Knowledge, beliefs and preventive behaviors regarding Influenza A in students: a test of the health belief model

The Relationship between Information Dissemination Channels, Health Belief, and COVID-19 Vaccination Intention: Evidence from China

In the context of the ongoing global epidemic of COVID-19 and frequent virus mutations, the implementation of vaccine is the key to the prevention and control of the epidemic at this stage. In order to provide recommendations and evidence to support global epidemic prevention and control and vaccination efforts from the perspectives of health communication and individual psychological perceptions and to improve the vaccination rate of COVID-19 vaccine among appropriate populations, this study conducted a questionnaire survey in eight districts of Beijing and collected a total of 525 valid data points. A health belief model was used to examine the predictors of COVID-19 vaccination behavior, and the relationship between different COVID-19 vaccine information dissemination channels, residents' health beliefs, and propensity to vaccinate was analyzed. This study found the following: (1) among new media, interpersonal communication and traditional media communication channels, the new media channel had the largest number of audiences; (2) the personal health beliefs of audiences in the three information channels differed significantly, with the highest perceived benefits and lowest perceived barriers in the interpersonal communication channel and the highest perceived barriers in the new media communication channel; (3) the health belief model was a significant predictor, with perceived benefits and barriers being the most effective attitudinal variables for predicting vaccination intention. This study is valuable for advancing and improving vaccine communication diffusion research and promoting wider application of the health belief model and communication media in health communication topics.

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States

Background

The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic.

Methods

Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM).

Results

Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene.

Conclusions

Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13259-w.

Knowledge, attitudes, practices and fear of COVID-19 among Iranians: A quick online survey

To control COVID-19, several strategies were proposed in Iran since the start of the outbreak. The number of reported infected people and its consequent death toll herald relative inadequacies in the quality and extent of the measures in curbing the COVID-19 transmission cycle. This study was conducted to investigate knowledge, attitude, precautionary practices and degree of fear related to COVID-19 in a sample of Iranian population. This study was conducted among 457 residents of Kurdistan Province, Iran, through social networks and social media (WhatsApp and Telegram). Knowledge, attitude and practice and fear of COVID-19 were collected using valid tools. Multiple logistic regression and multivariate linear regression analyses were used to identify factors associated with binary outcome attitudes, practices and continuous variables knowledge and fear of COVID-19, respectively. The mean (SD) age of participants was 37.86 (10.42); of them, 252 (55.1%) were men, and more than two-thirds were married (74.8%). About 10% of the respondents were in believed that COVID-19 could create a type of social stigma. Level of knowledge about COVID-19 in 77.8% of the study attendees was acceptable, and 352 of them (70%) were confident that the virus would eventually be successfully controlled in the world, but only 252 of the attendants (50%) had confidence about successful control of COVID-19 in Iran. Applying multiple logistic regression, knowledge (OR: 1.18, p = 0.028) and fear (OR: 1.04, p = 0.028) of COVID-19 were associated with positive attitude towards controllability of COVID-19. Gender (OR: 1.96, p = 0.012), sources of information (OR: 5.00, p = 0.005) and knowledge (OR: 1.27, p = 0.006) were also indicated association with taking precautionary practices to control COVID-19. Further studies are recommended to boost level of knowledge, strengthen positive attitude and ameliorate behavioural pattern for successful control of COVID-19 in Iran.

Using the Health Belief Model to examine travelers' willingness to vaccinate and support for vaccination requirements prior to travel

Data from a survey of 1478 travelers and multistep group structural equation model analysis revealed that the Health Belief Model constructs of cues to action (trust in third-party information sources), perceived severity of and susceptibility to COVID-19, and beliefs about the protection benefits of a COVID-19 vaccine, subsequently elicited willingness to vaccinate and beliefs that others should vaccinate prior to travel and enhanced support for pre-travel vaccination mandates. Also, significant differences in the perceived protection benefits of the vaccine and willingness to vaccinate were found across groups of travelers who travel more or less frequently and those with and without a prior positive test for COVID-19. The study provides a theoretically informed understanding of the dynamics that may enable the success of important health-related travel policy in the wake of COVID-19 and future pandemics and identifies the communication mechanisms that must be leveraged by governments and travel authorities in enforcing policy.

