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.

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."

Using behavioral theory to understand partisan differences in COVID-19 vaccination and booster intentions.

In 2020, the Food and Drug Administration granted emergency use authorization for two COVID-19 vaccines. Two years later, the Centers for Disease Control and Prevention estimated that more than 250 million individuals had received at least one dose of the vaccine. Despite the large numbers of individuals vaccinated against COVID-19, partisan differences surrounding the COVID-19 vaccine emerged, creating a potential challenge for health communications aimed at increasing vaccine uptake. A better understanding of partisan differences in attitudes and intentions towards vaccination may help guide public health strategies aimed at increasing vaccine uptake. To determine whether a commonly used theory of behavioral intentions used to craft public health messages explains partisan differences in intentions. Data were drawn from a national panel of US adults and collected between February 21, 2022, and March 3, 2022, using an online survey (n = 1845). Among respondents identifying as either Democrat or Republican (n = 1466), path analysis models were estimated to test whether partisan differences in vaccination or booster intentions were explained by the theoretical constructs of protection motivation theory (PMT). PMT accounted for approximately half of the covariate-adjusted mean difference in COVID-19 vaccination intentions between Democrats and Republicans, and nearly all the mean difference in booster intentions. Party affiliation indirectly affected intentions via its association with perceived susceptibility to COVID-19, vaccine/booster efficacy, and perceived costs of getting a COVID-19 vaccine or booster dose. Compared with Democrats, Republicans may be less likely to get vaccinated or receive a booster dose because of beliefs that they are less susceptible to COVID-19, that the vaccine is less effective, and that vaccination comes with disadvantages. Theories of behavioral intentions can help to identify the underlying theoretical determinants driving behavioral differences between political groups.

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.

When increasing risk perception does not work. Using behavioral psychology to increase smoke alarm ownership.

The central question of our study is which determinants drive smoke alarm ownership and intention to purchase one, and whether we can increase smoke alarm ownership by addressing these determinants in a communication-based intervention. We first made an inventory of possible determinants for smoke alarm prevention by consulting prominent prevention behavior theories protection motivation theory and Health Belief Model and other relevant literature. We expanded this list of determinants based on interviews (n = 15) and used survey data representative for the Netherlands to decide to focus on smoke alarm ownership (rather than installation or maintenance). We then tested the determinants of smoke alarm ownership and buying intention in a survey (n = 622). Based on these results, we ran an A/B test (n = 310) of two messages to stimulate smoke alarm ownership: one emphasized the determinants we found to be strong predictors in the survey (know-how, social norm, annoyance) and one emphasized typical determinants that are often addressed in campaigns but were poor predictors in the survey (vulnerability, severity, benefits). Results showed that the message based on the strong determinants resulted in a significant increase in smoke alarm ownership (9.1%) compared to the control group (0.9%; p = 0.027), while the message using the typical determinants did not lead to significant effects. Taken together, our results give a promising direction for interventions to increase smoke alarm ownership, and above all, show that a comprehensive problem analysis for a specific target behavior is a necessary step to induce behavioral change.

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.

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.

Psychometric evaluation of the Protection Motivation Theory scale in assessing fall protection motivation among older adults to reduce fall risk.

BACKGROUND: Protection Motivation Theory could be another potential and good framework that addresses essential elements in a behavioural change leading to positive fall protective behaviours. The positive behavioural change could reduce the risk of falls and improve the quality of life of the older community. The study aims to evaluate the reliability and validity of the culturally adapted Protection Motivation Theory scale for older adults' fall protection motivation or protective behaviours to reduce fall risk. METHODS: A cross-sectional study was conducted to establish a psychometric instrument validation. A total of 389 participants aged 55 years and above were included. The study was conducted in Sarawak, Malaysia, from November 2021 to January 2022 in two phases, translation of the PMT Scale, cross-cultural adaptation, face validation and pre-testing of the PMT Scale. The participants were selected using multistage random sampling in a primary healthcare clinic. Data entry and statistical analysis were performed using IBM SPSS version 26 for exploratory factor analysis and SmartPLS version 3.3.7 for confirmatory factor analysis using partial least square structural equation modelling. RESULTS: The Kaiser-Meyer-Olkin value was 0.760, Bartlett's sphericity test was significant and the total variance explained was 61%. It identified 31 items within eight dimensions of the Protection Motivation Theory scale. The Higher Order Constructs' measurement model indicates that the convergent and discriminant validity were established (Cronbach's alpha and composite reliability: ≥ 0.740; average variance extracted: 0.619 to 0.935 and Henseler's Heterotrait-Monotrait criterion for all constructs' discriminant validity: < 0.9). Test-retest for the intraclass correlation coefficient was 0.745. The model's coefficient of determination demonstrated R2 = 0.375. CONCLUSION: Overall, the Protection Motivation Theory Scale has established its reliability and validity for assisting older adults in the community. The Protection Motivation Theory Scale could be used in fall prevention interventions by promoting fall protective behaviours to reduce fall risk among community-dwelling older adults. The scale could assist healthcare providers in assessing the intention of older adults to use fall protective behaviours to reduce fall risk and serve as an alternative reference in developing fall prevention education in a fall prevention strategy.

