Changes in psychological wellbeing, attitude and information-seeking behaviour among people at the epicentre of the COVID-19 pandemic: a panel survey of residents in Hubei province, China

From fear to facts: a multi-channel approach to information seeking amid influenza-like illness outbreaks

Background

During recurrent large-scale influenza-like illness (ILI) crises, the factors influencing the information-seeking intentions of Chinese individuals across multiple channels during crises remain underexplored.

Objective

Guided by the risk information seeking and processing (RISP) model, this study proposes a modified RISP model to comprehensively analyze information-seeking intentions through the lens of risk communication.

Methods

To empirically validate the proposed research model, we conducted an online cross-sectional survey with 2,604 Chinese citizens aged 18 years and older. Structural equation modeling (SEM) and ordinary least squares regression analysis were employed to analyze the survey data.

Results

Our findings revealed that during ILI crises, Chinese individuals experienced a spectrum of emotions; as perceived risk increased, negative emotions intensified while positive emotions decreased. Increased negative emotions correlated with a greater sense of information insufficiency, whereas heightened positive emotions correlated with a reduced perception of it. Consequently, Chinese individuals facing information deficiencies were more inclined to seek information from diverse sources, including interpersonal sources, traditional media, search engines, and social media. Moreover, statistical analysis indicated that stronger beliefs in channel complementary strengthened the relationship between information insufficiency and information-seeking intention across multiple channels (access to medical expertise belief, tailorability belief, convenience belief, anonymity belief).

Conclusion

This study outlines a pathway for advancing the RISP model and offers practical strategies for effective risk communication to mitigate risks and enhance public perception and behavior. It also discusses implications for health communication, promotion, and behavior change.

Health Information as "Fodder for Fears": A Qualitative Analysis of Types and Determinants of the Nonuse of Health Information

As not all individuals are willing to pay attention to health information it is crucial to understand and distinguish the underlying motives and the scope of various nonuse behaviors. To increase conceptual clarity and specify theoretical assumptions about the types of nonuse of health information and their determinants, we used a qualitative research approach. Semi-structured interviews with 11 female, 10 male, and 10 non-binary participants aged between 18 and 67 (M = 39.7) showed that information ignoring and avoidance are two distinct behaviors characterized by their motivational patterns. Information ignoring is a preference for other content, serving as a strategy to manage limited time resources and receptivity. Information avoidance is understood as a decision to avoid threatening health information serving emotion regulation. Our data further indicate that information ignoring and avoidance are not unidimensional constructs. Instead, the selectivity and consistency of both behaviors build various types of information ignoring and avoidance, which need to be explained differently considering individual differences, cognitive, affective, socio-normative, and structural factors. Further, theory specification should build on the revealed findings and test which factors relate to which kind of nonuse behaviors.

Psychosocial health stigma related to COVID-19 disease among COVID-19 patients in Jordan: a comparative study

ABSTRACT

Objective

Beyond its effects on physical health, COVID-19 psychosocial stigma has emerged as a result of this global crisis, making people feel ashamed, alone and discriminated against. This comparative study aims to assess the psychosocial health stigma of COVID-19, and to evaluate the perceived stigma according to the sociodemographic variables during the pandemic in Jordan.

Method

A study in Jordan compared stigma between 112 COVID-19 patients (52 males and 60 females) and 118 healthy controls (56 males and 62 females), with participants ranging from 18 to over 60 years old in both groups.

Results

According to the data, 27% of COVID-19 patients had high-level stigma, with total stigma scores ranging from 46 to 111 and a mean of 80.23 (SD=12.79). Quartile results showed 50% scored 80, 25% over 88 and 75% over 78, indicating moderate stigma within a 0-160 range. On the other hand, the total scores of stigma among the healthy controls ranged from 40 to 112, with a mean of 78.55 (SD=12.41). 30.3% report high levels of stigma. Quartile results showed 50% scored 78, 25% over 85 and 75% over 71, indicating moderate stigma. No significant stigma score difference was found between patients and controls (t=1.09, p=0.28). No significant correlation with demographics, except among medical workers (t=-3.32, p=0.001).

