Determination of preventive behaviors for pandemic influenza A/H1N1 based on protection motivation theory among female high school students in Isfahan, Iran

The relationships of perceived susceptibility, perceived severity, and subjective norms with COVID-19 preventive behaviors: a secondary data analysis comparing adolescents and emerging adults in South Korea

PURPOSE

Based on the health belief model and theory of planned behavior, this study investigated how age group (adolescence and emerging adulthood) moderated the relative effects of perceived susceptibility, perceived severity, and subjective norms on preventive behavior against coronavirus disease 2019 (COVID-19).

METHODS

This secondary data analysis utilized data from adolescents (n=272) and emerging adults (n=239). Hierarchical multiple regression analysis was performed to test the moderating effect of age group on the relationships among variables.

RESULTS

Higher perceived susceptibility (β=.21, p<.001), perceived severity (β=.14, p=.002), subjective norms (friends) (β=.26, p<.001), subjective norms (parents) (β=.44, p<.001), and subjective norms (schools) (β=.28, p<.001) enhanced COVID-19 preventive behaviors. Moderated regression analysis showed that subjective norms (friends and school) impacted preventive behavior in adolescents more than in emerging adults.

CONCLUSION

Given the need to increase perceived susceptibility and severity among adolescents and emerging adults, these findings provide baseline data for designing effective COVID-19 prevention interventions that consider the developmental characteristics of different age groups. Interventions by health centers at universities can strengthen COVID-19 preventive behavior among emerging adults. As adolescents are influenced by friends, their peer roles must be strengthened to enhance adherence to COVID-19 preventive guidelines.

Education level modifies parental hesitancy about COVID-19 vaccinations for their children

It is important to encourage parental acceptance of children's vaccination against COVID-19 to ensure population immunity and mitigate morbidity and mortality. This study drew upon protection motivation theory (PMT) to explore the factors of parental hesitancy about vaccinating their children. A national online survey was performed in China. A total of 2054 Chinese parents of children aged 6-12 years were included in this study. They reported on measures that assessed hesitancy about children's vaccination against COVID-19, PMT constructs (susceptibility, severity, response efficacy, self-efficacy, and response costs) and sociodemographic characteristics. Chinese parents reported a hesitancy rate of 29.4% for children's vaccination. Parents with higher level education were more likely to hesitate to vaccinate their children against COVID-19. After controlling for parents' and children's demographic variables, logistic regression showed that parents' hesitancy about their children's vaccination increased if parents had lower levels of susceptibility, response efficacy or self-efficacy, as well as higher levels of response costs. In addition, a high educational level can significantly increase the promotive effect of response cost and the protective effect of response efficacy on vaccine hesitancy. In conclusion, our findings suggested that PMT can explain parents' vaccine hesitancy and that education level can modify the effect of copying appraisal, but not threat appraisal, on parental hesitancy. This study will help public health officials send targeted messages to parents to improve the rate of COVID-19 vaccination in children aged 6-12 years and thus reach a higher level of immunity in the population.

Desire to stay shorter time at the shopping mall: insight from protection motivation (PMT), behavioral inhibition system (BIS), reactance, and expectancy theories

After withdrawing the movement control order (MCO), new variant (Omicron) of COVID-19 returns as an outbreak again. Therefore, consumers are very much informed by various media to be more cautious in visiting shopping malls and spend less time in there. The purpose of this study was to identify the predictors influencing the desire to stay shorter at the shopping mall. This study was conducted in Malaysia, with the application of three psychological theories and one behavioural theory. This is quantitative research based on an online cross-sectional survey design. Data were collected from 296 respondents, by applying the online snowball sampling method through numerous media platforms i.e., Viber, WhatsApp, Messenger, and other apps in three severely affected cities in Malaysia i.e., Selangor state, Putrajaya, and Kuala Lumpur. SmartPLS was used to analyse the data. Using structural equation modelling, this study result shows risk, protection motivation, and fear have a significant effect on the desire to stay a shorter time at the shopping mall. Social norm moderates the association between fear and the desire to spend a shorter time at the shopping mall. These findings, highlight the need for a more empirical study to design more robust strategies, and a safer and risk-free shopping mall environment.