Factors associated with preventive behaviors for COVID-19 among adolescents in South Korea

PURPOSE

COVID-19's infection rate among adolescents is increasing; hence, it is important to prevent it as it can spread in the community through transmission in schools. It is crucial to determine the extent to which adolescents follow COVID-19 preventive measures and identify factors relating to such behaviors to implement more effective health education. This study aimed to understand factors related to COVID-19 preventive behaviors using the theory of planned behavior (TPB) and the health belief model (HBM) among adolescents in South Korea.

DESIGN AND METHODS

A cross-sectional face-to-face questionnaire survey was conducted among 272 adolescents in South Korea. Structural equation modeling was used to examine the relationships between perceived susceptibility, perceived severity, attitude, subjective norms, perceived behavioral control, intention, and COVID-19 preventive behaviors.

RESULTS

Among adolescents' COVID-19 preventive behavior scores, wearing masks was the highest and distancing was the lowest. Adolescents' adherence to COVID-19 preventive behaviors was directly or indirectly associated with their perceived susceptibility, perceived severity, subjective norms, perceived behavioral control, and intention.

CONCLUSIONS

Attention to mitigate social isolation is important to improve compliance with COVID-19 preventive behaviors. Perceived susceptibility, perceived severity, subjective norms, perceived behavioral control, and intention explained 61.3% of adolescents' COVID-19 preventive behaviors, there is a need for education to promote relevant factors.

PRACTICE IMPLICATIONS

To increase adolescent awareness of COVID-19 and increase attitudes, subjective norms, and perceived behavior control, nurses need to provide education including the evidence for COVID-19 preventive behavior to increase adolescents' understanding and active implementation of those behaviors.

Application of the health Belief Model to assess community preventive practices against COVID-19 in Saudi Arabia

Background

The novel coronavirus disease (COVID-19) has affected hundreds of thousands of people across more than 200 countries. As the pandemic continues, the health agencies, worldwide, are recommending strict preventive practices to avert its transmission at community scale. We sought to predict the behavior of the Saudi population for adopting community preventive practices during the COVID-19 pandemic.

Methods

An online questionnaire consisting of 22 items pertaining to the Health Belief Model constructs was used to measure the perceived susceptibility and perceived severity of contracting COVID-19, along with the perceived benefits and perceived barriers to follow the Ministry of Health’s recommendations. The outcome was assessed by their readiness to be compliant with the community protective measures. Data were analyzed using STATA at significance level of 0.05.

Results

A total of 900 individuals received the online survey link, of which 688 (response rate: 76.4%) respondents consented to participate in the study. The mean age of the respondents was 31.39 (SD = 8.94). Positive associations were observed between perceived susceptibility (Beta: 0.24; p value < 0.001), perceived severity (Beta: 0.16; p value < 0.001), perceived benefits (Beta: 0.41; p value < 0.001), cue to action (Beta: 2.61; p value < 0.001) and the participation in community preventive practices during the pandemic of the COVID-19.

Conclusions

Health belief model's constructs of perceived susceptibility, severity, benefits and cue to action can be adopted to help strengthen COVID-19 limiting behaviors and prevention programs which can delivered through community pharmacies in Saudi Arabia as well as around the world.

Knowledge, beliefs, mental health, substance use, and behaviors related to the COVID-19 pandemic among US adults: a national online survey

Aim

Given the need for data to inform public health messaging to mitigate the COVID-19 pandemic, this national survey sought to assess the state of COVID-19-related knowledge, beliefs, mental health, substance use changes, and behaviors among a sample of U.S. adults.

Subject and methods

In the period March 20–30, 2020, we collected data on COVID-19-related knowledge, awareness and adoption of preventive practices, depression and anxiety (Patient Health Questionnaire-4), stress (Impact of Event Scale-6), pessimism, and tobacco and alcohol use. Differences between age groups (18–39 years, 40–59 years and ≥ 60 years) were tested using Pearson’s chi-squared tests or ANOVAs; associations between drinking and smoking and depression, anxiety, and stress were tested using adjusted logistic regression models.