Conclusion

The study revealed negligible differences in stigma between the two groups, but greater stigma among medical field workers highlighting the need for integrated community and policy support to fight stigma.

Clarifying the Relationship Between Information Seeking and Avoidance: Longitudinal Analyses of Information Behaviors and Their Normative Influences

Information seeking and avoidance are relevant behaviors to cope with health crises. While there are various assumptions about their relationship, past research has not yet analyzed their interplay. The present study aims to clarify the relationship between information seeking and avoidance in the course of the COVID-19 pandemic and shed light on whether both behaviors are impacted by seeking- and avoidance-related norms, which are known factors in individuals' health- and risk-related behaviors. Based on a four-wave panel study conducted among German residents (n = 492), we investigated information seeking and avoidance and their normative influences from a longitudinal perspective. Results of random intercept cross-lagged panel models suggest that information seeking and avoidance are distinct, not causally related but correlated concepts. This understanding is supported by the findings that seeking- and avoidance-related norms operate differently for seeking and avoidance. The results add to construct clarification and theory development, but more research is needed to understand the relations between information behaviors.

Health-Seeking Behaviour and Its Determinants Following the COVID-19 Pandemic

OBJECTIVE

The purpose of this study was to determine the change in behaviour of individuals towards any health issues they faced after the coronavirus disease 2019 (COVID-19) pandemic and to compare the health-seeking behaviour of people who were infected by the virus and those who were not infected.

METHODS

A cross-sectional study was conducted among 400 participants visiting Shifa International Hospital, Islamabad, Pakistan, and Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan. Data was collected through a pilot-tested questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States).

RESULTS

In 286 participants (71.6%), health-seeking behaviours were significantly altered by the COVID-19 pandemic. Overall, this research showed that COVID-19 was linked to poor health-seeking behaviour.

CONCLUSION

Most of the participants' health-seeking behaviours were significantly altered by the COVID-19 pandemic. A significant change in how people behaved towards any health problem was reported. As a result, public awareness campaigns should focus on delivering more information about COVID-19 to promote their health-seeking behaviour.

Usage of Natural Health Products (NHPs) for respiratory diseases: user characteristics and NHP-Consumption behavior during the Covid-19 pandemic in Germany

BACKGROUND

Respiratory diseases (RD) can challenge healthcare systems around the globe. Natural health products (NHPs) are popular complementary and alternative medicine options for health issues concerning non-fatal RD. Little is known about the characteristics of the users of RD-NHPs and about their NHP consumption behavior during the Covid-19 pandemic in Germany.

METHODS

A representative online survey was conducted in Germany in 2022. 1707 participants were classified based on having used NHPs for RD within the previous 12 months, having used NHPs but not for RD within the previous 12 months and not having used NHPs. Data were analyzed using descriptive and inferential statistical methods as well as a multinomial logistic regression model.

RESULTS

Users of RD-NHPs within the previous 12 months were more likely to be employed and to consult pharmacists more often for non-fatal health issues than individuals who did not take RD-NHPs. RD-NHP users were more likely to suffer from a Covid-19 infection and to have children living in the same household than other NHP users. Compared to non-NHP users, RD-NHP users were more likely to be female, highly educated and have stronger openness-to-change value orientations. Vaccination-related behavior was no indicator of RD-NHP usage. Most RD-NHP users took NHPs in self-medication. Few reported informing their practitioner about their self-medication. Drugstores were the most visited supply source for NHPs during the pandemic, followed by pharmacies. Common information sources regarding NHPs were the products themselves and pharmacists.

