An Online Intervention Promoting HIV Testing Service Utilization Among Chinese men who have sex with men During the COVID-19 Pandemic: A quasi-experimental Study.

The COVID-19 pandemic created disruptions in HIV testing service utilization among men who have sex with men (MSM). The present study was to evaluate the effectiveness of an online health promotion program implemented by a community-based organization (CBO) in increasing the uptake of any type of HIV testing and home-based HIV self-testing (HIVST) over a six-month follow-up period. Participants of an observational prospective cohort study conducted during the same period served as the comparison group. This study was conducted between September 2020 and December 2021. Participants were Chinese-speaking adult MSM who were HIV-negative/unknown sero-status recruited through multiple sources in Hong Kong, China. Participants in the intervention group were exposed to the following health promotion components: (1) viewing an online video promoting HIVST, (2) visiting the project webpage, and (3) having access to a chargeable HIVST service implemented by the CBO. Among 400 and 412 participants in the intervention group and the comparison group, 349 (87.3%) and 298 (72.3%) completed follow-up evaluation at Month 6. Multiple imputation was used to replace missing values. At Month 6, participants in the intervention group reported significantly higher uptake of any type of HIV testing (57.0% versus 49.0%, adjusted odds ratios [AOR]: 1.43, p = .03) and HIVST (25.8% versus 14.8%, AOR: 2.04, p = .001), as compared to those in the comparison group. Process evaluation of the health promotion components for the intervention group was positive. Promoting HIVST is a potentially useful strategy to increase HIV testing service utilization among Chinese MSM during the pandemic.

Effects of Negative Attitudes towards Vaccination in General and Trust in Government on Uptake of a Booster Dose of COVID-19 Vaccine and the Moderating Role of Psychological Reactance: An Observational Prospective Cohort Study in Hong Kong.

Uptake of a booster dose of COVID-19 vaccine is effective in preventing infection and severe consequences caused by COVID-19. The present study examined the effects of negative attitudes towards vaccination in general and trust in government on uptake of a COVID-19 booster dose, as well as the moderating role of psychological reactance to pro-vaccination messages in Hong Kong. An observational prospective cohort study using online survey was conducted among 264 adults. Findings showed that, after adjustment for significant background characteristics, negative attitudes towards vaccination in general negatively predicted uptake of a booster dose, and trust in government positively predicted uptake of a booster dose. In addition, the association between negative attitudes towards vaccination in general and uptake of a booster dose was weaker among those who reported a higher level of psychological reactance. The present study highlighted the importance of improving attitudes towards vaccination in general especially among those who are not experiencing psychological reactance, and building trust in government. This study also suggested that interventions aimed at improving attitudes towards vaccination in general should seek to avoid psychological reactance, and special attention should be given to people who are experiencing psychological reactance to pro-vaccination messages.

The Roles of Information Valence, Media Literacy and Perceived Information Quality on the Association Between Frequent Social Media Exposure and COVID-19 Vaccination Intention.

PURPOSE: This study aimed to examine the associations between frequent exposure to positive/negative information about vaccine efficacy/safety on social media and intention of COVID-19 vaccination, and to test if media literacy and perceived information quality would moderate such associations. DESIGN: A multi-city cross-sectional survey. SETTING: At five universities in different regions of China. SUBJECTS: 6922 university students (a response rate of 72.3%). MEASURES: frequency of exposure to social media information about COVID-19 vaccination, media literacy, perceived information quality, intention of COVID-19 vaccination, and sociodemographic characteristics. ANALYSIS: Logistic regression analysis was conducted to test main and interaction effects. RESULTS: Higher exposure to positive information about vaccine efficacy (adjusted odds ratio [AOR] = 1.30, P < .001) and vaccine safety (AOR = 1.27, P < .001) were positively associated with vaccination intention. No significant associations were shown between exposure to negative information about vaccine efficacy/safety and vaccination intention. Higher net exposure to negative vs positive information was negatively associated with vaccination intention (AOR = .82, P < .001). High media literacy was further found to attenuate the effect of negative information exposure and strengthen that of positive information exposure. Perceived information quality was not a significant moderator. CONCLUSION: The valence of social media information regarding the efficacy and safety of COVID-19 vaccines and individuals' media literacy jointly shaped COVID-19 vaccination intention. The findings can inform the development of effective health promotion strategies for enhancing COVID-19 vaccination.

Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study.

BACKGROUND: The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break. OBJECTIVE: In this study, we investigated levels of COVID-19-related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19-related cognitive factors. METHODS: A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed. RESULTS: Only 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19-related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying. CONCLUSIONS: University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us.