Results

Approximately half of the sample (N_Total = 6391) were 50–69 years old and 58% were female. COVID-19 knowledge (mean = 12.0; SD = 1.2) and protective practice awareness (mean = 9.1; SD = 0.8) were high. Among respondents, 44% had a score consistent with depression and anxiety (PHQ-4 score ≥ 6), and 52% reported high stress scores (≥ median of 1.33). COVID-19-related anxiety and depression were associated with increased drinking (AOR = 1.79; 95% CI = 1.49, 2.15) and smoking (AOR = 2.17; 95% CI = 1.64, 2.88). High stress scores were also associated with increased drinking (AOR = 1.80; 95% CI = 1.49, 2.17, p < 0.001) and smoking (AOR = 1.75; 95% CI = 1.31, 2.33).

Conclusions

In spite of high knowledge levels, important gaps were identified. High prevalence of poor mental health outcomes and associated increases in drinking and smoking warrant ongoing risk communications tailoring to effectively disseminate information and expanding psychosocial services, particularly via telehealth, to mitigate the negative mental health impact of COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-021-01564-4.

The prevalence of preventive behaviors and associated factors during the early phase of the COVID-19 pandemic among Iranian People: Application of a Health Belief Model

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has developed into a severe public health concern. The present study was aimed to evaluate the related preventive behaviors to COVID-19, and associated factors among Iranians based on the constructs of the Health Belief Model (HBM).

METHODS

This cross-sectional study was conducted between March and April 2020 among Iranians. Data of 1,020 people were collected by a self-administered questionnaire based on the constructs of HBM and also a demographics questionnaire. Simple and multivariable linear regression models were used to determine the predictors of preventive behaviors concerning COVID-19. A P-value of less than 0.05 was considered significant.

RESULTS

The mean score of preventive behaviors concerning COVID-19 was 4.27 (standard deviation = 0.60). 40.6% (95% CI: 38.6-43.7%), and 56.5% (95% CI: 53.4-59.5%) of the participants exhibited a high, and moderate level of preventive behaviors, respectively. 75.1% of the participants would always/often wear face masks out home or in crowded places. The most common preventive behaviors were using of personal belongings in the workplace or at home (96.1%) and staying at home except for very necessary or for work (92.9%). Results showed that all six HBM constructs, i.e., perceived susceptibility (B = 0.07, P < 0.001), perceived severity (B = 0.08, P < 0.001), perceived benefits (B = 0.25, P < 0.001), perceived barriers (B = -0.12, P = 0.001), cues to action (B = 0.07, P < 0.001), and self-efficacy (B = 0.26, P < 0.001) were significant predictors of related preventive behaviors to COVID-19. Female gender was another predictor of preventive behaviors (B = 0.18, P < 0.001).

CONCLUSIONS

This study demonstrated the effectiveness of HBM constructs in predicting COVID-19 preventive behaviors. Therefore, the model as a framework for designing training programs for improving health behaviors among Iranians during the COVID-19 pandemic seems to be helpful.

Knowledge and Beliefs on Osteoporosis among African Postmenopausal Women in a Kenyan Semi-Rural County of Kiambu

BACKGROUND

Assessing people's knowledge and beliefs about osteoporosis is fundamental to the formulation of preventive strategies for this condition. To our knowledge, no randomized community survey has been conducted using Facts on Osteoporosis Quiz (FOOQ) and Osteoporosis Health Belief Scale (OHBS) exclusively in the postmenopausal women in Kenya. This study aimed to assess postmenopausal women&apos;s knowledge and beliefs concerning osteoporosis in semirural Kiambu County, Kenya.

METHODS

A cross-sectional study involving face-to-face interviews with 254 African postmenopausal women was conducted between October 2017 and February 2018. The questionnaire explored the socio-demographic characteristics; FOOQ was used to evaluate the knowledge these women had about osteoporosis, while OHBS was used to assess their beliefs.

