The relationship between government trust and preventive behaviors during the COVID-19 pandemic in China: Exploring the roles of knowledge and negative emotion

Trust in governments, public health institutions, and other information sources as determinants of COVID-19 vaccine uptake behavior in Japan

OBJECTIVES

Trust in governments and public institutions as a determinant of public health outcomes has gained increased attention since the COVID-19 pandemic. Provided historically low confidence in vaccines in Japan, investigating the role of trust in information sources and actual COVID-19 vaccination uptake behavior will be invaluable for future vaccine promotion policymaking. Therefore, the objective of this study was to elucidate the determinants of COVID-19 vaccination uptake and evaluate the relationship between trust in different information sources and COVID-19 vaccination behavior in Japan.

METHODS

For this study, we leveraged a longitudinal series of web-based surveys of 19,174 individuals in Japan conducted between 2021 and 2022 which asked questions regarding a wide range of sociodemographic and psychographic characteristics related to the COVID-19 pandemic. Determinant analysis for vaccination (at least one dose of a COVID-19 vaccine) was conducted via multiple logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were estimated.

RESULTS

After adjustment for sociodemographic determinants of vaccine uptake, aggregate trust in the systems and institutions of vaccine approval (OR: 1.42, 95% CI: 1.30-1.56), and trust in information about the COVID-19 pandemic coming from government sources (OR: 1.27, 95% CI: 1.12-1.44) were found to be consistently powerful predictors of COVID-19 vaccination. Trust in media sources including traditional media (OR: 1.21, 95% CI: 1.07-1.36), and the internet (OR: 0.77, 95% CI: 0.66-0.89) had significant and opposing effects.

CONCLUSIONS

Our findings support the broader hypothesis that trust in governments and public health institutions remains a powerful determinant for COVID-19 vaccine uptake in Japan. We also found that vaccination decision-making is a multifactorial process that includes the synthesis of trust in public institutions and media, and its interaction with psychosocial determinants such as prosociality and health literacy. We hope to apply this study's findings towards future vaccine programs for contagious diseases.

Protective behaviors against COVID-19 and their association with psychological factors in China and South Korea during the Omicron wave: a comparative study

OBJECTIVES

We aimed to explore the level of protective behaviors against COVID-19 and its association with psychological factors in China and South Korea during the Omicron wave.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a population-based cross-sectional survey from March 15 to 30, 2023 in China and South Korea. Demographic characteristics, health status, protective behaviors, and psychological factors (including perceived risks, efficacy belief, attribution of disease, fear of COVID-19, trust and evaluation, fatalism, resilience, and pandemic fatigue) were investigated. After adjusting for sociodemographic and health-related factors, multivariable regression models were constructed to explore the psychological influencing factors of protective behavior.

RESULTS

A total of 3000 participants from China and 1000 participants from Korea were included in the final analysis. The mean performance score for protective behaviors among all respondents was 2.885 in China and 3.139 in Korea, with scores ranging from 1 to 4. In China, performance scores were higher in those who were female, aged 30-39, employed, married, living in urban areas, having the highest income level, having the best subjective health status, and having a history of chronic disease (P-value <0.05). In Korea, performance scores were higher for individuals who were female, over 50 years old, educated to high school or below, unemployed, married, had a history of chronic disease, and had never been infected with SARS-CoV-2 (P-value <0.05). In the multivariable regression model, perceived severity (β = 0.067), attribution of disease (β = 0.121), fear of COVID-19 (β = 0.128), trust and evaluation (β = 0.097), psychological resilience (β = 0.068), and efficacy belief (β = 0.216) were positively associated with the performance scores, pandemic fatigue (β = -0.089) was negatively associated with performance scores in China (P-value <0.05). However, in Korea, perceived susceptibility (β = 0.075), fear of COVID-19 (β = 0.107), and efficacy belief (β = 0.357) were positively associated with protective behaviors (P-value <0.05), trust and evaluation (β = -0.078) and pandemic fatigue (β = -0.063) were negatively associated with performance scores (P-value <0.05).

CONCLUSIONS

Populations in both China and Korea demonstrated great compliance with protective behaviors during the Omicron wave. Because of the sociocultural, economic, and political differences, there were differences in the association between psychological factors and protective behaviors in the two countries. This study, from the perspective of psychological factors in different cultural contexts, would provide references for increasing adherence to protective guidelines in future outbreaks of emerging infectious diseases.

The dark side of social capital: Geographic differences in COVID-19 preventive behaviors among older adults in South Korea

AIM

The present study examined whether geographic location (i.e., rural vs. urban areas) moderated the relationship between social capital and COVID-19 preventive behaviors among older adults in South Korea.

METHODS

Participants were a nationally representative sample of 61 075 Korean adults aged 65 years or older from the 2021 Community Health Survey by the Korea Disease Control and Prevention Agency. The moderation analysis was conducted with PROCESS.

RESULTS

After adjusting for covariates, the moderation analysis showed a significant moderation effect of geographic location on the relationship between social capital and COVID-19 preventive behaviors among older adults in South Korea. Specifically, in urban areas, older adults with higher social capital were more likely to adhere to COVID-19 preventive behaviors. However, social capital negatively impacted older adults' COVID-19 preventive behaviors in rural areas.

CONCLUSIONS

Findings suggest that social capital is not always helpful for maintaining COVID-19 preventive behaviors among older adults in South Korea. The social characteristics of geographic location need to be considered when initiating COVID-19 prevention campaigns in South Korea. Geriatr Gerontol Int 2024; 24: 377-384.

Predicting Public Cooperation with Face Covering at the Early Phases of COVID-19: Building Public Trust, Confidence, Knowledge Through Governmental Two-Way Symmetrical Communication

Despite the agreement on the importance of two-way communication during governmental response to pandemics, few studies provided empirical evidence to support the effectiveness of such communication strategy in times of a public health crisis. Integrating the concept of two-way symmetrical communication and the Trust, Confidence, and Cooperation model (the TCC model), this study investigates how strategic communication practices, in particular two-way symmetrical communication, is related to public's perceived trust and confidence in governments (i.e., CDC in this study), and how these perceptions may affect decisions to comply with the preventive behaviors (i.e., face covering in this study), while taking the moderating role of knowledge into consideration. An online survey was conducted with 502 participants who were living in the United States in early April 2020. The findings showed that two-way symmetrical communication may increase public trust and confidence in governments, and improve individuals' knowledge about the pandemic, which all subsequently leads to compliance with recommended behaviors. The results contribute to the theoretical understanding of pandemic communication and provide implications for practitioners in pandemic management, suggesting that health institutions should adopt two-way symmetrical communication practices in respond to public health emergencies.

