Adoption Of Protective Behaviors Research Articles

The impacts of knowledge, risk perception, emotion and information on citizens\u2019 protective behaviors during the outbreak of COVID-19: a cross-sectional study in China

BackgroundIndividual protective behaviors play an important role in the control of the spread of infectious diseases. This study aimed to investigate the adoption of protective behaviors by Chinese citizens amid the COVID-19 outbreak and its associated factors.MethodsAn online cross-sectional survey was conducted from 22 January to 14 February 2020 through Wenjuanxing platform, measuring their knowledge, risk perception, negative emotion, response to official communication, and protective behaviors in relation to COVID-19. A total of 3008 people completed the questionnaire, of which 2845 were valid questionnaires.ResultsOn average, 71% of respondents embraced protective behaviors. Those who made no error in the knowledge test (AOR = 1.77, p < 0.001) perceived the high severity of the epidemic (AOR = 1.90, p < 0.001), had high negative emotion (AOR = 1.36, p = 0.005), reported good health (AOR = 1.94, p < 0.001), paid high attention to the governmental media (AOR = 4.16, p < 0.001) and trusted the governmental media (AOR = 1.97, p < 0.001) were more likely to embrace protective behaviors after adjustments for variations in potential confounding factors. Women and older people were also more likely to embrace protective behaviors. No regional or educational differences were found in the adoption of protective behaviors.ConclusionThe majority of Chinese citizens embraced protective behaviors. Higher levels of protective behaviors are associated with higher knowledge, perceived severity, negative emotion, and attention to and trust in the official governmental media. Official governmental communication is the largest single predictor of protective behaviors.

Key Considerations for Successful Risk Communication and Community Engagement (RCCE) Programmes During COVID-19 Pandemic and Other Public Health Emergencies.

Risk communication and community engagement (RCCE) is a key pillar in public health emergency response that ensures accurate health information sharing, adoption of protective behaviours by the affected people, and collaborative participation by all stakeholders, including of the local community structures. The success of RCCE programmes rely on strong partnerships and engagement among affiliated groups; clear programme plans and guidelines; establishment of well-laid down coordination structures; and clear measures for reporting and documentation of programme activities. RCCE activities during public health emergencies must put more emphasis on strengthening local structures and communities to ensure active participation of communities in interrupting disease transmission.

Risk Perception and Media in Shaping Protective Behaviors: Insights From the Early Phase of COVID-19 Italian Outbreak.

In the absence of target treatments or vaccination, the SARS-CoV-2 pandemic can be impeded by effectively implementing containment measures and behaviors. This relies on individuals’ adoption of protective behaviors, their perceived risk, and the use and trust of information sources. During a health emergency, receiving timely and accurate information enables individuals to take appropriate actions to protect themselves, shaping their risk perception. Italy was the first western country plagued by COVID-19 and one of the most affected in the early phase. During this period, we surveyed 2,223 Italians before the national lockdown. A quarter of the sample perceived COVID-19 less threatening than flu and would not vaccinate, if a vaccine was available. Besides, most people perceived containment measures, based on social distancing or wearing masks, not useful. This perceived utility was related to COVID-19 threat perception and efficacy beliefs. All these measures were associated with the use of media and their truthfulness: participants declared to mainly use the Internet, while health organizations’ websites were the most trusted. Although social networks were frequently used, they were rated lower for trustfulness. Our data differ from those obtained in other community samples, suggesting the relevance to explore changes across different countries and during the different phases of the pandemic. Understanding these phenomena, and how people access the media, may contribute to improve the efficacy of containment measures, tailoring specific policies and health communications.

Using Persuasion science to improve COVID-19 contact tracing

Using Persuasion science to improve COVID-19 contact tracing

Government trust, perceptions of COVID-19 and behaviour change: cohort surveys, Singapore.

