Believing That We Can Change Our World for the Better: A Triple-A (Agent-Action-Aim) Framework of Self-Efficacy Beliefs in the Context of Collective Social and Ecological Aims

PUBLIC ABSTRACT

Many people do not act together against climate change or social inequalities because they feel they or their group cannot make a difference. Understanding how people come to feel that they can achieve something (a perception of self-efficacy) is therefore crucial for motivating people to act together for a better world. However, it is difficult to summarize already existing self-efficacy research because previous studies have used many different ways of naming and measuring it. In this article, we uncover the problems that this raises and propose the triple-A framework as a solution. This new framework shows which agents, actions, and aims are important for understanding self-efficacy. By offering specific recommendations for measuring self-efficacy, the triple-A framework creates a basis for mobilizing human agency in the context of climate change and social injustice.

Fostering public climate change discussions from a social interaction perspective

Public discussions on climate change, as a form of social interaction, are widely recognized as effective tools for promoting collective action. However, there is limited research on examining the factors that influence climate change discussions from a social interaction perspective. In the present study, we conducted a large sample (N = 1,169) survey to investigate personal (such as self-efficacy and personal response efficacy) and others' (such as perceived others' response efficacy and social norms) factors influencing climate change discussions from a social interaction perspective. The results showed that (i) for people with high climate change perceptions, personal response efficacy, self-efficacy, and social norms have positive effects on climate change discussions, but the effect of perceived others' response efficacy on climate change discussion is not significant; (ii) for people with low climate change perceptions, self-efficacy and social norms have positive effects on climate change discussions, but the effects of personal response efficacy and perceived others' response efficacy on climate change discussion are not significant; (iii) irrespective of individuals' high or low perceptions of climate change, social norm remains the most important predictor of climate change discussions. These findings make valuable contributions to the theoretical literature and intervention efforts regarding climate change discussions from a social interaction perspective.

Impact of vascular screening interventions on perceived threat, efficacy beliefs and behavioural intentions: a systematic narrative review

Health-related behaviours contribute to the global burden of cardiovascular disease (CVD). Cardiovascular imaging can be used to screen asymptomatic individuals for increased risk of CVD to enable earlier interventions to promote health-related behaviours to prevent or reduce CVD risk. Some theories of behaviour and behaviour change assume that engagement in a given behaviour is a function of individual threat appraisals, beliefs regarding the performance of behaviour, self-efficacy for performing the desired behaviour and/or dispositions to act (e.g. behavioural intentions). To date, little is known about the impact of cardiovascular imaging interventions on these constructs. This article summarises evidence related to perceived threat, efficacy beliefs, and behavioural intentions after CVD screening. We identified 10 studies (2 RCTs and 8 non-randomised studies, n = 2498) through a combination of screening citations from published systematic reviews and meta-analyses and searching electronic databases. Of these, 7 measured behavioural intentions and perceived susceptibility and 3 measured efficacy beliefs. Findings showed largely encouraging effects of screening interventions on bolstering self-efficacy beliefs and strengthening behavioural intentions. Imaging results that suggest the presence of coronary or carotid artery disease also increased perceived susceptibility to CVD. However, the review also identified some gaps in the literature, such as a lack of guiding theoretical frameworks and assessments of critical determinants of health-related behaviours. By carefully considering the key issues highlighted in this review, we can make significant strides towards reducing CVD risks and improving population health.

Stay in Risk Area: Place Attachment, Efficacy Beliefs and Risk Coping

For residents living in earthquake-threatened areas, choosing suitable risk coping behaviors can effectively reduce the loss of family life and property. However, some residents still choose to continue to live within areas at risk of earthquake disaster. Place attachment may play an important role. Based on place attachment theory and the Protective Action Decision Model (PADM), this study explores the possible relationships among place attachment, efficacy beliefs, and evacuation/relocation intention. Furthermore, it examines the mediating role of efficacy beliefs. The study also used the partial least squares method (PLS-SEM) to test samples of 327 rural households in Wenchuan and Lushan earthquake-hit areas. The results show that: (1) Place attachment has a significant effect on response efficacy (RE), but not on self-efficacy (SE); (2) Place dependence (PD) has a negative and significant effect on relocation intention (RI) but has no significant effect on evacuation intention (EI). However, place identity (PI) can indirectly affect EI by influencing RE; (3) Efficacy beliefs have a significant positive effect on EI and RI. These results help us understand the complex relationships among place attachment, efficacy beliefs, and residents’ risk coping behavior, thus providing decision-making references for the formulation and improvement of regional disaster risk management policies.