CONCLUSION

This study emphasized the important role of NHPs as a popular prevention and treatment option for RD. RD-NHPs were more likely used by individuals who were employed, who suffered from a RD and who consult pharmacists for non-fatal health issues. The importance of product information and pharmacies as information sources should be considered to make communication strategies about safe self-medication options with RD-NHPs more effective, which could help to reduce the burden of health facilities regarding non-fatal RD. To improve and develop future pandemic-control strategies, health professionals and policy makers should consider NHP usage behavior and provide critical information about chances and risks of self-medicated NHP consumption.

Indonesian Ulema Council Fatwa on Religious Activities During the COVID-19 Pandemic: An Investigation of Muslim Attitudes and Practices

This cross-sectional study was conducted on 1139 Muslims in Indonesia. Attitudes and practices were assessed using a questionnaire developed by researchers referring to the main points of the Indonesian Ulema Council fatwa on religious activities during the COVID-19 pandemic. The findings suggest that most participants held positive attitudes (86.5%) and engaged in practices (76.4%). The regression analysis also indicates that attitudes explained approximately 31.5% of the variance in the practice score and 11.2% in the practice score while controlling for gender, age, residence, and education. The study reveals that understanding the relationship between sociodemographic variables, attitudes, and practices is relevant to implementing government policies related to religious practices during the COVID-19 pandemic.

The scar that takes time to heal: A systematic review of COVID-19-related stigma targets, antecedents, and outcomes

COVID-19, as a crucial public health crisis, has affected our lives in nearly every aspect. Besides its major health threats, COVID-19 brings severe secondary impacts, one of which is the rise of social stigma. Although numerous studies have examined the antecedents and outcomes of COVID-19-related stigma, we still lack a systematic understanding of who is being stigmatized during the COVID-19 pandemic, what exacerbates COVID-19-related stigma, and what impacts COVID-19-related stigma has on victims. Therefore, this review aims to provide a systematic overview of COVID-19-related stigma. With 93 papers conducted with 126,371 individuals in more than 150 countries and territories spanning five continents, we identify three targets that have received the most research: Chinese/Asian people, (suspected) patients and survivors, and healthcare workers. Furthermore, we find that for each stigma target, characteristics of the stigmatized, stigmatizer, and context contribute to COVID-19-related stigma and that this stigma negatively influences victims' health and non-health outcomes. We call for future research to provide a more integrative, balanced, and rigorous picture of COVID-19-related stigma via conducting research on neglected topics (e.g., contextual factors that contribute to stigma toward HCWs) and stigma interventions and using a longitudinal design. In practice, we urge governments and institutions (e.g., ministries of public health, hospitals) to pay close attention to stigma issues and to promote safe and inclusive societies.

COVID-19 related stigma among the general population in Iran

BACKGROUND

COVID-19 related stigma has been identified as a critical issue since the beginning of the pandemic. We developed a valid and reliable questionnaire to measure COVID-19 related enacted stigma, inflicted by the non-infected general population. We applied the questionnaire to measure COVID-19 related enacted stigma among Tehran citizens from 27 to 30 September 2020.

METHODS

A preliminary questionnaire with 18 items was developed. The total score ranged from 18 to 54; a higher score indicated a higher level of COVID-19 related stigma. An expert panel assessed the face and content validity. Of 1637 randomly recruited Tehran citizens without a history of COVID-19 infection, 1064 participants consented and were interviewed by trained interviewers by phone.

RESULTS

Item content validity index (I-CVI), Item content validity ratio (I-CVR), and Item face validity index (I-FVI) were higher than 0.78 for all 18 items. The content and face validity were established with a scale content validity index (S-CVI) of 0.90 and a scale face validity index (S-CVI) of 93.9%, respectively. Internal consistency of the questionnaire with 18 items was confirmed with Cronbach's alpha of 0.625. Exploratory factor analysis revealed five latent variables, including "blaming", "social discrimination", "dishonor label", "interpersonal contact", and "retribution and requital attitude". The median of the stigma score was 24 [25th percentile: 22, 75the percentile: 28]. A large majority (86.8%) of participants reported a low level of stigma with a score below 31. None of the participants showed a high level of stigma with a score above 43. We found that the higher the educational level the lower the participant's stigma score.