ObjectiveTo evaluate how public perceptions and trust in government communications affected the adoption of protective behaviour in Singapore during the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe launched our community-based cohort to assess public perceptions of infectious disease outbreaks in mid-2019. After the first case of COVID-19 was reported in Singapore on 23 January, we launched a series of seven COVID-19 surveys to both existing and regularly enrolled new participants every 2 weeks. As well as sociodemographic properties of the participants, we recorded changing responses to judge awareness of the situation, trust in various information sources and perceived risk. We used multivariable logistic regression models to evaluate associations with perceptions of risk and self-reported adopted frequencies of protective behaviour.FindingsOur cohort of 633 participants provided 2857 unique responses during the seven COVID-19 surveys. Most agreed or strongly agreed that information from official government sources (99.1%; 528/533) and Singapore-based news agencies (97.9%; 522/533) was trustworthy. Trust in government communication was significantly associated with higher perceived threat (odds ratio, OR: 2.2; 95% confidence interval, CI: 1.6–3.0), but inversely associated with perceived risk of infection (OR: 0.6; 95% CI: 0.4–0.8) or risk of death if infected (OR: 0.6; 95% CI: 0.4–0.9). Trust in government communication was also associated with a greater likelihood of adopting protective behaviour.ConclusionOur findings show that trust is a vital commodity when managing an evolving outbreak. Our repeated surveys provided real-time feedback, allowing an improved understanding of the interplay between perceptions, trust and behaviour.

The AGE Effect on Protective Behaviors During the COVID-19 Outbreak: Sociodemographic, Perceptions and Psychological Accounts.

COVID-19 outbreak is a sudden and devastating global pandemic in which the control of the spread is highly dependent on individual reactions, until the development of a vaccine and adequate treatments. Considering that older adults are at high risk for COVID-related medical complications and mortality, the present study focuses on the age-related differences on the adoption of protective behaviors during the initial stages of this outbreak, while accounting for the role of sociodemographic, COVID-related, perceived risk, and psychosocial variables (i.e., anxiety, optimism, fear of death, and social isolation) in this relation. The study sample included 1696 participants, aged between 18 and 85 years old, who completed an online survey during the initial stages of the first COVID-19 outbreak in Portugal. Overall, results reveal that the engagement in protective behaviors declines with advancing age and that older adults show a pattern toward lower perceived risk compared with middle-aged adults. Multicategorical mediation analyses show that anxiety, optimism, fear of death, and social isolation significantly mediate age effects on protective behaviors. Specifically, both anxiety and fear of death increase protective behaviors via higher perceived risk in the middle-aged and in the younger groups, respectively. Optimism directly predicts protective behaviors in the middle-aged groups, while social isolation reduces protective behaviors in the younger and older-aged groups. Results are discussed in terms of its implications for public health policies.

Social Psychological Correlates of Protective Behaviours in the COVID-19 Outbreak: Evidence and Recommendations from a Nationally Representative Sample.

BackgroundA clear picture of people’s adoption of protective behaviours, and a thorough understanding of psychosocial correlates in the context of contagious diseases such as COVID‐19, is essential for the development of communication strategies, and can contribute to the fight against epidemics.MethodsIn this paper, we report a survey on the adoption of the recommended protective behaviours before and during the epidemic. We also assessed demographic correlates, and beliefs (towards COVID‐19 and protective behaviours, towards SARS‐CoV‐2 transmission, social dilemma variables, and perceived external cues) of a representative sample of British residents. Data were collected during the early stage of the COVID‐19 epidemic that spread worldwide in 2020.ResultsResults showed a marked increase in the adoption of protective behaviour. We also identified targets for intervention in variables related to transmission of the virus and social dilemma‐related beliefs. Sex differences in the adoption of protective measures, as well as differences associated with the frequency of social contacts, were associated with differences in beliefs.ConclusionsThese findings suggest changeable determinants, which could be targeted in global communication about COVID‐19, or in interventions targeting specific sub‐groups not following the protective measures.

Subjective Deterioration of Physical and Psychological Health during the COVID-19 Pandemic in Taiwan: Their Association with the Adoption of Protective Behaviors and Mental Health Problems.

