secondly, food safety knowledge (FSK) and food safety concerns (FSCs) were measured. Thirdly, consumers' attitudes (ATUs), subjective norms (SNs), and behavioral intentions (BIs) toward food supplements were determined within the scope of the theory of reasoned action. The study used a convenient sampling, and 327 participants were included in the sample population. The data for the analysis was collected using the online survey method in the third quarter of 2023. The relationships between hypothesized items in the structural model were tested using the Smart-PLS. The validity and reliability of the measurement model were evaluated at the start of the structural equation modelling approach using confirmatory factor analysis (CFA). Regression analyses were performed in the structural model phase to evaluate overall fit and suggested relationships by way of the Smart-PLS. In light of the findings, it was determined that the interaction between HC and ATU was mediated by FSK, and the interaction between HC and the SN was mediated by FSK. Consequently, this research presents a variety of theoretical and practical implications to give clues for consumers' health regarding food supplement consumption.

Risk-taking in consumers' online purchases of health supplements and natural products: a grounded theory approach

BACKGROUND

Health supplements and natural products are widely used by the general public to support physical function and prevent disease. Additionally, with the advent of e-commerce, these products have become easily accessible to the general public. Although several theoretical models have been used to explain the use of health supplements and natural products, empirical evidence on how consumers make decisions to purchase online health supplements and natural products remains limited.

METHODS

In this study, a grounded theory approach was used to develop a substantive theoretical model with the aim of investigating the decision-making process of consumers when purchasing health supplements and natural products online. Malaysian adult consumers who had purchased these products via the Internet were either purposively or theoretically sampled. A total of 18 virtual in-depth interviews (IDIs) were conducted to elicit participants' experiences and priorities in relation to this activity. All the IDIs were audio-recorded and transcribed verbatim. The data were analysed using open coding, focus coding and theoretical coding. The analytical interpretations and theoretical concepts were recorded in research memos.

RESULTS

Consumers' decisions to purchase a health supplement or natural product over the Internet are based on a series of assessments regarding the perceived benefits and risks of this activity, which may be related to the product or the process. In the online marketplace, consumers attempt to choose products, online sellers, sales platforms and/or purchase mechanisms with lower perceived risk, which ultimately enhances their confidence in five elements related to the purchase: (1) product effectiveness, (2) product safety, (3) purchase convenience, (4) fair purchase and (5) online security. Consumers take an acceptable level of risk to purchase these products online, and this acceptable level is unique to each individual and is based on their perception of having control over the potential consequences if the worst-case scenario occurs.

CONCLUSIONS

In this study, a substantive theoretical model is developed to demonstrate how consumers decide to purchase online health supplements and natural products by accepting an acceptable level of risk associated with the product or process. The emerging model is potentially transferable to other populations in similar contexts.

Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The two most prevalent mental health conditions are anxiety and depression and they often coexist (comorbidity) in an individual aggravating the person's psychological or medical conditions. College students suffered from anxiety and depressive symptoms during the COVID-19 pandemic, according to numerous studies. The lack of information on the comorbidity of anxiety and depression (CAD) among international medical students, however, makes it difficult to develop effective policies or strategies to support these students.

OBJECTIVE

The present research seeks to investigate the incidence of CAD among international medical students in China and to identify the variables that may be useful in predicting CAD.

METHOD

A cross-sectional study was conducted at China Medical University in Shenyang, China, for international medical students during November 2020. A total of 519 international students provided information on their demographics, stress related to the COVID-19 pandemic, generalized anxiety disorder assessment (GAD-7), patient health questionnaire-9 (PHQ-9), simplified coping style questionnaire (SCSQ), perceived stress scale (PSS-10), the multidimensional scale of perceived social support (MSPSS), revised life orientation test (LOT-R), and resilience scale-14 (RS-14). To investigate the potential predictors of CAD, a chi-square test, a nonparametric test, and multinomial logistic regression analyses were carried out as appropriate.

RESULTS

The incidence of anxiety, depression, and CAD in the current study was 5.8%, 8.9%, and 22.7%, respectively. The predictors for students having symptoms of anxiety were observed to be the negative coping style (β = 0.662, OR = 1.938, CI:1.07-3.694) and perceived stress (β = 0.167, OR = 1.181, CI:1.076-1.297); the predictors for students having symptoms of depression were observed to be the COVID-19 pandemic-related stress (β = 0.323,OR = 1.382,CI:1.211-1.577), negative coping style (β = 0.693,OR = 2.000, CI:1.21-3.568), and perceived stress (β = 0.135,OR = 1.145,CI:1.050-1.248); whereas the predictors for students with CAD were observed to be staying up late (Yes VS No) (β = 1.028,OR = 2.794,CI:1.227-6.364), current place of residence (Other continents VS China) (β = -1.413, OR = 0.243,CI:0.065-0.910), COVID-19 pandemic-related stress (β = 0.371,OR = 1.450,CI:1.284-1.636), negative coping style (β = 1.092,OR = 2.979,CI:1.706-5.203), and perceived stress (β = 0.339,OR = 1.403,CI:1.289-1.527).