Perceived Information Distortion about COVID-19 Vaccination and Addictive Social Media Use among Social Media Users in Hong Kong: The Moderating Roles of Functional Literacy and Critical Literacy.

During the COVID-19 pandemic, distorted information about the COVID-19 vaccination is widely disseminated through social media. The present study examined the association between perceived information distortion about COVID-19 vaccination on social media, individuals' functional and critical literacy, and addictive social media use (SMU), as well as the moderating roles of functional and critical literacy in the association between perceived information distortion and addictive SMU among social media users in Hong Kong. A web-based, cross-sectional survey was conducted among 411 Chinese citizens from June to August 2021. Findings showed that after adjusting for significant background variables, including age, gender, marital status, education, occupation, and income, functional literacy was negatively associated with addictive SMU. In addition, significant moderation effects of functional literacy and critical literacy were also observed, such that a positive association between perceived information distortion on social media and addictive SMU was significant among participants with lower functional literacy or higher critical literacy. Findings highlight the importance of improving functional literacy in addictive SMU prevention for social media users. Special attention should also be paid to the potential influence of critical literacy on addictive SMUs.

Changes in Compliance With Personal Preventive Measures and Mental Health Status Among Chinese Factory Workers During the COVID-19 Pandemic: An Observational Prospective Cohort Study.

Coronavirus Disease 2019 (COVID-19) vaccination together with good compliance with personal preventive measures may help eradicate the ongoing pandemic. This observational prospective cohort study investigated the changes in compliance with personal preventive measures, depressive symptoms, and sleep quality among factory workers within a 3-month follow-up period. A total of 663 workers were recruited by a stratified multi-stage cluster sampling in March 2020, and all of them completed a follow-up survey three months later. Multilevel logistic and linear regression models (level 1: factories; level 2: individual participants) were fitted. A significant decline was observed in consistent facemask wearing in workplace (from 98.0 to 90.3%, P < 0.001) and in other public spaces (from 97.1 to 94.4%, P = 0.02), sanitizing hands (from 70.9 to 48.0%, P < 0.001), household disinfection (from 47.7 to 37.9%, P < 0.001) and probable depression (from 14.9 to 1.5%, P < 0.001) over the follow-up period. A significant improvement in avoiding crowded places (from 69.8 to 77.4%, P = 0.002) and sleep quality (proportion of participants reporting poor sleep quality dropped from 3.9 to 1.2%, P = 0.002) was also observed. Efforts are needed to maintain compliance with personal preventive measures during the pandemic. Mental health problems were uncommon and likely to be one-off among Chinese factory workers.

Multi-dimensional factors related to participation in a population-wide mass COVID-19 testing program among Hong Kong adults: A population-based randomized survey.

RATIONALE: Mass testing is considered as an important policy response to the COVID-19 pandemic, and high population coverage is pivotal to its effectiveness. A range of factors derived from health behaviour theories were hypothesized to be associated with public uptake of mass testing, including illness representations of COVID-19, perceived susceptibility to COVID-19, perceived efficacy of the testing program, and general trust toward governmental measures for controlling COVID-19. OBJECTIVE: This study aimed to investigate the multi-dimensional factors associated with participation in a free and voluntary population-wide mass COVID-19 testing program. METHODS: A cross-sectional study was conducted in Hong Kong within two weeks after the Universal Community Testing Program for COVID-19 concluded on September 14, 2020. A random population-based telephone survey interviewed 443 Hong Kong general adults who were aged ≥18 and had not joined other COVID-19 testing programs. The dependent variable was participation in the Universal Community Testing Program. Logistic regression analysis was conducted to test the associations of participation in the program with the proposed factors. RESULTS: The standardized participation rate of the testing program was estimated to be about 37.2% among the general adults (33.0% among males; 40.8% among females) in Hong Kong. The participation rates were significantly lower among males and younger adults. Adjusted for socio-demographics, significant factors included four dimensions of illness representations of COVID-19 (treatment control: adjusted odds ratio [AOR] = 1.41; illness identity: AOR = 1.10; concern: AOR = 1.14; emotions: AOR = 1.10), perceived susceptibility to COVID-19 (AOR = 1.40), perceived efficacy of the testing program (AOR = 2.73), and trust toward governmental control measures (AOR = 4.30). CONCLUSIONS: The participation rate of the population-wide mass testing program was not high among general adults in Hong Kong, evidence-based health promotion is necessary. The study informs some critical factors to be addressed to effectively boost public support for the mass testing policy in response to emerging infectious diseases.

The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses.

COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions.

Behavioural intention of receiving COVID-19 vaccination, social media exposures and peer discussions in China.

