The Relationship Between Meaning in Life and Health Behaviors in Adults Aged 55 Years and Over During the COVID-19 Pandemic: the Mediating Role of Risk Perception and the Moderating Role of Powerful Others Health Locus of Control.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has impacted many people's meaning in life and health behaviors. This study aimed to verify the relationship among meaning in life (MIL), epidemic risk perception, health locus of control (HLC), and preventive health behaviors among older adults after the COVID-19 outbreak was declared a pandemic. METHOD: In this longitudinal study, 164 participants aged 55 years and above completed the following measures at time 1 (February 19, 2021) and one month later at time 2 (March 19, 2021): Meaning in Life in the Epidemic Questionnaire, Epidemic Risk Perception Questionnaire, Multidimensional Health Locus of Control Scale, and Health Behaviors Before and After the Epidemic Survey. Hayes' SPSS Process Macro was used to analyze the mediating effect of epidemic risk perception (model 4) and the moderating role of powerful others HLC in the mediation model (model 14). RESULTS: The results showed that after controlling for gender, age, education level, and health behaviors at the baseline, risk perception had a significant mediating effect on the relationship between MIL and preventive health behaviors (ß = .02, SE = .01, 95% CI [.00, .04]). In addition, powerful others HLC had a moderating effect on the second half of the mediating effect (ß = .02, p = .02, 95% CI [.00, .03]). Specifically, compared to the older adults with low powerful others HLC, the risk perception of older adults with high powerful others HLC increased preventive health behaviors. CONCLUSION: Practitioners should adequately cultivate older adults' risk awareness and reinforce the importance of advice from doctors and professionals, thereby effectively enhancing the preventive health behaviors of older adults in China during the COVID-19 pandemic.

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

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.

Fighting COVID-19 Misinformation through an Online Game Based on the Inoculation Theory: Analyzing the Mediating Effects of Perceived Threat and Persuasion Knowledge.

The COVID-19 pandemic was accompanied by the rapid spread of misinformation through social media platforms. This study attempted to develop an online fake news game based on the inoculation theory, applicable to the pandemic context, and aimed at enhancing misinformation discrimination. It also tested whether perceived threat and persuasion knowledge serve as underlying mechanisms of the effects of the intervention on misinformation discrimination. In Study 1, we used online priming to examine the influence of inoculation on misinformation discrimination. In Study 2, we developed an online fake-news-game-based intervention and attempted to validate its effectiveness through a randomized controlled trial while also exploring the mediating roles of perceived threat and persuasion knowledge. In Study 1, brief inoculation information priming significantly enhanced the ability to recognize misinformation (F(2.502) = 8.321, p < 0.001, ηp2 = 0.032). In Study 2, the five-day game-based intervention significantly enhanced the ability to recognize misinformation (F(2.322) = 3.301, p = 0.038, ηp2 = 0.020). The mediation effect of persuasion knowledge was significant (ß = 0.025, SE = 0.016, 95% CI = [0.034, 0.075]), while that of perceived threat was not significant. Online interventions based on the inoculation theory are effective in enhancing misinformation discrimination, and one of the underlying mechanisms of this effect lies in its promotion of persuasion knowledge.

The effects of the COVID-19 pandemic, risk perception, and perceived social support on public trust in physicians in China: A latent transition analysis

A population-based, longitudinal study was conducted among 29 provinces in mainland China to investigate how public trust in physicians (PTP) changed since the outbreak of COVID-19 and how the resulting lockdown and social support contributed to its restoration. The baseline sample ( n = 3,233) was obtained during the period of the most rapid progression of COVID-19 (February 1 to 9, 2020, T1). Follow-up ( n = 1,380) took place during the recovery period (March 17 to 24, T2). Latent profile models and a latent transition model were estimated. Participants were classified into either a moderate trust (21% at T1;45% transition into high at T2) or a high trust (79% at T1;88% remained in the high group) group in the latent profile. A latent transition from moderate to high trust was observed in locked-down regions and among those with higher social support. Social support moderated the transition from low to high trust. The current study showed that the epidemic outbreak and lockdown experience in China were associated with increased PTP;furthermore, public trust can be restored during a public health emergency. Attention should be paid to assure that social support and risk management strategies maintain PTP.

