Predicting mask-wearing behavior intention among international students during COVID-19 based on the theory of planned behavior

COVID-19 in college: Risk perception and planned protective behavior

Objective: The Theory of Planned Behavior has been applied to COVID-19 protective behaviors, but evidence suggests this theory may be less predictive over time and less valid in individualistic societies. The current study applied this theory among American college students as vaccines became available and added perceived risk. Participants: 242 undergraduate students at two universities. Methods: Participants completed an online survey and analyses were conducted using PROCESS. Results: Perceived risk was indirectly related to protective behavior via intentions which were significantly impacted by positive attitudes, descriptive norms, and perceived behavioral control. Conclusions: Even within an individualistic culture and when vaccines were becoming available, the Theory of Planned Behavior predicts protective behaviors. Including risk perception also furthers understanding of this theory by identifying one factor related to norms and perceived behavioral control. These results may inform the design of interventions designed to increase compliance with pandemic-related policies and other positive behaviors.

Theory-based Trial to Promote Uptake and Sustained Use of Face Coverings During the COVID-19 Pandemic

BACKGROUND

Transmission of airborne viruses can be mitigated by wearing face coverings but evidence suggests that face covering declines with the removal of relevant legislation, partly due to low automatic motivation.

PURPOSE

Test whether an intervention based on implementation intentions could support people's automatic motivation and promote face covering during the COVID-19 pandemic.

METHODS

Randomized controlled design. At baseline (May 20 to June 6, 2022), 7,835 UK adults reported how much time they spent wearing face coverings in work, public transport, and indoor leisure settings as well as their capabilities, opportunities, and motivations. 3,871 participants were randomized to form implementation intentions; 3,964 control participants completed questionnaires only. Measures were repeated 6 months postbaseline (November 1 to November 14, 2022). Data were analyzed using mixed measures ANOVAs and Bayes Factors to examine whether the observed data supported the experimental hypothesis.

RESULTS

The proportion of time spend wearing face coverings declined substantially across the 6-month study period, from 15.28% to 9.87% in work settings, 38.31% to 24.55% on public transport, and 9.58% to 7.85% in leisure settings. Bayes Factors indicated moderate relative evidence of no effect of implementation intentions on behavior in work and leisure settings, and inconclusive evidence of a positive effect on public transport.

CONCLUSIONS

In the context of declining COVID-19 rates and removal of legal mandates, implementation intentions were not effective in sustaining face covering. Further research is required to ensure that evidence-based interventions are prepared and deployed in the event of future pandemics.

Very small effects of an imagery-based randomised trial to promote adherence to wearing face coverings during the COVID-19 pandemic and identification of future intervention targets

OBJECTIVE

Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e. intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow-up (T2).Results: Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants self-reporting 'suboptimal T1 adherence, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings.Conclusion: Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

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.

Development and initial validation of the attitudes toward face mask use scale (ATFMUS)

Despite availability of instruments for measuring attitudes towards mask use, the psychometric properties of many available instruments are not adequately established which limits their research usefulness across contexts. In three studies, we developed the Attitudes Towards Face Mask Use Scale (ATFMUS) in three phases: item generation, scale development, and scale evaluation. Phase one and two were addressed in study 1 while phase three was addressed in studies 2 and 3. In Study 1, a combined online and pen-and-paper sample of 174 (78% university students) completed a questionnaire with 19 items regarding attitudes towards face mask use derived from theory, previous research, and experience. Responses were subjected to item reduction analysis, exploratory factor analysis and reliability analysis. In Study 2, a student sample of 674 (70.5% high school) completed the new scale together with measures of COVID-19 related anxiety and obsession, personality, affect, social media use, and social desirability. Data from the ATFMUS were analyzed using confirmatory factor analysis and pertinent revisions done. The ATFMUS was then validated using correlation analyses, measurement invariance analyses, and known-group comparisons. In study 3, two samples of university students from Ghana (n = 242) and Kenya (n = 199) were involved in testing the cross-country invariance of the ATFMUS. The results reveal that the 5-item ATFMUS is a reliable and valid scale for assessing attitudes towards face mask use. Invariance analysis revealed that the ATFMUS is fair to use across participants of different age, level of education, and countries. The scale is also sensitive to participants' actual use of face masks as well as their beliefs about COVID-19 and efficacy of the facemasks. This study offers a foundation for further psychometric evaluation of the ATFMUS.