Association of COVID-19 information media, providers, and content with vaccine uptake among Tokyo residents

To elucidate appropriate ways to induce behavior that prevents the spread of infection, we examined the association between COVID-19 vaccination and COVID-19-related information after more than 85% of the population had been vaccinated. Nonprobability quota sampling was used to recruit 2000 Tokyo residents as participants. The association between previous vaccine uptake and how much people thought they were affected by each of nine media, seven providers, and four content types of information was assessed using an online survey form. Subjective influence was assessed, and order logistic regression analyses were performed. We further calculated standardized partial regression coefficients for the independent variables. The results showed that while people did not think they were strongly affected by any COVID-19 information, significant positive associations between 9 of 20 variables, and significant negative associations between 7 of 20 variables were observed with vaccine uptake. The regression analysis involving the interaction terms between independent variables and sex showed a significant association between vaccine uptake and only daily conversation. Simple slope analysis showed a stronger positive association for females than for males. Regression analysis with interaction terms between each independent variable and age showed a significant association between vaccine uptake and print newspapers, social networking services, prefectural governors, family/relatives, accessibility, side effects, and supply visibility. Simple slope analysis also showed that the positive association between the subjective influence of newspapers and vaccine uptake was observed only for older people (≥69 years), and that of prefectural governors was more significant for older than younger people (≤32 years). In contrast, the trustworthy information provided by family/relatives was positively associated with vaccine uptake only for younger people. These results suggest that careful consideration must be given to the differences in age and sex to provide appropriate information that motivates Tokyo residents to receive vaccination during COVID-19 pandemic.

Practice of pharmaceutical services and prescription analysis in internet-based psychiatric hospitals during COVID-19 pandemic in Wuxi, China

Objective

To study the practice of pharmaceutical services in internet-based psychiatric hospitals, and to analyze the prescriptions to ensure the safety and efficacy of internet-based medication in Wuxi, China.

Methods

All 1,259 internet-based prescriptions from our hospital in 2022 were collected, and data on patients' age, gender, diagnosis, medications used, medication types, dosage forms, rationality of medication use, and reasons for irrationality were analyzed through descriptive statistics.

Results

In the electronic prescriptions of internet-based psychiatric hospitals, females accounted for the majority (64.50%), with a female-to-male ratio of 1.82:1. Middle-aged and young adults accounted for the majority of patients (57.50%). There were 47 diagnosed diseases involved, with 89 types of medications used and 1,938prescriptions issued. Among them, there were 78 types of western medicine with 1,876 prescriptions (96.80%), and 11 types of traditional Chinese medicine with 62 prescriptions (3.20%). The main medications used were anti-anxiety and antidepressant medications (44.94%) and psychiatric medications (42.21%). The dosage forms were all oral, with tablets (78.53%), capsules (17.54%), and solution preparations (2.17%) being the top three in frequency. According to the prescription review results, the initial pass rate of internet-based system review was 64.26%. After intervention by the internet-based system and manual review by pharmacist reviewers, the final pass rate of internet-based prescriptions reached 99.76%.

Conclusion

The practice of pharmaceutical services and prescription analysis in internet-based psychiatric hospitals could significantly improve medication rationality, which fills the research gap in this field. In addition, it promotes the transformation of pharmaceutical service models.

Association between trust in COVID-19 information sources and engaging in infection prevention behaviors in Japan: A longitudinal study

OBJECTIVE

We examined changes in people's trust in information sources in Japan during the COVID-19 pandemic over the course of 1 year and investigated longitudinal associations between trust in such sources and engaging in infection prevention behaviors.

METHODS

We conducted a longitudinal survey of Japanese populations under a declared state of emergency at two time points, August 2020 and August 2021. We surveyed sociodemographic data, seven Trust in COVID-19 information sources and six COVID-19 preventive behaviors.

RESULTS

In all, 784 participants completed the two surveys. Physicians were the most consistently trusted information source over the 1-year period. We identified three preventive behaviors that were positively associated with trust in physicians as an information source (social distancing, wearing masks, and washing hands with soap), four preventive behaviors that were positively associated with trusting infected patients (social distancing, using ventilation, wearing masks, and using hand sanitizer), and one preventative behavior that was negatively associated with trust in government (avoiding closed spaces).

CONCLUSION

In the ongoing pandemic, information from physicians and patients may encourage people to engage in long-term preventive behaviors.

PRACTICE IMPLICATIONS

Physicians and patients should be promoted as trusted and behavior influencing sources of information during the pandemic.

The association between depression and non-compliance with COVID-19 preventive behaviors in South Korean older adults stratified by sex

OBJECTIVES

This study evaluated the association between depression and non-compliance with COVID-19 preventive behaviors among community-dwelling South Korean older adults.

METHODS

We utilized the 2020 Korean Community Health Survey-a community-based nationwide survey. A score of 10 points or higher on the Patient Health Questionnaire-9 was defined as depression. Non-compliance with COVID-19 preventive behaviors was assessed on the following three behaviors: washing hands, wearing masks, and watching distance. We also included socio-demographic characteristics, health behaviors, and COVID-19-related characteristics as covariates. Multiple logistic regression analyses were performed, and all statistical analyses were stratified by sex.

RESULTS

The 70,693 participants included 29,736 men and 40,957 women. Notably, 2.3% of men and 4.2% of women had depression. Non-compliance with washing hands was significantly higher in men than women (1.3% vs. 0.9%), whereas no significant differences were observed in wearing masks and watching distance. The adjusted logistic regression analysis showed that depression was positively associated with non-compliance with washing hands and watching distance in both sexes. The association between depression and non-compliance with wearing masks was significant only in women.

CONCLUSIONS

There was an association between depression and non-compliance with COVID-19 preventive behaviors in South Korean older adults. This signifies that health providers need to reduce depression to improve compliance with preventive behaviors in older adults.

A text-mining study on emotional cognition, understanding, and preventative behaviors during the COVID-19 pandemic

BACKGROUND

This study aimed to look at emotions perceived about the attributes, prevention, diagnosis, and treatment of infectious diseases related to coronavirus disease (COVID-19) that were widespread across the world and identify their relevance to knowledge about infectious diseases and preventative behaviors.

METHODS

Texts to measure emotional cognition were selected through a pre-test, and 282 people were chosen as participants based on the survey conducted for 20 days from August 19 to August 29, 2020, created with Google Forms. IBM SPSS Statistics 25.0 was used for the primary analysis, and the SNA package in R (version 4.0.2) was utilized to conduct the network analysis.

RESULTS

It was found that universal negative emotions such as feeling "anxious" (65.5%), "afraid" (46.1%), and "scared" (32.7%) commonly appeared among most people. Also, they were found to be feeling both positive ("caring" [42.3%] and "strict" [28.2%]) and negative ("frustrating" [39.1%] and "isolated" [31.0%]) emotions about efforts to prevent and curb the spread of COVID-19. In terms of emotional cognition for the diagnosis and treatment of such diseases, "reliable" (43.3%) took the biggest ratio among the replies. The level of understanding about infectious diseases showed differences in emotional cognition, thereby affecting people's emotions. However, no differences were found in the practice of preventative behaviors.

CONCLUSIONS

Emotions associated with cognition in the context of pandemic infectious diseases have been found to be mixed. Furthermore, it can be seen that feelings vary depending on the degree of understanding of the infectious disease.

Does noncompliance with COVID-19 regulations impact the depressive symptoms of others?

Before vaccines became commonly available, compliance with nonpharmaceutical only preventive measures offered protection against COVID-19 infection. Compliance is therefore expected to have physical health implications for the individual and others. Moreover, in the context of the highly contagious coronavirus, perceived noncompliance can increase the subjective risk assessment of contracting the virus and, as a result, increase psychological distress. However, the implications of (public) noncompliance on the psychological health of others have not been sufficiently explored in the literature. Examining this is of utmost importance in light of the pandemic's elevated prevalence of depressive symptoms across countries. Using nationally representative data from South Africa, we explore the relationship between depressive symptoms and perceived noncompliance. We examine this relationship using a double machine learning approach while controlling for observable selection. Our result shows that the perception that neighbors are noncompliant is correlated with self-reported depressive symptoms. Therefore, in the context of a highly infectious virus, noncompliance has detrimental effects on the wellbeing of others.