The Interplay Between Strictness of Policies and Individuals' Self-Regulatory Efforts: Associations with Handwashing During the COVID-19 Pandemic.

BACKGROUND: Patterns of protective health behaviors, such as handwashing and sanitizing during the COVID-19 pandemic, may be predicted by macro-level variables, such as regulations specified by public health policies. Health behavior patterns may also be predicted by micro-level variables, such as self-regulatory cognitions specified by health behavior models, including the Health Action Process Approach (HAPA). PURPOSE: This study explored whether strictness of containment and health policies was related to handwashing adherence and whether such associations were mediated by HAPA-specified self-regulatory cognitions. METHODS: The study (NCT04367337) was conducted among 1,256 adults from Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Self-report data on cross-situational handwashing adherence were collected using an online survey at two time points, 4 weeks apart. Values of the index of strictness of containment and health policies, obtained from the Oxford COVID-19 Government Response Tracker database, were retrieved twice for each country (1 week prior to individual data collection). RESULTS: Across countries and time, levels of handwashing adherence and strictness of policies were high. Path analysis indicated that stricter containment and health policies were indirectly related to lower handwashing adherence via lower self-efficacy and self-monitoring. Less strict policies were indirectly related to higher handwashing adherence via higher self-efficacy and self-monitoring. CONCLUSIONS: When policies are less strict, exposure to the SARS-CoV-2 virus might be higher, triggering more self-regulation and, consequently, more handwashing adherence. Very strict policies may need to be accompanied by enhanced information dissemination or psychosocial interventions to ensure appropriate levels of self-regulation.

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries.

BACKGROUND: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). METHODS: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. RESULTS: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. CONCLUSIONS: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic. TRIAL REGISTRATION: Clinical Trials.Gov, # NCT04367337.

Coping with coronavirus disease 2019: Relationships between coping strategies, benefit finding and well-being.

The coronavirus disease 2019 (COVID-19) pandemic has caused both physical and psychological changes in the general public. The current study aimed to examine the relationship between well-being and coping strategies in response to the pandemic. Furthermore, we aimed to investigate the mediational role of benefit finding. A total of 521 participants aged 18-65 years were recruited from 29 regions of mainland China. Situation-specific coping strategies, including support seeking, personal hygiene practice and social distancing, were measured at Time 1. Benefit finding and well-being were assessed 1 month later. A multilevel mediation model was conducted with region included in level 2 as cluster ID. Support seeking and personal hygiene practice were positive predictors of benefit finding, which further mediated their relationships with well-being, while social distancing negatively predicted well-being. These results highlight the relationships of support seeking, personal hygiene practice and benefit finding with well-being during the COVID-19 pandemic. Our findings indicate that besides adopting adaptive coping strategies to prevent infection by COVID-19, individuals should be encouraged to recognize benefits associated with the COVID-19 outbreak.

Future-oriented function of meaning in life: Promoting hope via future temporal focus

Two studies were conducted to examine the promotional role of meaning in life (MIL) on hope and the underlying mediating mechanism via future temporal focus (FTF). Study 1 was a three-wave longitudinal survey including 418 employees (Mage = 35.68;54.3% women). Results showed that Time 1 MIL positively predicted Time 3 hope via Time 2 FTF. Study 2 was an intervention study conducted with Chinese undergraduate students (n = 129;Mage = 19.65;84.5% women) during the COVID-19 pandemic. The intervention involved taking a photograph each day of things that “make you feel your life is meaningful.” MIL and FTF were measured before and after the intervention, and assessed daily during the intervention week. Results of the longitudinal mediation analysis and 2-1-2 multilevel mediation model supported the mediational role of FTF between MIL and hope. Furthermore, results showed that MIL increased significantly in both the intervention (n = 64) and control conditions (n = 65). Hierarchical linear modeling found a significant positive relationship of daily MIL on daily FTF. The present findings supported MIL's future-oriented function on hope via FTF. Nevertheless, special attention should be given to the stress context when conducting MIL interventions to promote MIL and hope.