The study aimed to investigate behavioural intentions to receive free and self-paid COVID-19 vaccinations (BICV-F and BICV-SP) among Chinese university students if the vaccine was 80% effective with rare mild side effects, to examine their associations with social media exposures and peer discussions regarding COVID-19 vaccination, and to explore the mediational role of perceived information sufficiency about COVID-19 vaccination. An online anonymous survey (N = 6922) was conducted in November 2020 in five Chinese provinces. Logistic regression and path analysis were adopted. The prevalence of BICV-F and BICV-SP were 78.1% and 57.7%. BICV-F was positively associated with the frequencies of passive social media exposure (adjusted odds ratio (AOR) = 1.32, P < 0.001), active social media interaction (AOR = 1.13, P < 0.001) and peer discussions (AOR = 1.17, P < 0.001). Indirect effects of the three factors on BICV-F via perceived information sufficiency were all significant (P < 0.001). The direct effect of active social media interaction on BICV-F was significantly negative (P < 0.001). Similar associations/mediations were observed for BICV-SP. The COVID-19 vaccination intention of Chinese university students needs improvement. Boosting social media exposures and peer discussions may raise students' perceived information sufficiency and subsequently increase their vaccination intention. Considering the potential negative effect of active social media interaction, caution is needed when using social media to promote COVID-19 vaccination.

Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study.

BACKGROUND: The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. OBJECTIVE: This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. METHODS: A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. RESULTS: Of the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%). CONCLUSIONS: Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic.

Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study.

BACKGROUND: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. OBJECTIVE: We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. METHODS: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. RESULTS: More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19-related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services. CONCLUSIONS: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers.

Associations of Mental Health and Personal Preventive Measure Compliance With Exposure to COVID-19 Information During Work Resumption Following the COVID-19 Outbreak in China: Cross-Sectional Survey Study.

BACKGROUND: Risk and crisis communication plays an essential role in public health emergency responses. The COVID-19 pandemic has triggered spontaneous and intensive media attention, which has affected people's adoption of personal preventive measures and their mental health. OBJECTIVE: The aim of this study was to investigate the associations between exposure to COVID-19-specific information and mental health (depression and sleep quality) and self-reported compliance with personal preventive measures (face mask wearing and hand sanitizing). We also tested whether these associations were moderated by thoughtful consideration of the veracity of the information to which people were exposed. METHODS: A cross-sectional, closed web-based survey was conducted among a sample of 3035 factory workers at the beginning of work resumption following the COVID-19 outbreak in Shenzhen, China. A stratified two-stage cluster sampling design was used for recruitment. Multivariate linear and logistic regression models were used for the analyses. RESULTS: The prevalence of probable moderate-to-severe depression was 170/3035 (5.6%), while that of good or excellent sleep quality was 2110/3035 (69.5%). The prevalence of self-reported consistent face mask wearing in public places was 2903/3035 (95.7%), while that of sanitizing hands every time after returning from public spaces or touching public installations was 2151/3035 (70.9%). Of the 3035 respondents, 1013 to 1638 (33.3% to 54.0%) reported >1 hour of daily exposure to COVID-19-specific information through web-based media and television. After controlling for significant background variables, higher information exposure via television and via newspapers and magazines was associated with better sleep quality and higher compliance with hand sanitizing. Higher exposure via unofficial web-based media was associated with higher compliance with hand sanitizing but was also associated with higher depressive symptoms. In contrast, higher exposure through face-to-face communication was associated with higher depressive symptoms, worse sleep quality, and lower compliance with hand sanitizing. Exposure to information about positive outcomes for patients with COVID-19, development of vaccines and effective treatments, and heroic stories about frontline health care workers were associated with both better mental health and higher compliance with preventive measures. Higher overall information exposure was associated with higher depressive symptoms among participants who were less likely to carefully consider the veracity of the information to which they were exposed; it was also associated with better sleep quality among people who reported more thoughtful consideration of information veracity. CONCLUSIONS: This study provides empirical evidence of how the amount, sources, and contents of information to which people were exposed influenced their mental health and compliance with personal preventive measures at the initial phase of work resumption in China. Thoughtful consideration of information quality was found to play an important moderating role. Our findings may inform strategic risk communication by government and public health authorities during the COVID-19 pandemic.

Self-Reported Compliance With Personal Preventive Measures Among Chinese Factory Workers at the Beginning of Work Resumption Following the COVID-19 Outbreak: Cross-Sectional Survey Study.