Panic Food Purchasing amid COVID-19 Pandemic: Does the Impact of Perceived Severity, Anxiety and Self-Isolation Really Matter?

This research examines the influences of perceived severity, anxiety, and self-isolation intention, amid the coronavirus disease of 2019 (COVID-19), on panic food purchasing. The research adopted a quantitative approach using a pre-examined instrument, which was self-administered by the research team (with support from a data collection-specialised company) to consumers who were urgently shopping for food in the Kingdom of Saudi Arabia (KSA). The results of structural equation modelling (SEM) using analysis of a moment structures (AMOS) software showed a significant positive impact of perceived severity on consumers' anxiety and self-isolation intention amid the COVID-19 pandemic. Self-isolation intention was found to have a significant positive impact on the anxiety of consumers amid the pandemic. Additionally, perceived severity, anxiety, and self-isolation have a significant positive impact on panic food purchasing. Both anxiety and self-isolation were found to have partial mediating effects in the link between perceived severity and panic purchasing intention. The results of the current research contribute to a better understanding of factors that influence panic purchasing behaviour, especially amid a pandemic. This will help policymakers to deal with this behaviour when such issues arise in the future. Other implications for scholars and policy makers are discussed.

A study to identify the impact of Covid-19 on the trust and risk perceptions of online buying behaviour

Coronavirus has become a global emergency and has left a strong impact on people all over the world. It has altered the way we live, the way we work, and the way we see the world around us. Ever since the virus escalated and with lockdown in place, a significant change has been reported in consumer’s online buying behavior. This research aims to provide implications from a consumer’s perspective, thereby helping brands to gain insight into this vulnerable and unreal environment. This change in consumer mindset is investigated with respect to the risk and trust perceptions of online buying behavior. During a lockdown, an increased purchase with regards to non-perishable items was observed. The lockdown has brought about positive changes in consumers in terms of food wastage. To test the proposed hypothesis, data was collected from 200 respondents through an online survey. The results provided strong evidence that was independent of the pandemic. However, COVID-19 has acted as an element that made consumers opt for the online channel.

Application of the protection motivation theory to understand determinants of compliance with the measure of banning gathering size >4 in all public areas for controlling COVID-19 in a Hong Kong Chinese adult general population

Background

Restriction of gathering size in all public areas is a newly and commonly exercised governmental social distancing policy during the COVID-19 pandemic. Its effectiveness depends on the general public’s compliance. This study applied the Protection Motivation Theory (PMT) to investigate determinants (i.e., perceived severity, perceived susceptibility, perceived response efficacy, and perceived self-efficacy) of compliance with the social distancing policy of banning gathering of >4 people in all public areas (BG4PA) in the Hong Kong general adult population.

Methods

300 participants were interviewed through a population-based telephone survey during April 21–28, 2020.

Results

The compliance rate of BG4PA was high (78%). Adjusted for the background factors, multiple linear regression analysis found that perceived response efficacy and perceived self-efficacy were significantly and positively associated with compliance with BG4PA (p<0.05), while the associations between perceived severity/perceived susceptibility and compliance were of marginal significance (0.05<p<0.10). A stepwise linear regression model considered four PMT constructs as candidates; its final model only selected self-efficacy but not the other three PMT constructs.

Conclusions

PMT can be applied to understand compliance with BG4PA. Perceived response efficacy and perceived self-efficacy were more influential than perceived severity and perceived susceptibility. Health promotion may focus on improving coping appraisal.

