Psychosocial determinants of handwashing and physical distancing behaviour during the COVID-19 pandemic in the Netherlands: A longitudinal analysis.

OBJECTIVES: Physical distancing and handwashing can be important infection prevention measures during an infectious disease outbreak such as the COVID-19 pandemic. To stimulate these behaviours, knowledge of psychosocial determinants as well as contextual factors is vital. We present longitudinal, within-person analyses of the impact of contextual and psychosocial factors on handwashing and distancing behaviour. DESIGN: We used individual-level data (186,490 participants completing 971,899 surveys) from the Corona Behavioural Unit COVID-19 Cohort, a dynamic cohort study conducted during 26 months of the COVID-19 pandemic in the Netherlands. METHODS: Fixed-effects models were employed to estimate within-person associations between psychosocial factors and behaviour, combined with main and moderating effects of contextual factors. RESULTS: Pandemic severity was associated with more handwashing and distancing behaviour, while the duration of the pandemic had little effect. Within-person changes in response efficacy were most relevant for changes in both handwashing and distancing behaviour, while self-efficacy, descriptive norms and perceived severity of infecting others affected behaviour indirectly. These effects were stable over time. Associations were larger in cross-sectional models, indicating that such models tend to overestimate effects. CONCLUSIONS: Our study highlights the importance of longitudinal data and within-person models to detect possible causal associations. The results suggest that during an outbreak, government and public health professionals should clearly communicate the severity of the pandemic (e.g., hospitalization rates) and the effectiveness of recommended prevention measures in reducing that risk; and seek to improve people's capabilities and opportunities to adhere to guidelines, for example, by modifying the environment.

Evaluating the usefulness of Protection Motivation Theory for predicting climate change mitigation behavioral intentions among a US sample of climate change deniers and acknowledgers.

BACKGROUND: This paper summarizes data from 7 studies that used Protection Motivation Theory (PMT) to guide climate messaging with the goal of increasing climate-mitigating behavioral intentions. Together, the studies address 5 research questions. 1) Does PMT predict behavioral intentions in the context of climate change mitigation? 2) Does PMT work similarly for climate change deniers vs acknowledgers? 3) Are the effects of threat and efficacy additive or multiplicative? 4) Does adding measures of collective threat and efficacy improve the model accuracy for a collective problem like climate change? 5) Can threat and efficacy appraisals - and ultimately behavioral intentions - be shifted through climate messaging? METHODS: Seven online experiments were conducted on US adults (N = 3,761) between 2020 and 2022. Participants were randomly assigned to a control condition or to one of several experimental conditions designed to influence threat, efficacy, or both. Participants indicated their belief in climate change, ethnicity, gender, and political orientation. They completed measures of personal threat and efficacy, collective threat and efficacy, and behavioral intentions. RESULTS: Multiple regressions, ANCOVAs, and effect sizes were used to evaluate our research questions. Consistent with PMT, threat and efficacy appraisals predicted climate mitigation behavioral intentions, even among those who denied climate change. Different interactions emerged for climate deniers and acknowledgers, suggesting that in this context threat and efficacy are not just additive in their effects (but these effects were small). Including measures of collective threat and efficacy only modestly improved the model. Finally, evidence that threat and efficacy appraisals can be shifted was weak and inconsistent; mitigation behavioral intentions were not reliably influenced by the messages tested. CONCLUSIONS: PMT effectively predicts climate change mitigation behavioral intentions among US adults, whether they deny climate change or acknowledge it. Threat appraisals may be more impactful for deniers, while efficacy appraisals may be more impactful for acknowledgers. Including collective-level measures of threat and efficacy modestly improves model fit. Contrary to PMT research in other domains, threat and efficacy appraisals were not easily shifted under the conditions tested here, and increases did not reliably lead to increases in behavioral intentions.

Predictors of self-care behaviors in hypertensive patients based on the protection motivation theory.