This study aimed to determine the proportion of individuals who reported the deterioration of physical and psychological health during the coronavirus disease 2019 (COVID-19) pandemic in Taiwan. Moreover, the related factors of deterioration of physical and psychological health and the association between deterioration of health and adoption of protective behavior against COVID-19 and mental health problems were also examined. We recruited participants via a Facebook advertisement. We determined the subjective physical and psychological health states, cognitive and affective construct of health belief, perceived social support, mental health problems, adoption of protective behavior and demographic characteristics among 1954 respondents (1305 women and 649 men; mean age: 37.9 years with standard deviation 10.8 years). In total, 13.2% and 19.3% of respondents reported deteriorated physical and psychological health during the COVID-19 pandemic, respectively. Participants with higher perceived harm from COVID-19 compared with severe acute respiratory syndrome (SARS) were more likely to report the subjective deterioration of physical and psychological health, whereas respondents who were older and perceived a higher level of social support were less likely to report a deterioration of physical and psychological health. The subjective deterioration of psychological health was significantly associated with avoiding crowded places and wearing a mask. Both subjective deteriorations of physical and psychological health positively related to general anxiety.

Social value orientation, subjective effectiveness, perceived cost, and the use of protective measures during the COVID-19 pandemic in Germany

ABSTRACT We investigated the influence of perceived protective value for the public, perceived self-protective value, and perceived cost of the behavior on the adoption of protective behavior during the COVID-19 pandemic. In a pilot study conducted when the lockdown was put in place in Germany, we investigated perceptions of the protective value and use of various protective behavioral measures against COVID-19. Although our sample (German general public, N = 419; age = 38.07, SD = 15.67; women = 71.1% [diverse = 0.5%]; students = 34.37%) consisted mostly of prosocially oriented individuals, we found that, above all, participants used protective measures that offered self-protection. In a second study conducted after the lock down in Germany had been lifted, which used a similar sample (German general public, N = 253; age = 42.53, SD = 16.03; women = 69.8% [diverse = 0.4%]; students = 24.10%), we observed the same results even after people had adapted to the threat. In addition, the second study showed a negative relationship between the perceived costs of a behavior and the frequency of its use. The two studies suggest that the use of protective measures during the COVID-19 pandemic is based on a cost-benefit perception. We conclude that health communication should focus on the perceived self-protective value of certain behaviors but should simultaneously emphasize their relatively low cost.

Mask-Wearing Increased After a Government Recommendation: A Natural Experiment in the U.S. During the COVID-19 Pandemic

On April 3 2020, the U.S. Centers for Disease Control and Prevention (CDC) recommended that all Americans wear face masks to prevent the spread of COVID-19. The announcement came during the fielding of a large, nationally-representative survey (N = 3,933) of Americans’ COVID-19-related knowledge, attitudes, and behaviors, providing an opportunity to measure the impact of the CDC’s recommendation on public reported mask wearing and buying behavior. The study found significant increases in reported mask wearing (+12 percentage points) and mask buying (+7 points). These findings indicate the speed with which government recommendations can affect the adoption of protective behaviors by the public. The results demonstrate the importance of national leadership and communication during a public health crisis.

A Mixed-Methods Approach to Understanding Knowledge of Mosquito-Borne Infections and Barriers for Protection in Hanoi, Vietnam.

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a “risk-mapping” exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control.

Association between sources of sexuality education, sexual beliefs and behaviours in Lebanese young adults: a university-based cross-sectional study

ABSTRACT This study assessed the association between sources of sexuality education, sexual beliefs and behaviour among Lebanese youth. 451 unmarried students at a private university, mean age 20.25 (±1.41) years, participated in the study. Main sources of information were teachers, mothers, internet and friends. Respondents wished for increased involvement of fathers and doctors in their sexuality education. There was a positive association between receipt of school classes on reproductive health and adoption of protective behaviour at first sexual experience (OR = 4.09, p < 0.05). A Sexual Belief Index (SBI) was calculated as a mean score on 18 items related to sexual permissiveness (Cronbach’s alpha = 0.83). Sex and classes on reproductive health predicted a rise in SBI. The timing of classes, namely earlier introduction, and communication with family and religious figures predicted a decrease in SBI. The SBI was positively associated with sexual activity (OR = 3.68, p = 4.399e-07), first sex at <17 years (OR = 5.262, p = 0.0099) and engagement in one-night stands (OR = 4.195, p = 0.0001). Students who engaged in same-sex sexual experiences had higher odds of contracting STIs (OR = 12.7, p = 0.0001). Findings reveal the need to include sexual health in school curricula; train parents, physicians and teachers as information providers and moderators of SBI; and improve access to youth-friendly services.

