**1. Introduction**

The COVID-19 pandemic swept across the world and has been deemed the most devastating disease since the Spanish Flu in 1918–1919 [1]. By the end of January 2021, COVID-19 caused over one hundred million confirmed infections and two million deaths worldwide [2]. Although the first confirmed case was identified in Wuhan in December 2019, and the disease rapidly spread to other parts of China, through strict and effective

**Citation:** Li, J.; Liu, X.; Zou, Y.; Deng, Y.; Zhang, M.; Yu, M.; Wu, D.; Zheng, H.; Zhao, X. Factors Affecting COVID-19 Preventive Behaviors among University Students in Beijing, China: An Empirical Study Based on the Extended Theory of Planned Behavior. *Int. J. Environ. Res. Public Health* **2021**, *18*, 7009. https:// doi.org/10.3390/ijerph18137009

Academic Editors: Cristina Mazza, Paolo Roma and Merylin Monaro

Received: 28 May 2021 Accepted: 28 June 2021 Published: 30 June 2021

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preventive regulations and fully implemented policies, China was successful in keeping the COVID-19 pandemic under control with the efforts of the entire society.

COVID-19 prevention and control posed greater challenges and more stringent requirements for higher education institutions (HEIs) than for other social organizations. In contrast to other social systems, HEIs have a high density of people, which means that once one student gets it, large-scale pandemic transmission is likely to be triggered due to the high rate of spread of COVID-19 in crowded settlements [3]. China's health authorities responded early and quickly regarding COVID-19 prevention in HEIs. In late January 2020, soon after the outbreak of COVID-19, China's Ministry of Education (MOE) issued a series of notices requesting that all educational institutions take effective epidemic prevention and control measures and postpone the start of the 2020 spring semester. On 13 April 2020, the MOE and the National Health Commission (NHC) released the Scheme on COVID-19 Prevention and Control in HEIs and proposed that comprehensive preventive measures be implemented before, during and after students' return to campus. After campuses reopened, the Guidelines on COVID-19 Prevention and Control in HEIs for the 2020 autumn semester and for the 2021 spring semester were issued successively by the MOE and NHC. HEIs in China also actively displayed their major functions (talent training, scientific research and social services) during the COVID-19 pandemic by providing professional personnel, knowledge, skills and resources to combat COVID-19 and contribute to the research and development of definitive vaccines and forms of therapy.

Although some countries and regions, including China, have introduced a wide range of vaccinations, given the long-term complexity of the global pandemic situation, the construction and promotion of the preventive literature and behavior are critical in the "new normal" period of COVID-19 in addition to treatment and vaccine development. In fact, increasing numbers of studies added to the understanding of general public preventive behavior in many countries after the outbreak of COVID-19 [4–9]. However, few have targeted higher education systems [10,11], and most have focused on the role of knowledge and attitudes in predicting students' COVID-19 preventive behavior [12]. Thus, although HEIs are regarded as effective settings to shape specific attitudes and behaviors of students through institutional interventions [13], we still have limited knowledge about how the institutional factors of HEIs are affecting the preventive behaviors of university students and the psychological mechanism underlying this relationship during the outbreak of the COVID-19 pandemic.

To overcome the limitations of existing studies, our study explicitly identifies the impacts of the institutional climate, attitudes, subjective norms, perceived behavioral control and perceived risk of university students' COVID-19 preventive behaviors based on an extended theory of planned behavior (TPB) model. The TPB model proposed by Ajzen [14] may be one of the most influential theoretical perspectives to explain a range of health behavior intentions or actual behavior. While the TPB has been used in several recent studies of COVID-19 preventive behaviors [15], to improve the predictive capabilities of the TPB model, it is necessary to study university students' COVID-19 preventive behavior by including the institutional climate in the TPB model, because the critical role of HEIs in the prevention and control of COVID-19 has been widely reported in the literature [16]. Although the existing literature recognizes the moderating role of risk perception on a range of health behaviors [17], to the best of our knowledge, no previous study has examined the variations in the influence of institutional factors and TPB components on COVID-19 preventive behaviors in terms of different levels of risk perception.

Bearing the above considerations in mind, the key objective of the current research is to employ an extended TPB model to (1) explore the influence of the institutional climate on the COVID-19 preventive behaviors of university students, (2) test the mediating effect of three TPB elements, namely attitudes, subjective norms and perceived behavioral control toward COVID-19 prevention in the relationship between the institutional climate and university students' preventive behaviors, and (3) investigate the moderating role of perceived risk for the impacts of the institutional climate and TPB elements on university students' preventive behaviors. The results of our study will contribute to widening the reach of the application of the TPB model in COVID-19 prevention within a higher education context and improve its explanatory capacity by adding external institutional factors and internal perceived risk. Notably, with deeper knowledge of the drivers of university students' preventive behaviors, the present research can shed further light on anti-epidemic practices and measures in HEIs in China and in other areas suffering the devastating effects of COVID-19.

#### **2. Theoretical Framework and Hypotheses**
