Impact of Information Exposure on Perceived Risk, Efficacy, and Preventative Behaviors at the Beginning of the COVID-19 Pandemic in the United States

Factors influencing risk perception during Public Health Emergencies of International Concern (PHEIC): a scoping review

The unknownness and dread potential of a risk event shapes its perceived risk. A public health emergency of international concern (PHEIC) declaration by the World Health Organisation (WHO) is a signal for such an event. Understanding perceived risk then shapes risk-avoiding behaviours, important for health prevention. The review aims to consolidate the determinants of risk perception during a PHEIC, underscoring the need for grounding in context and theory. Studies published from 2010 until end-2020, searching PubMed, PsycINFO, MedlinePlus, PubPsych, and CINAHL, were included. Studies with only biological conceptualisations of risk, or no association to risk perception, were excluded. A total of 65 studies were included. Quality of the cross-sectional studies was assessed using Newcastle Ottawa Scale (NOS), yielding an average of 5.4 stars (out of 10). Factors were classified into three broad categories - individual, contextual, and media. Individual risk factors include emotions; beliefs, trust, and perceptions; immutable physical traits (sex, age, ethnicity); mutable traits (education, income, etc.); and knowledge, with no definitive correlation to risk perception. Contextual traits include pandemic experience, time, and location, with only time negatively correlated to risk perception. Media traits include exposure, attention, and framing of media, with no clear association to risk perception. One limitation is excluding a portion of COVID-19 studies due to censoring. Still, this lack of consensus highlights the need to better conceptualise "risk perception". Specifying the context and timing is also important since jurisdictions experience different outbreaks depending on outbreak histories. Using theories to ground risk perception research assists with these tasks.

The Effect of Information Exposure on Stigma Toward the COVID-19 Patient Mediated by Perceived Risk, Attribution of Blame and Protection Norm Conformity

This study employed the model of stigma communication (MSC) to analyze how exposure to COVID-19-related information affected stigma-related information sharing about people who contracted COVID-19 during the pandemic and examined the cognitive process of the MSC in a collectivist culture. Based on a survey of 526 social media users during the COVID-19 pandemic in China, the study found that exposure to contact tracing information and pandemic control information had different impact on stigma-related information sharing through a series of cognitive variables. A dual-path model showed that perceived personal risk influenced stigma-related information sharing through attribution of blame toward the infected (the personal path), while perceived social risk influenced stigma-related information sharing through protection norm conformity (the social path). Compared to the personal path, the social path is more salient in shaping stigmatized attitudes and behaviors. The findings and discussions added to our understanding of the intricate stigma communication process in a collectivist culture.

Psychological flexibility prospectively predicts COVID-19 PPE use across a two-month interval

Perceived susceptibility, psychological flexibility and health behaviors (PPE use, social distancing) were measured at two time points spaced 2 months apart during the height of the COVID-19 pandemic and lockdown in the U.S.A (Time 1 April 2020; Time 2 June 2020). Demographic variables were also collected. Data from 151 Mturk workers indicated that Time 1 psychological flexibility significantly predicted PPE use and social distancing. The effect sizes were substantial. Perceived susceptibility was not a significant predictor. Psychological flexibility messaging and interventions could be an important way to increase the likelihood of people performing health protective behaviors to better constrain the continuing COVID-19 outbreak.

Explaining differences in self-focused and other-involved public health preventive behaviors between the US and China: the role of self- construal and health locus of control

Background

This study examined national similarities and differences in people's engagement in health preventive behaviors during a public health crisis, as well as investigated the underlying individual-level psychological mechanisms. A conceptual distinction was made between self-focused and other-involved preventive behaviors in response to public health crises.

Method

Two cross-sectional surveys were conducted in the United States (N = 888) and China (N = 844) during the early stage of the COVID-19 pandemic. Hayes' PROCESS was utilized to assess national differences in seven preventive behaviors, along with the mediating effects of self-construal and health locus of control.

Results

The results showed that American participants reported greater engagement in self-focused preventive behaviors than Chinese, whereas Chinese participants reported greater engagement in other-involved preventive behaviors than Americans. Chinese participants also engaged more in other-involved than self-focused preventive behaviors. Self-construal and health locus of control partially explained the observed differences in engagement in preventive behaviors.

Discussion

This study introduces a culture-sensitive approach to provide insights for crafting communication interventions that can enhance the effectiveness of health campaigns in the context of a public health crisis.

Depolarized by the Media? The Role of Heterogeneous and Homogeneous Traditional and Digital Media Diets in Issue Polarization Around COVID-19 in the United States

Research suggests that a heterogeneous media diet can foster more objective information evaluations, reducing issue polarization as a result. These findings beg the question: Can increased news heterogeneity reduce issue polarization around COVID-19? Using data from a cross-sectional survey in the United States (N = 1,262), this study found that - in line with theoretical expectations - at high levels of homogeneity of traditional and digital news consumption, the difference in support for COVID-19 prevention between Biden and Trump supporters was significantly large. Conversely, this attitude gap narrowed at high news heterogeneity levels. Our results continue to advance research on the role of homogeneous and heterogeneous media diets and biased cognitive processing in issue polarization, a crucial endeavor as polarization poses a challenge to effective public health policy implementation and pandemic management. At the outset, the implications of our findings for pandemic communication (and health communication more generally) are discussed.

Applying the extended parallel process model to understand households' responses to tornado and earthquake risks in Oklahoma

Oklahoma is a multihazard environment where both natural (e.g., tornadoes) and technological hazards (e.g., induced seismicity) are significant, making Oklahoma a unique setting to better understand how to manage and prepare for multiple hazards. While studies have attempted to understand drivers of hazard adjustments, few have focused on the overall number of adjustments undertaken instead of individual adjustments or adjustments in a multihazard environment. To address these gaps, we employ a survey sample of 866 households in Oklahoma to understand households' danger control responses (protective hazard adjustments) for tornado and earthquake risks in Oklahoma. We apply the extended parallel processing model (EPPM) to categorize respondents according to their relative level of perceived threat and efficacy of protective actions in predicting the number of hazard adjustments they intend to or have adopted in response to tornadoes and induced earthquakes. In line with the EPPM, we found that households have the highest number of danger control responses when their perceived threat and efficacy are both high. Counter to the EPPM literature, we found low threat coupled with high efficacy moved some individuals toward the adoption of danger control responses in response to both tornadoes and earthquakes. When households have high efficacy, threat appraisals matter in tornado danger control responses but not in earthquake danger control responses. This EPPM categorization opens new research approaches for studies of natural and technological hazards. This study also provides information for local officials and emergency managers making mitigation and preparedness investments and policies.