INTRODUCTION: Globally, hypertension is a significant public health concern and a leading cause of premature death. Since this disease is incurable, it is necessary to promote patients' self-care behaviors to control it. The goal of this research was to identify the elements that influence self-care actions in individuals with hypertension, utilizing the Protection Motivation Theory (PMT) framework. METHODS: A study was carried out in Omidiyeh, located in southern Iran, using a cross-sectional design, involving 397 adults with hypertension (198 females and 199 males) who were selected from comprehensive health centers using a stratified random sampling technique. Data was gathered through a demographic data collection form and a questionnaire created by the researcher, which was based on the PMT. Data were assessed utilizing SPSS 25 and AMOS 24 software, and various statistical tests including one-way ANOVA, Pearson correlation, multiple regression, independent t-test, and structural equation modeling were conducted. FINDINGS: The variables of intrinsic reward (r = 0.182), extrinsic reward (r = 0.288), and response cost (r = 0.126) showed a significant negative correlation with self-care behaviors. On the other hand, perceived susceptibility (r = 0.212), perceived severity (r = 0.110), self-efficacy (r = 0.555), and response efficacy (r = 0.424) demonstrated a significant positive correlation with self-care behaviors. Specifically, self-efficacy and response efficacy were the most powerful predictors of self-care behaviors, respectively. CONCLUSION: The results showed that several factors can forecast self-care behaviors in patients with hypertension. Researchers are recommended to incorporate PMT in educational interventions and concentrate on self-efficacy and response efficacy constructs.

Predictors of self-care behaviors in patients with hypertension: The integrated model of theories of "planned behavior" and "protection motivation".

BACKGROUND: Assessment of self-care behaviors in patients with hypertension may provide clinicians and practitioners with important information about how to better control hypertension. Therefore, the present study aimed to explore the predictors of self-care behaviors in patients with hypertension based on an integrated model of theories of planned behavior and protection motivation. MATERIALS AND METHODS: The present cross-sectional study was part of a larger study, conducted in 2022 on 344 hypertensive patients from Khamir County in Hormozgan Province in Iran. The sample was selected through a systematic random sampling. The patients completed a researcher-made questionnaire based on constructs of the theory of planned behavior and protection motivation theory. They also completed, Hypertension Self-Care Activity Level Effects (H-SCALE), Hypertension Knowledge-Level Scale (HK-LS), and a demographic questionnaire. The data were analyzed in SPSS 21 using the Pearson correlation coefficient, independent-samples T test, one-way ANOVA, and linear regression analysis. RESULTS: The participants' mean age was 47.34 ± 13.68 years. Adherence to medication, physical activity, weight management, diet, and nonsmoking scores were 42.7, 27.3, 66.3, 14.2, and 81.1, respectively. The linear regression model showed that behavioral beliefs (ß = 0.366, P < 0.001), perceived rewards (ß = -0.248, P < 0.001), control beliefs (ß = 0.133, P = 0.013), and normative beliefs (ß = 0.143, P = 0.025) were the major predictors of self-care behaviors in patients with hypertension. CONCLUSION: In light of the present findings, it can be concluded that it is crucial to change patients' attitudes toward self-care behaviors and improve the social acceptance of behavior and its development in society, and improve patients' control beliefs through goal-oriented education that develops resistance against the perceived rewards of the unfavorable behavior. Considering these constructs can act as strategies to promote self-care behaviors among patients.

The Mpox Vaccine Hesitancy Scale for Mpox: Links with Vaccination Intention among Men Who Have Sex with Men in Six Cities of China.