Effects of Negative Attitudes towards Vaccination in General and Trust in Government on Uptake of a Booster Dose of COVID-19 Vaccine and the Moderating Role of Psychological Reactance: An Observational Prospective Cohort Study in Hong Kong

Uptake of a booster dose of COVID-19 vaccine is effective in preventing infection and severe consequences caused by COVID-19. The present study examined the effects of negative attitudes towards vaccination in general and trust in government on uptake of a COVID-19 booster dose, as well as the moderating role of psychological reactance to pro-vaccination messages in Hong Kong. An observational prospective cohort study using online survey was conducted among 264 adults. Findings showed that, after adjustment for significant background characteristics, negative attitudes towards vaccination in general negatively predicted uptake of a booster dose, and trust in government positively predicted uptake of a booster dose. In addition, the association between negative attitudes towards vaccination in general and uptake of a booster dose was weaker among those who reported a higher level of psychological reactance. The present study highlighted the importance of improving attitudes towards vaccination in general especially among those who are not experiencing psychological reactance, and building trust in government. This study also suggested that interventions aimed at improving attitudes towards vaccination in general should seek to avoid psychological reactance, and special attention should be given to people who are experiencing psychological reactance to pro-vaccination messages.

Health persuasion through emoji: How emoji interacted with information source to predict health behaviors in COVID-19 situation

By providing health information through visual communication, public health organizations can effectively guide and persuade people to adopt healthy behaviors, which is critical in the context of public health crises. In this study, drawing upon congruity theory and the premise of visual communication, we examined how information source and emoji may shape people's preventive and self-protective behaviors through perceived fear (PF) and perceived controllability (PC). Using a convenience sample of 210 participants, we conducted a 2 (emoji: with versus without) × 2 (information source: official versus unofficial) between-subject experiment. The results indicated that, compared with nonuse, the use of emoji in information resulted in higher PF, stronger preventive behavioral intention (PBI), and lower PC. In addition, a strong interaction effect was observed between emoji and the source of information on PBI. When emoji were added to health information released by an unofficial organization, the text outperformed that from an official agency in persuading people to adopt preventive behaviors. Furthermore, we determined that PF mediated the effect of emoji on PBI, but only for unofficial information sources. These results provide a reference for enhancing the effectiveness of health information including visual cues, such as emoji.

Associations between Vaccination Behavior and Trust in Information Sources Regarding COVID-19 Vaccines under Emergency Approval in Japan: A Cross-Sectional Study

We examined the association between COVID-19 vaccination behavior and trust in COVID-19-related information sources during the initial period of COVID-19 vaccination in Japan. A cross-sectional survey was conducted in August 2021, 5 months after the start of COVID-19 vaccination for the general public under emergency approval. Participants were recruited using non-probability quota sampling from among Japanese residents who were under a declared state of emergency. Sociodemographic data, vaccination behavior, and levels of trust in eight media sources of information and three interpersonal information sources were assessed using an online survey form. A total of 784 participants completed the survey. The results of multiple logistic regression analysis showed that age, household income, underlying medical conditions, and living with family were significantly associated with COVID-19 vaccination behavior. Regarding COVID-19 vaccine information sources, trust in public health experts as a source of media information and primary care physicians as a source of interpersonal information showed significantly positive associations with COVID-19 vaccination behavior (odds ratio [OR] = 1.157, 95% confidence interval [CI] 1.017-1.31; OR = 1.076; 95% CI 1.006-1.150, respectively). Increasing trust in public health experts and primary care physicians and disseminating vaccine information from these sources will help promote vaccination under emergency approval.

The impact of COVID-19 misinformation and trust in institutions on preventive behaviors

Misinformation related to coronavirus disease 2019 (COVID-19) has the potential to suppress preventive behaviors that mitigate the spread of COVID-19. Early research on the behavioral consequences of COVID-19 misinformation is mixed, and most rely on cross-sectional data. We examined whether believing in COVID-19 misinformation at one time point influences engaging in preventive behaviors later. In addition, we investigated the role of trust in institutions. We conducted a two-wave survey in South Korea and examined the association between belief in COVID-19 misinformation at Wave 1 and preventive behaviors at Wave 2 controlling for preventive behaviors at Wave 1. We also analyzed whether there is an interaction between belief in COVID-19 misinformation and trust in institutions. Belief in COVID-19 misinformation at Wave 1 significantly increased avoidance of preventive behaviors at Wave 2, but after accounting for trust in institutions, this effect disappeared. Rather, trust in institutions significantly decreased avoidance of preventive behaviors. In addition, misinformation increased avoidance of preventive behaviors among those who trusted institutions the most. Results suggest that building trust in institutions is essential in promoting COVID-19 preventive behaviors. Belief in COVID-19 misinformation may have harmful effects, but these effects were pronounced for those who highly trust institutions.

Protective and Overprotective Behaviors against COVID-19 Outbreak: Media Impact and Mediating Roles of Institutional Trust and Anxiety

This study aims to explore how pandemic-related media use relates to both protective and overprotective behaviors and to probe the underlying mechanisms. The data were collected online during the early outbreak of COVID-19 in China, and a total of 1118 valid cases, which covered the 30 provincial administrative divisions in mainland China, were collected. Results showed that official government media use was positively associated with protective behaviors and institutional trust was an important mediator. Commercial media use was also found to be positively associated with overprotective behavior, and anxiety mediated this relationship. Findings of this study suggested that different media sources could play completely different roles. Institutional trust in government institutions and medical care systems were equally critical in translating the media effect into public compliance with the preventive measures advocated by the relevant departments. Media outlets and practitioners should also be responsible in order to avoid causing unnecessary anxiety among the public so as to reduce irrational overprotective behaviors.

Who spread COVID-19 (mis)information online? Differential informedness, psychological mechanisms, and intervention strategies

Based on a regional survey conducted in five cities of China (Beijing, Shanghai, Guangzhou, Chengdu, and Wuhan) in January 2020 and a national survey experiment conducted in 31 provinces of China in December 2020 during the COVID-19 pandemic, we investigated the intentions for the misinformed, uninformed, and informed individuals to spread COVID-19 related (mis)information online and the psychological factors affecting their distinct sharing behaviors. We found that (1) both misinformed and uninformed individuals were more likely to spread misinformation and less likely to share fact as compared with the informed ones; (2) the reasons for the misinformed individuals to spread misinformation resembled those for the informed ones to share truth, but the uninformed ones shared misinformation based on different motivations; and (3) information that arouses positive emotions were more likely to go viral than that arouses negative feelings in the context of COVID-19, regardless of facticity. The implications of these findings were discussed in terms of how people react to misinformation when coping with risk, and intervention strategies were proposed to combat COVID-19 or other types of misinformation in risk scenarios.

