3.2.2. Structural Model

Drawing on earlier correlational results, the hypothesized mediation model including direct and indirect paths between two independent variables (risk perception of COVID-19 and meaning-based resources), three mediating variables (coping strategies), and the dependent variable (psychological well-being) was tested (Figure 1). Gender and age were also controlled in our structural analysis. In addition, each mediator was estimated independently, which generated more accurate mediating effects.

**Figure 1.** The theoretical model of the relations among risk perception of COVID-19, meaning-based resources, coping, and psychological well-being.

Structured equation modelling analysis revealed that model 1, which included three mediators and direct paths from risk perception of COVID-19 and meaning-based resources to psychological well-being had rather an unsatisfactory fit with the data: χ<sup>2</sup> (20, *n* = 226) = 59.84, *p* < 0.001; GFI = 0.88; CFI = 0.83; NFI = 0.78; RMSEA = 0.09. Furthermore, some path coefficients were nonsignificant.

The model was thus modified to improve fit in accordance with the modification procedures (the order in which variables and paths were removed is included in a supplement). Emotion-focused coping and nonsignificant paths from risk perception of COVID-19 and meaning-based resources to psychological well-being were deleted. As a consequence, the final model turned out to have significant improvements and a satisfactory fit: χ<sup>2</sup> (15, *n* = 226) = 38.36, *p* < 0.001; GFI = 0.95; CFI = 0.93; NFI = 0.92; RMSEA = 0.04 (model 2, Figure 2).

The final model contained one statistically significant direct effect (β = −0.43) from risk perception of COVID-19 to psychological well-being, which indicates that higher risk perception was related to a lower level of psychological well-being. In addition, problem-focused and meaning-focused coping accounted for indirect effects. Risk perception of COVID-19 had indirect relationships with psychological well-being through the two aforementioned coping strategies. The positive directions of those paths suggested that higher risk perception was related to more frequent use of problemand meaning-focused coping, which again was related to a higher level of psychological well-being. Analogously, there was an indirect relationship between meaning-based resources and psychological well-being through significant positive paths comprising problem-focused coping and meaning-focused coping. More meaning-based resources were associated with more frequent use of problem- and meaning-focused coping, which was then associated with greater psychological well-being.

**Figure 2.** The final mediating model of the relations among risk perception of COVID-19, meaning-based resources, coping, and psychological well-being (standardized coefficients). \*\* *p* < 0.01; \*\*\* *p* < 0.001.

The bootstrapping procedure was applied to examine the mediating effects of problem- and meaning-focused coping on the association between risk perception of COVID-19 and psychological well-being as well as the association between meaning-based resources and psychological well-being (samples = 5000; 95% bias-corrected confidence intervals [47]) (Table 4).


**Table 4.** Standardized indirect and total effects, standard errors (SE), and 95% confidence intervals (CI).

PWB—psychological well-being; a—empirical 95% confidence interval does not overlap with zero.

The results of mediation analysis revealed that problem- and meaning-focused coping mediated the relationship between risk perception of COVID-19 and psychological well-being as well as the relationship between meaning-based resources and psychological well-being. Interestingly, despite conceptual differences between risk perception and meaning-based resources, the mediating effects showed a similar pattern for both paths. Risk perception and meaning-based resources exerted significant indirect effects on the sphere of well-being via problem-focused and meaning-focused coping strategies. The total effects, which denote the sum of the direct and indirect effects, were significant for both paths, which implies therefore that problem-focused coping and meaning-focused coping function in the form of simultaneous mediators.

In addition, we decided to test whether those two indirect effects are significantly different (i.e., whether one or the other of the mediating effects is stronger). The result demonstrates that the mediation for the meaning-based resources–coping–psychological well-being path was significantly stronger than for the risk perception–coping–psychological well-being path (effect = 0.33; SE = 0.06; 95% CI = 0.05 to 0.41).

#### **4. Discussion**

The purpose of this study was to examine risk perception of COVID-19 infection and meaning-based resources in relation to coping strategies and psychological well-being amongst healthcare personnel in southern Poland during the COVID-19 outbreak between March and June 2020. We found that risk perception of COVID-19 infection—risk of contracting, fear, and perceived threat of COVID-19—negatively correlated with psychological well-being, whereas meaning-based resources (i.e., MIL and existential mattering) correlated positively with well-being. Moreover, both risk perception of COVID-19 infection and meaning-based resources were related to psychological well-being through the mediating effect of coping strategies.

As was hypothesized, risk perception, which reflects how healthcare personnel assess the probability of COVID-19 infection negatively correlated with psychological well-being. These findings are in line with previous studies that demonstrated perceived risk as a predictor of emotional distress amongst SARS survivors during the SARs epidemic in Hong Kong [10], as well as negative emotions amongst the Chinese population during the COVID-19 pandemic [49]. Our findings complement previous research in two important ways. First, both Cheng et al. [10] and Li et al. [49] studies were carried out amongst the Chinese general population, yet the health workers in Europe are exposed to a greater risk of infection, because of the rapid spread of COVID-19 and the sudden huge influx of patients. Second, SEM analysis revealed that the direct relationship between risk perception and healthcare personnel's well-being remained significant, even after controlling for the mediating effect of coping strategies. This implies the relatively strong character of the relationship between the way in which healthcare personnel interpret risk of contracting, fear, and perceived threat of COVID-19 infection and their psychological well-being.