BACKGROUND: Vaccine hesitancy is a significant barrier to achieving high vaccination rates, particularly among men who have sex with men (MSM), a group at increased risk for Mpox. This study aimed to develop and validate a Mpox vaccine hesitancy scale specifically tailored for Chinese MSM, grounded in the protection motivation theory (PMT). METHODS: An online survey through snowball sampling was conducted from October 2023 to March 2024, collecting 2403 valid responses across six representative regions in China. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to evaluate the scale's construct validity, while reliability was assessed using Cronbach's α coefficient. The predictive validity of the scale was analyzed using Receiver Operating Characteristic (ROC) analysis. RESULTS: EFA ultimately retained 22 items in the Mpox vaccination scale and identified four distinct dimensions: Maladaptive Rewards (seven items), Self-efficacy (seven items), Response Efficacy (four items), and Response Costs (four items). These dimensions were confirmed by CFA, which demonstrated satisfactory model fit indices (χ²/df = 4.382, RMSEA = 0.053, SRMR = 0.048, GFI = 0.935, CFI = 0.967, NFI = 0.958, TLI = 0.963, and IFI =0.967). All indices were within acceptable ranges. The scale exhibited good internal consistency, with a Cronbach's alpha of 0.906, and strong content validity, with an S-CVI/Ave of 0.952. The scale's predictive accuracy was evaluated using Receiver Operating Characteristic (ROC) analysis. When used to evaluate the scale's predictive accuracy, it yielded an area under the curve (AUC) of 0.854 after adjustments, indicating good predictive ability between high and low hesitancy. CONCLUSIONS: This scale provides a reliable and valid tool for assessing Mpox vaccine hesitancy among MSM and can be used to gauge Mpox vaccination intention within this group.

Protection motivation when using biocidal products - A survey study in Germany.

Due to their inherent properties, biocidal products might pose a risk to human and animal health and the environment. In risk management, there exists uncertainty about private users' comprehension of and willingness-to-adhere to use instructions that mitigate these risks (e.g., limit frequency of use or application area). This study aimed at providing insights into the users' perspective by focusing on their attention, comprehension, and the attitudinal predictors of protection motivation. In the online study (N = 957 participants from Germany) were introduced to a hypothetical purchase scenario featuring an insect spray and a realistic set of use instructions. Next, the participants' attention for the use instruction was measured in self-report and by tracking the time spent on the page with the use instruction, while Likert scale-type questions measured the comprehensibility, protection motivation, and predictors. Participants reported higher protection motivation if they spent more time with the use instruction, perceived it as comprehensible, rated the threat to humans, animals, and the environment as more severe, perceived themselves as responsible (i.e., internal locus of control) and capable (i.e., self-efficacy) of adhering to the use instructions, perceived adherence to the use instructions as effective (i.e., response efficacy) and did not perceive biocidal products as inherently safe (i.e., neutral locus of control). These results offer valuable information for an improved regulation of biocidal products and better management of potential risks associated with their use. They also provide concepts for interventions to ensure users of biocidal products follow the instructions for a safe use and better protection of the environment.

The protection motivation theory as an explanatory model for intention to use alcohol protective behavioral strategies related to the manner of drinking among young adults.

AIMS: This study aimed to prospectively examine the explanatory value of the protection motivation theory (PMT) for the intention to use manner of drinking protective behavioral strategies (MD PBS) and to explore its invariance across genders. METHOD: A targeted sampling procedure was used to recruit 339 young adults in the community (Mage = 21.1; SD = 2.21; female = 50.7%) who completed baseline and 2-month follow-up measures of the PMT constructs and intentions to use each of the five MD PBS. RESULTS: Regression analyses revealed that the coping appraisal components (response efficacy and self-efficacy) had greater explanatory power for the intention to use MD PBS than the threat appraisal components (perceived vulnerability and perceived severity). Perceived vulnerability to alcohol consequences was not prospectively associated with any specific behavioral intention or with the total MD PBS score. In contrast, perceived severity was prospectively associated with the intention to use three out of five PBS and the total MD score. Regression coefficients revealed gender invariance for all six models. CONCLUSIONS: Our findings suggest that interventions aimed at encouraging young adults to use alcohol MD PBS would be most effective if they included components that enhance self-efficacy in using these strategies and emphasize their perceived usefulness in reducing alcohol-related consequences.

Identifying factors improving the intention to use antibiotics appropriately in children and adults using protection motivation theory.

