Associations between vaccination and protective behaviors against COVID-19: transfer and redundancy effects as potential psychological mechanisms.

This study aimed to investigate mechanisms explaining associations between vaccination and protective health behaviors during the COVID-19 pandemic. The study used a secondary analysis of data from a longitudinal online study at four time points between April 2020 and March 2021. Two hundred and forty participants responded to questionnaires assessing adherence to multiple COVID-19 protection behaviors, COVID-19 vaccination, behavioral specific outcome expectancies and general healthy lifestyle. Statistical analyses included z statistic for differences between correlations and moderation analysis by the SPSS PROCESS macro. The correlation between initial adherence to protective behaviors prior to availability of vaccination and actual vaccination was positive, but when vaccination was available, the concurrent correlation between these behaviors was null. Healthy lifestyle and outcome expectancies moderated the association between vaccination and adherence to protection behaviors. These results were explained by a 'redundancy effect', conceptualized as beliefs that engagement in specific health behaviors justifies evading other health behaviors. The 'redundancy effect' cancelled the initial positive correlation between vaccination and protective health behaviors, produced by a 'transfer effect', based on similarities between the perceived purposes of those behaviors. Theoretical and practical implications of the findings were discussed.

Core self-evaluations as resilience and risk factors of psychological distress during the COVID-19 pandemic.

In view of the grave consequences of distress reactions to the COVID-19 pandemic, this study investigated CSE (Core Self-evaluations) - internal/external health locus of control, generalized self-efficacy and trait optimism - and intolerance of uncertainty as potential correlates of distress reactions. We conducted an online questionnaire-based cross-sectional study with 422 Israeli respondents. Pandemic-related distress was defined by perceived stress, negative and positive affect, and worries. Predictors were: health locus of control, generalized self-efficacy, trait optimism, and intolerance of uncertainty. The findings show that CSEs and intolerance of uncertainty added between 11% (to perceived stress) and 22% (to negative affect) of explained variance beyond the background variables. Specifically, higher trait optimism and generalized self-efficacy were associated with less distress, and greater intolerance of uncertainty was correlated with higher distress. In conclusion, the CSE framework is useful for explaining psychological distress during the COVID-19 pandemic. Beyond their theoretical contribution, the findings may have practical implications for increasing resilience and ameliorating distress during a pandemic.

Vaccination Against COVID-19: A Longitudinal Trans-Theoretical Study to Determine Factors that Predict Intentions and Behavior.

BACKGROUND: Despite the clear benefits of vaccination, their uptake against common infectious diseases is suboptimal. In December 2020, vaccines against COVID-19 became available. PURPOSE: To determine factors that predict who will take the COVID-19 vaccine based on a conceptual model. METHODS: An online survey was administered twice: prior to public vaccination, and after vaccinations were available. Participants were 309 Israelis with initial data and 240 at follow-up. Baseline questionnaires measured intentions to be vaccinated and hypothesized predictors clustered in four categories: background, COVID-19, vaccination, and social factors. Self-reported vaccination uptake was measured at follow-up. RESULTS: Sixty-two percent of the sample reported having been vaccinated. Intentions were strongly associated with vaccination uptake and mediated the effects of other predictors on behavior. Eighty-six percent of the variance in vaccination intentions was explained by attitudes toward COVID-19 vaccination, regret for having declined vaccination, trust in vaccination, vaccination barriers, past flu vaccination, perceived social norms, and COVID-19 representations. CONCLUSIONS: Beliefs related directly to the COVID-19 vaccine explained most of the variance in intentions to vaccinate, which in turn predicted vaccination uptake.

The Association Between Healthy Lifestyle Behaviours and Coronavirus Protective Behaviours.