Predisposing, Enabling, and Reinforcing Factors of COVID-19 Prevention Behavior in Indonesia: A Mixed-methods Study

OBJECTIVES

To prevent the spread of coronavirus disease 2019 (COVID-19), behaviors such as mask-wearing, social distancing, decreasing mobility, and avoiding crowds have been suggested, especially in high-risk countries such as Indonesia. Unfortunately, the level of compliance with those practices has been low. This study was conducted to determine the predisposing, enabling, and reinforcing factors of COVID-19 prevention behavior in Indonesia.

METHODS

This cross-sectional study used a mixed-methods approach. The participants were 264 adults from 21 provinces in Indonesia recruited through convenience sampling. Data were collected using a Google Form and in-depth interviews. Statistical analysis included univariate, bivariate, and multivariate logistic regression. Furthermore, qualitative data analysis was done through content analysis and qualitative data management using Atlas.ti software.

RESULTS

Overall, 44.32% of respondents were non-compliant with recommended COVID-19 prevention behaviors. In multivariate logistic regression analysis, low-to-medium education level, poor attitude, insufficient involvement of leaders, and insufficient regulation were also associated with decreased community compliance. Based on in-depth interviews with informants, the negligence of the Indonesian government in the initial stages of the COVID-19 pandemic may have contributed to the unpreparedness of the community to face the pandemic, as people were not aware of the importance of preventive practices.

CONCLUSIONS

Education level is not the only factor influencing community compliance with recommended COVID-19 prevention behaviors. Changing attitudes through health promotion to increase public awareness and encouraging voluntary community participation through active risk communication are necessary. Regulations and role leaders are also required to improve COVID-19 prevention behavior.

Living in the era of codes: a reflection on China's health code system

This article offers a critical analysis of China's health code system, a data-powered pandemic control and contact tracing system that supposedly subjects all individuals in the country to its panopticon control, a surveillance system that monitors and categorises the Chinese population into the healthy (green), the dubious (yellow), and the unhealthy (red). The article highlights the pretence of surveillance as care and the digital divide that normalises discrimination against the elderly and other digitally left-behind population. It also illustrates how, from policy making and technological design to user engagement, the health code system is implemented, optimised, and used in everyday life to meet the needs of the vulnerable population. The health code is better taken as a medium of adaptable and communicative process that can reset the relation between the system and the lifeworld. It is the process of interchange between the system and the lifeworld that deserves our critical attention.

Americans' Trust in COVID-19 Information from Governmental Sources in the Trump Era: Individuals' Adoption of Preventive Measures, and Health Implications

This study analyzes differences among Americans in their trust in COVID-19 information from governmental sources and how trust is associated with personal adoption of preventative measures under the Trump administration. Based on our analysis of data from a nationally representative survey conducted in October 2020 (effective sample size after weighting = 2615), we find that Americans in general have more trust in COVID-19 information from state/local governments than from the federal government. Variables such as age, party affiliation, religiosity, and race are significantly associated with Americans' trust or lack of trust in COVID-19 information from governmental sources. During the study period, Republicans had more trust in the federal government as a COVID-19 information source than Democrats did, while Democrats had more trust in state/local governments. African Americans had the least trust in the federal and state/local governments as COVID-19 information sources, while Asian Americans had the most trust in both institutions. Trust in the state/local governments as COVID-19 information sources was positively associated with physical distancing and mask-wearing while trust in the federal government as a COVID-19 information source was negatively associated with physical distancing and mask-wearing, suggesting the distinctive roles that state/local governments and the federal government played in mobilizing Americans to adopt preventive measures.

Mediating Effects of Attitudes, Risk Perceptions, and Negative Emotions on Coping Behaviors

Based on the perspectives of social risk amplification and the knowledge-attitudes-practice model, this study aimed to test how the level of knowledge about COVID-19 and information sources can predict people's behavioral changes and to examine the effect mechanisms through the mediating roles of attitude, risk perception, and negative emotions in a survey of 498 older Chinese adults. The results showed that (1) older people had a lower level of factual knowledge regarding the variant strains and vaccines; (2) in the information sources-behavior, information sources had a critical influence on elderly individuals' coping behaviors; and (3) in the knowledge-behavior, factual knowledge had a significant effect on elderly individuals' coping behaviors. Specifically, for prevention behaviors, both risk perception and negative emotions played full mediating roles. The findings have significant implications for the development of an effective COVID-19 prevention program to older adults coping with pandemic conditions.

Inoculation works and health advocacy backfires: Building resistance to COVID-19 vaccine misinformation in a low political trust context

This study examines the effectiveness of the inoculation strategy in countering vaccine-related misinformation among Hong Kong college students. A three-phase between-subject experiment (n = 123) was conducted to compare the persuasive effects of inoculation messages (two-sided messages forewarning about misinformation related to COVID-19 vaccines), supportive messages (conventional health advocacy), and no message control. The results show that inoculation messages were superior to supportive messages at generating resistance to misinformation, as evidenced by more positive vaccine attitudes and stronger vaccine intention. Notably, while we expected the inoculation condition would produce more resistance than the control condition, there was little evidence in favor of this prediction. Attitudinal threat and counterarguing moderated the experimental effects; issue involvement and political trust were found to directly predict vaccine attitudes and intention. The findings suggest that future interventions focus on developing preventive mechanisms to counter misinformation and spreading inoculation over the issue is an effective strategy to generate resistance to misinformation. Interventions should be cautious about using health advocacy initiated by governments among populations with low political trust.

Basic COVID-19 knowledge according to education level and country of residence: Analysis of twelve countries in Latin America

Introduction

Knowing a disease is crucial for being able to fight it, especially in a region in which COVID-19 caused so many deaths, such as Latin America.

Objective

To determine the association between basic knowledge of COVID-19 and education level according to country of residence in Latin America.

Methodology

This is an analytical cross-sectional study. Basic level of knowledge was measured through nine close-ended questions (scale validated in Peru). The score obtained was analyzed through performing a crosstab vs. gender, age, education level, and country of residence.

Results

Of a total of 9,222 respondents, almost all of them knew the common symptoms (99%), modes of transmission (93%), and knew how to recognize which was not a specific symptom (93%). Through the multivariate model, we found that there was no association with gender (p = 0.716) or age (p = 0.059), in comparison with those who had primary or a lower education level. All the other higher education levels had statistically significant scores (all p-values p < 0.001). When comparing knowledge according to countries, and using Peru as reference for comparison, Chile, Paraguay, Mexico, Bolivia, Panama, Ecuador, Costa Rica, and Colombia had a better level of knowledge (all p-values < 0.001); however, only El Salvador had a lower level (p < 0.001).

Discussion

There was lack of knowledge of some topics, difference according to academic degree and country. As Peru was one of countries that obtained the lowest level of knowledge, it could have influenced the fact that it was the most affected country in the world.

Variation in Public Trust, Perceived Societal Fairness, and Well-Being before and after COVID-19 Onset-Evidence from the China Family Panel Studies

The sudden onset of the COVID-19 pandemic had a significant impact on all aspects of people's lives, including their attitudes toward society and psychological well-being. This study aimed to analyze the variation in public trust, perceived societal fairness, and well-being before and after the outbreak of the coronavirus disease 2019 (COVID-19). This study used two-wave longitudinal data of 15,487 residents (2018, T1; 2020, T2) derived from the Chinese Family Panel Studies (CFPS). A repeated measures analysis of variance showed that (a) public trust, perceived societal fairness, and subjective well-being significantly improved and (b) depression significantly increased. Linear regression analysis showed that education and socioeconomic status had a significant predictive effect on public trust, perceived societal fairness, and depression; socioeconomic status had a significant predictive effect on subjective well-being. This study provides evidence and direction for current social governance, namely, policy implementation and pandemic response.