CONCLUSION

Single anxiety and depressive symptoms were moderately prevalent among international medical students in China. However, CAD turned out to be the most prevalent mental health issue due to its relatively higher incidence. Negative coping style and perceived stress were the communal predictors of the three categories, whereas stress related to the COVID-19 pandemic was linked to both depression and CAD, and staying up late and in residential places were specific predictors for CAD. Study results suggest that COVID-19 pandemic-related stress was related to students' CAD and depressive symptoms, and specific intervention measures with stress reduction, proper coping strategy, and a good lifestyle might be useful in improving the international students' mental health status.

The use of theory of planned behavior to systemically study the integrative-qualitative intentional behavior in Romanian preschool education with network analysis

Predicting preschool teachers' intention to adopt qualitative and inclusive early childhood intentional behaviors represents an important research field. The objective of this research is first to develop and validate a scale to assess the integrative-qualitative intentional behavior (IQIB-ECEC) of preschool teachers in order to achieve SDG4.2's objective of ensuring that all children have access to high-quality pre-primary education and then to systemically analyze the relationship between variables with Network Analysis. The theory of planned behavior (TPB) describes key individual beliefs (attitudes, subjective norms, and perceived behavior control) that affect people's intentions to engage in a certain conduct and has previously been used with success in evaluating people's intentions to adopt a certain behavior. This research represents one of the first Romanian attempts to use the theory of planned behavior to study the Integrative-Qualitative Intentional Behavior in Romanian Preschool Education and systemically analyze results with Network Analysis approach. This study used a randomized 300 Romanian preschool teachers enrolled in a National Training Program entitled Qualitative and Inclusive Early Childhood Education managed by the Romanian Educational Ministry. Data were collected via an online questionnaire. The scale validation followed a confirmatory factor analysis (CFA). The fitting of the IQIB-ECEC 19-item scale showed that all coefficients CFI (0.942), TLI (0.920), SRMR (0.0452), and RMSEA (0.0451) bring strong evidence in the favor of the statistical validity of the scale. The final IQIB-ECEC 19 items and 8 factors scale obtained a Cronbach's alpha of 0.77. The systemic Network Analysis approach was used in interpreting data. The centrality of the network model was further investigated and the clustering coefficients index were calculated. According to the results, perceived power/control beliefs and behavioral intention were detected as the most important dimensions, whereas behavioral beliefs were less important. These findings were discussed in terms of their theoretical and practical significance.

Reliability and validity of the Chinese version of the COVID-19 Phobia Scale

BACKGROUND

The COVID-19 pandemic has become a source of fear worldwide and has negative mental health effects on the general population. In 2022, the epidemic continues to be characterized by many points, widespread and frequent in China, and the situation is serious and complex. To provide an effective and scientific tool, the study validated the Chinese version of the COVID-19 Phobia Scale (C19P-SC).

METHODS

This study selected 1138 Chinese individuals (age ranged 13 to 80).

RESULTS

Cronbach's alpha coefficient for the C19P-SC was 0.93 (the coefficients of the four dimensions ranged from 0.75 to 0.85). The results of the confirmatory factor analysis supported the four-factor structure of the C19P-SC. Meanwhile, there was a positive and significant correlation between coronaphobia and state anxiety (r = 0.48, p < 0.001). The metric invariance hypothesis and the scalar invariance hypothesis were valid in the different subgroups. Significant multivariate effects of gender, education level, and identity differences on coronaphobia were found.

CONCLUSIONS

The Chinese version of the COVID-19 Phobia Scale has good psychometric properties and is suitable for measuring COVID-19 phobia in Chinese individuals.

How the COVID-19 Pandemic Affected the Sustainable Adoption of Digital Signature: An Integrated Factors Analysis Model

Digital signatures have been widely and primarily used for document approval activities during the Coronavirus pandemic in Indonesia. This is the digital equivalent of a handwritten signature or stamped seal, although it provides more inherent security, such as validating the authenticity and integrity of a message, software, or virtual document. Therefore, this study aims to determine factors affecting consumer intention in using digital signatures based on (i) the unified theory of acceptance and use of technology 2, (ii) the theory of planned behavior, and (iii) the information acceptance model. A total of 358 respondents answered the online questionnaire containing 69 question items, with the data analyzed using the structural equation modeling technique to examine the hypotheses. The results showed that the relationship between consumers’ attitudes, perceived behavioral control, subjective norms, and information adoption had the highest and lowest effects on consumers’ behavioral intention. Moreover, the consumers’ attitudes had the most significant effect on their attitudinal intention to use digital signatures. The significant positive impact of these consumers’ attitudes had relevant implications for the sustainable adoption of the signature system. This indicated that an integrating model with the potential of extending to consumers’ intention analysis was established for digital signature adoption in other countries after the post-Coronavirus period.