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.

A Scoping Review of Emerging COVID-19 Health Communication Research in Communication and Media Journals

This article reports a scoping review of emerging research on COVID-19 health communication. We reviewed and analyzed 206 articles published in 40 peer-reviewed communication journals between January 2020 to April 2021. Our review identified key study characteristics and overall themes and trends in this rapidly expanding field of research. Our review of health communication scholarship during the early stages of the COVID-19 pandemic suggests that health communication scholars have risen to the challenges and interrogated important issues in COVID-19 communication at the individual, group, organizational, and societal levels. We identified important gaps that warrant future research attention including experimental research that seeks to test the causal effects of communication, studies that evaluate communication interventions in under-served populations, research on mental health challenges imposed by the pandemic, and investigations on the promise of emerging communication technologies for supporting pandemic mitigation efforts.

An evaluation of the quality of COVID-19 websites in terms of HON principles and using DISCERN tool

BACKGROUND

As many people relied on information from the Internet for official scientific or academically affiliated information during the COVID-19 pandemic, the quality of information on those websites should be good.

OBJECTIVE

The main purpose of this study was to evaluate a selection of COVID-19-related websites for the quality of health information provided.

METHOD

Using Google and Yahoo, 36 English language websites were selected, in accordance with the inclusion criteria. The two tools were selected for evaluation were the Health on the Net (HON) Code and the 16-item DISCERN tool.

RESULTS

Most websites (39%) were related to information for the public, and a small number of them (3%) concerned screening websites in which people could be informed of their possible condition by entering their symptoms. The result of the evaluation by the HON tool showed that most websites were reliable (53%), and 44% of them were very reliable. Based on the assessment results of the Likert-based 16-item DISCERN tool, the maximum and minimum values for the average scores of each website were calculated as 2.44 and 4.25, respectively.

CONCLUSION

Evaluation using two widely accepted tools shows that most websites related to COVID-19 are reliable and useful for physicians, researchers and the public.

Now What? Collective Sensemaking and Sensegiving in the Cystic Fibrosis Community in Sweden During the Initial Phase of the COVID-19 Pandemic

The COVID-19 pandemic's effects on people's lives and society induced a need for rapid individual and collective sensemaking, including communication forums enabling stakeholders in the health ecosystem to share information, solve problems, and learn. This study specifically focused on the needs of the patients and family caregivers living with cystic fibrosis (CF) or primary ciliary dyskinesia (PCD), conditions that lead to chronic infections and inflammation in the airways. We explored how CF and PCD patients, family caregivers, and clinicians collectively received, processed, and used information about COVID-19 to facilitate self-care and health care decisions at the beginning of the pandemic. We applied macrocognitive theory to analyze qualitatively the questions and answers exchanged in a series of six webinars facilitated by a CF learning network at the beginning of the pandemic (March - April 2020). We identified three macrocognitive functions: sensemaking, decision-making, and replanning. We further generated nine themes: (a) understanding the nature of COVID-19, (b) exploring self-care needs and possibilities, (c) understanding health care possibilities, (d) making decisions about prevention and testing, (e) managing COVID-19 within families, (f) adjusting planned care, (g) replanning chronic care management, (h) defining COVID-19 health care strategies, and (i) refining health care policies. The exchange of questions and answers played a central role in facilitating important cognitive processes, which enabled a rapid anticipation of needs and adaptation of services to support patients, family caregivers, and clinicians during the COVID-19 pandemic.

Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States

BACKGROUND

Using existing models of behavioral health promotion, specifically the Extended Parallel Process Model, previous research has identified factors that may impact engagement in preventive health behaviors during the COVID-19 pandemic such as perceived threat, perceived susceptibility to the threat, perceived severity, and perceived efficacy.

OBJECTIVE

This study aims to examine the role of perceived effectiveness of COVID-19 preventive behaviors, perceived susceptibility, perceived threat, and perceived severity of COVID-19 in participants' intentions to engage in Centers for Disease Control (CDC)-recommended individual health behaviors in the first year of the pandemic.

METHODS

In October 2020, a representative sample of 506 US adults completed a web-based survey through the RAND American Life Panel.

RESULTS

The study primarily found that participants who perceived that CDC-recommended health practices were effective had stronger intentions to engage in those practices. The second strongest correlate was participants' perceived severity of COVID-19 across the United States. Perceived effectiveness of recommended practices accounted for the largest variance in behavioral intention. However, analysis of individual behaviors indicated a mismatch in the behaviors perceived to be the most effective (avoiding sick people and mask-wearing) and those participants indicated intention to engage in (throwing away used tissues, avoiding sick people, and coughing into their elbows) in the next 30 days.

CONCLUSIONS

The authors recommend tailoring public health messaging to address the perceived threat of COVID-19 and self-efficacy. Thus, health promotion efforts should emphasize the effectiveness of CDC-recommended practices while highlighting the pandemic's severity. Additionally, rebuilding trust in public health messaging and messengers is necessary to increase perceived self-efficacy. As the COVID-19 pandemic continues, health messaging must continue to promote and build trust in CDC-recommended health practices and educate regarding the efficacy of vaccination and other preventive behaviors.

The impact of the intensity of media use on potential tourists' risk perception and travel protective behavioral intentions in COVID-19

Introduction

In light of the COVID-19 pandemic, there is an increased need for potential travelers to gather information about their trips to mitigate perceived risks. This study aims to understand the relationship between the intensity of media use (both new and traditional), epidemic risk perception, and tourism protection behavior intention among potential tourists.