Using Protection Motivation Theory to Predict Adherence to COVID-19 Behavioral Guidelines

COVID-19 has become a global pandemic. Throughout most of the pandemic, mitigating its spread has relied on human behavior, namely on adherence to protective behaviors (e.g., wearing a face mask). This research proposes that Protection Motivation Theory (PMT) can contribute to understanding differences in individual adherence to COVID-19 behavioral guidelines. PMT identifies four fundamental cognitive components that drive responses to fear appeals: perceptions of susceptibility (to the disease), severity (of the disease), self-efficacy (to protect oneself), and response efficacy (i.e., recommended behaviors' effectiveness). Two online self-report studies assessed PMT components' capacity to predict adherence to protective behaviors concurrently and across culturally different countries (Israel, Germany, India; Study 1), and again at six-week follow-up (Israeli participants; Study 2). Study 1's findings indicate excellent fit of the PMT model, with about half of the variance in adherence explained. No significant differences were found between participants from Israel (n = 917), Germany (n = 222) and India (n = 160). Study 2 (n = 711) confirmed that PMT components continue to predict adherence after six weeks. In both studies, response efficacy was the PMT component most strongly associated with adherence levels. This study demonstrates that PMT can serve as a theoretical framework to better understand differences in adherence to COVID-19 protective behaviors. The findings may further inform the design of adherence-promoting communications, suggesting that it may be beneficial to highlight response efficacy in such messages.

Role of Threat and Coping Appraisal in Protection Motivation for Adoption of Preventive Behavior During COVID-19 Pandemic

With more than 100 million cases and over 2 million deaths globally, the COVID-19 pandemic continues to remain a major threat. Identifying the behavioral factors influencing preventive behaviors for COVID-19 are crucial in devising public health policies to promote essential strategies to combat the pandemic in an efficient manner. The current study was therefore conducted to estimate the prevalence of COVID-19 preventive behaviors and measure their association with behavioral constructs like threat perception, response efficacy, and self-efficacy, as per socio-demographic background. A region-stratified online survey focusing on the constructs of protection motivation theory, for example, threat and coping appraisal for preventive health practices against COVID-19, was carried out among adult users of social media in India. Generalized linear models with cluster-adjusted-robust standard errors were used to analyze the responses and model the preventive practices among the study population. Analysis of a total 2,646 responses revealed that proper perceptions regarding cause, symptoms, and transmission of COVID-19 were prevalent in the majority of the respondents. The majority of the participants reported frequent use of face masks (93.20%), followed by frequent washing of hands with soap and water (84.90%). The majority of the respondents affirmed that, though not frequently but sometimes, they avoid touching the face with unclean hands. Frequently covering mouth with the crook of the elbow while sneezing and coughing, and maintaining physical distance when outside was noted among 74.14 and 83.84%, respectively. The proportion of participants frequently using sanitizers to clean hands and those infrequently practicing the same were comparable. Self-efficacy for preventive practices and threat-appraisal of COVID-19 illness were identified as important determinants of the selected COVID-19 preventive behaviors, independently. The analysis confirmed that practices of the behaviors were mostly synergistic to each other. Current findings highlight that formulation of precise risk communication strategies to improve perceptions regarding threat appraisal and self-efficacy could facilitate desirable practices, which are also effective in the prevention of airborne infections and, hence, may contribute toward broader policy directions. The evidence urges the implementation of precision-driven risk communication and diffusion of these practices to attain behavioral herd immunity.

Examining Protection Motivation and Network Externality Perspective Regarding the Continued Intention to Use M-Health Apps

M-health apps have developed rapidly and are widely accepted, but users' continued intention to use m-health apps has not been fully explored. This study was designed to obtain a better understanding of users' continued intention to use m-health apps. We developed a theoretical model by incorporating the protection motivation theory and network externalities and conducted an empirical study of a 368-respondent sample. The results showed that: (1) perceived vulnerability has a direct impact on users' self-efficacy and response efficacy; (2) self-efficacy and response efficacy have a direct impact on users' attitudes and continued intention; (3) network externalities affect users' attitudes and continued intention, among which direct network externalities have an indirect impact on users' continued intention through attitude; and (4) the impacts of self-efficacy, response efficacy, and indirect network externalities on continued intention are partially meditated by attitudes.

Response Efficacy of PD-1 and PD-L1 Inhibitors in Clinical Trials: A Systematic Review and Meta-Analysis

Background

Immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway have demonstrated promise in treating a variety of advanced cancers; however, little is known regarding their efficacy under various clinical situations, including different cancer types, treatment lines, drug combinations, and therapeutic regimens.

Methods

Published articles and conference abstracts (in English) in PubMed, Embase, the Cochrane Central Register, and Web of Science were searched up to February 10, 2020. The data were analyzed by the meta-analysis program in Stata.

Results

A total of 16,400 patients from 91 clinical trials were included in this meta-analysis. PD-1/PD-L1 inhibitors had a mean ORR of 19.56% (95% CI: 15.09–24.03), a median TTR of 2.05 months (m) (95%CI: 1.85–2.26), and a median DOR of 10.65 m (95%CI: 7.78–13.52). First-line treatment had a higher ORR (36.57% vs. 13.18%) but a shorter DOR (9.00 m vs. 13.42 m) compared to the second-line or subsequent treatment. Immunotherapy combined with chemotherapy (I+C) (46.81% [95%CI: 36.02–57.60]) had a statistically significant higher ORR compared to immunotherapy (I) (17.75% [95%CI: 14.47–21.03]) or immunotherapy combined with immunotherapy (I+O) (12.25% [95%CI: 1.56–22.94]), while I+C (8.09 m [95%CI: 6.86–9.32]) appeared to reduce the DOR compared to I (12.39 m [95%CI: 7.60–17.18]). PD-1 inhibitors were associated with better ORR (21.65% vs. 17.60%) and DOR (11.26 m vs. 10.03 m) compared to PD-L1 inhibitors. There were no significant differences in TTR under different situations.