BACKGROUND: Based on models of cross-behavioural associations and the role of past behaviour in predicting behaviour, an association was hypothesized between healthy lifestyle behaviours prior to the COVID-19 pandemic and adherence to coronavirus protective behaviours. Self-assessed health was also examined as a potential moderator. METHODS: A cross-sectional sample (N = 463) completed online questionnaires during a COVID-19-related lockdown that measured engagement in healthy lifestyle behaviours (e.g., exercising and eating fruits and vegetables), adherence to coronavirus protective behaviours (e.g., wearing a face mask and practicing social distancing), and self-assessed health (subjective evaluation of overall health). RESULTS: As predicted, higher engagement in healthy lifestyle behaviours prior to the pandemic was significantly correlated with higher adherence to coronavirus protective behaviours (Pearson r(459) = .308, p < .001). Adherence levels were higher than engagement in healthy lifestyle behaviours, and self-assessed health was related to the latter but not to the former. Moderation was examined using model 1 in PROCESS for SPSS; as expected, the association was stronger among individuals with higher levels of self-assessed health (coefficient 95% CI [.04, .20]). CONCLUSIONS: The findings highlight cross-behavioural facilitating processes, specifically between lifestyle behaviours and adherence to recommended protective behaviours during the pandemic. They also draw attention to the need to address individuals whose poorer evaluations of their general health might prevent them from implementing their behavioural intentions.

Comparisons Between Illness and Injury Outcomes: Potential Suppression Effects by Emotional Representations.

BACKGROUND: Based on recent findings that people perceive illness and injury as separate categories, we compared ill and injured participants with similar health conditions on illness perceptions and reported outcomes, e.g., functioning, distress, well-being. METHOD: A cross-sectional study with 182 ill and 160 injured participants affected by ankle, knee, or neck conditions compared them on standard measures of illness perception and other reported outcomes (self-assessed health; physical, emotional, and social functioning; depression, anxiety, and somatization; satisfaction with life, self-esteem, and acceptance of disability). RESULTS: The groups did not differ on the measured outcomes, but injury elicited stronger emotional representations, and illness was perceived as more chronic. After controlling for the effects of emotional representations, the injured group presented better outcomes on all outcome measures, including self-assessed health, physical functioning, emotional functioning, social functioning, vitality, health beliefs, depression, somatization, total distress, and acceptance of disability. CONCLUSION: Emotional representations may suppress the potential superior outcomes of injury compared with illness. The theoretical implications of these results for self-regulation theories are discussed, as well as clinical implications.

Health-related quality of life after injury: examining the roles of perceived daily-life stress and injury perceptions.

PURPOSE: The present study aimed to examine the effects of injury perceptions and perceived daily stress on health-related quality of life (HRQL) of individuals affected by a physical injury. METHODS: Two hundred and forty injured individuals completed questionnaires assessing HRQL (Medical Outcome Health Survey short-form 36), perceived daily-life stress (Perceived Stress Scale), and injury perceptions (Brief-InjPQ). RESULTS: The direct effects of stress on HRQL scores were not moderated by gender. Emotional representation of the injury significantly mediated the links between PSS and all HRQL subscales only among women, but not among men. However, the mediation of the HRQL total score by emotional representations was significant for both genders. In addition, treatment control perceptions of the injury mediated the link between PSS and self-assessed health among men but not women, and injury-self perceptions mediated the link between PSS and physical functioning among men but not women. CONCLUSION: These findings underscore the importance of perceived daily stress, gender, and injury perceptions as key factors for explaining variance in HRQL following injury. In addition to their conceptual contributions, the findings have clinical implications for treating injured populations.

Connectionism and Behavioral Clusters: Differential Patterns in Predicting Expectations to Engage in Health Behaviors.