How Do Perceived Health Threats Affect the Junk Food Eating Behavior and Consequent Obesity? Moderating Role of Product Knowledge Hiding

The predominant use of junk food in our societies is continuously held responsible for the obese body physiques and overweight among the kids and adolescents. The current supportive environments where organic foods are limited, and new processed foods have been brought to the market with more variant tastes and acceptability for the kids and adolescents that have diverged their eating patterns. It has significantly contributed to the health issues and growth discrepancies of the users. However, the awareness of the food contents is an important milestone for understanding the risks associated with the usage of junk foods. A quantitative approach has been used in this study to measure the effect of perceived severity, vulnerability and fear on the junk food eating behaviors and ultimately on the obesity. The moderating role of product knowledge hiding has also been measured on the relationship of junk food eating and obesity. Structural equation modeling is used using the software Smart-PLS for measuring the hypothesis with a sample size of 228 selected through purposive sampling. The sample consisted of kids and adolescents who were reached on purpose for data collection. The current study has explored the role of perceived severity, vulnerability and the fear of using junk foods which have been found as a negative effect on junk food eating behavior which is positively associated with obesity among the kids and adolescents. The result of study shows that perceived threat has a negative effect on the junk food eating behavior of the adolescents. However, the positive relationship of junk food eating behavior with obesity can be decreased if the information about the products is not hidden. This study will be useful for making the consumers aware of the product knowledge hiding of the junk food usage. Moreover, it will help the users in creating understanding of risks allied with the use of junk food which may be addressed in order to avoid obesity issues in the kids and adolescents globally.

Do liberals want curbside pickup more than conservatives? Contactless shopping as protectionary action against the COVID-19 pandemic

Consumers showed a dramatically increased interest in contactless shopping in reaction to the COVID-19 pandemic. Based on the protection motivation theory, this study investigated how contactless shopping grew as a protectionary action against COVID-19. Findings from a nationwide online survey (n = 311) confirmed the impact of politicization of the pandemic on consumer responses for contactless shopping intention and the significance of threat and coping appraisals in taking protectionary actions. This study adds knowledge to the existing literature on contactless shopping and protection motivation theory. Results imply that retailers must invest in contactless shopping and provide an in-store shopping environment that prioritizes the health and safety of shoppers and employees to decrease the threat of virus infection during shopping. However, in doing so, retailers are recommended to develop different marketing strategies regarding contactless shopping based on consumers' political orientations.

Predicting the COVID-19 vaccine receive intention based on the theory of reasoned action in the south of Iran

Background

Vaccination against Covid 19 disease was based on rational practice theory.

One of the most effective methods to control the COVID-19 pandemic is extensive vaccination coverage in the shortest time. The relevant beliefs and predictors of COVID-19 vaccine and the barriers to and facilitators of receiving COVID-19 vaccine should be identified. Individuals’ intention to receive COVID-19 and the effective factors are of an utmost importance. This study aimed to predict intention to receive COVID-19 vaccine in the South of Iran.

Methods

This cross-sectional study was performed over a period of 2 months (May 2021 to July 2021) in 4 southern provinces in Iran. The study population of this study included people over 18 years of age who did not receive the COVID-19 vaccine. The online questionnaire was used to collect data. We recruited participants through a self-selection sampling method and posted the online survey link. The questionnaire had two parts: demographic information and Theory of Reasoned Action (TRA) questions. All statistical calculations and hypotheses tests were performed using SPSS21 and Amos21 software and the significance level was considered 0.05.

Results

A total number of 2556 people participated in this study with a mean age of 37.76 (10.7) of years (Age Range = 18–75). The findings showed that attitudes and subjective norms and the use of social media predict the intention to receive COVID-19 vaccine. SEM showed that attitude (β = 0.596, P < 0.001), subjective norms (β = 0.265, P < 0.001) were significant predictors of vaccination intention. In this study, 78% of people were willing to receive the vaccine when they were officially allowed to.

Conclusion

According to the results of the study, it is suggested to strengthen positive attitudes and subjective norms about the importance of COVID-19 vaccination as well as using social media to inform the community in order increase the intention to vaccinate COVID-19 and increase vaccine coverage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12517-1.