BACKGROUND: Maintaining compliance with personal preventive measures is important to achieve a balance of COVID-19 pandemic control and work resumption. OBJECTIVE: The aim of this study was to investigate self-reported compliance with four personal measures to prevent COVID-19 among a sample of factory workers in Shenzhen, China, at the beginning of work resumption in China following the COVID-19 outbreak. These preventive measures included consistent wearing of face masks in public spaces (the workplace and other public settings); sanitizing hands using soap, liquid soap, or alcohol-based hand sanitizer after returning from public spaces or touching public installations and equipment; avoiding social and meal gatherings; and avoiding crowded places. METHODS: The participants were adult factory workers who had resumed work in Shenzhen, China. A stratified two-stage cluster sampling design was used. We randomly selected 14 factories that had resumed work. All full-time employees aged ≥18 years who had resumed work in these factories were invited to complete a web-based survey. Out of 4158 workers who had resumed work in these factories, 3035 (73.0%) completed the web-based survey from March 1 to 14, 2020. Multilevel logistic regression models were fitted. RESULTS: Among the 3035 participants, 2938 (96.8%) and 2996 (98.7%) reported always wearing a face mask in the workplace and in other public settings, respectively, in the past month. However, frequencies of self-reported sanitizing hands (2152/3035, 70.9%), avoiding social and meal gatherings (2225/3035, 73.3%), and avoiding crowded places (1997/3035, 65.8%) were relatively low. At the individual level, knowledge about COVID-19 (adjusted odds ratios [AORs] from 1.16, CI 1.10-1.24, to 1.29, CI 1.21-1.37), perceived risk (AORs from 0.58, CI 0.50-0.68, to 0.85, CI 0.72-0.99) and severity (AOR 1.05, CI 1.01-1.09, and AOR 1.07, CI 1.03-1.11) of COVID-19, perceived effectiveness of preventive measures by the individual (AORs from 1.05, CI 1.00-1.10, to 1.09, CI 1.04-1.13), organization (AOR 1.30, CI 1.20-1.41), and government (AORs from 1.14, CI 1.04-1.25, to 1.21, CI 1.02-1.42), perceived preparedness for a potential outbreak after work resumption (AORs from 1.10, CI 1.00-1.21, to 1.50, CI 1.36-1.64), and depressive symptoms (AORs from 0.93, CI 0.91-0.94, to 0.96, CI 0.92-0.99) were associated with self-reported compliance with at least one personal preventive measure. At the interpersonal level, exposure to COVID-19-specific information through official media channels (AOR 1.08, CI 1.04-1.11) and face-to-face communication (AOR 0.90, CI 0.83-0.98) were associated with self-reported sanitizing of hands. The number of preventive measures implemented in the workplace was positively associated with self-reported compliance with all four preventive measures (AORs from 1.30, CI 1.08-1.57, to 1.63, CI 1.45-1.84). CONCLUSIONS: Measures are needed to strengthen hand hygiene and physical distancing among factory workers to reduce transmission following work resumption. Future programs in workplaces should address these factors at multiple levels.

Negative cognitive and psychological correlates of mandatory quarantine during the initial COVID-19 outbreak in China.

Quarantine plays a key role in controlling the pandemic of 2019 coronavirus disease (COVID-19). This study investigated (a) the associations between mandatory quarantine status and negative cognitions (perceived discrimination because of COVID-19 and perceived risk of COVID-19 infection)/mental health status (emotional distress because of COVID-19, probable depression, and self-harm/suicidal ideation), (b) the associations between the negative cognitions and mental health status, and (c) potential mediations between quarantined status and probable depression and self-harm/suicidal ideation via COVID-19-related negative cognitions/emotional distress. An online cross-sectional survey was conducted among 24,378 students of 26 universities in 16 Chinese cities (February 1-10, 2020). Correlation coefficients, odds ratios (OR), structural equation modeling, and other statistics were used for data analysis. Mandatory quarantined status was significantly and positively associated with perceived discrimination (Cohen's d = 0.62), perceived high/very high risk of infection (OR = 1.61), emotional distress (Cohen's d = 0.46), probable depression (OR = 2.54), and self-harm/suicidal ideation (OR = 4.98). Perceived discrimination was moderately and positively associated with emotional distress (Spearman correlation = 0.44). Associations between perceived risk of infection and mental health variables were significant but relatively weak. Cross-sectional mediation models showed good model fit, but the overall indirect paths via COVID-19-related negative cognitions/emotional distress only accounted for 12-15% of the total effects between quarantined status and probable depression and self-harm/suicidal ideation. In conclusion, quarantined participants were more likely than others to perceive discrimination and exhibit mental distress. It is important to integrate mental health care into the planning and implementation of quarantine measures. Future longitudinal studies to explore mechanisms underlying the mental health impact of quarantines are warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).