COVID-19 Protective Behaviors Research Articles

Using the "Media as Mediator" Approach to Understand the Influence of Communication Channel Trust on COVID-19 Protective Behaviors: England, January 2022.

In a secondary analysis, we examine how trust in pro-recommendation versus alternative communication channels mediated effects of demographic, personality, lifestyle, and political variables on COVID-19 protective behavior in England. In so doing, we adapt the media-as-mediator approach to the pandemic context. Respondents reported that family, close friends, primary care medical providers, and mainstream news media were relatively supportive of public health recommendations, and social media friend networks, faith/community groups, alternative news sites, and alternative health practitioners were relatively unsupportive. Parallel mediation analyses showed that effects of age, dutiful civic-mindedness, sensation-seeking, healthy lifestyle orientation, and more marginally, race on COVID-19 protective behavior were mediated by trust in these pro-recommendation and/or alternative communication channels. In some cases, trust in exemplars of both types of channels resulted in these channels influences largely canceling one another out.

Life after Lockdown: An Exploratory Qualitative Study of Behaviors and Impacts of Avoiding COVID-19 in Individuals at High Risk of Severe COVID-19 and Their Caregivers

This exploratory qualitative study involved semi-structured interviews with adults and caregivers of adults at high risk of severe COVID-19, addressing current COVID-19 avoidance and protective behaviors and how these behaviors impacted their lives. Results were interpreted in a separate think tank session. Insights were developed into a conceptual model of COVID-19 avoidance and protective behaviors and the associated impacts on health-related quality of life and overall functioning. Data were interpreted using a hybrid inductive and deductive thematic analysis. Twelve high-risk individuals and two caregivers were interviewed across four focus groups (April–July 2022). Major behavioral themes included physical distancing, physical and medical protection, quality of support services and networks, and information to make decisions. Major impacts included family, social, and emotional functioning; work and finances; and healthcare access. The final conceptual model comprised 13 behaviors to avoid COVID-19 categorized within four themes, and 13 impacts within five themes. Individuals at high risk of severe COVID-19 and their caregivers continue practicing COVID-19 avoidance behaviors post-lockdown and feel left behind by the general population. Our conceptual model may be used to inform health authorities and other governing bodies’ decisions in executing strategies aimed at improving these individuals’ lives.

Social Vulnerability and Compliance With World Health Organization Advice on Protective Behaviors Against COVID-19 in African and Asia Pacific Countries: Factor Analysis to Develop a Social Vulnerability Index.

COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups. We developed a social vulnerability index (SVI) to predict individuals' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022. In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index. In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions. In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups.

Survey of public knowledge, attitudes, and practices regarding personal protection against COVID-19 in the post-pandemic era.

In the emerging post-pandemic era (the 'wavelet' era), humans must coexist with viruses for the foreseeable future, and personal protective behaviors will largely replace national-level preventive measures. In this new normal, encouraging the public to implement proper personal protective behaviors against the coronavirus disease (COVID-19) is vital to the sustainable development of cities and communities. This knowledge-attitude-practice (KAP) survey conducted in Chengdu (N = 900) narrowed the knowledge gap regarding post-pandemic public practices of protective behavior. Findings show that:(1) approximately 1/3 of the respondents are currently not concerned about COVID-19 at all; (2) respondents with different demographics and individual COVID-19-related factors showed significant differences in practice behaviors indoors and outdoors; (3) vulnerable groups performed better in practice behavior indoors/outdoors; (4) because the public may relax their vigilance outdoors, public places may become a transmission threat in the next outbreak; (5) attitudes are important, but limited incentives for practice; and (6) when knowledge increases beyond a threshold (68.75-75% in this study), protective behaviors decrease. Our results suggest that authorities must continue to educate and motivate the public, extending measures to cover personal protective practices, and have targeted policies for specific demographics to ensure equity in healthcare in the event of another pandemic (COVID-19 and alike crisis). Besides, comparing the results of the current study with similar studies conducted in other parts of the world can provide insights into how different populations respond to and adopt COVID-19 protective behaviors. The epidemiologists can use the data collected by this and other KAP surveys to refine epidemiologic models, which can help predict the spread of the virus and the impact of interventions in different settings.