The mediating effect of media usage on the relationship between anxiety/fear and physician-patient trust during the COVID-19 pandemic.

OBJECTIVE: Our study explored whether and how media usage can mediate the path from anxiety and fear to physician-patient trust. DESIGN: Study 1 was a population-based, longitudinal study using nationally representative data from 29 provinces in mainland China. The baseline sample (N = 3233) was obtained from February 1 to 9, 2020. Follow-up (N = 1380) took place during March 17 to 24, 2020. Study 2 was a machine learning-based sentiment analysis in which data were captured from Sina Weibo, a Chinese microblogging website, among the most popular official, unofficial, and health-related media accounts. The screened blogs from November to December 2019 and February to March 2020 were scored by Google APIs for positivity and magnitude. MAIN OUTCOME MEASURES: Physician-patient trust. RESULTS: Study 1 showed fear and anxiety affected changes in physician-patient trust through media usage, the indirect effect of which was 0.14 (0.03) and the 95% CI was [0.08, 0.19]. Study 2 indicated a more positive image of physicians after the outbreak compared to before [F (2, 3537) = 3.646, p = 0.026, partial η2=0.002]. CONCLUSION: The negative impact of anxiety and fear on physician-patient trust was mediated by media use, which can be explained by the more positive media image during the pandemic.

The relationship between perceived stress and emotional distress during the COVID-19 outbreak: Effects of boredom proneness and coping style.

The outbreak of a novel coronavirus (COVID-19) pandemic was a great threat to the physical and mental health of the general population. Our research aimed to investigate the relationship between perceived stress and emotional distress during the initial outbreak. Furthermore, potential risks and protective factors, i.e., coping and boredom proneness, of stress-related emotional distress were also explored. Data from 3233 participants in China were collected through an online survey platform during the initial outbreak of the COVID-19 from January 31 to February 9 in 2020. Results showed that higher perceived stress was associated with more emotional distress including depression, fear, compulsion-anxiety, neurasthenia, and hypochondria. Boredom proneness significantly and positively mediated the relationship between perceived stress and emotional distress. Moreover, coping style moderated the stress-emotional distress relationship, i.e., individuals who mainly adopted positive coping strategies suffered fewer symptoms of depression, compulsion-anxiety, and neurasthenia under stress, while negative coping strategies aggravated emotional distress. These results from the present study provide practical value for mental health intervention during the emergent public health events.

Disease knowledge and attitudes during the COVID-19 epidemic among international migrants in China: a national cross-sectional study.

Background: There are more than 258 million international migrants worldwide and the majority reside in countries with ongoing novel coronavirus disease 2019 (COVID-19) epidemic outbreaks. International migrants may not receive adequate and timely disease information during epidemics, increasing vulnerability to disease transmission. This is one of very limited studies focusing on international migrants' COVID-19 prevention knowledge and attitudes during the epidemic. Methods: A national cross-sectional online survey was conducted across 100 cities and 26 regions in China from February 17 and March 1, 2020. The sample included 1,426 international migrants representing 77 countries and 6 continents. Knowledge was defined as the number of correct responses to questions about COVID-19. Attitudes included worries, expectations, and general preparedness. Multivariable ordinal logistic regressions evaluated correlates of knowledge and attitudes including information channels and preferences, and trust in Chinese institutions and groups. Results: Just half of the sample, 730/1426 (51.2%) had a good level of knowledge and 656/1426 (46.0%) had a positive attitude towards the COVID-19 epidemic. Knowledge was associated with receiving information through social media (aOR: 2.0, 95%CI: 1.2-3.2), the Internet (aOR: 1.4, 95%CI: 1.2-1.8), the community (aOR: 1.5, 95%CI: 1.2-1.8), and encountering language barriers when receiving medical services (aOR: 0.8, 95%CI: 0.7-1.0). Positive attitude was associated with the level of trust in various Chinese institutions and groups. Conclusions: Roughly half of the sample reported inadequate knowledge and poor attitudes toward prevention and control of COVID-19. Tailored public health campaigns are needed to ensure that international migrants possess adequate knowledge to protect their health during future epidemics and disasters.

