Experience and Health-Related Behavior in Times of the Corona Crisis in Germany: An Exploratory Psychological Survey Considering the Identification of Compliance-Enhancing Strategies
Abstract
:1. Introduction
2. Theoretical Background
2.1. Health Beliefs and Behavior
- Perceived severity and vulnerability: First, people perceive a general health risk, then take preventive measures to reduce this risk; for example, many people do sports to reduce the risk of overweight or cardiovascular diseases. In addition, the likelihood of preventive behavior is further increased if people consider themselves to be at specific risk, for example, because there is corresponding previous illness in their family.
- Perceived benefits of behavior modification and low barriers: Furthermore, if a certain preventive behavior is regarded as actually effective in minimizing personal risk, this again increases the probability of corresponding behavioral performance. Finally, potential barriers and the effort involved in preventive behavior should be assessed as low as possible in order to increase the likelihood of its realization.
2.2. Preventive Behavior in Times of the COVID-19 Pandemic
- In the case of COVID-19, its extensive health-damaging potential was recognized and communicated in its entirety. Based on the previous and still incomplete data situation, the mortality risk for COVID-19 is estimated to be several times higher compared to seasonal influenza [32].
- The effectiveness of the preventive measures may well be confirmed, since flattened curves of the infection numbers could be observed after these measures came into force. The risk of a droplet or smear infection with COVID-19 seems to be drastically reduced, especially due to the social contact restrictions and strict compliance with hygiene practice [3,5,32].
- Regarding the estimation of required individual effort in order to perform preventive behavior, two classes of preventive measures must be distinguished first: (a) those who ask to practice additional behavior and (b) those who ask to refrain from habitual behavior patterns. The first category includes relatively inexpensive and time-efficient measures (such as regular thorough hand washing, use of disinfectants, wearing face masks) and is therefore associated with comparatively little behavioral effort. Regarding the second category, from a physical point of view it can be stated that it is energetically favorable to refrain from doing something rather than to do it. Regardless of these advantages however, the ‘costs’ of such an omission must always be considered, which—in the case of social isolation for example—could again act as a health risk factor.
3. Objectives
- How does our sample assess the severity of COVID-19 and its own vulnerability to an infection in terms of the HBM? Is there an optimistic bias regarding the assessment of one’s own risk of infection compared to the risk of other people?
- What and how many behavioral preventive measures are taken to protect oneself and others from an infection with COVID-19? Does the extent of the preventive behavior vary systematically between different subgroups of persons (e.g., between different ages or marital status) or are there relevant associations with other characteristics (e.g., affective or personality characteristics, satisfaction with information available, or the political management of COVID-19)?
- Is there any evidence that either the extent of the preventive behavior shown and/or other variables relevant to health behavior changed during our four-week period of investigation?
- What quality of affect balance can be determined in times of the COVID-19 pandemic compared to times before?
- Based on exploratory correlational analyses between all captured variables relevant to health behavior, can specific central clusters be identified, which can serve as effective starting points for designing public health strategies to promote compliance in times of the COVID-19 pandemic?
4. Materials and Methods
4.1. Measure and Operationalization
- Sociodemographic characteristics: By means of eight self-constructed items, we collected data for the participants’ gender, age, nationality, marital status, postcode, household size, level of education, and professional status.