RESULTS

The mean age of the participants was 64.6±10.7 years. About 26.4% (67/254) of the participants had no formal education, while 3.1% (8/254) were in formal employment. About 54.3% (138/254) of the women were married, and 51.2% (130/254) were in the lowest and lower wealth quintile. FOOQ had a mean score of 8.6 (standard deviation±1.8; range, 0-17). OHBS revealed a low level of perceived susceptibility to osteoporosis. Perceived benefits of exercising and calcium intake as well as perceived seriousness of osteoporosis as a disease were at moderate levels. The level of health motivation was also moderate.

CONCLUSIONS

The women in this study demonstrated limited knowledge about osteoporosis. The low susceptibility score makes the prevention and treatment of osteoporosis in this population challenging. We recommend public health education for all postmenopausal women in this setting.

Investigating Preventive Behaviors Toward COVID-19 Among Iranian People

Background: Considering the importance of preventive behaviors in reducing the transmission of COVID-19, this study was conducted to determine the preventive behaviors toward the spread of COVID-19. Methods: This cross-sectional study was performed 7 weeks after the confirmation of the first case of Covid-19 by the Ministry of Health and Medical Education in Iran. Data were completed online using a researcher-made questionnaire, the validity and reliability of which were confirmed, for 1,200 Iranians from 8 April 2020 to 9 May 2020. Results: The mean age of study participants was 37.77 ± 11.20 years. The mean score of preventive behaviors was 62.67 ± 8.53. The results showed that there was a significant relationship between the variables of gender, education, economic status, and preventive behaviors of COVID-19. The highest frequency is related to not using hookah and cigarettes and then avoiding losing and rubbing (78%) and the lowest percentage is related to exercising behavior (16%). Conclusion: Due to the low level of prevention behaviors during the outbreak of the disease, it is important to design educational and supportive interventions to improve and perform coronavirus prevention behaviors with more focus on men, illiterate people, and poor economic status.

What doubts, concerns and fears about COVID-19 emerged during the first wave of the pandemic?

OBJECTIVES

The control of the COVID-19 pandemic depends strongly on effective communication, which must be grounded on the population's perceptions and knowledge. We aimed to analyse the doubts, concerns and fears expressed by the Portuguese population about COVID-19.

METHODS

We performed a content analysis of 293 questions submitted to online, radio, newspaper and TV channel forums during the first month of the pandemic in Portugal.

RESULTS

Most questions contained doubts (n = 230), especially on how to prevent person-to-person transmission (n = 40) and how to proceed in case of symptoms (n = 37). Concerns and fears were also very commonly expressed (n = 144), mostly about which persons could be considered vulnerable (n = 53) and how to prevent transmission during daily life or normal activities (n = 37).

CONCLUSION

As the pandemic evolved and suppression measures were put in place, doubts moved to concerns of vulnerability, quarantine and social isolation, and to doubts about transmission, transmission prevention, and on how to proceed in case of symptoms.

PRACTICE IMPLICATIONS

These results may inform future communication strategies for a more adequate response in the next phases of the COVID-19 pandemic, as well as in future pandemics.

A Cross-Sectional Survey of Risky Travel and Leisure Behaviors During the COVID-19 Pandemic

PURPOSE

COVID-19 is largely spread through close contact with infected people in indoor spaces. Avoiding these spaces is one of the most effective ways to slow the spread. This study assessed who had engaged in risky travel and leisure behaviors before the availability of vaccines.

DESIGN

National cross-sectional on-line survey collected in November and December 2020. Setting: United States; Participants: 2589 adults representative by gender and race/ethnicity to the US population; Measures: The survey assessed if people had resumed 11 risky behaviors during the pandemic, prior to vaccines. Independent variables included age, race/ethnicity, region of the country, education, income, preexisting conditions, perceived severity and susceptibility, positive COVID diagnosis, and political ideology.