Methods

A total of 491 valid questionnaires were collected in Shanghai, China. Factor analysis, path analysis, and effect analysis were conducted using SPSS and AMOS to examine the impact of different media types on epidemic risk perception and tourism protection behavior.

Results

The findings indicate a positive association between new media use intensity and epidemic risk perception, as well as an intention to adopt safety-conscious tourism behaviors. In contrast, traditional media usage is inversely associated with risk perception but has no significant influence on protective behavior. The results also highlight the role of demographic factors, such as age, education level, occupation, and income, in modulating the relationship between media usage and risk perception.

Discussion

The contrasting effects of new and traditional media suggest the need for a tailored approach in epidemic communication strategies. Public health officials should leverage new media to enhance risk perception and safety-oriented behaviors, while recognizing the role of traditional media in managing lower risk perceptions and assuaging panic. The study emphasizes the importance of personalized messaging based on demographic disparities in media usage and perception. The mediating role of risk perception in shaping protective behaviors offers insights for promoting adherence to safety protocols.

Conclusion

This study contributes to a comprehensive understanding of media influences during health crises, emphasizing the responsibility of media platforms in transmitting accurate information. The findings call for a nuanced approach to epidemic communication, considering the strengths and weaknesses of different media types. Segmented and personalized messaging strategies can cater to demographic variations in media usage and perception. Enhancing risk perception through tailored messaging can promote protective behaviors and effectively manage public sentiment during health crises.

Psychological distress among healthcare students in Poland from COVID-19 to war on Ukraine: a cross-sectional exploratory study

Objectives

Healthcare students went through a rough time in March 2022 due to extreme changes in the educational system (moving from online to stationary learning) and Ukrainian-Russian war circumstances. Our study aims to update knowledge about psychological distress and its impact on healthcare students in Poland after two years of the COVID-19 pandemic, followed by intense and political instability in Europe.

Methods

We conducted a cross-sectional study on healthcare students from Poznan University of Medical Sciences, Poland, from March to April 2022. The questionnaire included subjective retrospective 5-point Likert-scales ratings of anxiety, stress, and depression and self-reported information on various psychological distress predictors.

Results

The anxiety levels at the beginning of the COVID-19 pandemic were higher than in April 2022. There was no significant reduction in stress and depression. Females had higher initial anxiety levels than post-pandemic levels. Higher reported levels of anxiety, stress, and depression were significantly correlated with political instability in Eastern Europe (Spearman r_anxiety = 0.178, r_stress = 0.169, r_depression = 0.154, p ≤ 0.001, respectively). The concern about moving towards online education showed a significant association only with stress level (r_stress = 0.099, p = 0.034). We also observed a positive correlation between anxiety, stress, and depression and deteriorating sleep quality (Spearman r_anxiety,=0.325, r_stress = 0.410, r_depression = 0.440, p < 0.001), the feeling of worsening relationships with family and peers (r_anxiety = 0.325, r_stress = 0.343, r_depression = 0.379, p < 0.001), and the sense of loss of efficient time management (r_anxiety = 0.321, r_stress = 0.345, r_depression = 0.410, p < 0.001).

Conclusion

Throughout the progression of the Ukrainian war and the COVID-19 pandemic, females reported improved (lower levels) levels of anxiety. Nevertheless, the current levels of self-reported anxiety post-pandemic remain alarming, while stress and depression levels remained unchanged. Mental, psychological, and social support activities are required for healthcare students, especially those away from their families. Time management, academic performance, and coping skills in relation to the additional stressors of war and the global pandemic require further research in this group of students.

Public perceptions of air pollution and associated health risks in Nevada, USA: applications for health communication

BACKGROUND

We examine the extent to which acute and chronic health conditions motivate individuals to seek air quality information. We apply the theoretical elements of the Health Belief Model (HBM) to improve risk communication about ambient air pollution. We discuss the practical applications of HBM, in tandem with the principles of health communication, within an environmental health context.

METHODS

We test the predictive power of selected components related to the HBM (perceived susceptibility, perceived severity, and cues to action) for intentions to seek information about ambient air quality. We surveyed 325 individuals throughout Nevada where poor air quality poses a risk for vulnerable populations.

RESULTS

Ordinal logistic regression analyses showed that experiencing mucous membrane symptoms (eye itching, nose irritation, and dry throat/cough), perceived severity to future health threats, and having an at-risk member in the household positively and significantly predicted intentions to seek air quality information. Experiencing neuropsychological symptoms (fatigue, feeling heavy-headed, and nausea/dizziness), and having a cardiovascular or a respiratory condition did not have significant effects on reported intentions.

CONCLUSIONS

We discuss how the results of this study can be integrated into health communication practices to increase public engagement with air quality information as a personal intervention measure.

Risk and Health Communication during Covid-19: A Linguistic Landscape Analysis

Since the outbreak of Covid-19 health communicators around the globe have had to reach, urge, and persuade individuals and communities to adopt appropriate health protective behaviors. They have used a mix of communication channels, including outdoor media and public signage which are the focus of this paper. Drawing on a comparative linguistic landscape analysis, this paper critically examined the amount, content, and prominence of Covid-19 signage in Hackney, a London borough severely hit by the first wave of the pandemic. Having analyzed 1288 signs collected between May and July 2020, we found significant differences in Covid-19 signage between deprived and less deprived areas. These differences (e.g., in messaging about staying at home) have created inequalities in access to Covid-19 related health information and guidance. We also explored the changes in Covid-19 signage over time and the tailoring of risk and health messages to minority communities.

Predicting COVID-19 Vaccination Intention: The Roles of Institutional Trust, Perceived Vaccine Safety, and Interdependent Self-Construal

The purpose of this study is to explore the process through which institutional trust influences individuals' vaccination intentions for a coronavirus vaccine. We collected data from a national representative sample of the Spanish population (N = 500) from an online research panel to test the proposed conceptual model. Results revealed a positive association of institutional trust with coronavirus vaccination intentions. This effect was mediated by perceived vaccine safety and positive attitude toward the vaccine. Furthermore, findings corroborate the moderating effect of interdependent self-construal on the indirect relationship between institutional trust and vaccination intention, implying that this effect was stronger for individuals with higher levels of interdependent orientation. Findings have implications for the development of evidence-based health communication strategies for encouraging COVID-19 vaccination.

