Changing Trends of Preventive Behavior and Perceived Risk Belief-Subjective Norm Model During the Emerging Infectious Disease in China
Zhang Weifang1,2, Fu Jialu1,2, Peng Sihui3, Yang Xiaozhao4, Wang Huihui1,2, Yang Tingzhong5
1.The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou 310006, China 2.Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, China 3.School of Medicine, Jinan University, Guangzhou 510632, China 4.School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou 510275,China 5.Center for Tobacco Control Research, Zhejiang University School of Medicine,Hangzhou 310058, China
Abstract:At present, emerging infectious diseases are still raging on a global scale. It does not only damage the health of the infected, but also makes a severe psychological impact on everyone. The key to curbing the epidemic of diseases, including emerging infectious diseases, is prevention. It is crucial to explore the mechanisms of prevention behavior forms of the population. However, the vast majority of previous studies on emerging infectious diseases have been descriptive. This study uses a prospective observation method and a perceived risk belief-subjective norm model as a framework to explore the public prevention behavior mechanisms of an emerging infectious disease.This study employs a longitudinal design. Participants were recruited for an online panel survey on different social media platforms. There were 5 groups of interviews, each having a dedicated electronic questionnaire access link. Information on perceived risk belief, subjective norm, preventive behavior, and related variables were collected via online surveys. They were measured using standard methods. Mean scores were calculated for the above variables at different observation points. The SAS GIMMIX program was used to conduct repeated measures analysis of variance to determine the changing trends across the five observation points, and to examine the association between perceived risk belief, subjective norm, and the others’ preventive behavior and personal preventive behavior.A number of 150 participants numbered were involved in linkable baseline surveys and 102 in the final survey. Of the study sample, 61.8% were female and 93.1% were Han Chinese. Perceived risk belief (β=-0.087, p<0.01)and knowledge risk belief(β=-0.078, p<0.01) manifested a statistically significant downward trend, but personal preventive behavior (β=0.048, p<0.05) and family members and relatives’ preventive behavior(β=0.051, p<0.05)indicated an upward trend over the observation period. Perceived risk belief (β=0.126, p<0.01) and knowledge risk belief (β=0.118, p<0.01) were positively associated with personal preventive behavior. Family members and relatives’ preventive behavior (β=0.628, p<0.01) and friends and colleagues’ preventive behavior (β=0.579, p<0.01) have also significant contributions to personal preventive behavior.This study examines the changing trends of personal preventive behavior and perceived risk belief-subjective norm model during the emerging infectious disease. Addressing a gap in the literature, it find perceived risk belief manifesting a statistically significant downward trend during the observation period. According to the Stimulus, Cognition and Response (SCR) theory, when the disease starts to spread (Stimulus) and people become aware of the serious threat the disease poses (Cognition), perceived risk levels will increase (Response). This is consistent with findings from other studies. As the number of cases dropped, the stimulus was reduced and perceived risk was also reduced. Preventive behavior, however, increased significantly over the period of the study. This trend is in the opposite direction of the epidemic. With differences in mental responses, preventive behavior is a behavioral model, which is initiated after people are stimulated, and then gradually strengthens. This study tested the perceived risk belief-subjective norm model of the emerging infectious disease. Perceived risk of diseases or injury and the severity of outcomes are crucial themes in individual health behavior. This study provides new evidences that perceived risk of contracting the disease is positively associated with personal preventive behavior — findings generally compatible with those from some other studies. Whether an individual’s behavior is based on personal preference or public norms is closely related to culture. In a society that emphasizes individualism, most people decide their behavior with their personal attitude; in a country that emphasizes collectivism, most people decide their behavior according to popular norms. This study confirms subjective norms’ contribution to the emerging infectious disease, suggesting that its prevention research and practice should pay attention to the attitudes and behaviors of the reference population. This provides a new perspective for the prevention of emerging infectious diseases in our country.
章伟芳, 傅嘉璐, 彭嗣惠, 杨晓照, 王慧慧, 杨廷忠. 新型传染病流行期预防行为变化及“危险信念—参照规范”模式[J]. 浙江大学学报(人文社会科学版), 2021, 51(2): 54-61.
Zhang Weifang, Fu Jialu, Peng Sihui, Yang Xiaozhao, Wang Huihui, Yang Tingzhong. Changing Trends of Preventive Behavior and Perceived Risk Belief-Subjective Norm Model During the Emerging Infectious Disease in China. JOURNAL OF ZHEJIANG UNIVERSITY, 2021, 51(2): 54-61.