The influence of pessimism on adverse network behavior during COVID-19: the mediating effect of negative affect and risk perception

There had been an information epidemic during the COVID-19, which led to a lot of adverse network behavior among Internet users. From the perspective of cognition and emotion, this study focused on exploring the influence mechanism of pessimism on undergraduates' adverse network behavior, and introduced the mediating variable of negative affect and risk perception. In this study, a cross-sectional questionnaire was used to evaluate pessimism, negative affect, risk perception and adverse network behavior of undergraduates to explore the characteristics of network behaviors of undergraduates during the COVID-19. 600 undergraduates from three universities in a city in China were selected as participants, among whom 312 students are female and 288 students are male. The results are as follows: (1) Pessimism is positively correlated with adverse network behavior, and pessimism has a significant positive effect on adverse network behavior. (2) Pessimism is positively correlated with negative affect, and negative affect is positively correlated with adverse network behavior. The mediating effect analysis shows that the mediating effect of negative affect on the relationship between pessimistic personality and adverse network behavior has statistical significance. (3) Pessimism is positively correlated with risk perception and risk perception is positively correlated with adverse network behavior. The mediating effect analysis shows that the mediating effect of risk perception on the relationship between pessimistic personality and adverse network behavior has statistical significance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03584-z.

The Association of Social Emotions, Perceived Efficiency, Transparency of the Government, Concerns about COVID-19, and Confidence in Fighting the Pandemic under the Week-Long Lockdown in Shenzhen, China

The outbreak and spread of the COVID-19 pandemic have had a far-reaching impact. The present study investigated the factors primarily affecting the execution of the control measures, including social emotions, concerns about the pandemic, perceived efficiency, transparency of the government in publishing the pandemic-related information, and confidence in fighting the pandemic. Specifically, we examined the differences in these factors across four areas (i.e., lockdown area, control area, prevention area, and safe area) according to different COVID control measures under the week-long lockdown in Shenzhen. We found that social emotions, concerns about the pandemic, perceived efficiency of the government, and confidence in fighting the pandemic were more negative in the lockdown area than that in other areas. More importantly, after controlling for areas and education level of participants, the emotion of optimism, concerns about the COVID-19 pandemic, perceived efficiency, and perceived transparency of the government in releasing COVID-19 relevant information positively predicted confidence in fighting the pandemic, while anger negatively predicted confidence in fighting the pandemic. Therefore, the government and communities could make efforts at effective communication and find innovative approaches to make individuals (especially in the lockdown area) maintain social connections, reduce negative emotions, and enhance confidence in combating the pandemic.

The effect of COVID-19 on public confidence in the World Health Organization: a natural experiment among 40 countries

Background

At a time when a highly contagious pandemic and global political and economic turmoil are intertwined, worldwide cooperation under the leadership of an international organization has become increasingly important. This study aimed to estimate the effect of COVID-19 on public confidence in the World Health Organization (WHO), which will serve as a reference for other international organizations regarding the maintenance of their credibility in crisis management and ability to play a greater role in global health governance.

Methods

We obtained individual data from the World Values Survey (WVS). A total of 44,775 participants aged 16 and older from 40 countries in six WHO regions were included in this study. The COVID-19 pandemic was used as a natural experiment. We obtained difference-in-differences (DID) estimates of the pandemic’s effects by exploiting temporal variation in the timing of COVID-19 exposure across participants interviewed from 2017 to 2020 together with the geographical variation in COVID-19 severity at the country level. Public confidence in the WHO was self-reported by the respondents.

Results

Among the participants, 28,087 (62.73%) reported having confidence in the WHO. The DID estimates showed that the COVID-19 pandemic could significantly decrease the likelihood of people reporting confidence in the WHO after controlling for multiple covariates (adjusted OR 0.54, 95% CI: 0.49–0.61), especially during the global outbreak (0.35, 0.24–0.50). The effect was found in both younger individuals (0.58, 0.51–0.66) and older adults (0.49, 0.38–0.63) and in both males (0.47, 0.40–0.55) and females (0.62, 0.53–0.72), with a vulnerability in males (adjusted P for interaction = 0.008).

Conclusion

Our findings are relevant regarding the impact of COVID-19 on people’s beliefs about social institutions of global standing, highlighting the need for the WHO and other international organizations to shoulder the responsibility of global development for the establishment and maintenance of public credibility in the face of emergencies, as well as the prevention of confidence crises.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-022-00872-y.

Perceived coronavirus health risk associated with students' life satisfaction: the role of trust in government policies

This study investigates whether trust in government policies has a mediation effect between the students' perception of COVID-19 health risk and their life satisfaction. In order to test the mediation effect, this study utilizes data collected from undergraduate students at Tecnológico de Monterrey in Mexico by means of online survey. The survey yielded 95 usable data out of 97. The valid results were tested via generalized linear model (GLM) Mediation approach for the mediation. Empirical findings of Delta method affirm the mediation (estimate = 0.4445, β = 0.474, z = 3.699, p < .001) role of trust in government as a mediator between students' perception of COVID-19 health risk and their life satisfaction. In other words, Mexican undergraduate students are of the view that trusting government plays a crucial role as a mediator between their perception of coronavirus health risk and life satisfaction. These findings may guide the governments' policy making efforts and motivate them to support their initiatives with trust-building efforts.

Three dimensions of COVID-19 risk perceptions and their socioeconomic correlates in the United States: A social media analysis

Social media analysis provides an alternate approach to monitoring and understanding risk perceptions regarding COVID-19 over time. Our current understandings of risk perceptions regarding COVID-19 do not disentangle the three dimensions of risk perceptions (perceived susceptibility, perceived severity, and negative emotion) as the pandemic has evolved. Data are also limited regarding the impact of social determinants of health (SDOH) on COVID-19-related risk perceptions over time. To address these knowledge gaps, we extracted tweets regarding COVID-19-related risk perceptions and developed indicators for the three dimensions of risk perceptions based on over 502 million geotagged tweets posted by over 4.9 million Twitter users from January 2020 to December 2021 in the United States. We examined correlations between risk perception indicator scores and county-level SDOH. The three dimensions of risk perceptions demonstrate different trajectories. Perceived severity maintained a high level throughout the study period. Perceived susceptibility and negative emotion peaked on March 11, 2020 (COVID-19 declared global pandemic by WHO) and then declined and remained stable at lower levels until increasing once again with the Omicron period. Relative frequency of tweet posts on risk perceptions did not closely follow epidemic trends of COVID-19 (cases, deaths). Users from socioeconomically vulnerable counties showed lower attention to perceived severity and susceptibility of COVID-19 than those from wealthier counties. Examining trends in tweets regarding the multiple dimensions of risk perceptions throughout the COVID-19 pandemic can help policymakers frame in-time, tailored, and appropriate responses to prevent viral spread and encourage preventive behavior uptake in the United States.