- In order to quantify the characteristics of the components specified in the HBM, we captured the following COVID-19-related personal information by means of 10 self-constructed items:
- Perceived severity of the COVID-19 pandemic (visual analogue scale, ranging from 0 = “not dangerous at all” to 10 = “extremely dangerous”);
- Perceived own vulnerability to COVID-19 (visual analogue scale, ranging from 0 = “not at risk at all” to 10 = “extremely at risk”);
- Possible affiliation to the COVID-19 high-risk group (dichotomous item answered by stating “yes” or “no”);
- Presence of symptoms of a COVID-19 infection (cough, pyrexia, coryza, and/or sore throat; dichotomous items answered by stating “yes” or “no”) and, if applicable, virus screening including test results (adaptive question if COVID-19 symptoms were present);
- Concerns about an own infection with COVID-19 as well as about infections of closely related persons (each designed as dichotomous item answered by stating “yes” or “no”);
- Preventive measures taken (keeping distance, restricting contacts, following the stay-at-home-appeal, frequent hand washing, using disinfectants, and/or wearing face masks; dichotomous format answered by stating “taken” or “not taken”);
- Satisfaction with the measures taken by politicians to contain the COVID-19 pandemic or reduce the number of new infections (categorical rating scale answered by stating “generally happy with it”, “more needs to be done”, “less needs to be done”, or “not sufficiently informed to rate this”), and, where appropriate, own suggestions for further measures (free text field);
- Satisfaction with the media information regarding the COVID-19 pandemic (categorical rating scale answered by stating “generally happy with it”, “too little or too little reliable information”, or “confronted with too much information”);
- Satisfaction with the with the measures taken by politicians to contain the economic consequences of the COVID-19 pandemic (categorical rating scale answered by stating “generally happy with it”, “more needs to be done”, “less needs to be done”, or “not sufficiently informed to rate this”).
- Cognitive appraisal: The construct is based on the transactional stress theory by Lazarus and Folkman [45] and was captured using the Primary Appraisal Secondary Appraisal questionnaire (PASA) [46]. The 16 items of the PASA focus on the individually experienced strain within a stressful situation like the COVID-19 pandemic: The primary appraisal of such a stressor includes its perception as frightening (Subscale 1) and/or as challenging (Subscale 2), while the secondary appraisal takes the stressor-related self-concept of abilities (Subscale 3) and the locus of control (Subscale 4) into account. Overall, the questionnaire can therefore be used to relate the situation’s perception and evaluation to the assessment of individual available coping skills regarding this situation. The respective significance of this relationship in the context of the COVID-19 pandemic has already been shown by the exemplary reported findings by Roma et al. [15]. The four subscales are captured by four items each that should be assessed on a six-point rating scale. The mean is then calculated from the two mean values of the subscales of one dimension in order to obtain the values for the primary and secondary appraisal. The difference between the primary and secondary appraisal is finally used to calculate the total experienced strain as a stress index. The homogeneities of the primary scales in a reference sample were α = 0.61–0.83.
- Personality: The Big Five represent the five cross-cultural and time-stable personality dimensions (1) openness to new experience, (2) conscientiousness, (3) extraversion, (4) agreeableness, and (5) neuroticism [47,48]. The importance of these personality traits in the context of the COVID-19 pandemic has already been shown by Nofal et al. [14]. To capture the Big Five, we used the short scale Big Five Inventory 10 (BFI-10) which comprises 10 items that should be assessed on a five-point rating scale [49,50]. The retest reliabilities of the five subscales in a reference sample were rtt = 0.58–0.84. The decision for this short scale, which covers the Big Five dimensions with only two items each, was made in view of less strain on the participants, although the questionnaire is proven to be less reliable than other questionnaires comprising more items to measure the same personality constructs [51].
- Social competence: As social support or perceived and communicated social norms are decisive influencing variables of individual health behavior [16,36,37,38,39,40], we have decided to capture selected aspects of social competence using 24 items from the Interpersonal Competence Questionnaire (ICQ) [52,53,54]. Overall, the questionnaire contains five scales with eight items each that should be assessed on a five-point rating scale. In our study, we decided to focus only on three subscales: (1) negative assertion (i.e., standing up for own rights and ability to criticize others), (2) emotional support to others, and (3) effective handling of interpersonal conflicts. The first omitted subscale “initiation of interactions and relationships” is largely redundant with the extraversion items of the BFI-10, and the second omitted subscale “disclosure of personal information” seemed to be irrelevant for the purpose of our study. The homogeneities of the three subscales in a reference sample were α = 0.77–0.84.
- Reactance: According to Brehm [55] and Miron and Brehm [56], reactance describes an inner motivational resistance to perceived social influence, such as demands or prohibitions, which is experienced as restricting an individual’s freedom of behavior and control. In terms of behavior, reactance (now more than ever and/or attraction of the forbidden) is comparable to defiance as an active insistence on one’s own position. Fear appeals, which are increasingly used in times of the COVID-19 pandemic by decision-makers and the media, do not automatically result in a favorable effect regarding health behavior, but can even lead to reactance, especially if coping skills are not supported at the same time [28]. We used the unidimensional Reactance Scale [57,58], to capture reactance tendencies in our sample. The scale consists of 12 items that should be assessed on a four-point rating scale. The retest reliabilities of the five subscales in a reference sample were rtt = 0.71.
