Utility of protection motivation theory for understanding behavioral intention and adherence to protective health behaviors related to COVID-19

ABSTRACT

Objectives: In response to the coronavirus, or COVID-19, pandemic, governments around the world have enacted behavioral recommendations to slow the spread of the virus. At the time of this study, in November 2020, the United States (US), the Centers for Disease Control and Prevention (CDC) recommended that individuals adhere to protective guidelines including wearing face masks when outside of the home, maintaining social distancing (e.g., keeping 6 feet apart from others) from individuals with whom they do not live, and other recommendations like washing hands frequently. At the time of study inception, early data suggested that adherence to these protective behaviors was variable among US adults (Brenan, 2020;Coroiu et al., 2020;Czeisler et al., 2020;Fisher et al., 2020;Igielnik et al., 2020;Moore et al., 2020;Oosterhoff & Palmer, 2020;Perotta et al., 2020), with emerging adults (EA;i.e., individuals aged 18-25) demonstrating lower levels of adherence than older age groups. Protection motivation theory (PMT;Rogers, 1983) may provide insight into cognitive processes (e.g., threat appraisal and coping appraisal) that contribute to intention to adhere and actual adherence to COVID-19 protective behaviors. The utility of the PMT model has been studied with respect to a variety of health behaviors including social distancing and is successful in predicting behavioral intention but explains less variance in adherence behavior. As such, attention to other factors that may impact behavior such as affective empathy, knowledge of COVID-19, and objective risk (e.g., risk of severe illness from COVID-19) may serve to explain additional variance above and beyond the PMT model in predicting intention or behavior with respect to COVID-19 protections. Therefore, the current study aimed to examine the utility of the PMT framework in predicting behavioral intention and adherence to COVID-19 protective behaviors, current at the time of the study, in a sample of US EA and to examine whether select factors outside of the PMT model contribute additional variance to EA adherence behavior. We hypothesized that PMT variables together will explain significant variance in concurrent reports of intention to adhere to COVID-19 protective behaviors and will also predict actual adherence to COVID-19 protective behaviors during the subsequent 2-week period. Behaviors of interest included social distancing with the general public, social distancing with friends, family, and significant other's that participants do not live with, social distancing with coworkers, and washing hands, wearing a mask, avoiding crowds, and avoiding those who are sick. We expected self-efficacy to emerge as the most salient correlate of behavioral intention, and behavioral intention to explain the most variance in actual adherence behavior. Finally, we expected that the addition of affective empathy, knowledge of COVID-19, and objective risk combined would explain additional variance in adherence to protective behaviors above and beyond variance explained by PMT variables. A sample of 434 EA participants were recruited through various online recruitment methods (e.g., social media, MTurk). Participants completed demographic information, a PMT measure, and questions assessing adherence to nine protective health behaviors related to the COVID-19 pandemic. Descriptive analyses summarized information about the sample. Bias corrected accelerated bootstrapping based on 1,000 samples was used to adjust for non-normal data for multiple regression analyses. Consistent with hypotheses, the PMT model explained significant variance in intention to adhere to the nine protective health behaviors, and in 66.67% of analyses, self-efficacy was the most salient construct. (PsycInfo Database Record (c) 2022 APA, all rights reserved)