In contrast, meaning-based resources positively correlated with psychological well-being. Thus, having more meaning-based resources was associated with higher well-being amongst healthcare personnel, which, in turn, can be used to deal with the negative psychological consequences of COVID-19. Healthcare workers who have a strong sense of purpose and value can more efficiently interpret and reorganize daily experiences, identify significant aspects of their life, and constructively pursue their aims. This finding corresponds with previous studies that indicated the predictive role of MIL on people's well-being [16–18] as well as the predictive role of MIL on the construction of individual identity amongst medical staff [19]. However, the direct relationship between meaning-based resources with psychological well-being was not obtained in the SEM analysis, after controlling for coping strategies. Given that SEM is considered to deliver more accurate results than correlations [50], these findings support an indirect rather than a direct relationship between meaning-based resources and well-being amongst healthcare personnel. Therefore, the availability of meaning-based resources can strengthen psychological well-being because they successfully trigger an effective use of coping strategies that can be applied to manage stress during the COVID-19 pandemic. The first hypothesis was only partially confirmed.

The main finding in this study was the mediating role played by coping strategies in the relationships between risk perception of the COVID-19 infection and meaning-based resources with healthcare personnel's psychological well-being. Two coping strategies—problem-focused and meaning-focused—were significant mediators in these relationships. The second and third hypotheses that assumed such relationships were thus confirmed. These results support previous studies that showed how coping strategies played a crucial role when people were facing an adverse situation [34,35,39,40]. They also suggest that perception and resource factors do not operate in "a vacuum" while influencing Polish healthcare personnel's psychological well-being; they are strongly interconnected with coping processes. It highlights the interplay of cognition (risk perception) and motivation (meaning-based resources) in managing stressful events and contributing to successful adaptation to stressors [51]. Problem-focused and meaning-focused coping is thus a dynamic process that varies according to one's cognitive appraisal and personal resources, and, consequently, regulates psychological well-being.

The present study builds on existing findings by revealing the cognitive and motivational mechanisms that underlie the effect of risk perception on psychological well-being in Polish healthcare personnel as they combat COVID-19. The two mediating strategies are predominately based on cognitive (problem-focused coping) and motivational (meaning-focused coping) processes. In contrast, emotional coping proved to be a less significant way of coping with stress during the pandemic. The utility of cognitive coping strategies in dealing with COVID-19 pandemic was confirmed by Gerhold's research [39], which showed that Germans tend to use problem-focused strategies in coping with COVID-19 (e.g., following expert advice and guidelines and thinking carefully about what to do). The current study extends Gerhold's [39] observations, by demonstrating that both problem-focused and meaning-focused coping operate simultaneously as mediators between risk perception and psychological well-being as well as between meaning-based resources and psychological well-being. There is, therefore, a noticeable interplay of cognitive and motivational processes underlying coping mechanisms in dealing with the dangers posed by COVID-19.

These findings suggest that although risk perception of the COVID-19 infection is related to lower psychological well-being, it paradoxically increases coping strategies, particularly problem-focused and meaning-focused coping (i.e., actions that help control the epidemics). In this sense, as noted by Li, Yang, Dou, Wang and colleagues [49], perceived severity can be regarded as a double-edged sword, being both risk and asset, in the encounter of pandemic.

These results can be interpreted within PMT, which posits that people confronted with threats resort to coping strategies that allow them to manage the threat. The decision to employ coping strategies is a consequence of severity, because people must believe that there is some potential harm (e.g., a high probability of infection with COVID-19 for healthcare personnel), and that they are vulnerable to this harm. The perception of threat from COVID-19 enhances the motivation to initiate the coping process [7]. The ability to adopt the recommended coping response may in turn enhance psychological well-being. This is in line with the meta-analysis of PMT findings by Milne et al. [52], which indicated that threat perception made it more likely that people would adopt some coping response because it provided motivational energy.

Our study shows that higher meaning-based resources predicted a more frequent use of problem-focused and meaning-focused coping, which was then related to a higher level of psychological well-being. Thus, personal resources that reflect the individual's convictions about having a significant, meaningful, and valuable life tend to play an important role in shaping coping behavior and, consequently, in predicting the well-being of healthcare personnel. These results can be interpreted within resource-based stress theories, which suggest that individual resources influence people's abilities to manage stress successfully and, consequently, to improve their well-being [12]. Meaning-based resources may be conducive to a constructive use of coping strategies, since a relatively stable pattern of commitment influences the way events are perceived and managed [25]. The predictive role of meaning-based resources in shaping the coping behavior of healthcare personnel is consistent with previous reports regarding the role of meaning in life in strengthening people's coping behavior and influencing their psychological well-being [19,20].

The present study also provides new empirical evidence by demonstrating that risk perception and meaning-based resources can operate together in predicting psychological well-being in healthcare personnel combating COVID-19. Problem-focused and meaning-focused coping mediated both the relationship between risk perception of COVID-19 infection and psychological well-being as well as the relationship between meaning-based resources and psychological well-being. However, the effect test showed that the mediating path for meaning-based resources was significantly stronger than for risk perception. This implies a more important role for coping strategies based on cognitive and motivational processes for healthcare personnel well-being in the case of personal meaning-based resources than the perceived risk of COVID-19 [20,38]. However, the mere availability of meaning-based resources does not contribute automatically to well-being, these resources must rely on coping strategies based on cognitive and motivational processes.

The present study has shortcomings. It should be emphasized that the cross-sectional design limits our ability to make a causal interpretation of the findings. The relationship between risk perception and well-being as well as the relationship between personal resources and well-being can be bilateral; risk perception and personal resources can affect healthcare personnel's well-being, but well-being may also contribute to more positive appraisals and higher meaning-based resources. Second, our explanation of the results of mediation analysis must be treated with caution. The model we tested, (which was confirmed), was based on theories and previous empirical research, but it should also be tested using a longitudinal design. Third, although respondents completed the measures anonymously, response bias could not be controlled, because the study was based on self-report. Therefore, future researchers need to attempt replication of the results with samples where this weakness is minimized.