Objective: This study aimed to employ hypothetical models based on the protection motivation theory (PMT) to identify factors that improve the intention to use antibiotics appropriately (intention) among individuals who take antibiotics or administer them to their children. Methods: Adult Japanese participants, including 600 parents who administer antibiotics to children aged <14 years and 600 adults who take them, completed an online survey. Structural equation modeling (SEM) was conducted on hypothetical models representing intention using 19 questions based on PMT. If the hypothesized model did not fit, SEM was repeated to search for a new model. Results: The hypothesized models did not fit. Two factors were extracted from SEM: "understanding the risk of antimicrobial resistance" and "excessive expectation of antibiotics." In adults, SEM revealed that "excessive expectation of antibiotics" (ß = -0.50, p < 0.001) negatively influenced intention; in children, "excessive expectation of antibiotics" (ß = -0.52, p < 0.001) negatively influenced intention, while "understanding the risk of antimicrobial resistance" (ß = 0.22, p < 0.001) positively influenced intention. Conclusion: Factors influencing intention varied between adult and pediatric antibiotic use. Innovation: Awareness activities for appropriate antibiotic use should be tailored to population characteristics.

Protection motivation theory in predicting intentional behaviors regards schistosomiasis: a WeChat-based qualitative study.

Background: Modifications of behavior can help reduce the risk of transmission by disrupting the parasite life cycle. Behavior intension is a necessary intermediate step in behavior change. This study aimed to explore protection motivation theory (PMT) in predicting likelihood of engagement in protective behavior against infection with Schistosoma. Methods: In China, a questionnaire for data collection was sent to users who followed the WeChat public account from June 2 to 6, 2023. Factors affecting intentional behavior of participants were analyzed using stepwise regression analysis and structural equation modeling. Results: A total of 2,243 valid questionnaires were collected, with a mean age of 30 ± 8.4 years. Approximately 1,395 (62.2%) participants reported that they had been exposed to wild waters in daily work and life. About 51.0 and 50.7% of respondents reported never having been exposed to wild water in the last 3 and 6 months, respectively. Results indicated that prior knowledge of schistosomiasis was associated with the 7 PMT subconstructs, which then influenced future preventative behaviors. Conclusion: Behavior intentionis a complicated and indispensable part of behavior change that is influenced by professional knowledge, socio-economic status, and personal characteristics. The effective dissemination of knowledge regards schistosomiasis should be strengthened to emphasize the effectiveness of protective measures against infection and severe disease.

Promoting new users' online health consultation services usage behavior strategically.

Online consultation services have the potential to reduce the workload of healthcare staff, provide timely care to patients, and improve doctor-patient relationships. The COVID-19 pandemic has accelerated the development of these services and platforms, but it remains to be seen whether the general public will continue to use them after the pandemic is under control. This research proposes a framework to examine the factors contributing to UK adults' continued usage of online healthcare consultation services after COVID-19 restrictions have been lifted. A total of 430 new users completed surveys, and the results indicate that expectation confirmation, system quality, and information quality can positively impact users' self-efficacy toward using online consultation services. This, in turn, can influence their continued usage behavior. Furthermore, the results suggest that participants' perception of health risks can moderate the relationship between self-efficacy and continued usage behavior. The strategic implications of these findings are discussed.

Development of a Reliable and Valid Survey Instrument to Measure Nurses' Health Behaviors Towards an Infectious Disease.

Background and Purpose: The purpose of this study is to describe the process for developing a reliable and valid survey instrument guided by the protection motivation theory (PMT) to evaluate nurses' health behaviors toward an infectious disease such as Ebola. Methods: The instrument was developed and tested through a systematic process that included a literature review, focus group, validity testing, and reliability testing. Results: The outcome variable, protection motivation, contained two elements, determined by principal component analysis. The instrument's internal consistency had a Cronbach's alpha of .80 or greater. Conclusion: The development and testing of an instrument based on PMT constructs as the theoretical framework have demonstrated a relationship between the perceived threat toward the disease and the proposed coping process needed to address the disease.

Parental intention on getting children COVID-19 vaccinations: Invariance evaluation across parenting roles and COVID-19-like symptoms experiences among Iranians during the pandemic period.

