Behavioral biases and heuristics in perceptions of COVID-19 risks and prevention decisions

From Hesitancy to Acceptance: An Interpretative Approach to Unravel the Vaccination Motivation Among the Rural Population

Our study focuses on vaccination decisions within a collectivistic framework, prioritizing social and behavioral factors over individualistic views amidst COVID-19. Integrating behavioral biases and social ties, we inform targeted public health communication strategies. Examining vaccine uptake in rural India, we use Interpretative Phenomenological Analysis (IPA) to interpret deviations, capturing personal experiences and biases. Through the COM-B model and 25 interviews, we uncover motivations influenced by individual, family, and community factors. Synthesizing findings, we propose tailored public health communication grounded in behavioral psychology. Rather than disregarding biases, we explore their implications for effective interventions. This research advances health communication, particularly benefiting lower-middle-income countries with non-pharmacological approaches.

Health Decisions Under Uncertainty: The Roles of Conspiracy Beliefs and Institutional Trust

Research on vaccination hesitancy has been extensive, but the role of information processing in decision making still needs to be explored. The study examines the alignment between parents' COVID-19 vaccination intentions and actual behavior, focusing on the impact of different kinds of information processing on the consistency or inconsistency of these behaviors. It analyzes parents' reliance on health information sources, and education levels, with institutional trust, ability to critically evaluate conspiracy theories and scientific knowledge as moderators. A total of 1118 Israeli parents participated in digital surveys and were classified into the following 4 groups based on their initial vaccination intentions and actual behaviors: (1) consistent-pro-vaccine and vaccinated; (2) inconsistent-pro-vaccine but unvaccinated; (3) inconsistent-anti-vaccine but vaccinated; and (4) consistent-anti-vaccine and unvaccinated). The results show that consistent parents process information using system 1, i.e., heuristic information processing, reliance on health information sources, moderated by institutional trust and education. However, inconsistent parents used systems 1 and 2, namely heuristic-systematic information processing, influenced by knowledge of COVID-19 and the ability to assess conspiracy theories critically.

Reconstructing Risk Dimensions in Telemedicine: Investigating Technology Adoption and Barriers During the COVID-19 Pandemic in Taiwan

BACKGROUND

The COVID-19 pandemic has shifted health care toward virtual and online models, impacting both users and providers. Numerous user concerns and perceived risks related to telemedicine are continually evolving and adjusting in response to the pandemic. In many countries, there has been a substantial increase in the use of virtual health care visits, which offers a unique opportunity for researchers to explore these user concerns.

OBJECTIVE

This study aimed to first reconstruct the risk dimensions associated with telemedicine, then identify the risk factors affecting users' adoption, and finally propose effective solutions to mitigate these concerns. By integrating the newly constructed perceived risk with the technology acceptance model (TAM), we scrutinized various dimensions of perceived risk and their influence on users' perceptions of ease of use, perceived usefulness, and use intention (UI).

METHODS

Our target population consists of adults aged ≥18 years who have used or may use telemedicine services, recruited through an anonymous, voluntary, open, web-based survey. We collected responses and used part of them to reconstruct risk dimensions using exploratory factor analysis. Subsequently, we analyzed the intricate relationship between perceived risk, the TAM, and the acceptance of telemedicine using structural equation modeling with another part of the responses.

RESULTS

A total of 1600 valid responses were collected. Eight distinct risk dimensions were reconstructed, revealing a substantial negative impact of performance risk on UI. The psychological and social risk was the strongest barrier to the ease of using telemedicine. Time risk, provider risk, and privacy risk were not statistically significant to the TAM. The resulting model elucidates a remarkable 66% variance in UI for telemedicine services.

CONCLUSIONS

This study substantially advances the field of telemedicine research by reconstructing and redefining 8 risk dimensions and confirming the statistical significance of 5 perceived risks on the adoption of telemedicine services. These insights are poised to facilitate the promotion and enhancement of telemedicine services in the health care sector.

