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Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory

Szczuka Z 1 , Siwa M 2 , Abraham C 3 , Baban A 4 , Brooks S 5 , Cipolletta S 6 Show all authors , Danso E 7 , Dombrowski SU 8 , Gan Y 9 , Gaspar T 10 , Gaspar de Matos M 11 , Griva K 12 , Jongenelis M 13 , Keller J 14 , Knoll N 15 , Ma J 16 , Abdul Awal Miah M 17 , Morgan K 18 , Peraud W 19 , Quintard B 20 , Shah V 21 , Schenkel K 22 , Scholz U 23 , Schwarzer R 24 , Taut D 25 , Tomaino SCM 26 , Vilchinsky N 27 , Wolf H 28 , Luszczynska A 29

Affiliations 

  • 1 Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities; Aleksandra Ostrowskiego 30b, 50505 Wroclaw, Poland. Electronic address: zszczuka@swps.edu.pl
  • 2 Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities; Aleksandra Ostrowskiego 30b, 50505 Wroclaw, Poland. Electronic address: msiwa@st.swps.edu.pl
  • 3 School of Psychology, Deakin University; 221 Burwood Hwy, Burwood VIC 3125, Australia. Electronic address: c.abraham@deakin.edu.au
  • 4 Department of Psychology, Babes-Bolyai University; Strada Mihail Kogălniceanu 1, Cluj-Napoca 400000, Romania. Electronic address: adrianababan@psychology.ro
  • 5 Faculty of Kinesiology, University of New Brunswick; 90 MacKay Dr, Fredericton, NB E3B 5A3, Canada. Electronic address: sydbrooks118@gmail.com
  • 6 Department of General Psychology, University of Padova; Via Venezia, 8 - 35131 Padova, Italy. Electronic address: sabrina.cipolletta@unipd.it
  • 7 Medical Research Council Unit - the Gambia at, London School of Hygiene and Tropical Medicine; F8F5+XP5, Atlantic Boulevard, Serrekunda, Gambia. Electronic address: ebdanso@mrc.gm
  • 8 Faculty of Kinesiology, University of New Brunswick; 90 MacKay Dr, Fredericton, NB E3B 5A3, Canada. Electronic address: stephan.dombrowski@unb.ca
  • 9 School of Psychological and Cognitive Sciences, Peking University; No. 52, Haidian Road, Haidian District, Beijing 100805, China. Electronic address: ygan@pku.edu.cn
  • 10 Institute of Environmental Health, Medical School, University of Lisbon; Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal. Electronic address: tania.gaspar.barra@gmail.com
  • 11 Institute of Environmental Health, Medical School, University of Lisbon; Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal. Electronic address: margarida.gaspardematos@gmail.com
  • 12 Lee Kong Chian School of Medicine, Nanyang Technological University; 11 Mandalay Road, Singapore 308232. Electronic address: konstadina.griva@ntu.edu.sg
  • 13 Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne; Redmond Barry Building, Parkville Campus, Melbourne VIC 3010, Australia. Electronic address: michelle.jongenelis@unimelb.edu.au
  • 14 Department of Education and Psychology, Freie Universität Berlin; Habelschwerdter Allee 45, 14195 Berlin, Germany. Electronic address: jan.keller@fu-berlin.de
  • 15 Department of Education and Psychology, Freie Universität Berlin; Habelschwerdter Allee 45, 14195 Berlin, Germany
  • 16 School of Psychological and Cognitive Sciences, Peking University; No. 52, Haidian Road, Haidian District, Beijing 100805, China. Electronic address: nina.knoll@fu-berlin.de
  • 17 Perdana University-Royal College of Surgeons in Ireland School of Medicine; Wisma Chase Perdana Jalan Semantan Damansara Heights 50490 Kuala Lumpur, 50490, Wilayah Persekutuan Kuala Lumpur, Malaysia. Electronic address: awalcp@yahoo.com
  • 18 Perdana University-Royal College of Surgeons in Ireland School of Medicine; Wisma Chase Perdana Jalan Semantan Damansara Heights 50490 Kuala Lumpur, 50490, Wilayah Persekutuan Kuala Lumpur, Malaysia. Electronic address: karenmorgan@perdanauniversity.edu.my
  • 19 Department of Psychology, University of Bordeaux; Amphithéâtre 3 à 12, 33000 Bordeaux, France. Electronic address: william.peraud@etu.u-bordeaux.fr
  • 20 Department of Psychology, University of Bordeaux; Amphithéâtre 3 à 12, 33000 Bordeaux, France. Electronic address: bruno.quintard@u-bordeaux.fr
  • 21 Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel Street, WC1E 7HT United Kingdom. Electronic address: vishna.shah@lshtm.ac.uk
  • 22 Applied Social and Health Psychology, Department of Psychology, University of Zurich; Binzmuehlestrasse 14, 8050 Zurich, Switzerland. Electronic address: konstantin.schenkel@psychologie.uzh.ch
  • 23 Applied Social and Health Psychology, Department of Psychology, University of Zurich; Binzmuehlestrasse 14, 8050 Zurich, Switzerland. Electronic address: urte.scholz@psychologie.uzh.ch
  • 24 Department of Education and Psychology, Freie Universität Berlin; Habelschwerdter Allee 45, 14195 Berlin, Germany. Electronic address: ralf.schwarzer@fu-berlin.de
  • 25 Department of Psychology, Babes-Bolyai University; Strada Mihail Kogălniceanu 1, Cluj-Napoca 400000, Romania. Electronic address: dianataut@psychology.ro
  • 26 Department of General Psychology, University of Padova; Via Venezia, 8 - 35131 Padova, Italy. Electronic address: silviacaterinamaria.tomaino@phd.unipd.it
  • 27 Department of Psychology, Bar-Ilan University; Anna and Max Webb and Family Psychology Building, Ramat Gan, Israel. Electronic address: Noa.Vilchinsky@biu.ac.il
  • 28 Department of Psychology, Bar-Ilan University; Anna and Max Webb and Family Psychology Building, Ramat Gan, Israel. Electronic address: hodayahw@gmail.com
  • 29 Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities; Aleksandra Ostrowskiego 30b, 50505 Wroclaw, Poland; Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne; Redmond Barry Building, Parkville Campus, Melbourne VIC 3010, Australia. Electronic address: aluszczy@uccs.edu
Soc Sci Med, 2023 Jan;317:115569.
PMID: 36436259 DOI: 10.1016/j.socscimed.2022.115569

Abstract

RATIONALE: The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information.

OBJECTIVE: Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs).

METHOD: The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection).

RESULTS: Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators.

CONCLUSIONS: We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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