Perceived Control Buffers the Effects of the COVID-19 Pandemic on General Health and Life Satisfaction: The Mediating Role of Psychological Distance.

BACKGROUND: Ways to maintain good health during a pandemic are very important for the general population; however, little is known about the impact of the coronavirus disease 2019 (COVID-19) on individuals' life satisfaction and perceived general health. This study aimed to examine the effects of COVID-19 on life satisfaction and perceived general health and reveal the buffering effect of perceived control on coping with COVID-19. METHODS: We collected 1,847 participants' data from 31 pandemic-affected provinces in China and obtained regional epidemic data of the same provinces. We employed a moderated mediation model with both individuals' self-report data and regional epidemic data to verify the hypotheses. RESULTS: Psychological distance mediated the relationships of regional pandemic severity with perceived general health and life satisfaction. Perceived control moderated the detrimental effects of regional pandemic severity through the moderating effects of regional pandemic severity on psychological distance, as well as the moderating effects of psychological distance on life satisfaction. CONCLUSIONS: Our findings indicate that perceived control may act as a protective factor buffering the psychological impact of the pandemic on general health and life satisfaction. Psychological distance can serve as a mediator that explains how the COVID-19 pandemic impacts perceived general health and life satisfaction.

Impact of the COVID-19 pandemic on mental health in the general Chinese population: Changes, predictors and psychosocial correlates.

The current COVID-19 pandemic is not only a threat to physical health, but also brings a burden to mental health in the general Chinese population. However, the temporal change of mental health status due to pandemic-related stress in relation to protective and risk factors to hostility is less known. This study was implemented at two timepoints, i.e., during the peak and the remission of the COVID-19 pandemic. 3233 Chinese individuals participated in the first wave, and among them 1390 participants were followed in a second wave. The result showed that fear significantly decreased over time, while depression level significantly increased during the second wave compared to the first wave of the survey. Younger age, lower-income, increased level of perceived stress, and current quarantine experience were significant predictors of depression escalation. Younger people and individuals who had a higher initial stress response tended to show more hostility. Furthermore, the use of negative coping strategy plays a potential intermediating role in the stress-related increase in hostility, while social support acts as a buffer in hostility in the general population under high stress. As the whole world is facing the same pandemic, this research provides several implications for public mental health intervention.

Immediate and delayed psychological effects of province-wide lockdown and personal quarantine during the COVID-19 outbreak in China.

BACKGROUND: The COVID-19 pandemic has greatly affected public health and wellbeing. In response to the pandemic threat of the coronavirus epidemic, several countries, including China, adopted lockdown and quarantine policies, which may cause psychological distress. This study aimed to explore the psychological impact of province-wide lockdown and personal quarantine during the COVID-19 outbreak in China as well as the corresponding risk factors and protective factors. METHODS: We examined the immediate (2-week) and delayed (2-month) impact of province-wide lockdown and personal quarantine on psychological distress in a national sample of 1390 Chinese residents. RESULTS: No immediate impact of province-wide lockdown on psychological distress was observed, whereas personal quarantine increased individuals' anxiety, fear, and anger. Despite the lack of initial association, psychological distress increased among those in province-wide lockdown. Self-stigma and personal control both significantly moderated the association between lockdown and psychological distress, but in different directions. Those with higher self-stigma and lower personal control were more impacted by the lockdown. Government support moderated the impact of quarantine on psychological distress, but not that of lockdown. CONCLUSIONS: The delayed effects of lockdown and quarantine on psychological distress were observed, and self-stigma, social support, and perceived control moderate the relationships. This study is the first to demonstrate the psychological costs of province-wide lockdowns on individuals' mental health, providing evidence of the need for mitigation strategies and timely public mental health preparedness in countries with recent outbreaks of COVID-19.