The Intolerance of Uncertainty and “Untact” Buying Behavior: The Mediating Role of the Perceived Risk of COVID-19 Variants and Protection Motivation

Draw on the protection motivation theory, this study investigated the impacts of intolerance of uncertainty on “untact” buying behavior, and examined the sequential mediating role of the perceived risk of COVID-19 variants and protection motivation. A total of 1,564 (M_age = 20.75, SD = 1.92) young individuals participated in the survey. The serial mediation analysis results reveal that intolerance of uncertainty influences one’s “untact” buying behavior through “perceived risk of COVID-19 variants - protection motivation.” Both internal (intolerance of uncertainty, protection motivation) and external (risk of COVID-19) factors worked together to accelerate the transition of individuals’ consumption behavior during COVID-19 pandemic. Therefore, our findings generate important implications for public mental health and economic recovery in the post-COVID-19 era.

Protection Motivation Theory and Rabies Protective Behaviors Among School Students in Chonburi Province, Thailand

Objectives

The aim of this study was to predict rabies protective behaviors (RPB) based on protection motivation theory (PMT) among fourth-grade students at schools in Chonburi Province, Thailand.

Methods

This cross-sectional study was conducted from December 2020 to February 2021. A multistage sampling technique was used for sample selection. The questionnaire was divided into socio-demographic data and questions related to PMT and RPB. Descriptive statistical analysis was conducted using the EpiData program and inferential statistics, and the results were tested using the partial least squares model with a significance level of less than 5%.

Results

In total, 287 subjects were included, of whom 62.4% were girls and 40.4% reported that YouTube was their favorite media platform. Most participants had good perceived vulnerability, response efficacy, and self efficacy levels related to rabies (43.9, 68.6, and 73.2%, respectively). However, 54.5% had only fair perceived severity levels related to rabies. Significant positive correlations were found between RPB and the PMT constructs related to rabies (β, 0.298; p<0.001), and the school variable (S4) was also a predictor of RPB (β, -0.228; p<0.001). Among the PMT constructs, self efficacy was the strongest predictor of RPB (β, 0.741; p<0.001).

Conclusions

PMT is a useful framework for predicting RPB. Future RPB or prevention/protection intervention studies based on PMT should focus on improving self efficacy and response efficacy, with a particular focus on teaching students not to intervene with fighting animals. The most influential PMT constructs can be used for designing tools and implementing and evaluating future educational interventions to prevent rabies in children.

Investigating preventive health behaviors against COVID-19 in elementary school students' parents: A cross-sectional study from Tehran - Capital of Iran

BACKGROUND

Parents act as a role model for children in showing health behaviors. This study investigated factors affecting the preventive behavior in elementary school students' parents based on protection motivation theory (PMT).

MATERIALS AND METHODS

This cross-sectional study was conducted in Tehran (Iran) in 2020. Multistage sampling was used to choose 660 elementary school students' parents. The data collection instrument was a multi-sectional questionnaire, including sections on demographic characteristics, PMT constructs, self-reported health, and information sources related to COVID-19. In this study, descriptive statistics (mean and standard deviation) and analytical statistical methods (Pearson correlation and path analysis) were used to analyze the data. The range of Cronbach's alpha of the study instrument varied from 0.71 to 0.97.

RESULTS

The results of the current study revealed significant association between all PMT constructs and preventive behaviors. Knowledge from both direct and indirect paths was related to preventive behaviors (B = 0.76). Preventive behaviors had the strongest, direct relationship with age (B = 0.76). Based on the final fitted model, knowledge had the greatest impact on preventive behaviors through indirect and direct routes.

CONCLUSION

Knowledge was the most important variable which influenced preventive behavior, and it should be noticed in prevention programs.