The Roles of Health and e-Health Literacy, Conspiracy Beliefs and Political Sympathy in the Adherence to Preventive Measures Recommended during the Pandemic

Adherence to preventive measures is of the utmost importance for limiting the spreading of the coronavirus. Many predictors of adopting preventive behaviors have been analyzed in different countries during the COVID-19 pandemic. Objectives: The study’s main aim was to assess the roles of health (HL) and e-health literacy (eHL), conspiracy beliefs, political sympathy, and religious practices in the adherence to COVID-19 preventive measures after adjusting for sociodemographic factors. The analysis was based on the data obtained from a survey conducted among 2410 adult Internet users in Poland in October 2020. The survey was performed with a computer-assisted web-based interviewing technique. Survey data were analyzed through uni- and multivariable linear regression models. The multivariable regression model revealed that after adjusting for sociodemographic variables, the preventive measures score (PMS) was significantly associated with HL (B = 0.04, p < 0.001), eHL (B = 0.03, p < 0.001) and the COVID-19-related conspiracy beliefs score (C19CBS) (B = −0.24, p < 0.001). There was also a significant statistical relationship between PMS and political sympathies and religious practices. HL and eHL are key factors eligible for modification through appropriate interventions and showing positive effects in compliance with preventive measures. Conspiracy beliefs, political sympathy and religious beliefs are independently associated with the adherence.

Explaining interpersonal differences in COVID-19 disease prevention behavior based on the health belief model and collective resilience theory: a cross-sectional study from Bolivia

Background

Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens’ adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen’s disease prevention behavior. These hypotheses deal with how citizens’ vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors.

Methods

From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling.

Results

Regarding a citizen’s vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior.

Conclusions

In the COVID-19 pandemic, a citizen’s low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13068-1.

The Prevention Behaviors and Impact Mechanisms Among Different Chinese Social Classes at the Early Stage of COVID-19 Pandemic

Background

Whether the pandemic can be effectively prevented and controlled depends on the entire population’s adherence to recommendations and preventive behaviors. The present study aimed to investigate the social class differences and internal mechanisms of prevention behaviors in the COVID-19 pandemic.

Methods

We conducted an online cross-sectional survey among the general Chinese population at the early stage of the COVID-19 pandemic. The survey website’s subscribers could access the questionnaire through the Tencent online platform, and a total of 1948 participants voluntarily completed it. Most of the participants were female (n = 1257, 64.528%), between the ages of 18–29 (n = 999, 51.284%), university graduates (n = 1015, 52.105%), and had an annual family income below 100,000 yuan (n = 1119, 57.444%). The differences in COVID-19 prevention behaviors among different social classes, the mediating role of infectious threat perception and the moderating role of perceived epidemic transparency were examined.

Results

1) There were significant differences in prevention behaviors among different social classes. 2) The level of infectious threat perception played a mediating role in the relationship between social class and prevention behavior. When the individuals were from a lower social class, the level of threat perception and the level of COVID-19 prevention behaviors were also lower. 3) Perceived epidemic transparency played a moderating role in the relationship between social class and COVID-19 prevention behavior. It also played a moderating role in the relationship between social class and infectious threat perception.

Conclusion

In the implementation of epidemic prevention and control measures, different social classes should be targeted and guided differently. In particular, lower-class individuals can be guided by improving the perceptions of epidemic transparency and infectious threat.

Configurational Approach to Understand Preventive Behavior Adoption among a Non-Adhering Population During the COVID-19 Pandemic

This study examined the risk preventive responses of individuals, especially those who do not adhere to preventive measures (e.g. anti-maskers) for COVID-19, by integrating three dominant theories in risk and health communication. The complex causal relationship between motivational elements and individuals' preventive behavior adoption was studied using Fuzzy-Set Qualitative Comparative Analysis. With a survey (N = 372) of non-abiding populations, this study found generalizable and unique configurations of motivational elements. Different effects of key motivational variables from three theories were found with different demographic factors. Theoretical and practical implications were also discussed.

The Impact of the COVID-19 Pandemic on the General Public in Urban and Rural Areas in Southern Japan

Urban and rural areas are situated in contrasting physical and social settings, which influence their levels of exposure as well as their preventive behaviors in response to the COVID-19 outbreak. The study investigated whether there were differences between the areas regarding the levels of difficulty and anxiety felt by the general public during the first wave of COVID-19 in April and May 2020. We conducted an online questionnaire in Fukuoka and Kumamoto Prefecture in southern Japan via a private research company and collected a total of 913 valid responses from individuals whose conditions of employment were affected by the coronavirus outbreak. Although urban areas experienced higher case rates compared to rural areas, ordinal logistic regression analysis revealed no significant differences between urban and rural respondents concerning the level of difficulty in routine life. The daily-life contents which made them feel difficult during the first wave also did not differ largely between the contrasting areas. Urban respondents appeared to have experienced a higher level of difficulty in finding an alternative job, but how respondents found one, if successful, did not differ between urban and rural areas. The area of residence played a role in explaining the level of anxiety toward being infected, especially when the anxiety-related questions involved relationships with neighbors. Rural respondents showed a significantly higher level of anxiety toward causing neighbors trouble and being criticized if infected. Respondents who were better embedded in their communities generally felt more anxious about being infected, regardless of whether they lived in urban or rural areas. Women and respondents with children were more likely affected by abnormal situations caused by the COVID-19 outbreak. Our study highlights the prevailing impact of the COVID-19 pandemic on the general public regardless of whether in urban or rural settings, as well as the potential contribution of social ties among people to protecting communities from infectious pathogens.

Different roles of interpersonal trust and institutional trust in COVID-19 pandemic control

The absence of pharmaceutical interventions made it particularly difficult to mitigate the first outbreak of coronavirus disease 2019 (COVID-19). The current study investigated how interpersonal trust and institutional trust influenced the control process. Trusts and COVID-19 data in 44 countries and 50 US states were analyzed; institutional trust was associated with case fatality rate, and interpersonal trust was associated with control speed. Two independent behavioral experiments showed that institutional trust manipulation increased participants’ willingness to complete the COVID-19 test and that interpersonal trust manipulation increased conscious compliance with prevention norms and decreased unnecessary outdoor activities. Agent-based modeling further confirmed these behavioral mechanisms for two types of trust in the COVID-19 control process. New interventions are needed to help countries heighten interpersonal and institutional trust as they continue to battle COVID-19 and other collective threats.

Knowledge of COVID-19 and its prevention among rural residents in Fuqing, China

Objectives

Rural areas are the weakest place for epidemic prevention and control, yet few studies have specifically conducted surveys in rural areas. The purpose of this study is to assess rural residents’ knowledge of the COVID-19 and its prevention in China.

Methods

A cross-sectional survey study containing 1,426 samples was conducted in Fuqing, China to assess rural residents’ knowledge of the COVID-19 and its prevention. Logistic regression was used to identify potential differences in participants’ knowledge of COVID-19 and its prevention and control in different population subgroups.

Results

The mean and median of residents’ knowledge of COVID-19 was 5.53 and 6 points, respectively. The mean and median of residents’ knowledge related to self-protection against COVID-19 was 10.34 and 11 points, respectively. Older adults (AOR_45–59 = 2.26, 95% CI 1.20 to 4.27; AOR_60-69 = 3.13, 95% CI 1.63 to 5.98; AOR_≥70 = 4.68, 95% CI 2.35 to 9.33) were more deficient in knowledge of COVID-19. Those who were better educated and with a higher average annual household income were less likely to be deficient in the knowledge of COVID-19 and knowledge of self-protection against COVID-19. Moreover, those who were single, divorced, or widowed (AOR = 1.67, 95% CI 1.13 to 2.46) were more deficient in the knowledge of self-protection against COVID-19.