Participation in Critical Dialogues With Illustrative Images Increases Knowledge About COVID-19 Prevention: A Mixed Methods Longitudinal Approach

This intervention study uses community-based participatory research (CBPR) and longitudinal design to examine changes in COVID-19 prevention knowledge over time (3 time points) among racially minoritized participants ( n = 38). The intervention comprised critical dialogues alongside an illustration used to engage participants in conversations about socioeconomic conditions affecting acquisition of COVID-19 knowledge. Quantitative data showed that COVID-19 prevention knowledge was higher for participants who completed the intervention. Qualitative data were used to illustrate the context under which participants experienced COVID-19 pandemic, how they received COVID-19 prevention information, and how they engaged in decision-making around COVID-19 protective behaviors. Contributions to mixed method research: The combination of CBPR, repeated measures, and critical dialogues (with and art form) in intervention research.

Effectiveness of an eHealth intervention for reducing psychological distress and increasing COVID-19 knowledge and protective behaviors among racialized sexual and gender minority adults: A quasi-experimental study (#SafeHandsSafeHearts).

Sexual and gender minority and racialized populations experienced heightened vulnerability during the Covid-19 pandemic. Marginalization due to structural homophobia, transphobia and racism, and resulting adverse social determinants of health that contribute to health disparities among these populations, were exacerbated by the Covid-19 pandemic and public health measures to control it. We developed and tested a tailored online intervention (#SafeHandsSafeHearts) to support racialized lesbian, gay, bisexual, transgender, queer, and other persons outside of heteronormative and cisgender identities (LGBTQ+) in Toronto, Canada during the pandemic. We used a quasi-experimental pre-test post-test design to evaluate the effectiveness of a 3-session, peer-delivered eHealth intervention in reducing psychological distress and increasing Covid-19 knowledge and protective behaviors. Individuals ≥18-years-old, resident in Toronto, and self-identified as sexual or gender minority were recruited online. Depressive and anxiety symptoms, and Covid-19 knowledge and protective behaviors were assessed at baseline, 2-weeks postintervention, and 2-months follow-up. We used generalized estimating equations and zero-truncated Poisson models to evaluate the effectiveness of the intervention on the four primary outcomes. From March to November 2021, 202 participants (median age, 27 years [Interquartile range: 23-32]) were enrolled in #SafeHandsSafeHearts. Over half (54.5%, n = 110) identified as cisgender lesbian or bisexual women or women who have sex with women, 26.2% (n = 53) cisgender gay or bisexual men or men who have sex with men, and 19.3% (n = 39) transgender or nonbinary individuals. The majority (75.7%, n = 143) were Black and other racialized individuals. The intervention led to statistically significant reductions in the prevalence of clinically significant depressive (25.4% reduction, p < .01) and anxiety symptoms (16.6% reduction, p < .05), and increases in Covid-19 protective behaviors (4.9% increase, p < .05), from baseline to postintervention. We demonstrated the effectiveness of a brief, peer-delivered eHealth intervention for racialized LGBTQ+ communities in reducing psychological distress and increasing protective behaviors amid the Covid-19 pandemic. Implementation through community-based organizations by trained peer counselors supports feasibility, acceptability, and the importance of engaging racialized LGBTQ+ communities in pandemic response preparedness. This trial is registered with ClinicalTrials.gov, number NCT04870723.

Assessing community-level impacts of and responses to stay at home orders: The King County COVID-19 community study.

At the beginning of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) of unprecedented scope and duration were implemented to limit community spread of COVID-19. There remains limited evidence about how these measures impacted the lived experience of affected communities. This study captured the early impacts and coping strategies implemented in King County, Washington, one of the first U.S. communities impacted by COVID-19. We conducted a cross-sectional web-based survey of 793 English- and Spanish-speaking adult King County residents from March 18, 2020 -May 30, 2020, using voluntary response sampling. The survey included close- and open-ended questions on participant demographics, wellbeing, protective actions, and COVID-19-related concerns, including a freeform narrative response to describe the pandemic's individual-, family- and community-level impacts and associated coping strategies. Descriptive statistics were used to analyze close-ended questions, and qualitative content analysis methods were used to analyze free-form narrative responses. The median age of participants was 45 years old, and 74% were female, 82% were White, and 6% were Hispanic/Latinx; 474 (60%) provided a qualitative narrative. Quantitative findings demonstrated that higher percentages of participants engaged in most types of COVID-19 protective behaviors after the stay-at-home order was implemented and schools and community spaces were closed, relative to before, and that participants tended to report greater concern about the pandemic's physical health or healthcare access impacts than the financial or social impacts. Qualitative data analysis described employment or financial impacts (56%) and vitality coping strategies (65%), intended to support health or positive functioning. This study documented early impacts of the COVID-19 pandemic and the NPIs implemented in response, as well as strategies employed to cope with those impacts, which can inform early-stage policy formation and intervention strategies to mitigate the negative impacts. Future research should explore the endurance and evolution of the early impacts and coping strategies throughout the multiyear pandemic.