Danger control and fear control during public health emergencies: Considering the roles of fear and hope in the EPPM across different levels of trust

Public health emergencies pose considerable threats to global health and safety. The control of these emergencies requires the efforts of healthcare professionals and calls for the public to take protective actions. The present study not only puts fear back in the extended parallel process model (EPPM) but also considers another similarly productive emotion: hope. We examined the mechanisms behind the effects of four cognitive perceptions on protective actions (i.e., danger control) and information avoidance (i.e., fear control). A national online survey was conducted with 1676 participants during the outbreak of COVID-19 in China from February 1 to 29, 2020. The results revealed that perceived severity and susceptibility could lead to fear, positively affecting protective actions. On the other hand, perceived response efficacy and self-efficacy induced hope, which was positively associated with protective actions but negatively associated with information avoidance. Furthermore, the mechanisms behind the relationships among cognitions, emotions, and behaviors varied across levels of trust in healthcare systems.

Social Distancing during the COVID-19 Pandemic in Switzerland: Health Protective Behavior in the Context of Communication and Perceptions of Efficacy, Norms, and Threat

The success of health protection measures depends on public compliance. This paper aims to understand the influence of three different types of communication (i.e., news media, social media, and interpersonal communication) on people's engagement in health protective behavior during a public health crisis. Our C-ENT model of health protective behavior proposes that communication raises perceptions of efficacy, norms, and threat, which in turn influence health protective behavior (communication → efficacy, norms, threat: C-ENT). We test the model for the case of social distancing during the COVID-19 pandemic, based on a representative online survey during the first week of the lockdown in Switzerland (N = 1005). The results support the C-ENT model and illustrate the important role of communication engagement during a public health crisis. News media use was associated with perceptions of behavior-related efficacy and norms and disease-related threat, and these perceptions were positively associated with compliance with social distancing. Social media use and interpersonal communication were related with perceived norms. Social media use was negatively and interpersonal communication positively associated with health behavior-supporting normative perceptions. Our findings suggest taking the distinct pattern among communication types (i.e., news media, social media, and interpersonal communication), perceptions, and behavior into account in order to understand existing dependencies and design respective communication strategies.

How perceived risk influences college students' preventive behavior: Novel data of COVID-19 campus lockdown from Wuhan, China

Following preventive behaviors is a key measure to protect people from infectious diseases. Protection motivation theory (PMT) suggests that perceived risk motivates individuals to take protective measures. The COVID-19 pandemic has posed unprecedented stress to the public, and changes in perceived risk may be more pronounced among college students than among other groups due to the related campus lockdown. With 1,119 college students recruited as research subjects, a quantitative research was conducted in Wuhan, China, to deduce the relationship between the perceived risk and preventive behavior of college students, as well as between the mediation effect of individual affect and the moderating effect of physical exercise. The results showed that the preventive behavior of college students was significantly affected by perceived risk, and both positive affect and negative affect played a mediating role between perceived risk and preventive behavior. Specifically, positive affect aided the relationship between perceived risk and preventive behavior, negative affect was detrimental to their relationship, and the mediation effect of positive affect is significantly higher than that of negative affect. Furthermore, physical exercise played a moderating role in the mediation effects of positive affect and negative affect. Therefore, appropriate measures should be taken to strengthen Chinese college students' perceived risk and provide them with corresponding guidance. The importance of physical exercise should also be emphasized to help college students with low perceived risk reduce negative affect, increase positive affect, and promote their preventive behavior.

Worldview Orientations and Personal and Social Risk Perceptions for COVID-19 in a U.S. Population-Based Sample

Adoption of COVID-19 preventive behaviors involves considering personal risk and the risk to others. Consequently, many COVID-19 prevention measures are intended to protect both the individual engaging in the behavior and others in the population. Yet, the preponderance of research is focused on perceptions of an individual's personal risk, making risk perception for others a critical area for investigation. Two worldview orientations describing values regarding how society should be organized, hierarchy-beliefs prioritizing social hierarchy, and individualism-beliefs prioritizing personal autonomy, have been linked to a range of risk perceptions. This study objective is to examine the association of worldview orientations with COVID-19 risk perceptions for oneself and others in a United States context. Using a national sample of 410 U.S. adults, we examined the associations between worldview orientations and six facets of risk (absolute risk, risk certainty, comparative risk, risk severity, fear, feelings of risk) using demographics-adjusted multivariable regression models. We conducted separate analyses for each of the following referents: (1) personal risk, (2) risk for the average person within the United States, and (3) risk to people within specific social groups (e.g., family, co-workers). Results indicate that stronger hierarchical and individualistic orientations were associated with lower COVID-19 risk perceptions for all three referents. The results were particularly consistent for fear and feelings of risk. Individualism was related to higher risk perception certainty for personal risk and the risk to people within specific social groups. Hierarchy was related to lower perceived severity for all referents. Findings suggest that U.S. public health messaging sensitive to worldview orientations may be needed to optimize acceptance of recommendations for protective behaviors, including vaccination. The relationship of worldview orientations to health risk perceptions may help guide messaging for future infectious outbreaks where risk perceptions are t drivers of protective behavior.

Communicating COVID-19 Risk on Instagram: A Content Analysis of Official Public Health Messaging During the First Year of the Pandemic

Early in the COVID-19 pandemic, social media platform Instagram surged in popularity as a source of health information. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) leveraged Instagram accounts to publicly distribute COVID-related information. The current study investigated whether WHO and CDC messaging strategies on Instagram adhered to best practices defined by two theoretical frameworks: the extended parallel process model and crisis and emergency risk communication. We conducted a quantitative content analysis of COVID-related posts (n = 726) published between January-December 2020 to determine how both agencies (1) communicated the threat of the pandemic (e.g. susceptibility and severity of negative COVID-19 consequences); (2) appealed to self-, response, and collective efficacy; (3) incorporated cues to action (e.g. preventive behaviors, information seeking); and (4) leveraged credibility cues (e.g. scientific evidence, experts). Results showed threat information was limited, whereas efficacy appeals and cues to action were abundant. The CDC relied more heavily on depictions of self- and response efficacy, whereas the WHO appealed more frequently than the CDC to collective efficacy. Neither visually modeled behaviors nor leveraged scientific evidence or experts with great frequency. Implications for future research and official communication efforts via social media are discussed.