Conclusions

Our study suggests that when facing a pandemic like COVID-19, the key is to inform the public to understand simple and effective self-protection measures. Therefore, we call on the governments to give priority to publicity and education on self-prevention measures for the targeted populations and regions. This is most evident among the vulnerable groups like those who were unmarried, elderly, and those with low education or low income. Similar suggestions may be of use in other countries as well.

When and How Trust in Government Leads to Compliance with COVID-19 Precautionary Measures

Despite the risks of COVID-19, some people ignore the COVID-19 precautionary measures, endangering public health. We aimed to investigate how and in what conditions trust in government and health authorities encourage individuals to comply with COVID-19 precautionary measures. Based on a sample of 664 respondents, we found that an increase in the level of trust in government is associated with higher compliance with COVID-19 precautionary measures. We also found that problem awareness mediates the effect of trust in government on compliance with COVID-19 precautionary measures. In addition, we examined whether individualistic orientation moderates the mediating effect of problem awareness. We found that individualistic orientation mitigates the mediating effect of problem awareness in the relationship between trust in government and compliance behavior. The findings of this study have the potential to inform policy and practice by addressing the ways in which compliance with COVID-19 precautionary measures can be improved.

Evidence-based guiding principles to build public trust in personal data use in health systems

Objective

Public trust in health systems is pivotal for their effective and efficient functioning. In particular, public trust is essential for personal data use, as demonstrated in debates in many countries, for example, about whether data from COVID-19 contact tracing apps should be pooled or remain on individuals’ smartphones. Low levels of public trust pose a risk not only to health system legitimacy but can also harm population health.

Methods

Synthesising our previous qualitative and theoretical research in the English National Health Service which enabled us to conceptualise the nature of public trust in health systems, we present guiding principles designed to rebuild public trust, if lost, and to maintain high levels of public trust in personal data use within the health system, if not.

Results

To build public trust, health system actors need to not rush trust building; engage with the public; keep the public safe; offer autonomy to the public; plan for diverse trust relationships; recognise that trust is shaped by both emotion and rational thought; represent the public interest; and work towards realising a net benefit for the health system and the public.

Conclusions

Beyond policymakers and government officials, the guiding principles address a wide range of actors within health systems so that they can work collectively to build public trust. The guiding principles can be used to inform policymaking in health and health care and to analyse the performance of different governments to see if those governments that operate in greater conformity with the guiding principles perform better.

Managing urban citizens' panic levels and preventive behaviours during COVID-19 with pandemic information released by social media

Reducing citizens' panic and promoting their preventive behaviours are critical parts of pandemic management for the government. However, the effects of pandemic information types (daily statistical vs. detailed case information) and sources (official vs. unofficial social media accounts) on the psychological states and behaviours of urban citizens need to be explored further. Furthermore, the heterogeneity of these effects for citizens from areas with different epidemic levels also needs further investigation. Therefore, we conducted a survey during the COVID-19 outbreak in mainland China in March 2020, and 1298 urban citizens (592 from Wuhan) offered reliable data. Results of linear regression analysis indicated that non-Wuhan urban citizens who were more concerned about detailed case information (e.g., patients' movement paths) exhibited more preventive behaviours than those concerned about daily statistical information (e.g., case numbers) and did not show higher panic levels. Additionally, regarding social media information sources, unofficial social media caused both Wuhan and non-Wuhan urban citizens to have higher levels of panic than official media but had no significant impacts on their preventive behaviours. These findings contribute to urban management through the discovery of the effects of different information types and social media information sources on urban citizens during pandemics.

The Paradox of Conspiracy Theory: The Positive Impact of Beliefs in Conspiracy Theories on Preventive Actions and Vaccination Intentions during the COVID-19 Pandemic

This study aims to analyze the direct and indirect impact of beliefs in conspiracy theories on COVID-19-related preventive actions and vaccination intentions. The dominant theory in the literature is that beliefs in conspiracy theories have negative consequences. In particular, strong beliefs in conspiracy theories lower people’s intentions to engage in preventive actions and get vaccinated. Previous studies indicated that this dominant theory applies in Korea as well. However, we find that this dominant theory does not apply in Korea. Based on an analysis of survey data, we find that beliefs in conspiracy theories have positive impact on preventive actions and vaccination intentions. In addition, beliefs in conspiracy theories play indirect roles in these two responses to COVID-19. Specifically, when perceived benefits and trust in the government or science enhance preventive actions or increase vaccination intentions, strong beliefs in conspiracy theories promote this effect. This positive role of conspiracy theories is paradoxical because they are generally viewed as negative.

Association Between Trust in Government and Practice of Preventive Measures During the COVID-19 Pandemic in Japan

BACKGROUND

Research suggests that preventive measures are critical to reducing the spread of coronavirus disease 2019 (COVID-19), but evidence regarding the association between trust in government and the practice of preventive measures is limited.

OBJECTIVE

To examine whether the practice of preventive measures against COVID-19 differs by one's level of trust in government.

DESIGN

A cross-sectional analysis using the Japan COVID-19 and Society Internet Survey (JACSIS) conducted in August and September 2020.

PARTICIPANTS

A nationally representative sample of Japanese individuals aged 15 through 79 years.

MAIN MEASURES

The primary outcome was the composite score for COVID-19 preventive measures, defined as the percentage of preventive measures an individual reported to be practicing (out of nine measures: social distancing, wearing masks, avoiding closed spaces, avoiding crowded spaces, avoiding close contact settings, hand washing, avoiding touching one's face, respiratory hygiene, and surface disinfection). The secondary outcomes were (1) support for stay-at-home requests, (2) use of a contact-tracing app, and (3) receipt of the influenza vaccine in the previous season.

KEY RESULTS

Our analysis included a total of 25,482 individuals. After adjusting for potential confounders, we found that individuals with high trust in government were likely to practice preventive measures more frequently compared to those with low trust (adjusted composite scores, 83.8% for high- vs. 79.5% for low-trust individuals; adjusted difference, +4.3 percentage points [pp]; 95% CI, +2.4 to +6.2pp; P<0.001). We also found that high trust in government was associated with higher likelihoods of support for stay-at-home requests, use of a contact-tracing app, and receipt of the influenza vaccine in the previous season.

CONCLUSIONS

High trust in government was associated with a higher intensity of practicing COVID-19 preventive measures among Japanese individuals at the national level. Our findings may provide useful information to develop and design effective public health interventions.

Social determinants in self-protective behavior: association rule mining study (Preprint)

Background

Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks.

Objective

Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil.

Methods

We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern–mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports.

Results

The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic.

Conclusions

Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions.

Trial Registration

Not applicable.

Identify and measure the degree of over-prevention behaviors in the post-COVID-19 era in China

Background

With the spread of vaccines, more and more countries have controlled the outbreak of the COVID-19. In this post-epidemic era, these countries began to revive their economy. However, pollution remains in the environment, and people’s physical and psychological health has been under threat due to some over-prevention behaviors. Instruments for governmental agencies to manage these behaviors are not yet available. This study aims to develop a measurement model to identify and measure the degree of over-prevention behaviors during the COVID-19 epidemic in China.