Changes in Capacity Building and Sustained Implementation Among a Statewide Coalition to Address Racial/Ethnic COVID-19 Disparities.

This article describes Arkansas Community Engagement Alliance Against COVID-19 Disparities (CEAL) Coalition initiatives and changes in measures of organizational capacity and sustainability via two waves of surveys. The Arkansas CEAL Coalition used several initiatives to address racial/ethnic COVID-19 disparities by building the capacity of community-based organizations and businesses to increase COVID-19 protective behaviors among their clients. Our study can inform future strategies that use a community-engaged coalition structure to reduce disparities among communities that suffer disproportionately from COVID-19. (Am J Public Health. (Am J Public Health. 2024;114(S1):S59-S64. https://doi.org/10.2105/AJPH.2023.307470).

General health literacy, COVID-19-related health literacy, and protective behaviors: evidence from a population-based study in Japan.

Health literacy (HL) can be regarded as a key element of non-pharmaceutical interventions used in emergency responses. The present study aimed to determine the associations of combinations of general HL and COVID-19-related HL with COVID-19 protective behaviors and healthy lifestyle behaviors. A questionnaire survey was conducted from December 2020 to January 2021 among residents in Japanese metropolitan areas. Valid responses were received from 1,443 residents. The levels of HL were categorized into four groups: low level in both HLs (reference), high level in general HL only, high level in COVID-19-related HL only, and high level in both HLs. The total scores of eight COVID-19 protective behaviors were dichotomized into low and high adherence. Healthy lifestyle behaviors included healthy and balanced diet, adequate sleep, and regular exercise. Poisson regression analyses were conducted to examine the associations between the HL groups and high adherence to COVID-19 protective behaviors. High level in COVID-19-related HL only was associated with high adherence to COVID-19 protective behaviors [prevalence ratio (PR), 1.25; 95% confidence interval (CI), 1.09-1.45], while high level in general HL only was associated with healthy and balanced diet (PR, 1.49; 95% CI, 1.04-2.13), adequate sleep (PR, 1.46; 95% CI, 1.02-2.10), and regular exercise (PR, 2.00; 95% CI, 1.29-3.13). High level in both HLs showed the highest prevalence of high adherence to COVID-19 protective behaviors and healthy lifestyle behaviors. These findings indicate that COVID-19-related HL and general HL can both be considered to enhance protective behaviors.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic

The COVID-19 pandemic profoundly affected physical, mental, and economic well-being across the globe and has disproportionately affected certain vulnerable groups. This paper provides a scoping review of literature on the impact of the COVID-19 pandemic on sex workers, published between December 2019 and December 2022. Six databases were systematically searched, identifying 1009 citations; 63 studies were included in the review. Thematic analysis revealed eight main themes: financial issues; exposure to harm; alternate ways of working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, mental health, and coping; access to support; access to health care; and the impact of COVID-19 on research with sex workers. COVID-associated restrictions led to reduced work and income, leaving many sex workers struggling to cover basic needs; additionally, government protections excluded those working in the informal economy. Fearing the loss of their already reduced number of clients, many felt compelled to compromise both prices and protective measures. Although some engaged in online sex work, this raised concerns about visibility and was impossible for those without technological access or skills. Many feared COVID-19, but felt pressure to continue working, often with clients who refused to wear masks or share exposure history. Other negative impacts on well-being related to the pandemic included reduced access to financial support or health care. Marginalized populations (and especially those in professions which require close contact like sex workers) need further support and capacity-building within the community to recover from the impact of COVID-19.

Study of COVID-19 Protective Behaviors Based on the Precaution Adoption Process Model PAPM in Women (Marivan, Iran)

Background &amp; Aims: people’s responsibility for protection behaviors against COVID-19 has a vital role in stopping chaining of transmission and, Adherence to preventive measures can be affected by psychosocial factors. The aim of this study was to investigate the survey of corona protection behaviors based on the precaution adoption process model (PAPM) in women referred to Marivan health centers in 2021, Iran. Materials and Methods: This descriptive (cross-sectional) study, were carried out between 380 women referring to health centers in Marivan in 2021. The samples were selected by the random cluster sampling method. The research tool was a researcher-made questionnaire consisting of two parts of demographic information and the construct of PAPM. Results: Results showed that people in the fifth and sixth stages of the model obtained higher scores in the model construct and the second and fourth stages of the model received the lowest scores. Conclusion: Uniform education for the general public may not have the expected results for protective behaviors and prevention of diseases, so education should be based on step-by-step models of health education and variables affecting individual decisions.

