Intention to maintain and willingness to stop: Applying a dual-process model to understanding the maintenance of COVID-19 preventive behaviors.

Preventive behaviors have played an essential role in coping with COVID-19 and may continue to exerting a crucial impact on pandemic control in the future. This study aimed to evaluate the effectiveness of social-cognitive factors on maintenance of COVID-19 preventive behaviors based on a dual-process model, which encompasses a reasoned path via the intention to maintain and a social reaction path via the willingness to stop. We collected a probability sample of 472 community-dwelling adults. Social-cognitive factors, behavioral tendencies, and preventive behaviors of COVID-19 were measured. The results supported that the dual-process framework could account for individual differences in preventive behaviors. Self-efficacy and response cost significantly explained the intention to maintain preventive behaviors, while favorability of risk image and subjective norm significantly explained the willingness to stop preventive behaviors. Our findings proposed strategies for promoting individuals' maintenance of preventive behaviors during a pandemic. The development of prevention policies may focus on two paths: strengthening the intended path by enhancing self-efficacy and decreasing response cost of preventive behaviors and monitoring and improving social influences, such as risk prototype and subjective norm, which can reduce the willingness to stop preventive behaviors.

The Impact of Pandemic-Related Life Stress on Internet Gaming: Social Cynicism and Gaming Motivation as Serial Mediators.

A heightened interest in online gaming has emerged during COVID-19, and people have become increasingly vulnerable to internet gaming disorder (IGD). However, playing video games can also have a positive effect; gaming has been recognized as an efficient coping strategy. Currently, relatively little is understood about how online gaming can turn from an efficient coping strategy into an addiction disorder. This study investigated the mediating roles of social cynicism, escape and coping motives on the association between daily disruption during COVID-19 and IGD, seeking to reveal the underlying mechanism that influences the effects of gaming. A total of 203 participants in Hong Kong who reported having played electronic games during COVID-19 were surveyed. We conducted three hierarchical multiple regressions, then tested a serial mediation model using path analysis with structural equation modeling. The results revealed that escape motives significantly mediated the relationship between daily disruption related to COVID-19 and IGD, but no such effect was found for coping motives. Social cynicism alone was not a significant mediator, but social cynicism and escape motives in series mediated the relationship between daily disruption and IGD. These difference outcomes suggested different underlying mechanisms of escape and coping motives.

Psychological stress self-help interventions for healthcare workers in the context of COVID-19 in China: A randomized controlled trial protocol.

Background: Public health emergencies may lead to severe psychological stress, especially for healthcare workers, including frontline healthcare workers and public health workers. However, few stress management interventions have been implemented for healthcare workers even though they require more comprehensive interventions than the general public. Self-Help Plus (SH+) is a novel psychological self-help intervention developed by the World Health Organization. It is accessible, scalable, and cost-effective and has the potential to be quickly applied to help people cope with stress and adversity. The major objective of this study is to evaluate the effectiveness of SH+ interventions on the alleviation of stress levels and mental health problems among healthcare workers. Methods: A randomized controlled trial of SH+ will be conducted to investigate the stress level and mental health status of Chinese healthcare workers and control subjects in Guangzhou. Assessments will be performed before (baseline), at the end of (1 month), and 2 months after (3 months) the intervention. After completing the baseline screening questionnaire, eligible participants will be randomly assigned to one of the two groups in a 1:1 ratio by block randomization. During the 1-month intervention period, the intervention group will receive the SH+ intervention and the control group will receive information about mental health promotion. The intervention will be delivered by the research assistant via social media platforms. The primary outcome is the level of stress, which will be measured by a 10-item Perceived Stress Scale. Secondary outcomes including mental health symptoms will also be collected. Discussion: Given the potential for multiple COVID-19 waves and other infectious disease pandemics in the future, we expect that SH+ will be an effective stress management intervention for healthcare workers. The findings from this study will facilitate the application of SH+, and the trial is expected to be extended to a larger population in the future.

Mental distress during the COVID-19 pandemic: Its association with public perceptions toward government's pandemic responses and lifestyle changes.

In order to propose better mental health interventions under the pandemic threat, the present study aimed to investigate whether depression and anxiety are associated to Chinese adults' perceptions of government's pandemic responses and the personal lifestyle changes imposed by those responses during the COVID-19 pandemic. We used a telephone survey with random sampling and obtained a probability community sample of 616 adults (39.1% men; M age = 41.7, SD age = 16.3) in Macao, China in April 2020. The prevalence of 8.8% probable depression and 12.0% probable anxiety was observed in this sample. Positive perceptions toward government's pandemic responses were found to be negatively associated with probable depression and probable anxiety (ORu = .36 and .41, p < .05). Three lifestyle-changing stressors (i.e., increased family conflict, friendship deterioration, and weight gain), were commonly reported (29.9, 27.5, and 43.0% respectively), and displayed positive associations with probable depression (ORu = 1.67 to 1.87, p < .05) and probable anxiety (ORu = 1.54 to 2.10, p < .05). Our findings suggest protective effects of perceived trust and satisfaction regarding government's pandemic responses against mental distress and the potential mental health threats from three pandemic-specific lifestyle-changing stressors. These findings can inform clinicians and policymakers to better prepare for the mental health impacts of the current and future pandemics.

Cognitive Factors Influencing COVID-19 Vaccination Intentions: An Application of the Protection Motivation Theory Using a Probability Community Sample.