Background: The traditional approach to health behavior research uses a single model to explain one behavior at a time. However, health behaviors are interrelated and different factors predict certain behaviors better than others. Purpose: To conceptualize groups of health behaviors as memory events that elicit various beliefs. A connectionist approach was used to examine patterns of construct activation related to expectations to engage in health behavior clusters. Methods: A sample of lay people (N = 1,709) indicated their expectations to perform behaviors representing four clusters (Risk Avoidance, Nutrition & Exercise, Health Maintenance, and General Well-Being) and rated them on 14 constructs obtained from health behavior literature. Results: Expectations to engage in all behavioral clusters were significantly and positively associated with "frequency of performance," "perceived behavioral control," and "anticipated regret," and negatively associated with "effort." However, each behavioral cluster was also predicted by activation of a unique pattern of predictors. Conclusions: A connectionist approach can be useful for understanding how different patterns of constructs relate to specific outcomes. The findings provide a rationale for lay people's cognitive schema of health behaviors, with each behavioral cluster possessing characteristics associated with distinct predictors of expectations to engage in it. These unique activation patterns point to factors that may be particularly significant for health interventions targeting different clusters of health behaviors.

Parental perceptions of children's exposure to tobacco smoke: development and validation of a new measure.

BACKGROUND: It is estimated that around 40% of children worldwide are exposed to tobacco smoke, largely by their parents. Discrepancies between biochemical measures of exposure and parental report imply that parents may be under-reporting children's exposure. Previous research has shown that there may be a fundamental misunderstanding among smoking parents as to what exactly exposure is and in what circumstances it occurs. METHODS: We aimed to develop and validate a measure to assess parental perceptions of exposure (PPE) regarding child tobacco smoke exposure (TSE). A model was developed based on a qualitative study of smoking parents and a questionnaire constructed using pictures and vignettes to assess parental rating of children's exposure in hypothetical situations. The questionnaire was completed online by 220 Israeli parents recruited via social media. Exploratory factor analysis was performed, and reliability and internal consistency were assessed using test-retest reliability and Cronbach's alpha coefficient. RESULTS: Factor analysis produced 6 factors for PPE which explained a cumulative total variance of 76.3%. Factors were termed: 1) second-hand exposure; 2) third-hand exposure; 3) perceived knowledge/certainty; 4) sensory perceptions; 5) time perceptions; and 6) distance perceptions. All sub-scales showed good internal consistency and variance. Test-retest reliability was high (r = 0.856, p = .001). Total PPE score and subscales were highly correlated with risk perceptions r = 0.766. Smokers scored significantly lower on PPE than non-smokers, defining fewer situations as involving greater exposure (p < 0.001). Logistic regression showed PPE was able to discriminate smoking status. CONCLUSIONS: Results provide supporting evidence for the PPE as a reliable and valid construct, which can be feasibly measured. Smokers perceived exposure less frequently than non-smokers. This new measure can shed light on parental smoking behaviour and may help us to increase parental awareness of exposure in order to potentially reduce children's exposure to tobacco smoke.

Mediation and moderation of the effects of watching the angiography screen on patients.

It has been reported that allowing patients to watch the coronary angiography screen during the procedure results in psychological benefits. This study aimed to investigate the roles of illness perceptions as mediators of this outcome and to examine whether individual differences in monitoring coping style moderated these effects. The experiment compared patients who were instructed to watch the monitor screen (n = 57) with those who were not (n = 51). Questionnaires were used to measure the research variables at one day and one month after the procedure. Results showed that watching the angiography screen increased patients' personal and treatment control perceptions that mediated changes in self-assessed health, risk perceptions, negative affect, general and diet outcome expectancies, and diet and physical activity intentions. The behavior-related outcomes were moderated by monitoring coping style. These findings illustrate the significance of illness perceptions, perceived control and monitoring coping style in achieving desirable outcomes among patients undergoing coronary angiography, and reveal opportunities for interventions using medical imaging technologies.

Identity Reconstruction Following Injury in Dancers.