- Affect: The emotional situation of the test subjects in the last two weeks before participation in the study was captured using the Positive and Negative Affect Schedule (PANAS) [59,60]. The questionnaire comprises 20 items/mood-related adjectives that should be assessed on a five-point rating scale. When completing this questionnaire, subjects are asked to judge the adjectives in terms of how often they experienced a specific mood in the defined 14-day interval. Ten adjectives each represent the two dimensions of negative and positive affect, so it can be determined whether an individual’s affectivity was overall positive or negative and whether there are significant deviations compared with a reference sample from non-COVID-19 times. The homogeneity of the two subscales was α = 0.85 and 0.89 in a reference sample.
- Resilience: The unidimensional Resilience Scale (RS-13) was used to capture the participants’ psychological resilience to stress and strain situations [61,62]. In contrast to the PASA items, which predominantly address situation-specific aspects, resilience rather describes a stable habitual tendency to react to stressors. As a short scale with 13 items that should be assessed on a seven-point rating scale, the RS-13 measures the extent to which stress experiences and negative emotions can be ‘cushioned’, to what extent people remain able to act, and whether they initiate necessary actions to cope with the stress/straining situation. The homogeneity of the scale was α = 0.90 in a reference sample.
4.2. Procedure
- aims and course of the investigation,
- absolute voluntariness of participation,
- possibility of dropping out of participation at any time,
- guaranteed protection of data privacy (collection of only anonymized data),
- possibility of requesting data cancelation at any time,
- no-risk character of study participation,
- contact information in case of any questions or problems.
4.3. Sample
4.4. Statistical Methods
5. Results
5.1. COVID-19-Related Personal Information and Assessments (Research Question 1)
5.2. Preventive Behavior in Times of COVID-19 (Research Question 2)
- Rigorous curfew (i.e., permission to leave the house only for essential activities): n = 60 (57.1% out of n = 105);
- Closedown of all nonessential facilities, shops, and businesses: n = 59 (56.2% out of n = 105);
- Special opening times of the essential businesses for high-risk groups: n = 58 (55.2% out of n = 105);
- Provision of protective clothing and disinfectants for private use: n = 39 (37.1% out of n = 105);
- Border closure for all non-supply-related entry, exit, and transit traffic: n = 53 (50.5% out of n = 105);
- Rigorous ban on travel: n = 47 (44.8% out of n = 105);
- Others (especially obligatory use of face masks, volume testing, stronger checks on compliance with preventive measures): n = 11 (10.5% out of n = 105).
5.3. Influence of Time Course (Research Question 3)
5.4. Affect Balance (Research Question 4)
5.5. Correlational Findings (Research Question 5)
- The higher the severity of COVID-19 is assessed, r(568) = 0.21, p < 0.001;
- The higher one’s own vulnerability to COVID-19 is assessed, r(568) = 0.21, p < 0.001;
- The more the COVID-19 pandemic is perceived as frightening, r(568) = 0.23, p < 0.001;
- The more the COVID-19 pandemic is perceived as challenging, r(568) = 0.30, p < 0.001;
- The higher the current stress index is, r(568) = 0.21, p < 0.001;
- The more neurotic a person is, r(568) = 0.13, p < 0.01;
- The more open to new experiences a person is, r(568) = 0.14, p < 0.01;
- The better a person can emotionally support others, r(568) = 0.10, p < 0.05;
- The better a person can handle interpersonal conflicts, r(568) = 0.08, p < 0.05;
- The more negative affect a person is currently experiencing, r(568) = 0.15, p < 0.001.