Skin cancer prevention behaviors, beliefs, distress, and worry among hispanics in Florida and Puerto Rico.

BACKGROUND: Incidence of skin cancer has been increasing among U.S. Hispanics, who often are diagnosed with larger lesions and at later stage disease. Behaviors to decrease exposure to ultraviolet radiation can reduce risk of skin cancer. We describe skin cancer prevention behaviors and psychosocial variables among Hispanic participants recruited into a skin cancer prevention trial. METHODS: Self-reported Hispanic participants from eight primary care clinics in Tampa, Florida and Ponce, Puerto Rico were recruited into a randomized controlled prevention trial. Information on demographics, sun-related behaviors, and psychosocial variables were collected before intervention materials were provided. Multivariable regression models were used to compare baseline sun-related behaviors and psychosocial variables across groups defined by geographic location and language preference. RESULTS: Participants reported low levels of intentional outdoor tanning, weekday and weekend sun exposure, and very low levels of indoor tanning. However, only a minority of participants practiced sun-protective behaviors often or always, and about 30% experienced a sunburn in the past year. Participants had low levels of recent worry and concern about skin cancer, modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy. When comparing across groups defined by geographic location and language preference, English-preferring Tampa residents (hereafter referred to as Tampeños) had the highest proportion who were sunburned (35.9%) and tended toward more risky behavior but also had higher protective behavior than did Spanish-preferring Tampeños or Puerto Ricans. Spanish-preferring Puerto Ricans had higher recent concern about skin cancer, comparative chance of getting skin cancer, and response efficacy compared to either English- or Spanish-preferring Tampeños. Spanish-preferring Tampeños had the highest levels of familism and recent distress about skin cancer. CONCLUSIONS: Our results mirror previous observations of low levels of sun-protective behavior among U.S. Hispanics compelling the need for culturally appropriate and translated awareness campaigns targeted to this population. Because Hispanics in Tampa and Puerto Rico reported modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy, interventions aiming to improve skin cancer prevention activities that are anchored in Protection Motivation Theory may be particularly effective in this population subgroup.

Predicting COVID-19 vaccination intentions: the roles of threat appraisal, coping appraisal, subjective norms, and negative affect.

BACKGROUND: As a new disease, communities possess little natural immunity to COVID-19 and vaccines are considered critical to preventing and reducing the incidence of severe illness. This study, inspired by Protection Motivation Theory (PMT), examines the relationship between citizens' threat appraisal, coping appraisal, subjective norms, negative affect, and their COVID-19 vaccination intentions. METHODS: A sample of 340 citizens from two main cities in Mainland China, Xi'an and Wuxi, was used for data analysis. Structural Equation Modeling (SEM) was employed with latent and observed variables to test hypotheses. Data were analyzed using AMOS 24.0. RESULTS: Several findings extend current understanding. Firstly, our proposed model explains 73% of the variance in vaccination intentions. Secondly, perceived severity only indirectly shapes COVID-19 vaccination intentions through negative affect. Thirdly, negative affect and response costs are negatively related to COVID-19 vaccination intentions. Finally, Perceived probability, subjective norms, response efficacy and self-efficacy are positively related to COVID-19 vaccination intentions; among them, self-efficacy contributes the most, followed by response efficacy and subjective norms, and lastly perceived probability. CONCLUSION: Theoretically, this study increases current understanding about subjective norms and affective responses. We provoke a certain amount of thought about the role of affect response in relation to threat appraisal and vaccination intentions. Specifically, governments must be vigilant that citizens' negative affect, such as fear, may cause vaccine hesitation.

Are threat perceptions associated with patient adherence to antibiotics? Insights from a survey regarding antibiotics and antimicrobial resistance among the Singapore public.