The predictors of adaptive and maladaptive coping behavior during the COVID-19 pandemic: The Protection Motivation Theory and the Big Five personality traits

The aim of this study was to evaluate the predictive value of the constructs proposed by two influential theoretical frameworks: the Protection Motivation Theory (PMT) and the Big Five (B5) model of personality in predicting health-related coping behavior during the SARS-CoV-2 pandemic. Both adaptive (i.e., preventive) and maladaptive (i.e., avoidant behavior and wishful thinking) coping behavior was measured. The study was conducted during the first wave of the pandemic. The sample consisted of 397 persons from the general Polish population. The findings provided strong support for the PMT constructs' predictive value, especially with regard to pandemic-related adaptive behavior. The B5 personality traits accounted for a small proportion of the variability of coping behavior, especially when maladaptive behavior was the outcome. The PMT model showed incremental validity over and above demographic variables and personality traits in predicting preventive behavior, avoidant behavior, and wishful thinking; however, the patterns of relationships differ across the types of coping behavior. According to the current results, to increase adherence to preventive measures during an epidemic, all the PMT constructs should be considered while persuasive communication to the public is formulated.

An active inference account of protective behaviours during the COVID-19 pandemic

Newly emerging infectious diseases, such as the coronavirus (COVID-19), create new challenges for public healthcare systems. Before effective treatments, countering the spread of these infections depends on mitigating, protective behaviours such as social distancing, respecting lockdown, wearing masks, frequent handwashing, travel restrictions, and vaccine acceptance. Previous work has shown that the enacting protective behaviours depends on beliefs about individual vulnerability, threat severity, and one’s ability to engage in such protective actions. However, little is known about the genesis of these beliefs in response to an infectious disease epidemic, and the cognitive mechanisms that may link these beliefs to decision making. Active inference (AI) is a recent approach to behavioural modelling that integrates embodied perception, action, belief updating, and decision making. This approach provides a framework to understand the behaviour of agents in situations that require planning under uncertainty. It assumes that the brain infers the hidden states that cause sensations, predicts the perceptual feedback produced by adaptive actions, and chooses actions that minimize expected surprise in the future. In this paper, we present a computational account describing how individuals update their beliefs about the risks and thereby commit to protective behaviours. We show how perceived risks, beliefs about future states, sensory uncertainty, and outcomes under each policy can determine individual protective behaviours. We suggest that these mechanisms are crucial to assess how individuals cope with uncertainty during a pandemic, and we show the interest of these new perspectives for public health policies.

Arab women feelings while seeking information during COVID-19 pandemic: applying PMT constructs

Purpose

This study investigates the effect of protection motivation theory (PMT) constructs on Arab women's feelings while seeking information during the COVID-19 pandemic.

Design/methodology/approach

The study has adopted a mixed-method approach using semi-structured interviews and a questionnaire to explore PMT constructs' impact on women's feelings while seeking information on COVID-19. Several tests, such as standard deviation, mean, skewness, kurtosis and persons, were used to check the reliability of data and inter-relationships between constructs.

Findings

The study results show a significant positive correlation between PMT constructs (perceived vulnerability, perceived severity, response efficacy, self-efficacy and response cost) with the feelings of Arab women during information seeking on COVID-19. However, the relationship between threat appraisal and feelings during information seeking was more substantial than coping appraisal and feelings during information seeking. The researchers hope that this study creates a baseline of cross-cultural studies on PMT constructs' effect on women's feelings while seeking health information.

Research limitations/implications

The current study was conducted on female participants only. While the study intended to examine Arab women's feelings during information seeking with PMT's application, the results may be affected by other factors that were not considered in the current study. Furthermore, the questionnaire was distributed in three Arab countries, which means that the results cannot be generalized in other geographical contexts. Therefore, similar studies need to be conducted in larger geographical areas as cultural factors may produce different results.

Originality/value

This study explores women's feelings while seeking COVID-19 information using the PMT constructs. As far as we know, this study is the first study to investigate Arab women's feelings while seeking health information during pandemics. PMT utilization is considered a new approach to discover and measure informational needs and feelings associated with it during pandemics.