Does Temporal Stability Moderate Reasoned Action Approach Relations With Covid-19 Preventive Behaviors?

Background

Preventive behaviors continue to play an important role in reducing the spread of the SARS-CoV-2 virus.

Purpose

This study aimed to apply the reasoned action approach (RAA) to predict Covid-19 preventive intentions and behavior and to test whether temporal stability moderates relations between RAA constructs and behavior.

Methods

A representative sample of UK adults (N = 603) completed measures of RAA variables (i.e., experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy and intention) in relation to six Covid-19 preventive behaviors (i.e., wearing face coverings, social distancing, hand sanitizing, avoiding the three Cs [closed spaces, crowded places, and close contacts], cleaning surfaces, and coughing/sneezing etiquette) at baseline (December 2020) and after 1 month. Self-reported behavior was assessed at baseline and after 1 and 2 months.

Results

The RAA was predictive of Covid-19 preventive intentions at time 1 and time 2; instrumental attitudes, descriptive norms, and capability were the strongest predictors at each time point. The RAA also predicted subsequent behavior across time points with intention, descriptive norms, and capability the strongest/most consistent predictors. Temporal stability moderated a number of RAA–behavior relationships including those for intention, descriptive norms, and capability. In each case, the relationships became stronger as temporal stability increased.

Conclusions

Health cognitions as outlined in the RAA provide appropriate targets for interventions to promote Covid-19 preventive intentions and behavior. Moreover, given that continued performance of Covid-19 preventive behaviors is crucial for reducing transmission of the SARS-CoV-2 virus, the results highlight the need for consistent messaging from governments and public health organizations to promote positive intentions and maintain preventive behavior.

Mask-wearing intentions on airplanes during COVID-19 - Application of theory of planned behavior model

The COVID-19 pandemic has devastated the air transport industry, forcing airlines to take measures to ensure the safety of passengers and crewmembers. Among the many protective measures, mask mandate onboard the airplane is an important one, but travelers' mask-wearing intentions during flight remain uninvestigated especially in the US where mask use is a topic of on-going debate. This study focused on the mask use of airline passengers when they fly during COVID-19, using the theory of planned behavior (TPB) model to examine the relationship between nine predicting factors and the mask-wearing intention in the aircraft cabin. A survey instrument was developed to collect data from 1124 air travelers on Amazon Mechanical Turk (MTurk), and the data was statistically analyzed using structural equation modeling and logistic regression. Results showed that attitude, descriptive norms, risk avoidance, and information seeking significantly influenced the travelers' intention to wear a mask during flight in COVID-19. Group analysis further indicated that the four factors influenced mask-wearing intentions differently on young, middle-aged, and senior travelers. It was also found that demographic and travel characteristics including age, education, income, and travel frequency can be used to predict if the airline passenger was willing to pay a large amount to switch to airlines that adopted different mask policies during COVID-19. The findings of this study fill the research gap of air travelers' intentions to wear a mask when flying during a global pandemic and provide recommendations for mask-wearing policies to help the air transport industry recover from COVID-19.

The Impact of the Fear of COVID-19 on Purchase Behavior of Dietary Supplements: Integration of the Theory of Planned Behavior and the Protection Motivation Theory

This study aimed at assessing the impacts of the fear of COVID-19 on consumer buying behavior toward dietary supplements. This investigation was a cross-sectional study in which literate adults regardless of gender over the age of 20 were recruited from three pharmacies in three different districts of Wuhan City, China. A total of 598 questionnaires were analyzed after excluding 10 with incomplete information. The current study demonstrated that attitudes, subjective norms, and perceived behavioral control had a positive impact on the intention of purchasing dietary supplements. Fear of COVID-19 was related to an enhanced purchase intention toward dietary supplements. Attitudes, subjective norms, and perceived behavioral control were significant factors that mediated the association between the fear of COVID-19 and the purchase intention of dietary supplements. This study helps provide practical advice for stakeholders in the pharmaceutical and healthcare industries to tailor appropriate strategies for improving product promotion or healthcare-related interventions.