6. Discussion
Health-Educational Sources for Enhancing Compliance with Preventive Behavior
7. Limitations and Conclusions
- The first one relates to the usual methodological aspects of a self-selected sample and the resulting lack of representativity, which is associated with decreased external validity. As a result of the recruitment of subjects primarily in an academic context, the proportions regarding the educational level and professional status were distorted compared to the total population. We were therefore unable to carry out group comparisons in this regard, which focus on the assessment of the pandemic and preventive measures taken, although we had intended to do so. In addition, due to the design of the study as an online survey, fewer older than younger subjects could be addressed, since only 67% of all people at the age of >65 years have internet access at all (in contrast to 96–99% of all people at the age of <65 years) [88]. Correspondingly, our results can be interpreted as a valid indication of certain processes in the population, but they should not be transferred offhand and to the total population.
- Secondly, some subscales of our questionnaire showed low or even insufficient reliability coefficients. A total of five subscales (three of the PASA and two of the BFI-10) of the overall 16 standardized subscales used, showed reliability coefficients only between 0.64 and 0.69. Nevertheless, we think that this did not affect internal validity excessively, since the comparatively large sample as well as the partly convergent other scales, which show good to excellent reliability coefficients, and whose results are in line with those of the less-reliable scales, compensate most of this particular lack of reliability. However, considering the two BFI-10 subscales consciousness and agreeableness, the reliability was completely insufficient (<0.60), so we had to exclude these subscales from further statistical analyses to avoid impairment of our conclusions’ validity. Of course, such an exclusion is always associated with a loss of information. Although the BFI-10′s test authors reported good psychometric properties within the questionnaire’s validation for a German sample, other studies recently carried out also seem to consistently meet reliability problems, especially with regard to the two subscales consciousness and agreeableness [89,90]. This indicates some shortcomings within the specification of the original measurement model and/or the test authors’ validation procedure. Future studies specifically focusing on the influence of personality traits on individual health behavior should therefore use other instruments to assess the Big Five, which offer better psychometric properties.
- Thirdly, both the sample bias and the reliability problems made it impossible for us to give extensive valid subgroup-specific recommendations regarding health promotion strategies to enhance compliance with preventive measures. Particularly, with regard to behavior-relevant competencies related to compliance with preventive measures during the COVID-19 pandemic, other relevant studies pointed out the differential effectiveness of implemented campaigns regarding communication of information and behavioral instructions. This means that in addition to culture-specific differences, attention must be paid to demographic, motivational, affective, cognitive, psychosocial, political, and religious characteristics of different target groups as well, as these can have a decisive influence on the reception and interpretation of information [42,43,91]. Accordingly, it seems plausible that certain behavioral appeals can cause the desired behavior by acting as effective social norms (especially in collectivistically oriented cultures like many Arab and Asian countries) or the same appeals rather tend to cause reactance (especially in individually oriented cultures like western industrial nations) [91,92]. In addition to such fundamental problems regarding the reception of information, there are many other aspects affecting the specific design of communication. For example, the complexity of the information provided should be aligned with the educational level and language barriers should be taken into account as well in order to simply ensure comprehensibility [42,43,91]. Due to these factors, it is conceivable that people who live in problem districts, or the rural population