Methods

A survey online was conducted to collect cognition from 1528 Chinese people, including descriptions of various over-prevention behaviors defined by health authorities. Factor analyses were used to develop the measurement model and test its validity. Logistic regression analyses were conducted to explore demographic characteristics, indicating people who are inclined to exhibit over-prevention behaviors.

Results

Four main factors were extracted to develop the model (eigenvalue = 7.337, 3.157, 1.447, and 1.059, respectively). The overall reliability (Cronbach’s α = 0.900), the convergent (AVE > 0.5, CR > 0.8 for each factor) and discriminant validity is good. There is also a good internal consistency among these factors (Cronbach’s α = 0.906, 0.852, 0.882, and 0.763, respectively). In Factor 1, gender has a negative effect (Beta = − 0.294, P <  0.05, OR = 0.745), whereas employment has a positive effect. Workers in institutions exhibit the greatest effect (Beta = 0.855, P <  0.001, OR = 2.352). In Factor 2, employment has a negative effect, with workers in institutions exhibit the greatest role (Beta = − 0.963, P <  0.001, OR = 0.382). By contrast, education level has a positive effect (Beta = 0.430, P <  0.001, OR = 1.537). In Factor 3, age plays a negative role (Beta = − 0.128, P < 0.05, OR = 0.880).

Conclusions

People show a discrepancy in the cognition toward various over-prevention behaviors. The findings may have implications for decision-makers to reduce the contradiction between the epidemic and economic revival via managing these behaviors.

Dynamic associations between temporal behavior changes caused by the COVID-19 pandemic and subjective assessments of policymaking: A case study in Japan

To design effective policies against COVID-19, there is a need for more evidence-based research. However, associations between actual policies and temporal behavior changes have remained underexplored. To fill this important research gap, a nationwide retrospective life-oriented panel survey on individuals' behavior changes from April to September 2020 was implemented in Japan. Reliability of information sources, risk perceptions, and attitudes toward policymaking were also investigated. Valid data were collected from 2643 respondents residing in different parts of the country. Risks were reported about general infections and public transport use. Attitudes toward policymaking were mainly about policymaking capacity and PASS-LASTING based policy measures. A dynamic structural equation model (DSEM) was developed to quantify dynamic associations between individuals' behavior changes over time and subjective assessments (i.e., attitudes) of policymaking. Survey results revealed that behavior changes are mostly characterized by avoidance behaviors. Modeling estimation results showed a statistically-significant sequential cause-effect relationship between accumulated behavior changes in the past, subjective factors, and the most recent behavior changes. The most recent behavior changes are mostly affected by accumulated behavior changes in the past. Effects of subjective assessments of policymaking on the most recent behavior changes are significant but moderate. Among attitudes toward policymaking, attitudes toward policymaking capacity are more influential than willingness to follow PASS-LASTING based policy measures. High risks of using public transport are found to significantly influence the most recent behavior changes, together with other risk perception factors. Insights into effective COVID-19 policymaking are summarized.

Self-Focused and Other-Focused Health Concerns as Predictors of the Uptake of Corona Contact Tracing Apps: Empirical Study

BACKGROUND

Corona contact tracing apps are a novel and promising measure to reduce the spread of COVID-19. They can help to balance the need to maintain normal life and economic activities as much as possible while still avoiding exponentially growing case numbers. However, a majority of citizens need to be willing to install such an app for it to be effective. Hence, knowledge about drivers for app uptake is crucial.

OBJECTIVE

This study aimed to add to our understanding of underlying psychological factors motivating app uptake. More specifically, we investigated the role of concern for one's own health and concern to unknowingly infect others.

METHODS

A two-wave survey with 346 German-speaking participants from Switzerland and Germany was conducted. We measured the uptake of two decentralized contact tracing apps officially launched by governments (Corona-Warn-App, Germany; SwissCovid, Switzerland), as well as concerns regarding COVID-19 and control variables.

RESULTS

Controlling for demographic variables and general attitudes toward the government and the pandemic, logistic regression analysis showed a significant effect of self-focused concerns (odds ratio [OR] 1.64, P=.002). Meanwhile, concern of unknowingly infecting others did not contribute significantly to the prediction of app uptake over and above concern for one's own health (OR 1.01, P=.92). Longitudinal analyses replicated this pattern and showed no support for the possibility that app uptake provokes changes in levels of concern. Testing for a curvilinear relationship, there was no evidence that "too much" concern leads to defensive reactions and reduces app uptake.

CONCLUSIONS

As one of the first studies to assess the installation of already launched corona tracing apps, this study extends our knowledge of the motivational landscape of app uptake. Based on this, practical implications for communication strategies and app design are discussed.

When Social Interaction Backfires: Frequent Social Interaction During the COVID-19 Pandemic Is Associated With Decreased Well-Being and Higher Panic Buying

The present research investigated a backfiring effect of social interaction on well-being and general confidence in Western populations during the COVID-19 pandemic. Across two studies, we observed that stronger self-other connectedness and frequent social communication with others during the first few weeks into the quarantine period were associated with worsened well-being and decreased general confidence. In Study 1 (n = 331), we showed that people who reported higher social connectedness and more frequent social interaction experienced declined well-being. In Study 2 (n = 327), we replicated the backfiring effect and showed that those who engaged in frequent social interaction, especially in COVID-19 related conversations, reported decreased general confidence, which mediated the accelerating effect of social interaction on panic buying. Overall, our findings indicated that frequent social interaction under a highly novel and uncertain crisis can relate to negative consequences on mental health and behavior.

Locking down behavioural compliance: The role of emotion and emotion regulation in breaches of COVID-19 mitigation measures in Aotearoa New Zealand

Although anxiety and worry can motivate engagement with COVID-19 preventative behaviours, people may cognitively reframe these unpleasant emotions, restoring wellbeing at the cost of public health behaviours. New Zealand young adults (n = 278) experiencing nationwide COVID-19 lockdown reported their worry, anxiety, reappraisal and lockdown compliance. Despite high knowledge of lockdown policies, 92.5% of participants reported one or more policy breaches (M = 2.74, SD = 1.86). Counter to predictions, no relationships were found between anxiety or worry with reappraisal or lockdown breaches. Findings highlight the importance of targeting young adults in promoting lockdown compliance and offer further insight into the role of emotion during a pandemic.

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.

What Explains Natives and Sojourners Preventive Health Behavior in a Pandemic: Role of Media and Scientific Self-Efficacy

The COVID-19 pandemic triggered a severe global public health emergency. The current research investigated and compared "Natives and Sojourners" health-protective behavior in Mainland China during the pandemic. We adopted a unified view to propose our theoretical model by adapting the Health Belief Model (HBM) and Institutional Theory (IT). The data obtained through an online survey questionnaire from 435 respondents during the second and third quarters of were analyzed. Structural equation modeling (SEM) was used to empirically analyze the proposed model. The media self-efficacy (MSE), scientific self-efficacy (SSE), perceived health risks (PHRs), and the perceived benefits of being protected have positive and significant effects on the definition of health-protective behavioral intentions among natives and sojourners in mainland China. Media and SSE can play a strategic role in formulating public health-protective behavior. The current research recommends an effective communication with sojourners during crisis for them to be a part of the national crisis management plan (i.e., infectious disease).