Objectives: To explore reconstructed identities of dancers who experienced an injury, using a model of identity reconstruction post-injury. Methods: An online questionnaire study with 145 dancers who had experienced a significant dance-related injury. Measures included a questionnaire measuring dancers' reconstructed identities, injury perceptions and injury centrality to self-concept. Statistical analyses included factor analysis, regression analyses and discriminant analysis. Results: Four latent variables discovered "supernormal self," "former self," "middle self," and "resentful self" reconstructed identities. Injury centrality to the self and specific injury perceptions were correlated with reconstructed identity scales in the predicted directions. Conclusions: The findings validated the existence of 4 distinct reconstructed identities associated with time distance from the injury. Classifying injured dancers according to these identities can help dance educators, practitioners and counselors detect dancers needing help and tailor counseling methods to modify the relevant injury perceptions.

A follow-up study on men tested for BRCA1/BRCA2 mutations: impacts and coping processes.

OBJECTIVE: The objective of this study was to examine cognitive, emotional, and behavioral impacts of testing for germline mutations in breast/ovarian cancer-associated genes (BRCA1/BRCA2) among men who undergo genetic testing. METHODS: A cross-sectional study compared 51 mutation carriers with 30 men who tested negative for the mutations in both genes. Telephone interviews were conducted with all participants at a median of 4 years after disclosure of test results in a genetic counseling context. Testing-related distress, cancer risk perceptions, perceived behavioral changes following testing, and perceptions of breast cancer were measured using standard questionnaires. RESULTS: Up to 4 years postgenetic testing, 48% of those who tested positively report that the test increased their perceptions of risk, and 74% of them increased surveillance for cancer. Men who had been tested as non-carriers did not report increased perceived risk (0%) and relatively few increased surveillance (31%). Carriers were significantly more distressed from testing, perceived breast cancer as having less consequences and emotional effects on the patient, and as being more treatable than non-carriers. CONCLUSIONS: These results have implications with regard to the Self Regulatory Theory. They show that (i) illness representations are affected by fear-arousing health information; (ii) risk perceptions elicit health behaviors; and (iii) men tested for BRCA mutations have specific concerns that should be attended to.

Values and risk perceptions: a cross-cultural examination.

This article examines the relationship between values and risk perceptions regarding terror attacks. The participants in the study are university students from Turkey (n = 536) and Israel (n = 298). Schwartz value theory (1992, 1994) is applied to conceptualize and measure values. Cognitive (perceived likelihood and perceived severity) and emotional (fear, helplessness, anger, distress, insecurity, hopelessness, sadness, and anxiety) responses about the potential of (i) being personally exposed to a terror attack, and (ii) a terror attack that may occur in one's country are assessed to measure risk perceptions. Comparison of the two groups suggests that the Turkish participants are significantly more emotional about terror risks than the Israeli respondents. Both groups perceive the risk of a terror attack that may occur in their country more likely than the risk of being personally exposed to a terror attack. No significant differences are found in emotional representations and perceived severity ratings regarding these risks. Results provide support for the existence of a link between values and risk perceptions of terror attacks. In both countries, self-direction values are negatively related to emotional representations, whereas security values are positively correlated with emotions; hedonism and stimulation values are negatively related to perceived likelihood. Current findings are discussed in relation to previous results, theoretical approaches (the social amplification of risk framework and cultural theory of risk), and practical implications (increasing community support for a course of action, training programs for risk communicators).

The perceived personal control (PPC) questionnaire: reliability and validity in a sample from the United Kingdom.

Outcome measures are important assessment tools to evaluate clinical genetics services. Research suggests that perceived personal control (PPC) is an outcome valued by clinical genetics patients and clinicians. The PPC scale was developed in Hebrew to capture three dimensions of PPC: Cognitive, decisional, and behavioral control. This article reports on the first psychometric validation of the English translation of the PPC scale. Previous research has shown that the Hebrew and Dutch translations have good psychometric properties. However, the psychometric properties of the English translation have not been tested, and there is disagreement about the factor structure, with implications for how to score the measure. A total of 395 patients attending a clinical genetics appointment in the United Kingdom completed several measures at baseline, and a further 241 also completed measures at 2-4 weeks follow-up. The English language PPC has (a) a one-factor structure, (b) convergent validity with internal health locus of control (IHLC), satisfaction with life (SWL), depression, and authenticity, (c) high internal consistency (α = 0.83), and (d) sensitivity to change, being able to identify moderate changes in PPC following clinic attendance (Cohen's d = 0.40). These properties suggest the English language PPC measure is a useful tool for both clinical genetics research and for use as a Patient Reported Outcome Measure (PROM) in service evaluation.