Predicting Chikungunya disease personal protective behaviors: Results of a cross-sectional survey of US-Caribbean travelers.

Background: Incidents of vector-borne disease have recently tripled in the United States. Chikungunya disease is a particularly common disease in the Caribbean, posing a threat to international tourists. However, the relationship between psychological variables derived from the protection motivation theory (PMT), and adoption of protective behaviors against the disease, is uncertain. This study sought to identify the psychological predictors of travelers’ protective health behaviors, specifically (1) appropriate clothing use, and (2) indoor spatial repellent use. Methods: An online, retrospective survey of U.S. international travelers to Caribbean destinations measured the five constructs of the PMT in the context of Chikungunya disease: Perceived severity, perceived vulnerability, perceived response efficacy, perceived self-efficacy, and knowledge. Hierarchical logistic regression analyzed whether these five theoretical constructs predicted the two protective behaviors in respondents who met study criteria (n = 184). Results: Results suggest that the interaction between chikungunya knowledge and perceived chikungunya severity predicts both appropriate clothing use (odds ratio [OR]: 1.95, CI: 1.18-3.25, P =0.010) and indoor spatial repellent use (OR: 1.55, CI: 1.05-2.29, P =0.029). In the cases of appropriate clothing use, the interaction between perceived chikungunya severity and perceived vulnerability was also a significant predictor (OR: 9.67, CI:1.23-75.80, P =0.031). Additionally, indoor spatial repellent use was also predicted by the interaction of chikungunya knowledge and perceived vulnerability (OR: 1.88, CI:1.18-3.02, P =0.009). Conclusion : Two-pronged educational approaches may be most efficacious in increasing protective health behaviors. Such efforts could reduce incidents of chikungunya disease and other vectorborne diseases in travel destinations featuring high exposure risks.

Sun protection habits and behaviors of a group of outdoor workers and students from the agricultural and construction sectors in north-Italy.

Background:Despite the relevant frequency of ultraviolet induced adverse health effects in workers, solar ultraviolet radiation (UVR) exposure is an occupational risk not adequately minimized in Italy.Objective:To assess the characteristics and prevalence of sun exposure habits and behaviors in a group of students and outdoor workers (OW) from the agricultural and construction sectors of a north-Italian region.Methods:Based on a previously developed standardized questionnaire, we collected full information on individual sun exposure habits at work and during leisure activities.Results:In 2018, 380 high school students and OW from the agricultural and construction sectors participated in a sun-safety campaign. More than a third (39.0%) of OW reported never using sunglasses, 52.8% never applied sunscreens at work, and a quarter never wear a UV protective hat. Considering leisure-time, students reported more frequent sunburns compared to OW: 25.0% vs. 13.8%; half (51.6%) of students and a third (36.4%) of OW reported never wearing a UV protective hat. A third (30.1%) of students and 37.2% of OW never or only seldom applied sunscreens on holidays.Discussion:The majority of OW in our study reported poor protective solar exposure habits. Young students of the construction and agricultural sectors indicated even worse sun-protective behaviors, both during apprenticeship and leisure activities. Our study highlights the low health literacy related to solar UVR in OW and apprentices. Further educational initiatives are required in Italy to improve the adoption of protective behaviors during outdoor activities.