BACKGROUND: Public health strategies to improve patient adherence to antibiotics rely mostly on raising awareness of the threat of antimicrobial resistance (AMR) and improving knowledge about antibiotics. We aimed to evaluate how adherence to antibiotics relates to knowledge and the threat perceptions proposed by the Protection Motivation Theory (PMT). METHOD: A cross-sectional online survey was conducted in September-December 2020 with 1002 participants aged 21-70 years in Singapore. Two items, which were reverse coded, evaluated adherence to antibiotics: 'how often do you obtain antibiotics that were left over from the previous prescription' and 'how often did you treat yourself with antibiotics in the past year'. Questions about the PMT-related constructs, and knowledge regarding antibiotics and AMR knowledge were also included. Hierarchical regression models were performed at a 5% significance level. RESULTS: Adherence to antibiotics was associated with knowledge level (ß = 0.073, p < 0.05), education level (ß = - 0.076, p < 0.01), and four of the five PMT constructs: "perceived response cost" (ß = 0.61, p < 0.01), "perceived response efficacy of adherence to antibiotic" (ß = 0.096, p < 0.01), "perceived susceptibility to AMR" (ß = 0.097, p < 0.01), and "perceived severity of AMR" (ß = - 0.069, p < 0.01). Knowledge about AMR, perceived self-efficacy in adhering to antibiotics, age, and sex were not associated with adherence. CONCLUSIONS: In Singapore, patient adherence to antibiotics appear to be driven by the perceived costs of visiting a doctor to obtain antibiotics, followed by perceptions of AMR as a threat and to a lesser extent, knowledge about antibiotics. Public health strategies to mitigate antibiotic misuse should consider these patient barriers to medical care.

Can protection motivation theory predict protective behavior against ticks?

BACKGROUND: Cases of reported tick-borne diseases in humans have increased over the past decades. Strategies informing the public about ticks, their associated diseases, and preventive measures are often highlighted as important in limiting pathogen transfer and disease. However, knowledge about the motivation for people to apply preventative measures is sparse. METHODS: The aim was to examine if Protection Motivation Theory, a model of disease prevention and health promotion, can predict the use of protective measures against ticks. Ordinal logistic regression and Chi-square tests were used on data from a cross-sectional survey with respondents from Denmark, Norway, and Sweden (n = 2658). We examined the effect of (1) the perceived seriousness of tick bites, Lyme borreliosis (LB), and tick-borne encephalitis (TBE), and (2) the perceived probability of getting a tick bite, Lyme borreliosis, and tick-borne encephalitis on protection against ticks. Finally, we examined if there was an association between the use of a protective measure and the perceived efficacy of that measure. RESULTS: The perceived seriousness of a tick bite and LB significantly predict who is more likely to apply protective measures for all three countries combined. The perceived seriousness of TBE did not significantly predict the level of adoption of protective measures applied by respondents. The perceived likelihood of getting a tick bite within the next 12 months and the perceived likelihood of getting LB if bitten by a tick significantly predicted the application of protective measures. However, the increases in the likelihood of protection were very small. The application of a certain type of protection was always correlated with the perceived efficacy of the same protective measure. CONCLUSION: Some variables of PMT may be used to predict the level of adoption of protection applied against ticks and tick-borne diseases. We found that the perceived seriousness of a tick bite and LB significantly predict the level of adoption protection. The perceived likelihood of getting a tick bite or LB also significantly predicted the level of adoption of protection, although the change was very small. The results regarding TBE were less clear. Lastly, there was an association between applying a protective measure and the perceived efficacy of the same measure.

Protective motivators and precautionary behaviors against COVID-19 in Turkey.

In this research, we investigated the protection motivators and precautionary behaviors against coronavirus disease 2019 (COVID-19) and the associations between them. To do this, we developed two original scales, collected data (2783 responses) using an online survey, after removing the responses (319), which were filled in incompletely or incorrectly in the questionnaire, we obtained 2464 participants covering the aged 18+ population in Turkey. Based on random sampling, our sample complies with these ratios and generally reflects the aged 18+ population of Turkey. We confirmed the psychometrical validity and reliability of our two scales using the collected data. Herewith, we found that perceived susceptibility of COVID-19 infection is very high, perceived severity of COVID-19 is medium, COVID-19 related information seeking is high, beliefs on precautions' efficacy is high and also the practice of precautionary behaviors is high. Our research depicts that all protection motivators significantly are related with the practice of precautionary behaviors (routine and leisure). However, with the only exception of perceived severity of COVID-19 is not related with precautionary behaviors (routine). Besides, we saw that females' average in all variables is significantly higher than males and some variables are sensitive to age, education level, marital status and the number of children. We believe that the findings provide essential inputs for authorities in establishing public health policies against the present pandemic and likely ones in the future.

Health literacy and COVID-19-related beliefs and behaviors: a longitudinal study of the Japanese general population.