Countries worldwide are facing challenges with increasing the COVID-19 vaccination rates for children. This study examined associations between perceived knowledge, coping appraisal, threat appraisal, adaptive response, maladaptive response, and intention, and possible variance across parents (mother or father) and COVID-19-like symptoms experiences regarding parental intentions to vaccinate their children. A total of 836 Iranian parents with children between the ages of 6 and 12 y completed measures assessing perceived knowledge, coping appraisals, threat appraisals, intentions, adaptive responses, and maladaptive responses. Multigroup structural equation modeling revealed that perceived knowledge was positively associated with both coping and threat appraisals, coping appraisals positively associated with adaptive responses, maladaptive responses, and intentions to vaccinate, threat appraisals positively associated with adaptive and maladaptive responses, and adaptive responses positively associated with intentions to vaccinate. The invariance evaluation revealed no differences across parents or COVID-19-like symptoms experiences in parental intentions to get their children vaccinated. The findings suggest that cogent information regarding childhood COVID-19 vaccination may boost parents' knowledge influencing their appraisals, adaptive responses and intentions to vaccinate their children. Specifically, coping appraisals and adaptive responses appeared to be important mediators between knowledge and intentions to vaccinate. Furthermore, intentions to vaccinate children may not be strongly influenced by parental roles or COVID-19-like symptoms experiences. These findings may help multiple stakeholders promote COVID-19 vaccination rates among children, and countries should further examine ways of increasing rates based on their specific needs.

Understanding cervical cancer screening motivations from women and health practitioners' perspectives: A qualitative exploration.

Purpose: Cervical cancer (CC) screening remains challenging, where the motivational focus towards utilizing CC screening services is rarely highlighted. This study aimed to understand the motivation to undergo CC screening from women and healthcare practitioners' perspectives based on Protection Motivation Theory (PMT). Method: This qualitative study used the nominal group technique (NGT) and in-depth interview (IDI), where the NGT participants were healthcare practitioners from various disciplines (n = 12). Nominal group discussions were conducted via Zoom and involved one moderator, facilitator and observer. The IDI was conducted via Google Meet among seven women who had been included based on purposive sampling. All nominal group discussions and interviews were transcribed, verbatim and underwent deductive thematic analysis. Results: Healthcare practitioners emphasized input on CC knowledge of epidemiology, risk, etiology, nature, and outcome to encourage motivation. Women underlined their important role in the family, and reducing the negative perception as a motivational focus. Having living example of witnessing the CC patient dying and fear of stigma of cancer could be the driven force to undergo screening. Emphasis on the important of sufficient knowledge and correct the misconceptions towards screening could impart the motivation among women. Conclusions: The motivational focus was enriched by the differing perspectives of the healthcare practitioners and women. The findings can guide intervention program development towards enhancing CC screening in the future.

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 of N = 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.

Motives for Vaccination Against COVID-19 Among the Ultra-orthodox Jewish Community in Israel.

According to official data, the ultra-Orthodox group in Israel had the highest COVID-19 infection rate yet the lowest vaccination rate compared to the general population. The present study aimed to explore the rate of vaccine uptake as well as reported reasons for vaccine avoidance. In addition, we examined whether several protection motivation theory (PMT) components are good predictors of vaccine uptake. The components we addressed were: perceived susceptibility to the threat of COVID-19, perceived severity of the virus, and perceived efficiency and safety of the vaccine (i.e., response efficacy). The sample included 623 individuals (337 men) aged 18 + who were drawn from a database of a survey company specializing in the ultra-Orthodox community. We conducted a cross-sectional online survey between June 22, 2021, and July 7, 2021, approximately six months after the beginning of vaccination distribution. Results revealed that 65.8% of the participants (versus 89% of the general population) were vaccinated. Women were vaccinated at lower rates than men, whereas those in the Misnagdim ultra-Orthodox subgroup were vaccinated at higher rates than other subgroups in that community. The most prominent reasons for vaccine avoidance were perceived immunity based on prior infection by the virus and lack of trust in the vaccine's safety. In support of the PMT model, the perceived severity of the virus and the vaccine high efficacy were significant predictors of vaccine uptake. The study results call for better outreach to this community and specific psycho-education interventions tailored for its women.

Clearing the air: evaluating institutions' social media health messaging on wildfire and smoke risks in the US Pacific Northwest.