When do people increase COVID-19 protective behaviors? A longitudinal analysis of the impact of infections among close contacts and in the community

Studies examining individual-level changes in protective behaviors over time in association with community-level infection and self or close-contact infection with SARS-CoV-2 are limited. We analyzed overall and demographic specific week-to-week changes in COVID-19 protective behaviors and their association with COVID-19 infections (regional case counts and self or close contacts). Data were collected through 37 consecutive weekly surveys from 10/17/2021 – 6/26/2022. Our survey panel included 212 individuals living or working in St. Louis City and County, Missouri, U.S.A. Frequency of mask-wearing, handwashing, physical distancing, and avoiding large gatherings was self-reported (more/the same/less than the prior week). Close contact with COVID-19 was reported if the panel member, their household member, or their close contact tested positive, got sick, or was hospitalized for COVID-19 in the prior week. Regional weekly COVID-19 case counts were matched to the closest survey administration date. We used generalized linear mixed models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations. Evidence for effect modification was assessed using the likelihood ratio test. Increased protective behaviors were positively associated with COVID-19 case counts (ORhighest vs. lowest case count category = 4.39, 95% CI 3.35–5.74) and with participant-reported self or close contacts with COVID-19 (OR = 5.10, 95% CI 3.88–6.70). Stronger associations were found for White vs. Black panel members (p <.0001). Individuals modulated their protective behaviors in association with regional COVID-19 case counts and self or close contact infection. Rapid reporting and widespread public awareness of infectious disease rates may help reduce transmission during a pandemic by increasing protective behaviors.

Cross-temporal relations of conditional risk perception measures with protective actions against COVID-19

Two decades ago a research team clarified that cross-sectional associations of risk perceptions and protective behavior can only test an “accuracy” hypothesis: e.g., people with higher risk perceptions at Ti should also exhibit low protective behavior and/or high risky behavior at Ti. They argued that these associations are too often interpreted wrongly as testing two other hypotheses, only testable longitudinally: the “behavioral motivation” hypothesis, that high risk perception at Ti increases protective behavior at Ti+1, and the “risk reappraisal” hypothesis, that protective behavior at Ti reduces risk perception at Ti+1. Further, this team argued that risk perception measures should be conditional (e.g., personal risk perception if one's behavior does not change). Yet these theses have garnered relatively little empirical testing. An online longitudinal panel study of U.S. residents' COVID-19 views across six survey waves over 14 months in 2020–2021 tested these hypotheses for six behaviors (hand washing, mask wearing, avoiding travel to infected areas, avoiding large public gatherings, vaccination, and [for five waves] social isolation at home). Accuracy and behavioral motivation hypotheses were supported for both behaviors and intentions, excluding a few waves (particularly in February–April 2020, when the pandemic was new in the U.S.) and behaviors. The risk reappraisal hypothesis was contradicted—protective behavior at one wave increased risk perception later—perhaps reflecting continuing uncertainty about efficacy of COVID-19 protective behaviors and/or that dynamic infectious diseases may yield different patterns than chronic diseases dominating such hypothesis-testing. These findings raise intriguing questions for both perception-behavior theory and behavior change practice.

Persuasive Messages for Improving Adherence to COVID-19 Prevention Behaviors: Randomized Online Experiment.

Adherence to nonpharmaceutical interventions for COVID-19, including physical distancing, masking, staying home while sick, and avoiding crowded indoor spaces, remains critical for limiting the spread of COVID-19. The aim of this study was to test the effectiveness of using various persuasive appeals (deontological moral frame, empathy, identifiable victim, goal proximity, and reciprocity) at improving intentions to adhere to prevention behaviors. A randomized online experiment using a representative sample of adult Canadian residents with respect to age, ethnicity, and province of residence was performed from March 3 to March 6, 2021. Participants indicated their intentions to follow public health guidelines, saw one of six flyers featuring a persuasive appeal or no appeal, and then rated their intentions a second time. Known correlates of attitudes toward public health measures were also measured. Intentions to adhere to public health measures increased in all appeal conditions. The message featuring an empathy appeal resulted in a greater increase in intentions than the control (no appeal) message. Moreover, the effectiveness of persuasive appeals was moderated by baseline intentions. Deontological, empathy, identifiable victim, and reciprocity appeals improved intentions more than the control message, but only for people with lower baseline intentions to adhere to nonpharmaceutical interventions. Public health marketing campaigns aiming to increase adherence to COVID-19 protective behaviors could achieve modest gains by employing a range of persuasive appeals. However, to maximize impact, it is important that these campaigns be targeted to the right individuals. ClinicalTrials.gov NCT05722106; https://clinicaltrials.gov/ct2/show/NCT05722106.