Since the outbreak of novel coronavirus disease-2019 (COVID-19), health communication has played a critical role in the process of disease prevention. Based on the concepts of health literacy and protection motivation theory, this study longitudinally examined the relationship between general health literacy measured immediately before the COVID-19 outbreak, and COVID-19-related information utilization, health literacy, beliefs and protective behaviors during the subsequent year in the Japanese general population. The participants were 767 Japanese residents who completed self-administered questionnaire surveys in January 2020 and February 2021. Based on the hypotheses, we constructed and tested a path model to predict the adoption of protective behaviors. Higher health literacy in 2020 was significantly related to higher COVID-19-related health literacy in 2021, which, in turn, was related to the adoption of recommended protective behaviors both directly and indirectly through threat and coping appraisal. Coping appraisal, but not threat appraisal, significantly differed by health literacy level. Generic health literacy skills for accessing, understanding and applying health information may enable people to better adapt to specific health risks. Our findings provide guidance for future health literacy education and health risk communication in populations with different health literacy levels.

Using Protection Motivation Theory to Predict Adherence to COVID-19 Behavioral Guidelines.

COVID-19 has become a global pandemic. Throughout most of the pandemic, mitigating its spread has relied on human behavior, namely on adherence to protective behaviors (e.g., wearing a face mask). This research proposes that Protection Motivation Theory (PMT) can contribute to understanding differences in individual adherence to COVID-19 behavioral guidelines. PMT identifies four fundamental cognitive components that drive responses to fear appeals: perceptions of susceptibility (to the disease), severity (of the disease), self-efficacy (to protect oneself), and response efficacy (i.e., recommended behaviors' effectiveness). Two online self-report studies assessed PMT components' capacity to predict adherence to protective behaviors concurrently and across culturally different countries (Israel, Germany, India; Study 1), and again at six-week follow-up (Israeli participants; Study 2). Study 1's findings indicate excellent fit of the PMT model, with about half of the variance in adherence explained. No significant differences were found between participants from Israel (n = 917), Germany (n = 222) and India (n = 160). Study 2 (n = 711) confirmed that PMT components continue to predict adherence after six weeks. In both studies, response efficacy was the PMT component most strongly associated with adherence levels. This study demonstrates that PMT can serve as a theoretical framework to better understand differences in adherence to COVID-19 protective behaviors. The findings may further inform the design of adherence-promoting communications, suggesting that it may be beneficial to highlight response efficacy in such messages.

Assessing the predictors of adaptive and maladaptive Covid-19 preventive behaviours: an application of protection motivation theory.

Despite the high death toll of the COVID-19 pandemic, reported rates of adherence to adaptive preventive health behaviours during the early wave of the pandemic were suboptimal for reducing the risk of disease spread. Additionally, some have adopted practices with the intention of preventing infection that have harmful consequences. Protection Motivation Theory (PMT), consisting of perceived vulnerability, severity, response efficacy, and self-efficacy, has been used to predict intentions to engage in behaviours in past pandemics, and can be extended to the COVID-19 outbreak. Three hundred and thirty-three American adults completed a survey in May 2020 through Amazon's Mechanical Turk. Ten behaviours recommended by the CDC and WHO and two 'maladaptive' behaviours presented in the media were selected for investigation. Binary logistic regressions were conducted to assess the impacts of demographic variables and PMT constructs on behaviour frequency. Perceived severity and vulnerability were not significant predictors of behaviour frequency. Behaviour specific response efficacy and self-efficacy were significant predictors of 11/12 (odds ratios: 2.70-6.22) and 10/12 (odds ratios: 2.59-4.64) behaviours, respectively. Age, gender, education, political ideology, perceived severity, and perceived vulnerability were generally unimportant predictors. Beliefs about the effectiveness of the behaviour and one's ability to carry out that behaviour consistently seem to be more important in predicting how often someone engages in that behaviour than the perceived dangerousness of COVID-19 and one's believed susceptibility to infection. These results suggest that interventions trying to modulate the likelihood of engaging in preventive behaviours should focus on the effectiveness of these behaviours in reducing risk of spread and the individual's ability to engage in these behaviours frequently rather than the dangerousness of the COVID-19 pandemic and the individual's risk of becoming infected.

Uncertainty in individual risk judgments associates with vulnerability and curtailed climate adaptation.

