Association of Perceived Threat, Negative Emotions, and Self-Efficacy With Mental Health and Personal Protective Behavior Among Chinese Pregnant Women During the COVID-19 Pandemic: Cross-sectional Survey Study

Abstract

Background COVID-19 is an emerging infectious disease that has created health care challenges worldwide. Pregnant women are particularly affected by this disease. Objective The aims of this study are to assess the levels of perceived threat (susceptibility, severity, impact), negative emotions (fear, worry), and self-efficacy of pregnant women in China related to COVID-19 and to examine their associations with mental health (depression and anxiety) and personal protective behavior (wearing a face mask). Methods A total of 4087 pregnant women from China completed a cross-sectional web-based survey between March 3 and 10, 2020. Results The prevalence of probable depression and anxiety was 48.7% (1989/4087) and 33.0% (1347/4087), respectively; 23.8% participants (974/4087) reported always wearing a face mask when going out. Of the 4087 participants, 32.1% (1313) and 36.4% (1490) perceived themselves or their family members to be susceptible to COVID-19 infection, respectively; 3216-3518 (78.7%-86.1%) agreed the disease would have various severe consequences. Additionally, 2275 of the 4087 participants (55.7%) showed self-efficacy in protecting themselves from contracting COVID-19, and 2232 (54.6%) showed efficacy in protecting their family members; 1303 (31.9%) reported a high level of fear of the disease, and 2780-3056 (68.0%-74.8%) expressed worry about various aspects of COVID-19. The results of the multivariate multinominal logistic regression analyses showed that perceived severity, perceived impact, fear, and worry were risk factors for probable depression and anxiety, while self-efficacy was a protective factor. The results of the multivariate logistic regression analysis showed that perceived susceptibility was associated with always wearing a face mask. Conclusions Chinese pregnant women showed high levels of mental distress but low levels of personal protective behavior during the COVID-19 pandemic. Interventions are needed to promote the mental health and health behavior of pregnant women during the pandemic.

What Prompted the Adoption of Self-Protective Behaviors in Response to COVID-19? Evidence From Women Living in the Rural Areas of Western China

“…This difference could be explained by the fact that the public in China is more open to mask-wearing due to the experience of previous outbreaks, such as the severe acute respiratory syndrome (52), early recognition of asymptomatic transmission, government's effort to increase public awareness of the importance of mask-wearing, and strict enforcement of the mask mandate (53). We found that greater perceived efficacy in coping with COVID-19 is associated with increased self-protective behaviors, which echoes the findings from a growing number of studies that demonstrate the link between self-protective behavior and efficacy (31,34,54,55). EPPM proposed that when faced with health risks, people would perceive that they themselves are able to perform recommended self-protective behaviors and that these behaviors are effective in responding to the threat.…”

“…Another study in China indicated that perceived risk and severity of the participants were associated with excess protective behavior (30). One study indicated that perceived susceptibility to COVID-19 was associated with consistent mask-wearing among Chinese pregnant women (31). However, no studies have examined the direct and indirect associations among these variables, especially among women in rural areas of western China.…”

Behavioral Responses of Pregnant Women to the Early Stage of COVID-19 Pandemic in the Network Era in China: Online Questionnaire Study

“…Corbett et al recruited patients in the second and third trimester of pregnancy and demonstrated that they had major changes in behavior including self-isolating, changing their primary method of transportation, bulk-buying, and so on in COVID-19 pandemic [13]. A cross-sectional, Web-based survey between March 3 and 10, 2020, in China showed that 55.7% of the participants protected themselves from contracting COVID-19 with self-efficacy [14].…”

“…There have been few studies on pregnant women's behavioral responses during disease outbreaks, including SARS, middle east respiratory syndrome coronavirus (MERS), and Ebola. Recent studies found that pregnant women had changes in behavior including self-isolating, changing their method of transportation, and so on in COVID-19 pandemic [13,14]. However, those studies only focused on pregnant women without a control group of nonpregnant women.…”

Associations of COVID-19 risk perception, eHealth literacy, and protective behaviors among Chinese college students following vaccination: a cross-sectional study

“…Wang et al [24] pointed out that lower self-perception of susceptibility and good protective behaviors were two important protective factors for good mental health during the COVID-19 outbreak. Mo PKH et al [25] found that much greater concerns and self-perceived susceptibility towards COVID-19 were the risk factors for anxiety and depression. This suggested that more attention should be given to assessing the psychological state to prevent the rising of psychological health issues.…”