Understanding the impact of information sources on COVID-19 related preventive measures in Finland

The COVID-19 pandemic amplified the influence of information reporting on human behavior, as people were forced to quickly adapt to a new health threatening situation by relying on new information. Drawing from protection-motivation and cognitive load theories, we formulated a structural model eliciting the impact of the three online information sources: (1) social media, (2) official websites, and (3) other online news sources; on motivation to adopt recommended COVID-19 preventive measures. The model was tested with the data collected from university employees and students (n = 225) in March 2020 through an online survey and analyzed using partial least square structural equation modeling (PLS-SEM). We observed that social media and other online news sources increased information overload amongst the online information sources. This, in turn, negatively affected individuals' self-isolation intention by increasing perceived response costs and decreasing response efficacy. The study highlights the role of online information sources on preventive behaviors during pandemics.

Application of the protection motivation theory for predicting COVID-19 preventive behaviors in Hormozgan, Iran: a cross-sectional study

BACKGROUND

The high prevalence and mortality of coronavirus disease 2019 (COVID-19) have made it the most important health and social challenge around the world. However, this disease can be largely prevented by adherence to hygienic principles and protective behaviors. It seems that identifying the processes involved in protective health behaviors can be effective in planning and implementing suitable interventions to encourage the community toward protective behaviors. Therefore, the present study aimed to predict the preventive behaviors of COVID-19 according to the Protection Motivation Theory (PMT).

METHODS

This cross-sectional study was conducted over 2 months in Hormozgan Province, Iran. The study population consisted of all citizens above the age of 15 years. An online questionnaire was used to collect the data. The questionnaire link was available to the participants through social networks. The questionnaire consisted of two sections, including the demographic information and the PMT constructs. All statistical calculations and hypothesis testing were performed in SPSS Version 21 and AMOS Version 21. The significance level was considered to be 0.05 for hypothesis testing.

RESULTS

A total of 2032 subjects, with the mean age of 34.84 ± 9.8 years (r = 15-98), participated in this study. Most of the participants were 31-40 years old, female (60.4%), married (72%), urban residents (87.3%), and employed (58.8%). The majority of them also had a bachelor's degree or higher (58.8%). Significant positive correlations were observed between the preventive behaviors of COVID-19 and the perceived vulnerability (r = 0.192, P < 0.001), perceived severity (r = 0.092, P < 0.001), response efficacy (r = 0.398, P < 0.001), self-efficacy (r = 0.497, P < 0.001), and protection motivation (r = 0.595, P < 0.001). On the other hand, significant negative correlations were found between the preventive behaviors of COVID-19 and maladaptive behavior rewards (r = - 0.243, P < 0.001) and perceived costs (r = - 0.121, P < 0.001).

CONCLUSION

The present findings showed that maladaptive behavior reward and fear negatively predicted the protective behaviors. On the other hand, response efficacy and self-efficacy positively predicted the protective behaviors; the impact of self-efficacy was the strongest. Overall, the information provided in this study can contribute to health policymaking in Iran.

Preventive Behavioral Insights for Emerging Adults: A Survey during the COVID-19 Pandemic

Emerging adulthood is an important period for establishing health behavior patterns in life. This study aimed to examine factors related to preventive behaviors of emerging adults during the COVID-19 pandemic. A descriptive online survey design was used. Data were collected using a self-administrated, 28-item questionnaire completed by 239 undergraduate students from a university in Seoul, South Korea. The questionnaire was developed based on previous studies and the guidelines of the World Health Organization about COVID-19 preventive behaviors. The mean age of participants was 21.97 years, and the average score for COVID-19 preventive behaviors was 4.13 (SD: ±0.42) on a 5-point scale. Hierarchical regression analyses revealed that subjective norms related to parents (β = 0.425, p < 0.001), issue involvement related to COVID-19 (β = 0.160, p = 0.024), and sex (β = 0.137, p = 0.029) were significant factors related to preventive behaviors of emerging adults after controlling for demographic characteristics. The variables explained 20.1% of the variance in preventive behaviors. The results of this study suggest that better strategies for subjective norms related to parents and issue involvement related to COVID-19 must be considered to improve emerging adults’ preventive behaviors.