BACKGROUND: Wildfire smoke contributes substantially to the global disease burden and is a major cause of air pollution in the US states of Oregon and Washington. Climate change is expected to bring more wildfires to this region. Social media is a popular platform for health promotion and a need exists for effective communication about smoke risks and mitigation measures to educate citizens and safeguard public health. METHODS: Using a sample of 1,287 Tweets from 2022, we aimed to analyze temporal Tweeting patterns in relation to potential smoke exposure and evaluate and compare institutions' use of social media communication best practices which include (i) encouraging adoption of smoke-protective actions; (ii) leveraging numeric, verbal, and Air Quality Index risk information; and (iii) promoting community-building. Tweets were characterized using keyword searches and the Linguistic Inquiry and Word Count (LIWC) software. Descriptive and inferential statistics were carried out. RESULTS: 44% of Tweets in our sample were authored between January-August 2022, prior to peak wildfire smoke levels, whereas 54% of Tweets were authored during the two-month peak in smoke (September-October). Institutional accounts used Twitter (or X) to encourage the adoption of smoke-related protective actions (82% of Tweets), more than they used it to disseminate wildfire smoke risk information (25%) or promote community-building (47%). Only 10% of Tweets discussed populations vulnerable to wildfire smoke health effects, and 14% mentioned smoke mitigation measures. Tweets from Washington-based accounts used significantly more verbal and numeric risk information to discuss wildfire smoke than Oregon-based accounts (p = 0.042 and p = 0.003, respectively); however, Tweets from Oregon-based accounts on average contained a higher percentage of words associated with community-building language (p < 0.001). CONCLUSIONS: This research provides practical recommendations for public health practitioners and researchers communicating wildfire smoke risks on social media. As exposures to wildfire smoke rise due to climate change, reducing the environmental disease burden requires health officials to leverage popular communication platforms, distribute necessary health-related messaging rapidly, and get the message right. Timely, evidence-based, and theory-driven messaging is critical for educating and empowering individuals to make informed decisions about protecting themselves from harmful exposures. Thus, proactive and sustained communications about wildfire smoke should be prioritized even during wildfire "off-seasons."

Preventive behaviors against COVID-19 among health care providers in Iran: A cross-sectional study.

Background and Aim: During outbreaks of infectious diseases, if healthcare providers do not follow the principles of prevention, the risk of personal infection increases and they become a source of infection spread. This study aimed to determine the factors related to the preventive health behaviors of COVID-19 among Iranian healthcare providers based on protection motivation theory (PMT). Methods: This analytical cross-sectional study included 346 healthcare providers. Data was collected by an online researcher-made questionnaire based on PMT. To analyze the data, independent T tests, analysis of variance (ANOVA), Spearman correlation coefficient, multiple linear regression, and SPSS 22 software were used. α was considered as 0.05. Results: 85.3% of the healthcare providers would always wear masks, 80.7% would always refuse to kiss and touch hands with others, and 34.7% sometimes would exercise at home. The preventive behaviors were significantly correlated with protection motivation (r = 0.84), self-efficacy (r = 0.51), response efficiency (r = 0.43), perceived severity (r = 0.41) Fear (r = 0.21), perceived susceptibility (r = 0.11), response cost (r = -0.14), and reward (r = -0.15). PMT constructs were able to predict 77% of the variance of the behaviors and the protection motivation construct was the strongest predictor (ß = 0.806). Income above 300 Dolars per month was significantly related to the decrease in the mean score of preventive behaviors against COVID-19. The female sex and the individual or family history of infectious diseases were significantly related to increasing the mean score of COVID-19 preventive behaviors. Conclusion: Based on the study results, it is suggested that some educational interventions be designed and implemented with a focus on this construct and the perceived severity construct and that more attention be given to the education of health care providers with high-income levels, male providers, and the individuals without a history of corona infection in themselves or their family members.

What drives low-income older adults' intention to use mobility applications?