Interdependency or submission to authority? The impacts of horizontal and vertical collectivist orientation on vaccine attitudes in mainland China

Culture has a profound impact on preventive measures during the COVID-19 pandemic. Previous research has revealed that collectivism is associated with more effective responses to COVID-19 on the national or regional level. However, the impact of different components of collectivist orientation on vaccine attitudes remains insufficiently explored on the individual level. Two survey studies conducted in August 2021 in mainland China consistently found that individual-level horizontal collectivist orientation, rather than vertical collectivist orientation, was linked with more favourable vaccine attitudes. Specifically, Study 1 (N = 731) indicated that horizontal collectivist orientation was positive associated with vaccination intention indirectly via risk perception, and horizontal collectivist orientation was also positively associated with vaccination persuasion both directly and indirectly via risk perception. Study 2 (N = 1481), employing multilevel modelling, demonstrated that the link between horizontal collectivist orientation and confidence in vaccines remained robust regardless of provincial-level variations in socioeconomic development and cultural tightness. These findings convergently suggest that the positive vaccine attitudes among mainland Chinese are primarily driven by an amplified risk perception due to concern for others, rather than submission to authority.

The impact of epidemic experiences on biosecurity behavior of pig farmers: an analysis based on protection motivation theory

Farm biosecurity is considered an important component of "One Health". Biosecurity measures are crucial for preventing and controlling outbreaks and spread of diseases on farms. Protection motivation theory (PMT) links perception of risk and coping ability with taking preventive actions. Based on field survey data of pig farmers, this study utilizes OLS and mediating effect model to explore the impact and mechanism of epidemic experiences on farmers' implementation of biosecurity measures. The research findings are as follows: first, epidemic experiences significantly promote farmers' implementation of biosecurity measures. The conclusion remains robust after addressing potential endogeneity issues. Second, epidemic experiences, through accumulated experience, further encourage farmers to implement biosecurity measures. Third, the impact of epidemic experiences on farmers' biosecurity behavior shows heterogeneity in farm size. Compared to small-scale farmers, epidemic experiences have a greater promoting effect on biosecurity behavior of professional farmers. Therefore, emphasizing farmers' epidemic experiences, enhancing biosecurity training, and increasing farmers' awareness are of significant importance in promoting farmers' implementation of biosecurity measures.

Portrayal of risk information and its impact on audiences' risk perception during the Covid-19 pandemic: A multi-method approach

Over the last years, infectious diseases have been traveling across international borders faster than ever before, resulting in major public health crises such as the Covid-19 pandemic. Given the rapid changes and unknown risks that mark such events, risk communication faces the challenge to raise awareness and concern among the public without creating panic. Drawing on the social amplification of risk framework-a concept that theorizes how and why risks are amplified or attenuated during the (1) transfer of risk information (by, for instance, news media) and (2) audiences' interpretation and perception of these information-we were interested in the portrayal of risk information and its impact on audiences' risk perception over the first wave of the Covid-19 pandemic in Germany. We therefore conducted a quantitative content analysis of a major public and private television (TV) newscast (N = 321) and combined it with survey data (two-wave panel survey, t1: N = 1378 and t2: N = 1061). Our results indicate that TV news (as a major information source at that time) were characterized by both risk-attenuating and risk-amplifying characteristics, although risk-amplifying attributes were particularly pronounced by the private TV newscast. Notably, those who only used private TV news between both waves showed the highest perceived severity at time 2. However, the interaction effect of time and use of public and/or private TV news was only significant for perceived susceptibility. Overall, more research is needed to examine the effects of different types of media and changes in risk perceptions over time.

Modeling prevention behaviors during the COVID-19 pandemic using Bayesian belief networks and protection motivation theory

Prevention behaviors are important in mitigating the transmission of COVID-19. The protection motivation theory (PMT) links perceptions of risk and coping ability with the act of adopting prevention behaviors. The goal of this research is to test the application of the PMT in predicting adoption of prevention behaviors during the COVID-19 pandemic. Two research objectives are achieved to explore motivating factors for adopting prevention behaviors. (1) The first objective is to identify variables that are strong predictors of prevention behavior adoption. A data-driven approach is used to train Bayesian belief network (BBN) models using results of a survey ofN = 7797 $N=7797$ participants reporting risk perceptions and prevention behaviors during the COVID-19 pandemic. A large set of models are generated and analyzed to identify significant variables. (2) The second objective is to develop models based on the PMT to predict prevention behaviors. BBN models that predict prevention behaviors were developed using two approaches. In the first approach, a data-driven methodology trains models using survey data alone. In the second approach, expert knowledge is used to develop the structure of the BBN using PMT constructs. Results demonstrate that trust and experience with COVID-19 were important predictors for prevention measure adoption. Models that were developed using the PMT confirm relationships between coping appraisal, threat appraisal, and protective behaviors. Data-driven and PMT-based models perform similarly well, confirming the use of PMT in this context. Predicting adoption of social distancing behaviors provides insight for developing policies during pandemics.

