ABSTRACT
BACKGROUND: Hand hygiene, facemask wearing, and physical distancing play a crucial role in the prevention of the COVID-19 pandemic. Identifying the key psychosocial determinants of these precautionary behaviors contributes to effective intervention and policymaking for COVID-19 and future pandemics. PURPOSE: This study aimed to systematically review and meta-analyze available evidence on psychosocial determinants of the general population's practice of three precautionary behaviors, based on the Risk, Attitudes, Norms, Abilities, and Self-regulation (RANAS) framework. METHODS: Literature was identified by searching seven databases and relevant review papers. Observational and experimental studies targeting the general population (≥18 years) published between January 2020 to September 2021 were included. Pooled effect sizes were calculated with the inverse-variance method using random-effects models. RESULTS: A total of 51 studies (64 samples) were included in the qualitative synthesis, of which 30 studies (42 samples) were included in the meta-analysis. RANAS-based constructs including knowledge, pros attitudes, and perceived norms were identified as significant determinants of all three behaviors in the meta-analysis. Perceived susceptibility and cons attitudes showed no significant associations with any behaviors. Perceived severity, perceived control, self-efficacy, and behavioral intention were significantly associated with one or two behaviors. Country (western vs. eastern hemispheres) significantly moderated the effects of certain risk and ability factors. CONCLUSIONS: More research is needed with respect to the intention-behavior relationship, self-regulatory and reflexive factors of precautionary behaviors, as well as the exploration of the potential moderating effect of sociodemographic factors.
Identifying the psychosocial factors affecting the practice of three precautionary behaviors (hand hygiene, facemask wearing, and physical distancing) contributes to effective intervention and policymaking for the COVID-19 and future pandemics. Given the lack of summarized evidence, we conducted a systematic review and meta-analysis. Through seven databases and relevant review papers, we summarized the research findings of 51 observational studies that targeted the general population (≥18 years) and were published between January 2020 and September 2021. We found that (a) more knowledge, positive behavioral attitudes, and better compliance with the norms were associated with better practices of all three precautionary behaviors; (b) perceived susceptibility to the disease and negative behavioral attitudes were not associated with any precautionary behaviors; (c) higher levels of perceived disease severity, perceived behavioral control, self-efficacy, and behavioral intention were associated with better practices of one or two behaviors. In addition, we found that country (western vs. eastern hemispheres) differed in the relationship between psychosocial factors and behavioral practices. Specifically, both the association of perceived susceptibility with hand hygiene and the association of perceived severity with physical distancing were stronger among western populations. In contrast, the contribution of self-efficacy on the practice of physical distancing was stronger among eastern populations.