CONCLUSION

We found a low level of stigmatizing thoughts and behavior among the non-infected general population in Tehran, which may be due to the social desirability effect, to the widespread nature of COVID-19, or to the adaptation to sociocultural diversity of the large city.

Public and Private Information Sharing under "New Normal" of COVID-19: Understanding the Roles of Habit and Outcome Expectation

Information sharing is critical in risk communication and management during the COVID-19 epidemic, and information sharing has been a part of individual prevention and particular lifestyles under the "New Normal" of COVID-19. Thus, the purpose of this study was to explore influencing factors and mechanisms in public and private information sharing intention among people under the regular risk situation. This study investigated an information sharing mechanism based on a cross-sectional design. We collected 780 valid responses through a sample database of an online questionnaire platform and utilized partial least squares structural equation modeling (PLS-SEM) to further analyze the data. To explore the difference caused by news frames, we divided respondents into two groups according to the news frame (action frame vs. reassurance frame) and proceeded with the multi-group analysis. The results showed that four types of outcome expectations (information seeking, emotion regulation, altruism and public engagement) and habit had impacts on public and private information sharing intention. Two paths influencing information sharing proposed in this study were supported. The results showed that outcome expectations were positively related to habit, which implies that the cognitive mechanism was positively relevant to the formation of habit. The results proved that habit played a mediating role between outcome expectations and information sharing. This research found that emotion regulation and public engagement outcome expectations only affected two types of information sharing intention mediated by habit. Regarding the role of the news frame, this study found no significant difference between the group exposed to action-framed news and the group exposed to reassurance-framed news. By exploring influencing factors and the mechanism of information sharing under the "New Normal", these findings contribute to understanding of information sharing and have implications on risk management. The proposed mechanism classifying public and private information sharing complements risk information flowing by considering online risk incubation.

Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions

BACKGROUND

Although timely and accurate information during the COVID-19 pandemic is essential for containing the disease and reducing mental distress, an infodemic, which refers to an overabundance of information, may trigger unpleasant emotions and reduce compliance. Prior research has shown the negative consequences of an infodemic during the pandemic; however, we know less about which subpopulations are more exposed to the infodemic and are more vulnerable to the adverse psychological and behavioral effects.

OBJECTIVE

This study aimed to examine how sociodemographic factors and information-seeking behaviors affect the perceived information overload during the COVID-19 pandemic. We also investigated the effect of perceived information overload on psychological distress and protective behavior and analyzed the socioeconomic differences in the effects.

METHODS

The data for this study were obtained from a cross-national survey of residents in 6 jurisdictions in Asia in May 2020. The survey targeted residents aged 18 years or older. A probability-based quota sampling strategy was adopted to ensure that the selected samples matched the population's geographical and demographic characteristics released by the latest available census in each jurisdiction. The final sample included 10,063 respondents. Information overload about COVID-19 was measured by asking the respondents to what extent they feel overwhelmed by news related to COVID-19. The measure of psychological distress was adapted from the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Protective behaviors included personal hygienic behavior and compliance with social distancing measures.

RESULTS

Younger respondents and women (b=0.20, 95% CI 0.14 to 0.26) were more likely to perceive information overload. Participants self-perceived as upper or upper-middle class (b=0.19, 95% CI 0.09 to 0.30) and those with full-time jobs (b=0.11, 95% CI 0.04 to 0.17) tended to perceive higher information overload. Respondents who more frequently sought COVID-19 information from newspapers (b=0.12, 95% CI 0.11 to 0.14), television (b=0.07, 95% CI 0.05 to 0.09), and family and friends (b=0.11, 95% CI 0.09 to 0.14) were more likely to feel overwhelmed. In contrast, obtaining COVID-19 information from online news outlets and social media was not associated with perceived information overload. There was a positive relationship between perceived information overload and psychological distress (b=2.18, 95% CI 2.09 to 2.26). Such an association was stronger among urban residents, full-time employees, and those living in privately owned housing. The effect of perceived information overload on protective behavior was not significant.