Political views, health literacy, and COVID-19 beliefs and behaviors: A moderated mediation model

RationaleMitigating the spread of COVID-19 requires that people understand the need for and engage in protective behaviors. Given the complexity and rapid progression of media information about the pandemic, health literacy could be essential to acquiring the accurate beliefs, concern for societal risks, and appreciation of restrictive policies needed to motivate these behaviors. Yet with the increasingly politicized nature of COVID-related issues in the United States, health literacy could be an asset for those with more liberal views but less so for those with more conservative views. ObjectiveThis study tested a hypothesized model proposing that political views moderate the associations of health literacy with COVID-19 protective behaviors as well as the mediational roles of accurate and inaccurate COVID-19 beliefs, concern for society, and governmental control attitudes. MethodsWe surveyed residents in three diverse regions of California in June 2020 (N = 669) and February 2021 (N = 611). Participants completed measures of health literacy, political views, and COVID-19 beliefs and behaviors. ResultsModerated mediational analyses largely supported the proposed model with both samples. Health literacy was associated with more accurate COVID-19 beliefs, less inaccurate COVID-19 beliefs, greater concern for societal risks, more positive attitudes regarding restrictive government control, more protective behavior, less risky behavior, and stronger vaccine intentions; beliefs, concern for society, and governmental control attitudes mediated the health literacy-behavior relationships. As predicted, however, these associations of health literacy with adaptive beliefs, attitudes, and behaviors varied according to political views. The direct and mediated relationships were held for participants with more liberal views and, to a lesser extent, for those with moderate views, but they were weaker or absent for participants with more conservative views. ConclusionsThese findings contribute new evidence of processes linking health literacy with adaptive beliefs, attitudes, and behaviors and how social and political contexts can shape those processes.

Stigma, Post-traumatic Stress, and COVID-19 Vaccination Intent in Mongolia, India, and the United States.

Background: Stigma and discrimination during the coronavirus (COVID-19) pandemic have increased precipitously worldwide. This multinational study examines how stigma, blaming groups for virus spread, concern regarding contracting the virus, resource loss, life satisfaction, and protective behaviors that help control the spread of COVID-19 are associated with post-traumatic stress and vaccine intent in Mongolia, India, and the United States. Method: 1429 people in Mongolia, India, and the United States completed measures assessing stigma during the COVID-19 pandemic, post-traumatic stress, blame, protective behaviors, and vaccine intent. Results: Mean post-traumatic stress scores in all three countries exceeded the cut-off that is commonly used to determine probable post-traumatic stress. Post-traumatic stress was associated with COVID-19 stigma experience, personal behavior change due to COVID-19 stigma, blaming groups for the spread of COVID-19, fear of COVID-19, and resource loss. In India and the United States, personal behavior change due to COVID-19 stigma, anger at individuals spreading COVID-19, and perceived susceptibility to illness were positively associated with vaccine intent. Conclusions: Stigma is a collateral stressor during the pandemic. The findings underscore the importance of prompt action to address stigma as a deleterious consequence of the pandemic. The findings illuminate potential barriers to receiving the vaccine and provide direction for future research to address barriers.

Data, discourse, and development: Building a sustainable world through education and science communication