AIM: Mobility applications have the potential to support low-income older adults in facing mobility challenges. However, there is a generally lower uptake of technology in this segment. To understand factors affecting the intention to use a mobility app, we drew upon the Protection Motivation Theory, and tested a model of low-income older adults' technology adoption. METHODS: A cross-sectional survey was conducted across seven states in Malaysia among community-dwelling low-income older adults aged ≥60 years old (n = 282). Measurement items were adapted from pre-validated scales and 7-point Likert Scales were used. Partial least squares structural equation modeling was utilized to assess the hypothesized model. RESULTS: Mobility technology awareness was found to shape an individual's threat and coping appraisals associated with their intention to use a mobility app. The decision of a low-income older adult to adopt a mobility app as a protective action is not a direct function of threat and coping appraisals but is indirect, and mediated by the underlying cost-benefit perceptions of non-adoption and adoption of the mobility app. In terms of technology perceptions, perceived usefulness is a significant predictor, but not perceived ease of use. CONCLUSIONS: This study entails a new model by uncovering the psychological factors encompassing mobility technology awareness, threat-coping appraisals, and cost-benefit perceptions on Technology Acceptance Model studies. These insights have important implications for the development and implementation of a mobility app among low-income older adults. Geriatr Gerontol Int 2024; 24: 342-350.

Temporal changes in factors associated with COVID-19 vaccine hesitancy among Chinese adults: Repeated nationally representative survey.

Background: COVID-19 vaccine hesitancy has been cited as one of the main obstacles impacting vaccine coverage. However, factors that affect hesitancy may change over time. Understanding these evolving concerns and adapting strategies accordingly are crucial for effectively addressing vaccine hesitancy effectively and promoting public health. We aimed to explore the temporal changes in factors associated with COVID-19 VH during the COVID-19 pandemic and assess the dynamic evolution of VH. Methods: In August 2022 and February 2023, repeated online surveys were undertaken to collect information from 5378 adults across four regions of China. Multiple linear regression models assessed the influencing factors of COVID-19 VH. The association between protective motive theory (PMT) (perceived severity, susceptibility, benefits, barriers, and self-efficacy) and VH was evaluated by structural equation modeling (SEM). Results: Repeated measures showed that 573 (10.7%) and 1598 (29.7%) of the 5378 participants reported COVID-19 VH in the baseline and follow-up surveys, respectively. Educational levels, chronic disease, history of allergy, COVID-19 infection, and trust in medical staff and vaccine developers were positively associated with COVID-19 VH (P＜0.05). The application of SEM revealed that perceived severity, susceptibility, vaccination barriers, and self-efficacy in the PMT directly impacted on VH (P＜0.05). In addition, severity, susceptibility, benefits, and barriers had a significant direct effect on self-efficacy as ß = 0.113, ß = 0.070, ß = 0.722, ß = -0.516 respectively with P < 0.001. Conclusion: The prevalence of COVID-19 VH was relatively low in the baseline survey and much higher in the follow-up survey, with a significant increase in hesitancy rates among mainland Chinese residents. Acknowledging the substantial impact on the shaping of COVID-19 VH, one must consider factors including perceived severity, susceptibility, vaccination barriers, and self-efficacy.

Vicarious experiences of long COVID: A protection motivation theory analysis for vaccination intentions.

Context: Long COVID can appear as a severe late consequence (sequela) of a COVID-19 infection, leading to the inability to work or participate in social life for an unknown amount of time. To see friends or family struggling with long COVID might influence people's risk perceptions, vaccine efficacy expectations, and self-efficacy perceptions to prevent COVID-19 and its consequences. Methods: In an online survey in August 2022, n = 989 German-speaking participants indicated whether they knew someone who suffered from long COVID illness. Four dimensions of protection motivation theory (PMT) were assessed afterwards, as well as vaccination intentions. Results: Multiple mediation analysis with participants who knew vs. didn't know someone with long COVID (n = 767) showed that knowing someone with long COVID was associated with higher perceived affective and cognitive risk of long COVID-19 as well as higher perceived vaccine efficacy. Self-efficacy, i.e., the ease to protect oneself against long COVID, was lower in participants who knew long-COVID patients. Indirect positive effects for response efficacy and affective risk suggest that vicarious experience with long COVID is associated with increased intentions to get a COVID-19 vaccine. Conclusion: The protection from long COVID through vaccination are relevant aspects for individual decisions and health communication.