Predicting adherence to COVID-19 preventive measures among South Korean adults aged 40 to 69 Years using the expanded health empowerment model

The public health environment in South Korea is advancing toward the late stages of the COVID-19 pandemic. However, there is limited knowledge about the extent of individuals' compliance with preventive measures during this transitional period and the potential predictors that determine such compliance behaviors. In this study, we employed the expanded health empowerment model to investigate factors associated with COVID-19 preventive behaviors among Korean adults in late 2022. Our theoretical framework integrates the knowledge-attitude-behavior model with the health belief model to conceptualize health empowerment underlying the formation of preventive behaviors. We collected data from 1100 Korean adults aged 40-69 years through an online survey conducted in October 2022. Participants responded to questions about their knowledge of COVID-19, attitudes towards the disease, adherence to preventive measures, infection history, and sociodemographic characteristics. Structural equation modeling was employed to assess the relationships between knowledge, attitudes, and preventive behaviors related to COVID-19. Results showed that attitudes toward the disease predict adherence to preventive behaviors. We also found that COVID-19 knowledge partially determined the attitudes toward the disease. However, COVID-19 knowledge was not directly associated with adherence to preventive behaviors. Additionally, the associations between knowledge, attitudes, and preventive behaviors did not differ between infected and never-infected individuals. Overall, this study finds empirical support for the expanded health empowerment model, which connects knowledge to preventive behaviors through positive attitudes toward the disease, while underscoring the limited role of infection history in this association. These findings can help policymakers understand individual responses to public health guidelines in the late pandemic era and develop policies to mitigate further transmission of COVID-19.