Atitude dos jovens face à contraceção oral de emergência: tradução e validação de uma escala

The objective was to validate the Contraceptive Pills (ECPs) - Attitude for the Portuguese university population, allowing the evaluation of the attitude of young people to oral emergency contraception (OEC). Translation, adaptation, and validation of the same for the Portuguese population. A study was carried out using a sample of 457 university students, and their psychometric characteristics were evaluated by developing studies of reliability and validity. The sample consisted mostly of female youth (61.71%), with a mean age of 21.14 years. After performing the psychometric studies, it was possible to obtain values of Cronbach's alpha coefficient of 0.820, for the Scale of Attitudes towards the use of Emergency Oral Contraception (EACOE) and for factor 1 (Fear of misuse) - 0.83; Factor 2 (Easy Access) - 0.826 and Factor 3 (Health Concerns) - 0.691. The scale was adequate and easy to use to assess young people's attitudes about EOC, which is fundamental to the perception of young people's predisposition to their use, which may prove to be harmful to the adoption of protective behaviors within the scope of the experience of their sexuality.

Psychometric properties of the European Portuguese version of the Perceived Risk of HIV Scale in the general population and HIV-uninfected partners from sero-different couples

BackgroundPerceived risk of HIV plays an important role in the adoption of protective behaviours and HIV testing. However, few studies have used multiple-item measures to assess this construct. The Perceived Risk of HIV Scale (PRHS) is an 8-item measure that assesses how people think and feel about their risk of HIV infection. This cross-sectional study aimed to assess the psychometric properties (reliability and validity) of the European Portuguese version of the PRHS, including the ability of this scale to discriminate between individuals from the general population and HIV-uninfected partners from sero-different couples on their perceived risk of HIV infection (known-groups validity).MethodsThis study included 917 individuals from the general population (sample 1) to assess the psychometric properties of the PRHS. To assess the known-groups validity, the sample comprised 445 participants from the general population who were in an intimate relationship (sub-set of sample 1) and 42 HIV-uninfected partners from sero-different couples (sample 2). All participants filled out a set of questionnaires, which included a self-reported questionnaire on sociodemographic information, sexual behaviours, HIV testing and the PRHS. Sample 1 also completed the HIV Knowledge Questionnaire – 18-item version.ResultsThe original unidimensional structure was reproduced both in exploratory and confirmatory factor analyses, and the PRHS demonstrated good reliability (α = .78; composite reliability = .82). The differential item functioning analyses indicated that the items of the PRHS, in general, did not function differently for men and women or according to HIV testing. Significant associations with sexual risk behaviours and HIV testing provided evidence for criterion validity. The known-groups validity was supported.ConclusionsThe PRHS is a suitable scale in the evaluation of the perceived risk of HIV, and its psychometric characteristics validate its use in the Portuguese population. Furthermore, the present study suggests that interventions improving individuals’ HIV risk perceptions may be important since they were associated with different sexual behaviours and the likelihood of HIV testing.

Views and Experiences of Travelers from US States to Zika-Affected Areas.

Travelers to areas with Zika virus transmission are at risk of infection and of transmitting the virus after returning home. While protective behaviors during and after travel can reduce these risks, information about traveler practices or underlying views is limited. We examined these issues using data from the first representative poll of travelers from US states to Zika-affected areas, including US territories and Miami, Florida, conducted December 1 to 23, 2016. We analyzed results among all travelers (n = 1,285) and 2 subgroups at risk for pregnancy-related complications: (1) travelers in households where someone was pregnant or considering pregnancy (n = 72), and (2) other travelers of reproductive age (n = 631). We also examined results among those with different levels of awareness and knowledge about Zika virus. Results show that in households where someone was pregnant or considering pregnancy, awareness of Zika in the destination, concern about infection, and adoption of protective behaviors was relatively high. That said, sizable shares of travelers as a whole did not know information about asymptomatic and sexual transmission or post-travel behaviors. Further, concern about getting infected during travel was low among travelers as a whole, including other travelers of reproductive age. Few travelers consistently adopted protective behaviors during or after travel. Even among travelers who were aware of Zika in their destination and knew how to protect themselves, adoption of protective behaviors was only slightly higher. Findings from this poll suggest communications may be more effective if tailored to different levels of true and perceived risk. To address gaps in knowledge about transmission and post-travel protective behaviors, messaging should include facts and acknowledge the complexities of novel information and social context. Consideration should also be given to emphasizing other benefits of Zika protective behaviors or prioritizing behaviors that are most feasible.