Parent-for-child mask behavior during the COVID-19 pandemic in Canada and the United States: An investigation of attitudes, norms, and perceived control using the theory of planned behavior

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Child mask behavior is influenced by their parents’ attitudes, accepted norms, and self-efficacy.

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For healthy children, mask behavior is primarily driven by parents’ strong beliefs about mask effectiveness.

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For children with pre-conditions that may make mask-wearing difficult, mask behavior is driven by parents’ strong intentions to enforce mask wearing.

Face masks continue to be a necessity until a large proportion of the population, including children, receive immunizations for COVID-19. The aim of this study was to investigate the relationship between parental attitudes and beliefs about masks and parent-for-child mask behavior using the Theory of Planned Behavior. We administered a survey in August 2020 to parents of school-aged children residing in the United States and Canada. Measures included sociodemographic variables for the parent and child, attitudes, norms, perceived control over children’s mask use, intentions and enforcement of mask wearing among children (also titled “parent-for-child mask behavior”). Data were analyzed using structural equation modelling. We collected data from 866 parents and 43.5% had children with pre-existing conditions (e.g., allergies, anxiety, impulsivity, skin sensitivity, asthma) that made extended mask wearing difficult, as per parent’s report. Among the full sample, negative attitudes (β = -0.20, p = .006), norms (β = 0.41, p = .002), and perceived control (β = 0.33, p = .006) predicted intentions. Norms (β = 0.50, p = .004) and intentions (β = 0.28, p = .003) also predicted parent-for-child mask use, while attitudes and perceived control did not. Intentions mediated the associations between attitudes, norms, perceived control, respectively, and mask behavior. Subgroup analyses revealed intentions as the key predictor of parent-for-child mask use among children with pre-conditions and norms as the key predictor among children without pre-conditions (i.e. healthy). Future public health messaging should target parental intentions, attitudes, norms, and perceived control about children’s masks wearing.

A Phenomenological Study on the Positive and Negative Experiences of Chinese International University Students From Hong Kong Studying in the U.K. and U.S. in the Early Stage of the COVID-19 Pandemic

Background: The COVID-19 pandemic has caused distress in students globally. The mental health of international students studying abroad has been neglected during the COVID-19 pandemic, especially Chinese students who have been unfairly targeted. Objective: To explore and document the positive and negative experiences of a group of Hong Kong Chinese international students studying in the U.K. and U.S. from an insider perspective in the early stage of the COVID-19 pandemic. Methods: The qualitative study used four 1.5-h online focus group interviews of 20 Chinese international students from Hong Kong aged 18 or older studying in universities in the United Kingdom or the United States, from 3 May to 12 May 2020. A framework approach with a semi-structured interview guide was used to reflect students' stressors, cognitive appraisals, coping, and outcomes (negative impacts and positive gains), in the early stages of COVID-19. Different strategies were used to ensure the credibility, dependability, confirmability, and transferability of the study. Transcripts were analyzed using qualitative thematic content analysis. Results: Twenty full-time international University students (60% female, 90% aged 18-25 years and 65% undergraduates) were recruited. Students reported (i) stress from personal (e.g., worries about health and academic attainment), interpersonal (e.g., perceived prejudice and lack of social support), and environmental factors (e.g., uncertainties about academic programme and unclear COVID-19-related information); (ii) significant differences in culture and cognitive appraisal in the levels of perceived susceptibility and severity; (iii) positive thinking and using alternative measures in meeting challenges, which included effective emotion and problem coping strategies, and the importance of support from family, friends and schools; and (iv) negative psychological impact (e.g., worries and stress) and positive personal growth in crisis management and gains in family relationships. Conclusions: With the rise in sinophobia and uncertain developments of the pandemic, proactive support from government and academic institutions are urgently needed to reduce stress and promote the well-being of international students, especially Chinese students in the U.K. and U.S. Clear information, public education and policies related to the pandemic, appropriate academic arrangements from universities and strong support systems play important roles in maintaining students' psychological health. Clinical Trial Registration: The study was registered with the National Institutes of Health (https://clinicaltrials.gov/, identifier: NCT04365361).