CONCLUSIONS

Our findings revealed that respondents who were younger, were female, had a higher socioeconomic status (SES), and had vulnerable populations in the household were more likely to feel overwhelmed by COVID-19 information. Perceived information overload tended to increase psychological distress, and people with higher SES were more vulnerable to this adverse psychological consequence. Effective policies and interventions should be promoted to target vulnerable populations who are more susceptible to the occurrence and negative psychological influence of perceived information overload.

Anxiety and Depression Prevalence and Risk Factors Among Patients With Cardiovascular Diseases in Post-COVID-19 China

Objective: Data are limited on the psychological disorders of patients with cardiovascular disease during the post-COVID-19 period, although mental health status is associated with morbidity and mortality. We aimed to investigate the prevalence of anxiety and depression and risk factors among patients with cardiovascular disease in the post-pandemic period.

Method: A cross-sectional survey was conducted through opportunistic and snowball sampling in southeast China from 10 October to 24 November. Anxiety and depression were assessed on the hospital anxiety and depression scale (HADS).

Results: A total of 435 patients with hypertension (48.05%), atrial fibrillation (17.24%), coronary artery disease (14.48%), heart failure (9.89%) and other heart diseases (10.34%) completed the survey. Interestingly, most patients reported monthly income comparable to (90.11%) or even greater than (8.51%) pre-pandemic income. The occurrence of anxiety and depression was 11.72 and 9.20%, respectively. Marital status and treatment interruption during the pandemic were independent risk factors for both anxiety and depression. Moreover, current monthly income and access to telemedicine during the pandemic were independent risk factors for anxiety.

Conclusion: Patients with cardiovascular disease may experience anxiety and depression not only because of disease complications but also because of the effects of the pandemic. In facing the global challenge posed by the coronavirus, efforts should be made to improve patients' psychological well-being in the management of populations with cardiovascular disease.

Information Seeking Behavior on COVID-19 Among Older Adults: A Cross-Sectional Study in Northern Iran

This study aimed to assess the information-seeking behavior about COVID-19 among older adults in northern Iran. Two hundred-fifty three older adults living in Rasht, northern Iran, were enrolled in a cross-sectional study. Most older adults obtained information about COVID-19 from television, friends, and acquaintances. They relied less on special patient associations and the Ministry of Health telephone system. The use of social networks, the Ministry of Health telephone system, the Ministry of Health text message system, and friends and acquaintances for obtaining information about COVID-19 were significantly higher in people aged 60 to 70 years than in people aged >70 years. The use of newspapers/magazines to get information about COVID-19 was significantly higher in men than women. The use of websites, social networks, physicians, other health care workers, friends and acquaintances, newspapers/magazines, and special patients' associations for obtaining information about COVID-19 was significantly higher in people with tertiary education than in others. Older adults were more satisfied receiving information about COVID-19 from nurses and physicians. Therefore, it is recommended that policymakers and health managers pay special attention to developing health programs and social media programing to educate older adults about COVID-19 and access to the right media for accurate information.