compared to metropolitans need different messages in order to address them effectively. The accessibility of different target groups in terms of their preferred sources of information must also be considered. For example, younger people are more likely to use social media, while older people are more likely to use traditional print or broadcast media [68]. Another decisive factor affecting the acceptance of information is who is providing the information. Different population subgroups differ in who they perceive as a peer or authority, so social norms intended to implement by communication can have differential effects [91,92]. This differential effectiveness of information management should be examined systematically in longitudinal studies in order to be able to implement effective campaigns without delay in the future.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Instrument | Subscale | Reliability |
---|---|---|
PASA | assessment as frightening | 0.80 1 |
assessment as challenging | 0.69 1 | |
self-concept of COVID-19-related abilities | 0.66 1 | |
COVID-19-related locus of control | 0.64 1 | |
BFI-10 | openness to new experience | 0.64 2 |
conscientiousness | 0.52 2 | |
extraversion | 0.72 2 | |
agreeableness | 0.26 2 | |
neuroticism | 0.64 2 | |
ICQ | negative assertion | 0.84 1 |
emotional support to others | 0.88 1 | |
effective handling of interpersonal conflicts | 0.79 1 | |
Reactance Scale | — | 0.80 1 |
PANAS | positive affectivity | 0.83 1 |
negative affectivity | 0.83 1 | |
RS-13 | — | 0.89 1 |
Preventive Measure | ntaken1 | Comparison | nobs2 | nexp3 | χ2-Test | p | φ |
---|---|---|---|---|---|---|---|
Keeping distance | 160 | Weeks 1 + 2 | 81.0 | 80.0 | χ2(1) = 1.03 | 0.31 | |
Weeks 3 + 4 | 79.0 | 80.0 | |||||
Restricting social contacts | 156 | Weeks 1 + 2 | 81.0 | 78.0 | χ2(1) = 4.73 | <0.05 | −0.17 |
Weeks 3 + 4 | 75.0 | 78.0 | |||||
Following the stay-at-home appeal | 104 | Weeks 1 + 2 | 58.0 | 52.0 | χ2(1) = 3.79 | 0.05 | |
Weeks 3 + 4 | 46.0 | 52.0 | |||||
Washing hands | 152 | Weeks 1 + 2 | 78.0 | 76.0 | χ2(1) = 1.44 | 0.23 | |
Weeks 3 + 4 | 74.0 | 76.0 | |||||
Using disinfectants | 81 | Weeks 1 + 2 | 36.0 | 40.5 | χ2(1) = 1.98 | 0.16 | |
Weeks 3 + 4 | 45.0 | 40.5 | |||||
Using face masks | 27 | Weeks 1 + 2 | 10.0 | 13.5 | χ2(1) = 2.17 | 0.14 | |
Weeks 3 + 4 | 17.0 | 13.5 |
Aspects of the Perception and Assessments of the COVID-19 Pandemic | Comparison | n1 | M2 | SD3 | t-Test | p | dCohen |
---|---|---|---|---|---|---|---|
Perceived severity | Weeks 1 + 2 | 82 | 6.62 | 2.01 | t(162) = 1.96 | 0.05 | |
Weeks 3 + 4 | 82 | 6.04 | 1.80 | ||||
Perceived own vulnerability | Weeks 1 + 2 | 82 | 3.84 | 2.30 | t(162) = 1.83 | 0.07 | |
Weeks 3 + 4 | 82 | 3.23 | 1.96 | ||||
Challenge assessment (PASA) 4 | Weeks 1 + 2 | 82 | 4.83 | 0.81 | t(162) = 2.35 | 0.02 | 0.37 |
Weeks 3 + 4 | 82 | 4.54 | 0.78 | ||||
Neuroticism (BFI-10) 5 | Weeks 1 + 2 | 82 | 3.05 | 1.00 | t(162) = 2.10 | 0.04 | 0.33 |
Weeks 3 + 4 | 82 | 2.74 | 0.90 |
Affectivity Dimension | Comparison | n1 | M2 | SD3 | dCohen |
---|---|---|---|---|---|
Positive affectivity | Reference sample | 349 | 27.35 | 6.38 | 0.15 |
Analysis sample | 570 | 28.35 | 6.57 | ||
Negative affectivity | Reference sample | 349 | 14.67 | 5.19 | 1.01 |
Analysis sample | 570 | 20.78 | 6.55 |
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Welter, V.D.E.; Welter, N.G.E.; Großschedl, J. Experience and Health-Related Behavior in Times of the Corona Crisis in Germany: An Exploratory Psychological Survey Considering the Identification of Compliance-Enhancing Strategies. Int. J. Environ. Res. Public Health 2021, 18, 933. https://doi.org/10.3390/ijerph18030933
Welter VDE, Welter NGE, Großschedl J. Experience and Health-Related Behavior in Times of the Corona Crisis in Germany: An Exploratory Psychological Survey Considering the Identification of Compliance-Enhancing Strategies. International Journal of Environmental Research and Public Health. 2021; 18(3):933. https://doi.org/10.3390/ijerph18030933
Chicago/Turabian StyleWelter, Virginia Deborah Elaine, Naemi Georgina Eliane Welter, and Jörg Großschedl. 2021. "Experience and Health-Related Behavior in Times of the Corona Crisis in Germany: An Exploratory Psychological Survey Considering the Identification of Compliance-Enhancing Strategies" International Journal of Environmental Research and Public Health 18, no. 3: 933. https://doi.org/10.3390/ijerph18030933