The effects of information framing on self-protective behavior: Evidence from the COVID-19 vaccine uptake

Objectives

The Healthy China 2030 strategy outlines the government's plans for healthcare reform, emphasizing the need for increased awareness about infectious diseases to prevent and fight future infections. Information campaigns can be used as a medium to raise awareness and encourage citizens' willingness to protect themselves against diseases, such as COVID-19. Extant studies have found that individual health behavior decision-making can be changed under different information frames. However, limited evidence is available about emerging infectious diseases. Based on the Prospect Theory and Theory of Planned Behavior, the impact of information frames on self-protective behavior-vaccination against COVID-19 is investigated in this study.

Methods

A 2(gain/loss frame)*2(factual/emotional frame) intergroup experimental design was designed to explore the effects of different information frames. 228 valid participants in China were recruited and the experiment was performed online.

Results

First, the gain frame was more effective in promoting public self-protection behavior than the loss frame under information frame intervention. Compared with the factual frame, the emotional frame is more effective in reducing individual risk perception. Second, perceptual behavior control has masking effects on self-protection behavior under the influence of the gain/loss frame. Third, age, subjective norms, attitudes, and the gain frame, have predictive effects on self-protection behavior.

Conclusions

This study provides empirical evidence on the impact of information framing interventions on public self-protection behavior during the COVID-19 pandemic and provides important practical implications for public administrators and media practitioners.

Application of behavioral change theory and models on COVID-19 preventive behaviors, worldwide: A systematic review

Objective:

This systematic review aimed to assess the global application of behavioral change theory and models on COVID-19 preventive behaviors.

Methods:

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Databases such as PubMed/MIDLINE, Web of Science, Scopus, EMB ASE, World Health Organization libraries, and Google Scholar were used to search all published articles in the area of application of behavioral change theory and model on COVID-19 preventive behavior until October 1, 2022. Studies published in another language other than English were excluded. Two independent reviewers did the article selection and quality check. A third reviewer asked if any disagreement were found.

Result:

Seventeen thousand four hundred thirty-six total articles were retrieved from all sources after the removal of duplicated articles and those not evaluating the outcome of interest were excluded. Finally, 82 articles done using behavioral change theory and model on COVID-19 preventive behaviors were included. The health belief model (HBM) and theory of planned behavior (TPB) were most commonly used in COVID-19 preventive behaviors. The constructs of most behavioral theories and models were significantly associated with COVID-19 preventive behaviors such as hand washing, face mask use, vaccine uptake, social isolation, self-quarantine, social distance, and use of sanitizers.

Conclusion:

This systematic review summarizes comprehensive evidence on the application of behavioral change theory and model on COVID-19 preventive behaviors globally. A total of seven behavioral change theories and models were included. The HBM and TPBs were most commonly used for COVID-19 preventive behaviors. Therefore, the application of behavioral change theory and models is recommended for developing behavioral change interventional strategies.

Red Media, Blue Media, Trump Briefings, and COVID-19: Examining How Information Sources Predict Risk Preventive Behaviors via Threat and Efficacy

Upon the growing concern over a massive infodemic and politicization of health issues during the COVID-19 pandemic, this study investigated how individuals' use of partisan media and Trump briefings, along with other information sources, predicts risk preventive behaviors. Drawing on the Extended Parallel Process Model (EPPM), our survey analysis (n= 1,106) revealed that those obtaining COVID-19 information from conservative media and Trump briefings were less likely to believe that COVID-19 is a serious threat (perceived threat) and that recommended preventive behaviors are effective and feasible (perceived efficacy). These beliefs, in turn, resulted in their decreased intentions to adopt risk preventative behaviors. In contrast, those who got COVID-19 information from liberal media, health organizations' briefings, and traditional media reported heightened threat and efficacy perception, which, in turn, led to their willingness to take risk preventive actions.

Evolving perceptions of COVID-19 vaccines among remote Alaskan communities

Given the dynamic nature of the ongoing pandemic, public knowledge and perceptions about COVID-19 are evolving. Limited transportation options, inconsistent healthcare resources, and lack of water and sanitation infrastructure in many remote Alaskan communities located off the road system have contributed to the experience of the COVID-19 pandemic in these areas. We used longitudinal surveys to evaluate remote Alaskan residents' early vaccine acceptance, vaccine uptake and motivations, risk perceptions regarding COVID-19 vaccines, and likelihood of getting a booster. Slightly over half of respondents showed early vaccine acceptance (November/December 2020), with the highest rate among those over the age of 65 years. However, by March 2021, 80.7% of participants reported receiving the COVID-19 vaccine or planning to get one. Of the unvaccinated, reasons for not getting a vaccine included concerns about side effects and not trusting the vaccine. By September 2021, 88.5% of people had received two doses of a COVID-19 vaccine and 79.7% said they would get the booster (third dose) when it became available. There were misconceptions about vaccine recommendations for pregnant women and effects on fertility and DNA. Although initial vaccine concerns may have subsided, the booster rollout and forthcoming vaccines for youth under 12 years of age present new hurdles for vaccine communication efforts.

The knowledge, attitudes and practices of hand, foot, and mouth disease prevention strategies amongst parents and educators of children under 5 years amidst COVID-19 pandemic: A cross-sectional study

Background

Hand, foot, and mouth disease (HFMD) is endemic in Singapore. Prevention efforts have been ramped up since major outbreaks in the early 2000's. This study aims to assess the current knowledge, and attitudes towards and practise (KAP) levels of HFMD prevention strategies (HFMD-PS) amongst parents and teachers of children under 5 years amidst the COVID-19 pandemic.