Risk assessments are key for the effective management of potential environmental threats. Across probabilistic phenomena, climate change is an exemplar of paramount uncertainties. These uncertainties have been embraced in supporting governments' decisions; yet receive scarce attention when studying individual behavior. Analyzing a survey conducted in the USA, China, Indonesia, and the Netherlands (N=6242), we explore socio-economic, psychological, and behavioral differences between individuals who can subjectively assess risks, and those who are risk-uncertain. We find that risk-uncertain individuals are more likely to belong to societal subgroups classically considered as vulnerable, and have reduced capacities and intentions to adapt to hazards-specifically floods. The distinctions between risk-aware and risk-uncertain individuals indicate that ignoring differences in individuals' capacity to assess risks could amount to persistent vulnerability and undermine climate-resilience efforts. While we use floods emblematically, these finding have consequences for the standard practice of dropping or bootstrapping uncertain responses, irrespective of the hazard, with implications for environmental management.

Using Protection Motivation Theory to Predict Intentions for Breast Cancer Risk Management: Intervention Mechanisms from a Randomized Controlled Trial.

The purpose of this study is to evaluate the direct and indirect effects of a web-based, Protection Motivation Theory (PMT)-informed breast cancer education and decision support tool on intentions for risk-reducing medication and breast MRI among high-risk women. Women with ≥ 1.67% 5-year breast cancer risk (N = 995) were randomized to (1) control or (2) the PMT-informed intervention. Six weeks post-intervention, 924 (93% retention) self-reported PMT constructs and behavioral intentions. Bootstrapped mediations evaluated the direct effect of the intervention on behavioral intentions and the mediating role of PMT constructs. There was no direct intervention effect on intentions for risk-reducing medication or MRI (p's ≥ 0.12). There were significant indirect effects on risk-reducing medication intentions via perceived risk, self-efficacy, and response efficacy, and on MRI intentions via perceived risk and response efficacy (p's ≤ 0.04). The PMT-informed intervention effected behavioral intentions via perceived breast cancer risk, self-efficacy, and response efficacy. Future research should extend these findings from intentions to behavior. ClinicalTrials.gov Identifier: NCT03029286 (date of registration: January 24, 2017).

Health and Environmental Protective Behavioral Intentions for Reducing Harm from Water Pollutants.

Understanding what motivates people to adopt protective behaviors is important in developing effective risk messaging. Motivations may vary depending on the nature of the risk and whether it poses a personal or impersonal threat. Water pollution creates both personal (human health) and impersonal (environmental) threats, yet few studies have examined people's motivations to protect both personal health and environmental health. Protection motivation theory (PMT) uses four key variables to predict what motivates individuals to protect themselves in relation to a perceived threat. Using data from an online survey (n = 621), we investigated the relationships between PMT variables related to health and environmental protective behavioral intentions related to toxic water pollutants among residents in Oregon, Idaho, and Washington, USA. Among PMT variables, high self-efficacy (belief in one's own capacity to carry out certain behaviors) significantly predicted both health and environmental protective behavioral intentions for water pollutants, while perceived severity of the threat was only significant in the environmental behavioral intentions model. Perceived vulnerability and response efficacy (belief that a specific behavior will effectively mitigate the threat) were significant in both models. Education level, political affiliation, and subjective knowledge of pollutants were significant predictors of environmental protective behavioral intentions, but not health protective behavioral intentions. The results of this study suggest that when communicating environmental risks of water pollution, highlighting self-efficacy in messaging is particularly important to promote protective environmental and personal health behavior.

Determinants of Farmers' Adaptation Intent And Adoption of Adaptation Strategies To Climate Change And Variability In Mwanga District, Tanzania.

Pegged on Protection Motivation Theory, a modified socio-cognitive model of private adaptation to climate change and variability was deployed in order to provide a better understanding of the determinants of small-scale farmers' adaptation intent and adoption of adaptation strategies in semi-arid lowlands of Mwanga District. In this regard, adaptation was conceptualized as a two-step process encompassing farmers' perceptions that climate was changing and farmers' response to changes. Basing on a pragmatic philosophy, a cross-sectional sequential explanatory mixed methods research design was deployed. During the first step-process, categorical data were collected through administration of a closed-ended survey questionnaire to 328 household heads. Binary and proportional odds logistic regressions were run through IBM SPSS (Version 20) in order to analyze categorical data for testing nine (9) null hypotheses. Statistically significant results were established when p values were < 0.05 at 95% confidence intervals. During the second step-process, qualitative data were generated through focus group discussions with 30 participants, in-depth interviews with 16 key informants, and participant observations and subjected to iterative thematic content analysis. The findings revealed that income, village's geographical location, farming system, membership to farmer-based group, competitive price for produce, credit, age, education, and extension service positively influenced farmers' adoption of adaptation strategies while workforce and perceived risk of rain on crop yields negatively influenced farmers' adoption of adaptation strategies. Thus, it was concluded that farmers' adaptation intent and adoption of adaptation strategies in the study area were largely explained by objective adaptive capacity rather than cognitive factors.