The Latent Perception of Pregnancy.

Background: The main purpose of this study was to describe the latent structure of pregnancy perception by investigating the role of risks and medical examinations in pregnancy perception across the sexes and pregnancy status. Methods: Study 1 developed a questionnaire based on the responses of 29 young adults on their perception of pregnancy. Study 2 consisted of distributing the questionnaire among 290 participants (mean age 29.3; standard deviation = 7.5). Results: The statistical clustering analysis revealed three major clusters of pregnancy perceptions: "evaluative," "physio-medical," and "future considerations," each of them encompassing several meaningful sub-clusters. This structure of pregnancy perceptions supports Beck and Beck-Gernsheim's modernization approach. Negative emotions toward pregnancy were related to social cognitions, whereas thoughts about risks were included in the medical sub-cluster. After reliability analyses, comparisons of scale scores revealed that women experienced more positive emotions, thought more about physical symptoms and about future issues compared to men (evolutionary explanation was offered). Conclusion: Pregnant participants felt less ambivalence toward pregnancy, thought more about risks and medical examinations and less about parents' duties than non-pregnant participants.

Making sense of COVID-19: a longitudinal investigation of the initial stages of developing illness representations.

OBJECTIVES: To describe and explain peoples' developing threat appraisal and representations of the novel illness COVID-19 over the first months of the pandemic. The Common-Sense Model of illness perceptions provided the theoretical framework. DESIGN: A cross-sectional study with 511 respondents and a follow-up study 4 months later on 422 respondents completing an online survey measuring demographic factors, media consumption, self-assessed health, experience with the disease, health anxiety, COVID-19 threat, worries and cognitive and emotional illness representations. RESULTS: Health anxiety, media consumption, female gender, lower self-assessed health, knowing a deceased COVID-19 patient and being infected explained variance in threat appraisal. Worries represented 2 factors: psychosocial and existential. Threat appraisal and worries explained variance in illness representations. Representations of the disease worsened and started stabilizing over time. Emotional representations were exceptionally stable and explainable by threat appraisals. CONCLUSIONS: These studies revealed the initial stages of developing representations of a new disease in the context of the COVID-19 pandemic. Gaining insights into those representations is key to understanding, predicting and modifying behavioral and mental responses to the pandemic.

COVID-19 state anxiety of older adults: effects of defensive information processes.

BACKGROUND AND OBJECTIVES: To explore coping processes used by adults aged 60 and above (defined as high age-related risk group) in reaction to the COVID-19 threat, and the associations between these processes and state anxiety. DESIGN AND METHODS: A cross-sectional study with 498 respondents of an online survey, 72 (15%) in the high age-related risk group. Questionnaires measured: background variables, state anxiety, and COVID-19 related perceptions. RESULTS: The high age-related risk group perceived the coronavirus as more severe, their belongingness to a risk group as higher, and the behavioral recommendations as more effective compared to the low age-related risk group. The part of perceived vulnerability that is not explained by belonging to an age-related risk group (defined as residual perceived vulnerability) was lower in the high age-related risk group. Mediation analysis indicated that the high (compared to the low) age-related risk group had lower anxiety levels, and that this effect was mediated by lower residual perceived vulnerability and higher perceived disease severity levels. CONCLUSIONS: The higher age-related risk group maintains a relatively moderate level of anxiety without denying their belonging to a high risk group. This can be explained by defensive processing of COVID-19 related information and by developmental processes.

Who deserves to be sick? An exploration of the relationships between belief in a just world, illness causal attributions and their fairness judgements.