Conclusions

PD-1/PD-L1 inhibitors were promising immunotherapeutic agents to achieve satisfactory response efficacies with different cancer types, treatment lines, drug combinations, and therapeutic regimens. This comprehensive summary of the response efficacy of PD-1/PD-L1 inhibitors serves as a reference for clinicians to make evidence-based decisions.

Information Sources, Risk Perception, and Efficacy Appraisal's Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey

Background

As the COVID-19 pandemic has become a major public health threat worldwide, it is critical to understand what factors affect individual engagement in protective actions. Because of its authoritarian political system and state-owned media system, how Chinese individuals engaged in protective actions against COVID-19 might be different compared to other countries.

Objective

The purpose of this study is to examine how the source of information about COVID-19, Chinese individuals’ risk perception of COVID-19 (ie, perceived severity and perceived susceptibility), and their efficacy appraisal in controlling COVID-19 (ie, response efficacy and self-efficacy) affected their engagement in protective actions. Additionally, this study aims to investigate whether there is any difference in these relationships throughout the duration of this pandemic.

Methods

A six-wave repeated cross-sectional survey (N=1942) was conducted in six major cities in China between February 7 and April 23, 2020. Participants’ reliance on expert versus inexpert sources for information about COVID-19, their perceived severity of and susceptibility to COVID-19, their response efficacy and self-efficacy, and their engagement in protective actions (staying at home, wearing a face mask, and washing hands) were measured. Demographic variables (sex, age, income, education, and city of residence), knowledge of COVID-19, and self-rated health condition were controlled.

Results

Reliance on expert sources did not become the major factor that motivated these actions until wave 3, and the negative effect of inexpert sources on these actions was limited to wave 2. Perceived severity encouraged some protective behaviors but its effect varied depending on the specific behavior. In addition, perceived severity exhibited a stronger effect on these behaviors compared to perceived susceptibility. The positive effect of response efficacy was only significant at waves 1 and 2, and limited to certain behaviors.

Conclusions

Chinese individuals’ engagement in protective behaviors might not entirely be their autonomous decision but a result of compliance with executive orders. After the early outbreak, expert sources started to facilitate protective behaviors, suggesting that it might take time to develop trust in these sources. The facilitating effect of perceived severity lasted throughout the duration of the pandemic, but that of response efficacy was limited to the early stage.

Impact of Social Support and Social Trust on Public Viral Risk Response: A COVID-19 Survey Study

Public health has been under continuous threat worldwide in recent years. This study examined the impact of social support and social trust on the activities and efficacy of the public’s risk response in the case of COVID-19. We conducted an online survey over eight days with 620 Korean adult participants. Data were analyzed using structural equation modelling and K-means cluster analysis. Our results showed that public support had a positive impact on response efficacy, while response efficacy had a positive impact on sanitation, distancing, and purchasing activities. In addition, social support positively moderated the impact of public and individual support on response efficacy, while response efficacy negatively moderated the impact on sanitation activities. These results suggest that, first, amid viral risk, governments should proactively supply tools and information for infection-prevention, and deliver messages that encourage and support infection-prevention activities among the public. Second, when viral risk occurs, governments, along with all other members of society, must engage in aggressive risk response measures. Third, there is a need for risk communication that further emphasizes the importance of personal sanitation activities in the face of viral risk.

Self-efficacy and response-efficacy: critical components of sexual and reproductive health interventions targeting condom use intention among American Indian adolescents

The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N = 267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.

Do Metaphors in Health Messages Work? Exploring Emotional and Cognitive Factors

Health communicators publicize messages that use metaphors to compare abstract health-related concepts to concrete concepts in other domains. Such messages aim to change health attitudes and behavior, but do they work? According to Conceptual Metaphor Theory, metaphors can shape thought by transferring personalized knowledge of a concrete concept to understand and relate to an abstraction, despite their superficial differences. The authors extend this claim to specify emotional and cognitive factors potentially moderating the productivity (and counter-productivity) of metaphoric health messages. A source resonance hypothesis predicts that when a message frames a health risk metaphorically in terms of a concrete hazard (versus literally), individual differences in fear surrounding that particular hazard will differentially predict risk-related worry and thus prevention intentions. A metaphoric fit hypothesis predicts that a risk metaphor will be more persuasive when the recommended prevention response is itself framed metaphorically as addressing the concrete hazard (versus literally). These hypotheses were supported in three experiments conducted with online, undergraduate, and community samples (N = 539). With skin cancer as a case study, the studies tested the impact of messages framing sun exposure and sun-safe practices with or without metaphors of enemy combat. Findings illuminate how, when, and for whom metaphoric messages are persuasive, with theoretical and practical implications for health communication and metaphoric construal.