1 World Health Organization, “Mental health and psychosocial considerations during the COVID-19 outbreak,” https://www.who.int/publications-detail/mental-health-and-psychosocial-considerations-during-the-covid-19-outbreak, 2020-06-19. 2 Mehrabian A. & Russell J. A., An Approach to Environmental Psychology, Cambridge, MA: MIT Press, 1974. 3 杨廷忠: 《健康研究:社会行为理论与方法》,北京:人民卫生出版社,2018年。 4 Li J. B.,Yang A. & Dou K. E. et al., “Chinese public’s knowledge, perceived severity,and perceived controllability of the COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour: a national survey,” https://psyarxiv.com/5tmsh/, 2020-06-19. 5 Lunn P. D., Belton C. A. & Lavin C. et al., “Using behavioral science to help fight the coronavirus,” https://doi.org/10.30636/jbpa.31.147, 2020-06-19. 6 吕书红、田本淳、杨廷忠: 《非典期间与非典后期居民相关健康行为比较》,《中国公共卫生》2008年第8期,第960-961页。 7 Yang X. Y., Peng S. H. & Yang T. Z. et al., “Uncertainty stress, and its impact on disease fear and prevention behaviors during the COVID-19 epidemic in China: a panel study,” https://www.medrxiv.org/content/10.1101/2020.06.24.20139626v1, 2020-06-24. 8 Greenberg N., Docherty M. & Gnanapragasam S. et al., “Managing mental health challenges faced by healthcare workers during COVID-19 pandemic,” British Medical Journal, 2020-03-26, https://doi.org/10.1136/bmj.m1211, 2020-06-19. 9 Cullen W., Gulati G. & Kelly B. D., “Mental health in the COVID-19 pandemic,” QJM: An International Journal of Medicine, Vol. 113, No. 5 (2020), pp. 311-312. 10 Bish A. & Michie S., “Demographic and attitudinal determinants of protective behaviours during a pandemic: a review,” British Journal of Health Psychology, Vol. 15, No. 4 (2010), pp. 797-824. 11 Wise T., Zbozinek T. D. & Michelini G. et al., “Changes in risk perception and protective behavior during the first week of the COVID-19 pandemic in the United States,” https://psyarxiv.com/dz428/, 2020-05-18. 12 杨廷忠: 《感知信念—参照规范影响理论——一个文化适宜健康行为模式的构建与实证》,《中国热带医学》2019年第12期,第1105-1107页。 13 Dorfan N. M. & Woody S. R., “Danger appraisals as prospective predictors of disgust and avoidance of contaminants,” Journal of Social and Clinical Psychology, Vol. 30, No. 2 (2011), pp. 105-132. 14 Vartti A. M., Oenema A. & Schreck M. et al., “SARS knowledge, perceptions, and behaviors: a comparison between Finns and the Dutch during the SARS outbreak in 2003,” International Society of Behavioral Medicine, Vol. 16, No. 1 (2009), pp. 41-48. 15 Yang J. Z. & Chu H., “Who is afraid of the Ebola outbreak? the influence of discrete emotions on risk perception,” Journal of Risk Research, Vol. 21, No. 7 (2018), pp. 834-853. 16 Ajzen I. & Fishbein M., “Understanding Attitudes and Predicting Social Behavior,” Englewood Cliffs: Prentice-Hall, 1980. 17 Yip H. K., Tsang P. C. S. & Samaranayake L. P. et al., “Knowledge of and attitudes toward severe acute respiratory syndrome among a cohort of dental patients in Hong Kong following a major local outbreak,” British Association for the Study of Community Dentistry, Vol. 24, No. 1 (2007), pp. 43-48. 18 Zhuang Z., Zhao S. & Lin Q. et al., “Preliminary estimation of the novel coronavirus disease (COVID-19) cases in Iran: a modelling analysis based on overseas cases and air travel data,” International Society for Infectious Diseases, Vol. 94 (2020), pp. 29-31. 19 Rubin G. J., Potts H. W. W. & Michie S., “The impact of communications about swine flu (influenza A H1N1V) on public responses to the outbreak: results from 36 national telephone surveys in the UK,” Health Technology Assessment, Vol. 14, No. 34 (2010), pp. 183-266. 20 Qian M., Wu Q. & Wu P. et al., “Psychological responses, behavioral changes and public perceptions during the early phase of the COVID-19 outbreak in China: a population based cross-sectional survey,” https://www.medrxiv.org/content/10.1101/2020.02.18.20024448v1, 2020-06-19.