This research explored relationships between beliefs about justice, illness causal attributions and fairness judgements of those causes. Participants (n = 200) completed questionnaires assessing their belief in a just world (BJW) and measuring causal attributions and fairness judgements for 42 illness causes classified into behavioural, environmental and hidden (genetic, mystic, psychosocial) categories. As predicted, BJW was correlated positively with all fairness judgements, but with none of the illness causal attributions. Behavioural causes of illness were judged to be fairer than environmental causes, which were judged fairer than hidden causes. Finally, for environmental and hidden causes (uncontrollable illness attributions), positive correlations between causal attributions and their corresponding fairness judgements were found only among participants with high BJW. Implications of these findings for decision makers and health professionals are discussed, with emphasis on the need to consider the combined effect of causal attributions and BJW on illness fairness judgements.

Adherence to COVID-19 protective behaviors: A matter of cognition or emotion?

OBJECTIVES: To compare the relative strengths of cognitive and emotional factors in explaining variance in adherence to recommendations for protective health behaviors against the coronavirus disease 2019 (COVID-19). DESIGN: A longitudinal (4-month) study with 422 participants who completed an online survey assessing cognitive factors: perceptions of the severity of the disease, vulnerability to it, and the effectiveness of the protective behavior recommendations against it. The emotional factors investigated were: trait health anxiety, worries, and anxiety related to COVID-19. RESULTS: Adherence and perceived behavior efficacy decreased over time, while perceived vulnerability and worries increased. Regression analyses showed a clear predictive advantage of beliefs about the efficacy of adherence to protective behaviors. CONCLUSIONS: The findings support the "cognitive approach" to explaining pandemic-related behaviors, particularly the key role of perceived efficacy of behavior recommendations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Invasive prenatal testing decisions in pregnancy after infertility.

OBJECTIVE: This study assessed decisional conflict about invasive prenatal testing among women pregnant after infertility. METHODS: We surveyed 180 pregnant women with a history of infertility using a mixed methods cross-sectional design. Difficulty in deciding whether to have prenatal testing was measured using the Decisional Conflict Scale. RESULTS: A minority of women (31%) chose to have invasive prenatal testing. Most participants (72%) reported low decisional conflict (score < 25; mean = 22.1; standard deviation = 23.2; range: 0-100). Half (53%) of the participants said that infertility made the testing decision easier. Qualitative data suggest that infertility makes the decision easier by clarifying relevant values and priorities. Most infertility characteristics studied were not significantly associated with decisional conflict. Variables associated with higher decisional conflict included infertility distress due to rejection of a childfree lifestyle, disagreement with others about testing, and choosing to have invasive testing after having had treatment for infertility. CONCLUSIONS: For some women, infertility may make the invasive prenatal testing decision easier. Women with the greatest need for decisional support were those who have had treatment and choose invasive testing, who disagree with others about their testing choice, or who are particularly distressed about being childless.

Exploring dimensions of health behaviors' representations.

Objectives: To discover underlying dimensions of health behavior representations and to suggest a new framework for their investigation.Methods: A total of 1709 participants rated 45 health behaviors on 14 theoretical constructs denoting features by which individuals can cognitively represent health behaviors. Correlations among constructs were aggregated across behaviors using a meta-analytic approach, and subjected to factor analysis.Results: The analysis resulted in three interpretable dimensions: 'Importance', 'Negative Experience' and 'Ease', and one tentative factor, 'Other'.Conclusion: 'Importance', 'Negative Experience' and 'Ease' may be considered key dimensions for studying perceptions of health behaviors within a self-regulatory framework. These dimensions suggest new integrative and parsimonious ways for investigating health behaviors. The findings also highlight the importance of expanding the category of health behaviors to include psycho-social behaviors (e.g. stress management, social relationships), and the need for theoretical refinement of affective constructs anticipated during and after performance of health behaviors. This may improve the understanding and potential modification of health behaviors.