A longitudinal analysis of the effects of COVID-19 on tourists' health risk perceptions

The COVID-19 pandemic provoked a large impact on tourism because of the enforcement of harsh travel restrictions and the increased global health risks caused by international mobility. This paper utilizes a longitudinal analysis to tests the impact of COVID-19 on tourists' health risk perceptions, and their relationships with destination image perception and visiting intentions. Tourists are surveyed at two different points of time, before and after the COVID-19 pandemic. Multi-group structural equation modeling is utilized for the comparison of the relationships at the two points of time. The results show that the negative influence of health risk perceptions on destination image perception and visiting intentions are significantly larger after the COVID-19 pandemic while there are no significant differences in the impact of destination image perception on visiting intentions. Thus, not only are tourists more sensitive to health risk perceptions after COVID-19, but this higher sensitivity has larger impacts both on their perceptions of destination image and on the behavioural implication. The results have useful implications in terms of the need to dedicate more efforts for the management of health conditions of destinations after COVID-19.

Preferences of bereaved family members on communication with physicians when discontinuing anticancer treatment: referring to the concept of nudges

BACKGROUND

This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges.

METHODS

A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care units in Japan.

RESULTS

The following explanations were rated as essential or very useful: (i) treatment would be a physical burden to the patient (42.9%), (ii) providing anticancer treatment was impossible (40.5%), (iii) specific disadvantages of receiving treatment (40.5%), (iv) not receiving treatment would be better for the patient (39.9%) and (v) specific advantages of not receiving treatment (39.6%). The factors associated with a high need for improvement of the physician's explanation included lack of explanation on specific advantages of not receiving treatment (β = 0.228, P = 0.001), and lack of explanation of 'If the patient's condition improves, you may consider receiving the treatment again at that time.' (β = 0.189, P = 0.008).

CONCLUSIONS

Explaining the disadvantages of receiving treatment and the advantages of not receiving treatment, and presenting treatment discontinuation as the default option were effective in helping patients' families in making the decision to discontinue treatment. In particular, explanation regarding specific advantages of not receiving treatment was considered useful, as they caused a lower need for improvement of the physicians' explanation.

"Oh no, they caught it!": Vicarious experience of COVID-19, protection motivation and protective behaviors

Utilizing the components of the protection motivation theory, this study investigated the role of close others' diagnosis of COVID-19 (as a vicarious experience) in individuals' adherence to protective behavior against COVID-19. Path analysis of online survey data from 3695 participants showed that the presence of a diagnosed close other was positively related to perceived vulnerability, while being negatively related to perceived response efficacy and self-efficacy. In addition, perceived severity and efficacy appraisals were positively associated with protective behavioral tendencies. Although efficacy appraisal mediated the relationship between vicarious experience and protective behavior, threat appraisal did not mediate this relationship. In sum, the results suggest that efficacy appraisal derived from vicarious experiences can be more consequential for protective behaviors than threat appraisal. Implications of these results on future large-scale health crises are discussed along with limitations and future directions.

The lesser of two evils: Assessing the public acceptance of AI thermal facial recognition during the COVID-19 crisis

AI thermal facial recognition (AITFR) has been rapidly applied globally in the fight against Coronavirus disease 2019 (COVID-19). However, AITFR has also been accompanied by a controversy regarding whether the public accepts it. Therefore, it is necessary to assess the acceptance of AITFR during the COVID-19 crisis. Drawing upon the theory of acceptable risk and Siegrist's causal model of public acceptance (PA), we built a combined psychological model that included the perceived severity of COVID-19 (PSC) to describe the influencing factors and pathways of AITFR acceptance. This model was verified through a survey conducted in Xi'an City, Shaanxi Province, China, which collected 754 valid questionnaires. The results show that (1) COVID-19 provides various application scenarios for AI-related technologies. However, the respondents' trust in AITFR was found to be very low. Additionally, the public appeared concerned about the privacy disclosure issue and the accuracy of the AITFR algorithm. (2) The PSC, social trust (ST), and perceived benefit (PB) were found to directly affect AITFR acceptance. (3) The PSC was found to have a significant positive effect on perceived risk (PR). PR was found to have no significant effect on PA, which is inconsistent with the findings of previous studies. (4) The PB were found to be a stronger mediator of the indirect effect of the PSC on ST induced by AITFR acceptance.