Dramatic expansion of distance learning during COVID-19 widened the digital divide and highlighted the importance of students' digital and data literacy skills. Simultaneously, science was playing out in front of the public as information and communication about the importance of COVID-19 protective behaviors and vaccines evolved. Yet within the global discourse, misinformation was rampant. The public questioned the validity of COVID-19 data. They did not know who or what to trust. Their concerns about the impacts of COVID-19 protective behaviors and the need for vaccinations rose. Some science educators were asked to avoid discussing the topic with their students. All of this is emblematic of an even larger problem—the inability of many people to understand and use data to make informed decisions to develop their communities. This article will use one example from the Smithsonian Science for Global Goals project: Vaccines! How can we use science to help our community make decisions about vaccines?, which invites students ages 8–17 to use data to change discourse and develop their own communities using inspiration from the United Nations Sustainable Development Goals (SDGs). This project encourages students to: (1) use investigations to gather and analyze data from their communities as they build data literacy skills (data); (2) communicate this information to others as a way of catalyzing and changing community conversations to make informed decisions (discourse); and (3) become active partners in creating more sustainable and equitable communities (development). These competencies of data, discourse, and development—integrated into science, technology, engineering, and math education for sustainable development (STEM4SD)—are aligned with a “data for learning” conversation that emerged during the pandemic. To expand students' data skills, educators must be grounded in a framework that holistically considers ethics, community impact, and science. Data must be contextualized to the problems that students face locally. Students must be given the tools to communicate scientific understanding to others in service of sustainable development. As such, an SDG-aligned approach to data for learning that promotes discourse drives learners to act to protect themselves, our societies, and our planet, while educating students on the underlying science and social science of sustainable development.

Should we take care of each other? Enhancing COVID-19 protective behaviors, a study in Chile, Mexico, and Colombia

The literature has suggested that social norms and perceptions of risk and severity are critical variables in predicting protective health behaviors. Using an integrative conceptual framework, this study evaluates educational level, socioeconomic status, injunctive pro-care norms, perception of risk, and severity of COVID-19 as predictors of hygiene behaviors, mask use, and physical distancing. Participants included 2,075 adults from Chile, Mexico, and Colombia, three countries with the worst pandemic management. A structural equation model including the hypothesized structure of relations among the study variables fitted the data well and was invariant among Chilean, Mexican, and Colombian data. As proposed, injunctive pro-care norms against COVID-19 predicted protective health behaviors directly and indirectly through the perception of the risk and severity of COVID-19, and educational level predicted pro-care norms against COVID-19. These findings are essential in light of the development of prevention campaigns and the promotion of COVID-19 care strategies.

The association between social factors and COVID-19 protective behaviors and depression and stress among midwestern US college students.

The aim of this cross-sectional study was to examine the relationship between social factors and COVID-19 protective behaviors and two outcomes: depressive and perceived stress symptoms. In September 2020, 1,064 randomly selected undergraduate students from a large midwestern university completed an online survey and provided information on demographics, social activities, COVID-19 protective behaviors (i.e., avoiding social events and staying home from work and school), and mental health symptoms. Mental health symptoms were measured using the Center for Epidemiological Studies Depression-10 questionnaire for depression and the Perceived Stress Scale-10 for stress symptoms. The results showed respondents who were males and also the respondents who were "hanging out" with more people while drinking alcohol reported significantly lower depressive symptoms and lower stress symptoms. On the contrary, staying home from work or school "very often" was associated with higher stress symptoms, compared with "never/rarely" staying home from work/school. Similarly, having a job with in-person interaction was also associated with increased stress. These findings suggest that lack of social engagement was associated with depression and stress symptoms among college students during the COVID-19 pandemic. Planning social activities that align with recommended safety precautions, as well as meet students' social needs, should be an important priority for higher education institutions.

COVID-19 Protective Behaviors of Iranian Healthcare Workers: A Psychological Theoretical Design Analysis

Background: This study aimed to investigate COVID-19 protective behaviors of Iranian healthcare workers (HCWs) using an extended parallel process model (EPPM). Methods: This cross-sectional study was conducted online on a convenience sample of 418 Iranian HCWs in 2020. Data were gathered using a standardized electronic questionnaire published on the Porsline website, designed based on the EPPM, to assess the relationships between different constructs of EPPM and COVID-19 protective behaviors. For data analysis, statistical tests, such as descriptive tests, independent t-test, ANOVA, Pearson's correlation test, and multiple regression analysis, were performed in SPSS version 18. Results: Most participants (40.4%) were in the age group of 30-40 years, and most were female (70.6%). Significant associations were found between COVID-19 protective behaviors and EPPM constructs of perceived self-efficacy (r = 0.373, P = 0.000), perceived response efficacy (r = 0.120, P = 0.014), and intention (r = 0.462, P = 0.000). Perceived self-efficacy (P = 0.000, beta = 0.398) and behavioral intention (P = 0.000; Beta = 0.283) were predictors of protective behaviors. Also, 34.4% of the HCWs were involved in the danger control process. Conclusions: Only one-third of the HCWs contributed to the process of COVID-19 danger control. The HCWs' motivation for protection against COVID-19 depended on their perception of self-efficacy and their perceived efficacy of COVID-19 preventive behaviors. The present results can be used to design and implement training programs to improve the protective behaviors of HCWs.