Factors associated with non-adherence to social distancing rules during the COVID-19 pandemic: a logistic regression analysis

BACKGROUND

On March 23, 2020, the government of the United Kingdom told the British people to stay home, an unprecedented request designed to limit the spread of the COVID-19 virus and stop the National Health Service from being overwhelmed.

METHODS

This study undertook a cross-sectional design to survey a convenience sample of 681 residents of North London on their social distancing (SD) behaviours, demographics, housing situation, politics, psychology and social support using an online questionnaire. Logistic regression was used to measure the associations between these explanatory factors and non-adherence to all SD rules and intentional non-adherence to SD rules.

RESULTS

The vast majority (92.8%) of participants did not adhere to all SD rules and nearly half (48.6%) engaged in intentional non-adherence of rules. The odds of not adhering to all SD rules increased if a participant was not identified as highly vulnerable to COVID-19 [OR = 4.5], had lower control over others' distancing [OR = .724], had lower control over responsibilities for which coming into contact with others was unavoidable [OR = .642], and if SD behaviours were reported after lockdown was first relaxed [OR = .261]. The odds of intentionally not adhering to SD rules increased if a participant had a lower intention to socially distance [OR = .468], had lower control over others' distancing [OR = .829], had a doctoral degree compared to a master's degree [OR = .332], a professional qualification [OR = .307], a bachelor's degree [OR = .361] or work-related qualification [OR = .174], voted for the UK Government compared to not voting for the Government [OR = .461], perceived higher normative pressure from neighbours [OR = 1.121] and had greater support from friends [OR = 1.465].

CONCLUSIONS

Non-adherence to all SD rules had a stronger association with vulnerability to COVID-19 and control over SD, whereas intentional non-adherence had a stronger association with intention and anti-social psychological factors. It is recommended that people living in high-risk environments, such as those living in houses of multiple occupancy, should be specially supported when asked to stay at home, and public health messaging should emphasise shared responsibility and public consciousness.

Location-Based Games and the COVID-19 Pandemic: An Analysis of Responses from Game Developers and Players

In early 2020, as a countermeasure to mitigate the spread of the COVID-19 pandemic, governments issued limitations on the movements of their citizens, cancelling social events and advising people to stay home. As location-based games (LBGs) have been found to influence human movement, their role during COVID-19 deserves closer inspection. Under regular circumstances, the very aim of these games is to motivate people to go out, explore and meet other people. However, during COVID-19, people were advised to do the exact opposite. To study how LBG developers and players reacted to the situation, we used the netnography research method utilizing three types of data: (1) COVID-19 related in-game changes made by seven popular LBG developers during March 2020; (2) social media reactions on 20 posts across three popular Pokémon GO subreddits; and (3) the raiding activity (collaborative play) in Pokémon GO in a Finnish municipality during February–May 2020. All observed LBGs made in-game changes due to COVID-19. The social media reactions showed overwhelming appreciation towards these changes, and two central second order themes arose: (1) LBGs have the ability to influence human movement during pandemics; and (2) people should be able to self-regulate their behaviour during COVID-19 independent of LBG influence. Surprisingly, recorded Pokémon GO player activity in Finland was more influenced by offered in-game rewards than the COVID-19 pandemic. Our findings have implications on how games and gamification can be used to direct human movement in situations such as COVID-19 where population-level interventions are needed.

Impact of Online Information on Self-Isolation Intention During the COVID-19 Pandemic: Cross-Sectional Study

BACKGROUND

During the coronavirus disease (COVID-19) pandemic, governments issued movement restrictions and placed areas into quarantine to combat the spread of the disease. In addition, individuals were encouraged to adopt personal health measures such as social isolation. Information regarding the disease and recommended avoidance measures were distributed through a variety of channels including social media, news websites, and emails. Previous research suggests that the vast amount of available information can be confusing, potentially resulting in overconcern and information overload.