COVID-19 vaccines have been shown to provide protection against severe disease and death. However, substantial individual differences in vaccination intentions have hindered achieving optimal vaccination rates across the population. To look for efficient strategies to promote vaccination, this study tested whether the protection motivation theory (PMT), a cognitive model based upon threat and coping appraisals, would account for the differences in vaccination intentions under three scenarios (i.e., in the context of getting vaccinated in general, and in the context of high- and low- efficacy for reducing COVID-19 transmission risk). A phone survey was conducted in early 2021 and obtained a probability community sample (n = 472; 49.2% men) in Macao, China. We found that 54.0% of respondents indicated their relatively strong intention to receive COVID-19 vaccination for high-efficacy vaccines, compared to 29.5% for low-efficacy vaccines and 31.0% for vaccines in general. After adjusting for demographics, self-efficacy (i.e., the perceived capability of receiving COVID-19 vaccines) and maladaptive response reward (i.e., the perceived benefits of not receiving COVID-19 vaccines) were consistently associated with COVID-19 vaccination intentions under all three scenarios. The perceived severity of COVID-19 infection and response cost (i.e., the perceived costs of receiving COVID-19 vaccines) were significantly associated with vaccination intention for high-efficacy vaccines, while the response efficacy of lowering the COVID-19 impact with COVID-19 vaccination was positively associated with vaccination intention for general and low-efficacy vaccines. Given that the relative strength of PMT constructs depends on perceived vaccine efficacy, we recommend taking PMT constructs and vaccine efficacy into account for encouraging vaccination.

Measuring COVID-19 related anxiety and obsession: Validation of the Coronavirus Anxiety Scale and the Obsession with COVID-19 Scale in a probability Chinese sample.

BACKGROUND: With concern over the rise in mental health symptoms associated with the COVID-19 pandemic, the present study set out to address the absence of pandemic-specific screening tools for detecting those in Chinese societies who are at-risk for experiencing mental distress due to the pandemic; thus, its aim was to validate the Coronavirus Anxiety Scale (CAS) and Obsession with COVID-19 Scale (OCS) in Chinese adults. METHODS: With a two-stage cluster random sampling method, we surveyed 1011 Chinese community-dwelling adults (38.8% men; 41.2 years old on average with an SD of 15.8) in June and July of 2020. RESULTS: Our psychometric evaluation results showed that the Chinese version of CAS and OCS retained their original one-dimensional structure and demonstrated measurement invariance across genders. In line with validation studies of the CAS and OCS in other languages, subsequent analyses also provided support to our Chinese version with respect to their satisfactory internal consistency (α = .87 and .73, respectively), and good concurrent validity (i.e., positive associations with negative feelings, excessive time-consumption, subjective distress, and functioning impairment). LIMITATIONS: Due to constraints of time and cross-sectional design, we only validated CAS and OCS among Chinese adults and did not evaluate their test-retest reliability nor predictive validity. CONCLUSIONS: Considering the practical benefits of understanding the source of mental symptoms during the pandemic, we recommend the use of CAS and OCS in Chinese communities to facilitate early identification and intervention for those who require clinical attention due to their COVID-19 related anxiety and obsessive thoughts.

Problematic Smartphone Use during the COVID-19 Pandemic: Its Association with Pandemic-Related and Generalized Beliefs.

Smartphone technologies have played a crucial role in the fight against the COVID-19 pandemic; however, the increased use of smartphones during the pandemic period may expose the general public to a higher risk of problematic smartphone use (PSU). This study aimed to estimate the prevalence of PSU among Chinese community adults and adopted a social-cognitive theory and social axiom framework to evaluate the effects of beliefs on PSU. A Chinese adult sample (N = 616) was obtained through probability sampling via a telephone survey from Macao, China and included 591 smartphone users' data (39.4% men) for formal analysis. The prevalence of PSU was 43.3% in the overall sample, with 41.9% in women, and 45.5% in men. Two types of beliefs derived from the social-cognitive theory, pandemic-related self-efficacy and government efficacy, both showed significant and negative correlations with PSU (r = -0.13 and -0.10, p < 0.05). As for the two beliefs from the social axiom framework, reward for application was negatively correlated with PSU (r = -0.10, p < 0.05), whereas social cynicism was positively associated with PSU (r = 0.25, p < 0.001). Among those four beliefs, social cynicism exerted the most substantial effect on PSU when controlling for demographics. Our findings enriched the understanding of PSU during the pandemic and provided empirical direction regarding cognition-based intervention strategies for reducing PSU.

Adherence to COVID-19 Precautionary Measures: Applying the Health Belief Model and Generalised Social Beliefs to a Probability Community Sample.

BACKGROUND: In the face of the global pandemic of coronavirus disease-2019 (COVID-19), people's adherence to precautionary behavioral measures (e.g. social distancing) largely influences the effectiveness of those measures in containing the spread of the coronavirus. The present study aims at testing the applicability of the health belief model (HBM) and generalised social beliefs (i.e. social axioms) to explore strategies for promoting adherence to COVID-19 precautionary measures. METHODS: We conducted a telephone survey with a two-step stratified random sampling method and obtained a probability sample of 616 adults in Macao, China (18-87 years old; 60.9% women) in April 2020. RESULTS: Our participants showed stronger adherence to some COVID-19 precautionary measures (e.g. face mask wearing; 96.4%) but not others (e.g. social distancing; 42.3%). Their adherence to those measures was found to be significantly associated with four HBM factors and two social axioms, after controlling for gender, age, and years of education. CONCLUSIONS: The HBM and the generalised social beliefs of social cynicism and reward for application can be applied to understanding adherence to precautionary measures against COVID-19. Strategies based on beliefs were proposed to facilitate the promotion of precautionary measures.