ANALYSIS

Univariate analysis and logistic regressions were used to assess demographic and psychological factors of those resuming these behaviors. Results: Most (60.3%) of people had resumed at least 1 behavior with eating inside of restaurants (33.2%) and visiting family and friends (37.5%) being the most prevalent. In the multivariate analyses, perceived susceptibility was significant across all behaviors. Young people, fiscal conservatives, and people with higher perceived severity were more likely to perform several of the behaviors. Preexisting conditions did not predict any of the behaviors.

CONCLUSIONS

Travel and leisure behaviors vary by type of risk and may need specific tailored, prevention messages to promote risk reduction during future pandemics.

Awareness and acceptance of H1N1 vaccination among physicians: Experience of 2017 vaccination campaign

CONTEXT

India experienced pandemic phase of H1N1 in May 2009 to December 2010. The postpandemic phase went on from January 2011 to December 2014. As per the WHO, all countries should immunize their health-care workers as a first priority to protect the essential health infrastructure.

AIMS

The aim of the study is to assess the level of awareness and acceptance of influenza vaccine among physicians and also the perception of physicians regarding H1N1 infection. This study also examined time of vaccine administration in relation with efficacy concerns based on literature.

SETTINGS AND DESIGN

A vaccination campaign was conducted for all health-care workers of Seth GSMC and KEM Hospital, Mumbai, in the month of July 2017 based on which a cross-sectional observational study was conducted among the physicians of the same institute.

METHODS

After ethical clearance, a prevalidated pretested survey based on a pilot survey of 20 physicians was distributed among physicians, which was based on the awareness and acceptance of H1N1 vaccination among physicians and perception of H1N1 infection. Effective sample size was 272.

STATISTICAL ANALYSIS USED

Descriptive statistics and Chi-square test were generated for the survey responses. All the continuous variables were reported as mean, median, and range. Categorical variables were reported as tables and pie charts. P < 0.05 was taken as significant. Data analysis was done with SPSS version 21.

RESULTS

The overall vaccine compliance was 29.8%. This study has found that area of work, deficiency in knowledge about adverse effect of vaccine, misconceptions regarding vaccine, and concerns about efficacy and duration of vaccine are the important factors which lead to decreased vaccine compliance. Furthermore, it is found during the study that timing of vaccination was not given due importance as considering the epidemiological pattern.

CONCLUSIONS

More emphasis should be given to education sessions and counseling of physicians regarding H1N1 vaccination and oseltamivir therapy. At administrative level, more focus should be given on timing of vaccination and other logistics. Vaccine campaigns should be conducted ideally 1 month before expected rise in cases. Quadrivalent vaccine would be more appropriate over trivalent based on epidemiology of infection in India.

Development and Validation of a Questionnaire to Assess Knowledge, Threat and Coping Appraisal, and Intention to Practice Healthy Behaviors Related to Non-Communicable Diseases in the Thai Population

Non-communicable diseases (NCDs) are important issues in Thailand and health sectors are now focusing on modifiable risks that include cognitive, affective and behavioral factors. This study aimed to develop and validate a questionnaire to assess knowledge about NCDs, threat appraisal, coping appraisal and intention to practice based on protection motivation theory. Content validity was determined by the mean of the item content validity index (I-CVI) from five experts. The questionnaire was pilot tested for difficulty of knowledge items and reliability test using the Kuder-Richardson (KR)-20 and Cronbach’s alpha coefficient among 30 Thai adult subjects in the health office for two sub-districts. The mean I-CVI ranged from 0.90–1.00 and difficulty of knowledge ranged from 0.3–0.9. The reliability test of knowledge by KR-20 ranged from 0.648–0.799, while Cronbach’s alpha coefficients of threat and coping appraisal and intention to practice ranged from 0.70–0.843. We compared sociodemographic data, knowledge about NCDs, threat appraisal, coping appraisal and intention to practice between 50 diabetic type 2 cases and 50 controls. T2DM cases had higher age, knowledge scores on diabetes and hypertension, threat appraisal scores on hypertension and cardiovascular disease when compared with control (p < 0.05). The questionnaire was valid and sufficiently reliable to use for data collection.

Predictors of healthcare service utilization for mental health reasons

This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.