Comparing the adoption of protective behaviors: The framing effects of national culture and hazard onset type

ABSTRACTOn the basis of framing effect and protective action decision model, this study examines the differences in people's response to diverse hazard onset types (sudden or gradual) under different cultural frameworks (China and the United States) and the framing effects of culture and hazard onset type on people's perception and behavioral response. The data are derived from three questionnaire surveys on people's behavioral response to H7N9 and smog emergency in China and H1N1 in the United States. Results indicate that people with different cultures and diverse contexts of hazard onset type present substantial differences in risk perception, protective action perception, stakeholder perception, and behavioral expectations. Furthermore, culture and hazard onset type exert significant framing effects on people's three types of perception, reliance on official information sources, and intention to adopt protective actions. This research empirically verifies the existence of framing effect in culture and decision scenarios, thereby helping in developing different emergency communication strategies.

Compliance with recommended protective actions during an H7N9 emergency: a risk perception perspective

This study investigates the factors determining an individual's response to official recommended protective measures, based on the Health Belief Model and the Protective Action Decision Model, to understand the adoption of protective behaviour during an H7N9 (Avian Influenza A) emergency. A public survey involving 1,375 respondents was conducted in Anhui Province, China, during the 2013 H7N9 outbreak to test the research model and hypotheses. The results indicate that protective, stakeholder, and risk perceptions influence positively an individual's willingness to take recommended actions. Protective and stakeholder perceptions also have a positive bearing on lay people's risk perceptions. A stakeholder perception is a vital determinant of a protective perception. More importantly, the effects of protective and stakeholder perceptions on behavioural responses to recommendations are mediated in part by risk perception. These findings can help public health officials to develop messages to encourage members of the population to protect themselves effectively during an influenza crisis.

Avian influenza A/H7N9 risk perception, information trust and adoption of protective behaviours among poultry farmers in Jiangsu Province, China

BackgroundPoultry farmers are at high-risk from avian influenza A/H7N9 infection due to sustained occupational exposures to live poultry. This study examined factors associated with poultry farmers’ adoption of personal protective behaviours (PPBs) based on Protection Motivation Theory (PMT).MethodsTotally, 297 poultry farmers in three cities of Jiangsu Province, China were interviewed during November 2013-January 2014. Data on PMT constructs, perceived trustworthiness of A/H7N9 information from mass media (formal sources), friends and family (informal sources), intention to adopt and actual adoption of PPBs and respondents’ demographics were collected. Structural equation modeling (SEM) identified associations between demographic factors and PMT constructs associated with A/H7N9-oriented PPB intention. Moderated mediation analysis examined how demographics moderated the effects of information trust on PPB intention via risk perceptions of A/H7N9.ResultsRespondents generally perceived low vulnerability to A/H7N9 infection. The SEM found that male respondents perceived lower severity of (β = −0.23), and lower vulnerability to (β = -0.15) A/H7N9 infection; age was positively associated with both perceived personal vulnerability to (β = 0.21) and perceived self-efficacy (β = 0.24) in controlling A/H7N9; education was positively associated with perceived response efficacy (β = 0.40). Furthermore, perceived vulnerability (β = 0.16), perceived self-efficacy (β = 0.21) and response efficacy (β = 0.67) were positively associated with intention to adopt PPBs against A/H7N9. More trust in informal information (TII) was only significantly associated with greater PPB intention through its positive association with perceived response efficacy. Age significantly moderated the associations of TII with perceived Self-efficacy and perceived response efficacy, with younger farmers who had greater TII perceiving lower self-efficacy but higher response efficacy.ConclusionPoultry farmers perceive A/H7N9 as a personally-irrelevant risk. Interventions designed to enhance perceived response efficacy, particularly among lower educated respondents may effectively motivate adoption of PPBs. Informal information may be an important resource for enhancing response efficacy.