Association between health anxiety dimensions and preventive behaviors during the COVID-19 pandemic among Japanese healthcare workers

Objective

Health anxiety (HA), defined as excessive worry about having a serious medical condition, may affect preventive behaviors during the coronavirus disease 2019 (COVID-19) pandemic. We examined the distinct role of two dimensions of HA-perceived likelihood (probability dimension) and awfulness of illness (awfulness dimension)-in self-protection, as reflected in preventive behaviors during the pandemic.

Methods

Participants comprised 657 healthcare workers. Data were collected between February 24 and 26, 2021. The Short Health Anxiety Inventory determined the HA dimensions. Adherence to the government's recommendations for COVID-19 preventive behaviors was self-rated. An independent association between each HA dimension and participants' adherence to the recommendations was examined using multivariable regression.

Results

Within the analyzed sample of 560 subjects, severe HA was observed in 9.1 %. The more the participants felt awful, the less frequently they engaged in the recommended preventive behaviors (adjusted odds ratio = 0.993, 95 % confidence interval: 0.989, 0.998, p = 0.003) regardless of their profession, working position, psychological distress, sleep disturbance, and current physical diseases. However, the probability dimension was not associated with their preventive behaviors.

Conclusion

The awfulness dimension of HA could be a more sensitive marker of preventive behaviors than the probability dimension. Paying particular attention to the awfulness dimension may help optimize self-protection strategies during the COVID-19 pandemic. A two-dimensional understanding of HA may be useful for the maintenance of the healthcare system and public health as well as healthcare workers' own health.

Abrupt peaks in perceived risk of occasional drug use after changing the question order in a repeated self-administered survey

Background

Question-order changes in repeated surveys can distort comparisons. We want to describe the evolution of drug risk perceptions among Spanish adolescents and assessing whether the 2006 peaks in perceived risk of occasional drug use can be explained by question-order changes.

Methods

The subjects were secondary students from a biennial national survey during 2000-2012. A one-off intervention was applied in 2006, replacing the two-adjacent items on perceived risk of occasional and regular use of each drug by non-adjacent items. Annual prevalence of high-risk perception were obtained for occasional and regular use of cannabis, heroin, cocaine and ecstasy. Subsequently, the 2006 percent level change (PC) in such were estimated prevalence using segmented Poisson regression, adjusting for various student and parent covariates.

Results

The 2006 PC in prevalence of high-risk perception of occasional drug use ranged from +63% (heroin) to +83% (ecstasy). These PCs were very high in all considered subgroups. However, the 2006 PC in prevalence of high-risk perception of regular drug use ranged from 1% (heroin) to 12% (cannabis). The evolution of preventive interventions does not suggest alternative causal hypotheses for 2006 peaks other than question-order changes.

Conclusion

Within the cognitive heuristics framework, the 2006 spikes in perceived risk of occasional drug use were most likely due to a release of the anchor exerted by perceived risk of regular drug use over that of occasional use triggered by 2006 question-order changes. In repeated surveys it is inexcusable to pre-test the effect of any change in questionnaire format.

Causal Modeling of Descriptive Social Norms from Twitter and the Physical World on Expressed Attitudes Change: A Case Study of COVID-19 Vaccination

The high infection rate of SARS-CoV-2 makes it urgent to promote vaccination among the public. Previous studies found that people tend to follow the behaviors desired in descriptive social norms, which exist in both social media (e.g., Twitter) and physical-world communities. However, it remains unclear whether and to what extent the descriptive social norms from the cyber and physical communities affect people's attitude change. This study, focusing on COVID-19 vaccination, developed a Directed Acyclic Graphs model to investigate the causal effects of the descriptive social norms of (i) Twitterverse and (ii) physical-world communities on people's attitude change as well as the temporal scales of the effects. It used a Long Short-Term Memory classifier to extract expressed attitudes and changes from relevant tweets posted by 843 sample users. We found that a people's attitude change toward the vaccination receives a more significant impact from Twitter-based descriptive social norms over the prior week, whereas the norms in the physical-world communities tend to be less influential but still notable with the time gap between 2 weeks and 1 month. The findings revealed the potential of using online social norm approaches to proactively motivate behavioral changes toward a culture of health.

Differences in Stakeholders' Perception of the Impact of COVID-19 on Clinical Care and Decision-Making

Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.