A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action

Infectious diseases, including COVID-19, are crucial public health issues and may lead to considerable fear among the general public and stigmatization of, and discrimination against, specific populations. This meta-analysis aimed to estimate the pooled prevalence of stigma in infectious disease epidemics. We systematically searched PubMed, PsycINFO, Embase, MEDLINE, Web of Science, and Cochrane databases since inception to June 08, 2021, and reported the prevalence of stigma towards people with infectious diseases including SARS, H1N1, MERS, Zika, Ebola, and COVID-19. A total of 50 eligible articles were included that contributed 51 estimates of prevalence in 92722 participants. The overall pooled prevalence of stigma across all populations was 34% [95% CI: 28-40%], including enacted stigma (36% [95% CI: 28-44%]) and perceived stigma (31% [95% CI: 22-40%]). The prevalence of stigma in patients, community population, and health care workers, was 38% [95% CI: 12- 65%], 36% [95% CI: 28-45%], and 30% [95% CI: 20-40%], respectively. The prevalence of stigma in participants from low- and middle-income countries was 37% [95% CI: 29-45%], which is higher than that from high-income countries (27% [95% CI: 18-36%]) though this difference was not statistically significant. A similar trend of prevalence of stigma was also observed in individuals with lower education (47% [95% CI: 23-71%]) compared to higher education level (33% [95% CI: 23-4%]). These findings indicate that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging effects of the infodemics during infectious disease epidemics, including COVID-19, and reduce infectious disease-related stigma.

Public Awareness on Prevention Behavior of Coronavirus Disease-19 at North Sulawesi Indonesia

BACKGROUND: The coronavirus diseases (COVID)-19 outbreak around the world has prompted the government to urge its citizens to take precautionary measures to minimize the incidence of COVID-19, which has been continued to attack the world, including Indonesia. The pandemic has led to a massive global public health campaign to slow the spread of the virus by increasing hand washing, reducing face touching, wearing masks in public, and physical distancing. AIM: This study aims to analyze the sociodemographic relationship of knowledge, attitudes, and practices of preventing COVID-19. METHOD: This study was an analytic survey with a cross-sectional study design, conducted for 3 months with number of samples 356 people spared across four districts and cities in North Sulawesi Province. There are two types of data collection those are through Google forms and face to face questions. The studied variables are sociodemography as independent variables and knowledge, attitude, and behavior of COVID-19 prevention. Data were analyzed with Chi-square test. RESULTS: The result of study, only gender has a relationship toward people’s attitudes toward COVID-19 prevention with p = 0.046; while most of the variables, namely, age (0.333), education (0.085), occupation (0.152), and income (0.966), did not have a significant relationship with attitudes toward the prevention of COVID-19. Gender has a relationship toward people’s attitudes toward COVID-19 prevention with p = 0.046; while most of the variables, namely, age (0.333), education (0.085), occupation (0.152), and income (0.966), did not have a significant relationship with attitudes toward the prevention of COVID-19. Most of the variables had a significant relationship with prevention measures, including age (0.008), education (0.009), and occupation (0.038); and only the gender variable (0.895) and monthly income (0.077) had no statistical relationship. CONCLUSION: It is important for the government and society to take a role by becoming more concerned about the COVID-19 pandemic through wise steps to prevent and protect public health using all available resources.

Does education matter for psychological recovery amidst the COVID-19 pandemic? Evidence from a panel survey in Hubei, China

OBJECTIVES

Little has been done to examine socioeconomic differences in the trajectory of psychological well-being during a disaster. This paper investigates educational differences in the changes in psychological well-being during the COVID-19 pandemic and explores the mechanisms of the differences.

METHODS

The data were obtained from a unique two-wave panel survey conducted during the peak and waning phases of the pandemic in Hubei province, the epicenter of the pandemic in China.

RESULTS

At the peak of the pandemic, individuals with different levels of education reported high and similar levels of psychological distress. As the pandemic subsided, the psychological well-being of people of all educational levels rebounded, but the recovery was greater and faster for those with tertiary education. Mediation analysis shows that neighborhood social support and evaluation of the performance of grassroots government partially explained the advantage of the more highly educated.

CONCLUSION

This study reveals how social differentiation is translated into health disparities when a disaster strikes. It may also inform public policy by identifying segments of the population at heightened risk of psychological distress during the COVID-19 pandemic.

Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis

Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.