OBJECTIVE

This study investigates the impact of online information on the individual-level intention to voluntarily self-isolate during the pandemic. Using the protection-motivation theory as a framework, we propose a model outlining the effects of cyberchondria and information overload on individuals' perceptions and motivations.

METHODS

To test the proposed model, we collected data with an online survey (N=225) and analyzed it using partial least square-structural equation modeling. The effects of social media and living situation were tested through multigroup analysis.

RESULTS

Cyberchondria and information overload had a significant impact on individuals' threat and coping perceptions, and through them on self-isolation intention. Among the appraisal constructs, perceived severity (P=.002) and self-efficacy (P=.003) positively impacted self-isolation intention, while response cost (P<.001) affected the intention negatively. Cyberchondria (P=.003) and information overload (P=.003) indirectly affected self-isolation intention through the aforementioned perceptions. Using social media as an information source increased both cyberchondria and information overload. No differences in perceptions were found between people living alone and those living with their families.

CONCLUSIONS

During COVID-19, frequent use of social media contributed to information overload and overconcern among individuals. To boost individuals' motivation to adopt preventive measures such as self-isolation, actions should focus on lowering individuals' perceived response costs in addition to informing them about the severity of the situation.

Predictors of sun protection behavior in high school students of Ahvaz: a cross-sectional study

OBJECTIVE

The aim of this study was to predict sun protection behavior by using the protection-motivation theory (PMT).

INTRODUCTION

Sun exposure during childhood and adolescence has a very important role in the development of skin cancer in the future.

CASE

This was a cross-sectional study. Applying multi-stage random assignment, 380 students from Ahvaz were entered into the study in 2014. Data were collected using a valid and reliable questionnaire based on the PMT. An independent t-test, the Mann-Whitney test, Spearman's correlation and a regression test were used to analyze data by SPSS 15.

RESULT

Among 380 students, 48.2% were male and 51.8% were female. Constructs of the PMT accounted for (adjusted R²) 39% observed variance of protection-motivation or intention to do behaviors and 15% observed variance for sun-protection behaviors through protection motivation, self-efficacy and perceived susceptibility, respectively.

DISCUSSION

The PMT may be used as a framework to design intervention programs in an attempt to improve intention to perform sun protection behaviors of students. However, the model did not show optimal predictive power for adherence to sun-protection self-care behavior. The findings from this study have important implications in skin cancer prevention.

Value for Money in H1N1 Influenza: A Systematic Review of the Cost-Effectiveness of Pandemic Interventions

BACKGROUND

The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research?

OBJECTIVE

The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective.

METHODS

We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality.

RESULTS

The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises.

CONCLUSIONS

This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time.

Influenza vaccination uptake and associated factors among elderly population in Hong Kong: the application of the Health Belief Model

The impact of influenza on elderly can be severe and fatal. Influenza vaccination (IV) has been shown to be effective in reducing influenza-related complications, but the IV uptake among elderly in Hong Kong remains low. This study investigated the prevalence and factors associated with IV among Chinese elderly in Hong Kong using the Health Belief Model (HBM). A total of 1101 Chinese elderly aged over 65 was randomly selected and completed a phone interview. Background information, experience of and intention to receive IV and IV-related knowledge and perceptions based on the HBM were measured. Results showed that 48.5 and 49.5% of the participants have ever been vaccinated and intended to receive IV, respectively. Female gender, having chronic disease, and participating in community activities were significantly associated with previous IV. Knowledge of the fact that IV is required every year, lower perceived side effect, IV price lower than HK$150, and recommendations from health care providers was associated with both previous IV and intention to be vaccinated in the next year. Interventions promoting IV among elderly should disseminate knowledge regarding the necessity of IV and correct misconceptions about the side effects of IV.