Methods and results

A convenience sample of 240 teachers and 404 parents responded to a self-administered standardised questionnaire between mid-October and December 2020. A scoring framework was used to assess responses in the 'knowledge', 'attitude', and 'practice' domains. A multivariable analysis was adjusted for ethnicity and attitudes towards getting children to follow proper handwashing steps and regularly disinfecting children's toys amongst parents, knowledge about HFMD's infectious period, and the responses to a child turning symptomatic in the childcare centre amongst teachers. Existing levels of knowledge and attitudes of parents and teachers were not high, and only a small proportion practised high levels of prevention measures (99 parents and 28 teachers). Key facilitators for a higher practise level in parents include the following: (1) awareness of regular liquid soap's efficacy as a disinfectant, (2) toy cleaning before and after playtime, and (3) the cleaning agent used for this practise. Teachers had no significant factors associated with higher practise levels.

Conclusion

This study suggested potential gaps between positive knowledge and attitudes towards prevention strategies and their actual adoption levels in homes and childcare centres during COVID-19 pandemic. These evidences suggest the importance of continuous promotion of HFMD prevention practise in homes and childcare centres, even amidst pandemics.

A Health Crisis in the Age of Misinformation: How Social Media and Mass Media Influenced Misperceptions about COVID-19 and Compliance Behavior

The media are important information disseminators in society. Particularly in uncertain times, such as the COVID-19 pandemic, citizens are very "media dependent." The way in which people are informed about the coronavirus heavily depends on the type of media they use. Especially on social media, the share of misinformation is considerable, which might impact the way in which people comply with preventive measures. Our study investigates how media use affects misperceptions about the coronavirus and whether this influences important behavioral determinants as well as compliance behavior itself. The results of a unique 5-wave panel survey (N = 1,741) conducted between April 2020 and October 2020 show that the use of mass media reduces misperceptions. The same was found for Twitter users, whereas Facebook and Instagram users have more misperceptions about the coronavirus. Misperceptions negatively influence the perceived severity, susceptibility and efficacy of preventive measures taken by governments, which may ultimately result in decreased compliance. Our findings underline the important role of media consumption and misperceptions in shaping citizens' beliefs and behavior regarding COVID-19. They re-emphasize the importance of mass media, such as newspapers, television broadcasts or reliable news websites, to inform the public about current affairs. They also imply that platform media might be more heterogeneous in their effects than mass media.

Risk-Likelihood Perceptions and Preventive Behaviors Against Infectious Diseases: Testing Different Types of Risk-Likelihood Perceptions in the Context of MERS and COVID-19

Effective public health communication should take into the consideration how communicated risk perceptions might influence the public. Although many health behavior theories claim that high perceived risk likelihood motivates preventive health behaviors, this general prediction is complicated by different ways of estimating risk likelihood. Our review of 14 previous studies on perceived risk of infectious diseases revealed different measures of risk likelihood and inconsistent findings regarding the relationship between perceived risk likelihood and behavioral intention. Drawn from the review, we examined the predictive power of different types of risk likelihood on intention to prevent infectious diseases. Using two separate data sets, collected during the 2015 outbreak of the Middle East respiratory syndrome (N = 557) and the COVID-19 pandemic of 2021 (N = 1,001), we demonstrated that perceived risk likelihood that specifies future inaction on health behaviors (i.e., conditional absolute risk perception) better predicted behavioral intention than did other types of risk perceptions. When the effect of conditional absolute risk perception was controlled, the behavioral intention and unconditional absolute risk perception showed a negative relationship. The findings have theoretical and practical implications that can inform strategic communication during future outbreaks.

A content analysis of Canadian influencer crisis messages on Instagram and the public’s response during COVID-19

Successful mitigation of emerging infectious disease requires that the public adopt recommended behaviours, which is directly influenced by effective crisis communication. Social media has become an important communication channel during COVID-19 where official actors, influencers, and the public are co-creating crisis messages. Our research examined COVID-19-related crisis messages across Canadian influencer accounts within news media, politicians, public health and government, science communicators, and brand influencer and celebrities, posted on Instagram between December 2019 and March 2021 for Health Belief Model and Extended Parallel Processing Model constructs and the corresponding public comment sentiment and engagement. Thirty-three influencer accounts resulted in a total of 2,642 Instagram posts collected, along with 461,436 comments, which showed overall low use of constructs in both captions and images. Further, most posts used no combinations (n = 0 or 1 construct per post) of constructs in captions and images and very infrequently used captions that combined threat (severity and susceptibility) with cues to action and efficacy. Brand influencers and celebrities, politicians, and science communicators had above average post engagement while public health and government and news media had lower. Finally, most influencers saw the largest proportion of neutral sentiment comments. Crisis messages must be designed to include combinations of constructs that increase message acceptance and influence risk perception and efficacy to increase the adoption of recommended and mandated behaviours.

Should I buy or not? Revisiting the concept and measurement of panic buying

Following various precautionary measures as executed by the government to curb the transmission of COVID-19, erratic changes in the form of temporary lockdowns and movement restrictions have created an emergency phenomenon-panic buying. While such consequence has emerged as a timely and relevant topic, reviewed literature indicate an apparent oversight for portraying panic buying through the perspectives of impulsive and compulsive consumptions. Given the gap in the association between panic buying and consumers' emotional aspects within the context of the COVID-19 pandemic, this study aspires to develop a contemporary measurement that accurately defines panic buying as a research variable. A combined methodology was hereby adopted, with the employment of qualitative inquiries towards the scale development of panic buying. Following this, quantitative data as collected from a total sample of 600 respondents through an online survey was analysed via both SPSS and AMOS statistical software towards scale assessment and hypothesis testing. Obtained findings uncovered the direct significance of both personal (fear, perceived risk, and perceived scarcity) and social (word-of-mouth and social media) factors on panic buying during the pandemic, whilst having indirect significance on the ensuing post-purchase regret. Impulsivity was further confirmed to exert a substantial moderating impact on the correlation between panic consumption and post-purchase emotional distress. Implications of the study are ultimately discussed.

