A situational test of the health belief model: How perceived susceptibility mediates the effects of the environment on behavioral intentions.

OBJECTIVE: Existing evidence regarding the role of perceived susceptibility in shaping preventative health behavior is mixed for the Health Belief Model (HBM). To clarify whether and under which conditions perceived susceptibility affects preventative behavior, this study aims to better understand how situational environmental factors affect perceived susceptibility, thereby shaping health decisions, and whether this mediation relationship is conditioned by other HBM cognitions, namely perceived benefits and severity. METHODS: Therefore, we employed a scenario-based experiment in a large, representative sample of the German population (N = 4,802) in April 2022. Respondents were presented with a fictional invitation to a social gathering, which mimicked a post in a messenger group chat. The invitation included five experimentally manipulated scenarios: no COVID-19 preventative measure implemented, a COVID-19 test is required; either testing negative, being vaccinated, or being recovered from COVID-19 is required (known as 3G in the German context); reduced number of attendees; or the social gathering occurred outside. Moreover, perceived susceptibility to contract COVID-19 at the social gathering and perceived severity and benefits (independent of the scenario) were measured. RESULTS: We found evidence that perceived susceptibility mediates the relationship between each implemented preventative measure and willingness to attend the social gathering. The effect of the preventative measures on perceived susceptibility and the indirect effect of the preventative measure on attendance via perceived susceptibility were moderated by perceived benefits. However, there is lack of robust evidence that perceived severity moderates the effect of perceived susceptibility on attendance. CONCLUSION: In summary, our study provides evidence that individuals perceive and adapt their perceptions and behavior to preventive measures in a given situation, which speaks to the dynamic nature of the cognition perceived susceptibility. Moreover, our findings suggest a promising avenue forward for the HBM is to examine how the cognitions and the environment together shape preventative health behavior.

Examining double standards in layoff preferences and expectations for gender, age, and ethnicity when violating the social norm of vaccination.

Whether vaccination refusal is perceived as a social norm violation that affects layoff decisions has not been tested. Also unknown is whether ascribed low-status groups are subject to double standards when they violate norms, experiencing stronger sanctions in layoff preferences and expectations, and whether work performance attenuates such sanctioning. Therefore, we study layoff preferences and expectations using a discrete choice experiment within a large representative online survey in Germany (N = 12,136). Respondents chose between two employee profiles, each with information about ascribed characteristics signaling different status groups (gender, age, and ethnicity), work performance (work quality and quantity, and social skills), and whether the employees refused to vaccinate against COVID-19. We found that employees who refused vaccination were more likely to be preferred and expected to be laid off. Respondents also expected double standards regarding layoffs due to vaccination refusal, hence, harsher treatment of females and older employees. Nonetheless, their preferences did not reflect such double standards. We found little support that high work performance attenuates these sanctions and double standards, opening questions about the conditions under which social biases arise. Our results suggest detrimental consequences of vaccination refusal for individuals, the labor market, and acceptance of health policies.

A Moderated Mediation Model Explaining the Relationship Between Risk-Group Membership, Threat Perception, Knowledge, and Adherence to COVID-19 Behavioral Measures.

Background: COVID-19 is a threat to individual and global health, thus, reducing the disease's spread is of significant importance. However, adherence to behavioral measures against the spread of COVID-19 is not universal, even within vulnerable populations who are at higher risk of exposure to the virus or severe COVID-19 infection. Therefore, this study investigates how risk-group membership relates to adherence to COVID-19 behavioral measures, whether perceived threat of COVID-19 is a mechanism explaining this relationship, and whether knowledge about COVID-19 moderates these effects. Methods: We conducted a web-based survey (N = 4,096) representative of the adult population in Germany with regard to gender, age (18 to 74), and province. Therein, we assessed risk group membership with two indicators (risk of exposure to COVID-19 and risk of severe COVID-19 infection), perceived COVID-19 threat with the Perceived Coronavirus Threat Questionnaire, knowledge about COVID-19 with a knowledge test; and adherence to six behavioral measures to protect against the spread of COVID-19 (e.g., keeping distance, using mouth-nose protection, and following contact restrictions). We used moderated mediation models to test whether perceived threat mediates the relationship between risk-group membership and adherence and whether knowledge about COVID-19 moderates this relationship. Results: We found that risk group members had more perceived COVID-19 threat and that knowledge about COVID-19 increased perceived threat. Moreover, risk group membership had a positive direct effect on adherence to most behavioral measures and risk group members with less knowledge about COVID-19 violated measures more frequently. Risk-group membership also had positive indirect effects on adherence via perceived COVID-19 threat. The moderated indirect effects of threat indicate that threat led to more adherence when knowledge was low, but lost relevance as knowledge increased. Conclusion: The results may help to evaluate disease-regulation measures and to combat the pandemic more effectively. For example, increasing COVID-19 knowledge in the general population could increase adherence to COVID-19 behavioral measures. However, policy makers should be mindful that this could also have negative mental health implications as knowledge increases perceived COVID-19 threat.

Perceived risk of COVID-19 exposure and poor COVID-19 prognosis impair sleep: The mediating and moderating roles of COVID-19-related anxiety and knowledge.

The ongoing COVID-19 pandemic has been linked to increased levels of stress, depression, and anxiety in many people around the world. Therefore, identifying individuals at risk of psychosocial burden during this unprecedented crisis is essential for developing prevention measures and treatment options for mental health issues. To this aim, we investigated two risk groups: individuals at higher risk of exposure to the virus and individuals at higher risk of poor prognosis if they contract the virus. We conducted a survey (N = 4167) with a representative sample of the German population and assessed perceived risk of COVID-19 exposure and poor prognosis if infected, COVID-19-related anxiety, problems with sleep and daytime functioning, as well as self-reported knowledge about the disease. Results showed that perceived risk group membership was linked to increased problems with sleep and daytime functioning via elevated levels of COVID-19-related anxiety. This mediated effect was further moderated by self-reported COVID-19 knowledge, but only for individuals who rated themselves at higher risk of COVID-19 exposure. Thus, knowledge buffered the negative effect of exposure risk on anxiety and ultimately on sleep in this risk group. Reaching individuals at increased risk of exposure with clear information about the disease, how to prevent infection, and treatment options could be an effective strategy to contain anxiety levels and promote good sleep, which is important for general well-being.