Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media–Based Survey Study

Abstract

Background Health behavior is influenced by culture and social context. However, there are limited data evaluating the scope of these influences on COVID-19 response. Objective This study aimed to compare handwashing and social distancing practices in different countries and evaluate practice predictors using the health belief model (HBM). Methods From April 11 to May 1, 2020, we conducted an online, cross-sectional survey disseminated internationally via social media. Participants were adults aged 18 years or older from four different countries: the United States, Mexico, Hong Kong (China), and Taiwan. Primary outcomes were self-reported handwashing and social distancing practices during COVID-19. Predictors included constructs of the HBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Associations of these constructs with behavioral outcomes were assessed by multivariable logistic regression. Results We analyzed a total of 71,851 participants, with 3070 from the United States, 3946 from Mexico, 1201 from Hong Kong (China), and 63,634 from Taiwan. Of these countries, respondents from the United States adhered to the most social distancing practices (χ23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing (χ23=309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (odds ratio [OR]United States 1.58, 95% CI 1.21-2.07; ORMexico 1.5, 95% CI 1.21-1.96; ORHong Kong 2.48, 95% CI 1.80-3.44; ORTaiwan 2.30, 95% CI 2.21-2.39) and social distancing practices (ORUnited States 1.77, 95% CI 1.24-2.49; ORMexico 1.77, 95% CI 1.40-2.25; ORHong Kong 3.25, 95% CI 2.32-4.62; ORTaiwan 2.58, 95% CI 2.47-2.68) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the United States, Mexico, and Taiwan. Conclusions Social media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context.

A cross-sectional study of COVID-19 knowledge, beliefs and prevention behaviors among adults in Senegal

“…Rather, perceived COVID-19 risk was a stronger predictor of prevention behaviors, which is also supported by previous international research. [2,31] Low perceptions of risk may result in low compliance with virus restrictions and adherence to prevention behaviors, [32][33][34] and therefore facilitates COVID-19's spread. This confirms another recent study which recruited using social media from the United States, China, Taiwan, and Mexico.…”

“…Selection bias is common in online and social media recruitment because recruited participants tend to be more well-educated and younger than the general population. [2,42] To address potential confounding between recruitment methods, we controlled for recruitment method in our multivariate regression modelling. At the same time, we believe that our multi-modal recruitment strategy bolsters the representativeness of our sample and is a key strength of our study.…”

“…This confirms another recent study which recruited using social media from the United States, China, Taiwan, and Mexico. [2] Hsing and colleagues found that perceived COVID-19 severity and susceptibility -constructs that comprise perceived risk/threat in the Health Belief Modelwere both predictors of hand washing and social distancing. [2] In our study based in Senegal, perceived risk not only predicted hand washing and social distancing, it also predicted staying home, using hand sanitizer, and mask wearing.…”

“…[2] Hsing and colleagues found that perceived COVID-19 severity and susceptibility -constructs that comprise perceived risk/threat in the Health Belief Modelwere both predictors of hand washing and social distancing. [2] In our study based in Senegal, perceived risk not only predicted hand washing and social distancing, it also predicted staying home, using hand sanitizer, and mask wearing. These findings suggest that to prevent COVID-19 spread in Senegal and other parts of francophone West Africa, we need to focus more on perceived risk than knowledge.…”

“…[1] Given that ongoing prevention strategies implemented at the country, community, and individual level will be needed to curb the COVID-19 pandemic, it is critical to study health beliefs and adherence to prevention behaviors within specific social and political contexts. [2] Providing relevant and timely research is essential for guiding evidence-based outreach and interventions, especially during public health emergencies. It is particularly important to advance equity within public health, and the health of populations, by understanding the social contexts and health beliefs among indigenous, marginalized, and vulnerable populations around the globe.…”