Risk Perception towards COVID-19: A Systematic Review and Qualitative Synthesis

Several studies have attempted to identify how people's risk perceptions differ in regard to containing COVID-19 infections. The aim of the present review was to illustrate how risk awareness towards COVID-19 predicts people's preventive behaviors and to understand which features are associated with it. For the review, 77 articles found in six different databases (ProQuest, PsycInfo, PubMed, Science Direct, SCOPUS, and Web of Science) were considered, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was followed, and data synthesis was conducted using a mixed-methods approach. The results indicate that a high-risk perception towards COVID-19 predicts, in general, compliance with preventive behaviors and social distancing measures. Additionally, risk awareness was found to be associated with four other key themes: demographic factors, individual factors, geographical factors, and timing. Therefore, gaining a greater understanding of individual and cultural differences as well as how people behave could be the basis of an effective strategy for raising public risk awareness and for countering COVID-19.

Influence of COVID-19 Crisis on Motivation and Hiking Intention of Gen Z in China: Perceived Risk and Coping Appraisal as Moderators

People’s lives have drastically changed since the outbreak of COVID-19. One concern during the pandemic has been the level of inactivity among people. Compared to various generations (e.g., baby boomers, generation alpha), Generation Z (Gen Z) traditionally spends much less time in outdoor spaces. Due to the pandemic, their inactiveness is assumed to be even more severe. Hiking, an outdoor activity, has become a possible remedy for young people to exercise in a safer sport environment compared to traditional facility-based activities. Although various studies have supported the link between motivations and hiking intention, the relationship may be altered based on psychological influences unique to the pandemic situations—perceived risk and coping appraisals. The current study was conducted to investigate the relationship between Gen Z’s motivations and hiking intention and moderating roles of perceived risk and coping appraisals in a pandemic environment. Data were collected from Gen Z between 18 and 24 in China (N = 407). The validity and reliability of all the constructs were assessed by confirmatory factor analysis (CFA), average variance extracted (AVE), and composite reliability. For testing hypotheses, PROCESS Macro 4.0 was used. The findings proposed that the appraisals of the pandemic situation (i.e., perceived risk and coping ability) moderated the relationship between two of the motivations—intellectual and destination motivations—and hiking intention. As a result, organizers of outdoor sports programs can implement viable strategies and take valid measurements to minimize the fear and worries among people in the time of the crisis.

Associations Between COVID-19 Information Acquisition and Vaccination Intention: The Roles of Anticipated Regret and Collective Responsibility

While public health communication has been suggested to be a key for improving acceptance of COVID-19 vaccination, this study tested mediation pathways through which three types of vaccine information acquisition, i.e. seeking, scanning, and discussing, affect COVID-19 vaccination intention. The pathways comprise two mediators, i.e. anticipated regret due to inaction and collective responsibility. Results suggest that information seeking and discussing may have encouraged the intention to get vaccinated, but mainly indirectly through the two mediators. Information seeking and discussing may have elicited anticipated regret and collective responsibility, which in turn increased vaccination intention. The paths from information scanning were smaller in effect sizes and statistically unacknowledged. Implications and limitations are discussed.

Evaluating the Impact of Verified Government Accounts on the Knowledge, Attitudes, and Intentions of Saudi Residents During the COVID-19 Pandemic

Governments utilize various media channels to disseminate knowledge pertaining to infectious diseases such as COVID-19. When it was declared a pandemic, society began to depend on the media for critical information and countermeasures that would facilitate tackling the virus. The main objective of this research is to examine the impact of verified Saudi government accounts across various media outlets on respondents’ knowledge, attitudes, and intentions regarding COVID-19.A structured online questionnaire was distributed and 315 responses were used for analysis. The results were analyzed using SPSS. The results indicate that the residents of Saudi Arabia have adequate knowledge concerning the symptoms, precautionary measures, and modes of transmission of COVID-19. The respondents have gained this knowledge from verified Saudi government accounts across various media outlets, most prominently via social media..

Does media slant polarize compliance with science-based public health recommendations? Effects of media consumption patterns on COVID-19 attitudes and behaviors in the United States

Has political polarization undermined the media' informational role during the COVID-19 pandemic? Recent studies show that politicized reporting from conservative media discouraged compliance with COVID-19 guidelines in the U.S. However, greater attention to the 24-hour news cycle may make high-consumption viewers better factually informed regardless of the source. We examine how the extent of media consumption affects people's emotions, attitudes, and behaviors toward the pandemic. With an online survey of 1128 respondents, we found a strong convergence in anxiety and health-protective behaviors in more avid media viewers regardless of media outlet while finding a divergence in attitudes toward specific mitigation strategies.

Compliance with the main preventive measures of COVID-19 in Spain: The role of knowledge, attitudes, practices, and risk perception

In epidemics such as COVID‐19, major changes need to be made to the population's behavior to prevent infection and stop disease transmission. The three most recommended preventive measures are wearing a mask, washing hands with soap or hydroalcoholic gel, and watching an interpersonal distance of at least two meters (3W) from other people. This study aimed to assess adherence to these COVID‐19‐related three preventive measures and its association with knowledge, attitudes, risk perception, and practices in Spain. The COSMO‐Spain survey, based on the WHO Behavioral Insights questionnaire on COVID‐19, was conducted in the general Spanish population using an online questionnaire (n = 1,033). Sociodemographic, knowledge, attitudes, practices, and risk perception variables were included. A multivariable logistic regression model was carried out to evaluate the factors associated with compliance with the three preventive measures. Half of the respondents (49.8%) were women with a median age of 45 (Inter‐quartile Range, IR = 21) years. In the logistic regression, the factors associated with 3W compliance were being over 45 years; knowing about how COVID‐19 spreads and wearing masks properly; appropriate attitudes towards COVID‐19 (greater agreement with mandatory mask use); high risk perception (feeling that the coronavirus is spreading rapidly, being concerned about non‐mask wearers), and adherence to other preventive measures against COVID‐19, such as staying at home. Adequate knowledge, attitudes and risk perception are determinants of 3W compliance. Developing effective health education programs and frequent communication strategies are necessary, particularly for those who adhere less to preventive measures.

Hand hygiene during the COVID-19 pandemic among people experiencing homelessness-Atlanta, Georgia, 2020

People experiencing homelessness are at risk for coronavirus disease 2019 (COVID-19) and may experience barriers to hand hygiene, a primary recommendation for COVID-19 prevention. We conducted in-depth interviews with 51 people experiencing sheltered and unsheltered homelessness in Atlanta, Georgia during May 2020 to August 2020 to (1) describe challenges and opportunities related to hand hygiene and (2) assess hand hygiene communication preferences. The primary hand hygiene barrier reported was limited access to facilities and supplies, which has disproportionately impacted people experiencing unsheltered homelessness. This lack of access has reportedly been exacerbated during COVID-19 by the closure of public facilities and businesses. Increased access to housing and employment were identified as long-term solutions to improving hand hygiene. Overall, participants expressed a preference for access to facilities and supplies over hand hygiene communication materials.

Impact of Sex on COVID-19 Media Exposure, Anxiety, Perceived Risk, and Severity in Middle-Aged and Older Adults

OBJECTIVES

To examine associations between COVID-19 media exposure and anxiety/perceived risk/severity and investigate their dependency on sex in middle-aged/older adults.

METHODS

Adults aged 50+ years completed online surveys: Coronavirus Anxiety Scale, COVID-19 media exposure, COVID-19 media dependency for health information, and COVID-19 perceived risk and severity. Multiple regressions examined independent and interactive (with sex) associations between COVID-19 media exposure/dependency and COVID-19 anxiety/perceived risk and severity. Analyses controlled for age, education, race, total medical conditions, and COVID-19 status.

RESULTS

Higher COVID-19 media exposure was associated with higher COVID-19 anxiety among men (not women) and higher perceived risk/severity in both sexes. Higher COVID-19 media dependency was associated with higher COVID-19 anxiety and perceived risk/severity in both sexes.

CONCLUSION

In middle-aged/older adults, the use/dependency of media for COVID-19 information may be linked to negative psychological health and increased COVID-19 perceived risk and severity. Men may be at increased risk of anxiety related to media exposure.

Development of the 12-Item Social Media Disinformation Scale and its Association With Social Media Addiction and Mental Health Related to COVID-19 in Tunisia: Survey-Based Pilot Case Study

BACKGROUND

In recent years, online disinformation has increased. Fake news has been spreading about the COVID-19 pandemic. Since January 2020, the culprits and antidotes to disinformation have been digital media and social media.

OBJECTIVE

Our study aimed to develop and test the psychometric properties of the 12-item Social Media Disinformation Scale (SMDS-12), which assesses the consumption, confidence, and sharing of information related to COVID-19 by social media users.

METHODS

A total of 874 subjects were recruited over two phases: the exploratory phase group had a mean age of 28.39 years (SD 9.32) and the confirmatory phase group had a mean age of 32.84 years (SD 12.72). Participants completed the SMDS-12, the Internet Addiction Test, the COVID-19 Fear Scale, and the 10-item Perceived Stress Scale. The SMDS-12 was initially tested by exploratory factor analysis and was subsequently tested by confirmatory factor analysis.

RESULTS

The test supported the three-factor structure. In addition, no items were removed from the measurement scale, with three factors explaining up to 73.72% of the total variance, and the items had a lambda factor loading ranging from 0.73 to 0.85. Subsequently, confirmatory factor analysis confirmed the robustness of the measure by referring to a wide range of goodness-of-fit indices that met the recommended standards. The construct validity of the scale was supported by its convergent and discriminant validity. The reliability of the instrument examined by means of three internal consistency indices, and the corrected item-total correlation, demonstrated that the three dimensions of the instrument were reliable: Cronbach α values were .89, .88, and .88 for the consumption, confidence, and sharing subscales, respectively. The corrected item-total correlation ranged from 0.70 to 0.78. The correlation of the instrument's dimensions with internet addiction and mental health factors showed positive associations.

CONCLUSIONS

The SMDS-12 can be reliably utilized to measure the credibility of social media disinformation and can be adapted to measure the credibility of disinformation in other contexts.

Battling for Consumer's Positive Purchase Intention: A Comparative Study Between Two Psychological Techniques to Achieve Success and Sustainability for Digital Entrepreneurships

This research focuses on students' online purchase intentions in Pakistan toward different products available for sale on numerous e-business websites. This study's main objective is to determine which methodology is better to enhance customer online purchase intention. It also aims to discover how to improve perceived benefits and lower perceived risks associated with any available online product and entrepreneurship. AMOS 24 has been used to deal with the mediation in study design with bootstrap methodology. The study was conducted on 250 students from different educational institutes in Pakistan using a simple random sampling technique. A finding of this study suggests that both methods positively impact online purchase intention of consumers and sustainable digital economy. But social media advertisement is more effective through enhancing the perceived benefits of products. In contrast, product content factors are more effective at lowering the perceived risks associated with available online products.

Receptivity of Governmental Communication and Its Effectiveness During COVID-19 Pandemic Emergency in Vietnam: A Qualitative Study

Vietnam is considered as one of the countries with the earliest and most effective responses to the outbreak of 2019 novel coronavirus disease (COVID-19), a pandemic with acute respiratory syndrome caused by the new strain of coronavirus (SARS-CoV-2). An important contribution to the overall success is the effectiveness of the governmental communication strategy in achieving the desired cognitive, affective, and behavioral outcomes. Analysis of the qualitative data collected from twelve focus group discussions with a total of 60 participants revealed that due to the government’s communication efforts, Vietnamese people have adequate information/knowledge about the COVID-19 pandemic, and majority of them experience low emotional levels of anxiety, fear, dread, stress, and panic. Moreover, the communication strategy has helped to form both health-promoting and safety-seeking behaviors among the community. Further, the characteristics of an effective communication strategy such as reliable sources of communication, usages of multiple social media channels, and transparent message contents in the form of infographic or video clips are identified.