key: cord-0877788-6w7ng885 authors: Luo, Yetao; Yao, Lili; Zhou, Li; Yuan, Feng; Zhong, Xiaoni title: Factors Influencing Health Behaviours during the COVID-19 Outbreak in China: an Extended IMB Model date: 2020-07-09 journal: Public Health DOI: 10.1016/j.puhe.2020.06.057 sha: c517bb75aa5abdc685e1753dd5e2daf7ceb4a17b doc_id: 877788 cord_uid: 6w7ng885 Abstract Objectives This study explored the factors influencing health behaviours during the coronavirus disease 2019 (COVID-19) outbreak in China. The impact of perceived stress and positive perception of interventions on health behaviours in China were assessed using the extended information-motivation-behaviour skills (IMB) model. Study design Cross-sectional survey. Methods The Questionstar online survey tool was used to construct a structured questionnaire based on the IMB model. Between 14 and 22 February 2020, during the peak of COVID-19 epidemic in China, 2449 participants were recruited by snowball sampling on WeChat and Tencent QQ social media platforms in China. Data were collected through an online questionnaire and structural equation modelling was performed to evaluate the extended IMB model. Results Health behaviours were assessed using a scoring system (total score range 8–40); the average health behaviour score in this study was 34.62 ± 4.44. The term ‘health risk stress’ refers to the impact that perceived stress has on health and this was experienced by 39.9% of participants. Only 35.9% of participants answered all 7 questions on COVID-19 information correctly. The final model showed that information, motivation, behavioural skills, heath risk stress and positive perception of interventions had significant direct effects on health behaviours. Health behaviours were positively associated with the positive perception of interventions, but negatively associated with health risk stress. Behavioural skills had the greatest impact on health behaviours. Conclusions In the face of public health emergencies, the extended IMB model has been used as a theoretical framework to construct more effective interventions. The government should pay attention to publicity and guidance, strengthen positive interactions with the public and disclose relevant information in a timely manner to gain trust and to maintain the positive public perception of the interventions. In terms of health education, the government should focus on behavioural skills, promptly rectify ineffective prevention information and raise awareness about the disease in order to relieve stress and anxiety in the population. On 30 January 2020, the World Health Organization (WHO) declared coronavirus disease 2019 31 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as the 32 sixth public health emergency of international concern 1 . As of 14 June 2020, there were 7,690,708 33 confirmed cases and 427,630 deaths worldwide 2 . WHO's risk assessment is very high. In addition 34 to public health, COVID-19 poses a serious threat to global economic and social development. and accurate information about COVID-19, actively carried out health education and provided 41 residents with authoritative, detailed and specific operational prevention and control guidelines 3 . 42 In addition, it was very important for residents to follow the instructions, adopt appropriate health 43 behaviours and maintain good health habits, such as correctly wearing a mask and avoiding 44 outings or gatherings. These measures help to control the epidemic and reduce the risk of 45 The aforementioned prevention strategy is consistent with the theory of the 47 information-motivation-behaviour skills (IMB) model, which classifies the factors affecting the 48 occurrence and changes of preventive behaviour into three components of information, motivation 49 and behaviour skills 4 . IMB is a well-proven method that can predict and promote health 50 behaviors 5 . It has been widely used in AIDS prevention 6, 7 , health promotion 8, 9 , public health 10, 11 , 51 chronic disease management 12, 13 , vaccination 5 and other fields. The IMB model can be easily 52 converted into intervention practice and has broad applicability. 53 This study adds two factors to the original IMB model-perceived stress and positive 54 perception of interventions. Stress and anxiety in the population tends to increase during public 55 health emergencies 14 , which may have a negative impact on health behaviours. In addition, 56 residents' positive perception of government interventions could also have an effect on health 57 behaviours, such as the degree of understanding and support of intervention measures. 58 Therefore, based on the extended IMB model, this study explores the factors influencing 59 Chinese residents' health behaviours during the COVID-19 outbreak, and assesses the impact of 60 perceived stress and positive perception of interventions on health behaviours. Participants were required to read the informed consent and agree to participate before gaining 73 access to the questionnaire to complete. Inclusion criteria were as follows: (1) aged ≥18 years old; 74 (2) ability to use smart electronic devices (e.g. computers, tablets, mobile phones,); and (3) agree 75 to participate in this study (i.e. provide informed consent). Exclusion criteria were as follows: (1) 76 suffering from a mental health illness (such as anxiety neurosis or depression) in the past year; and 77 (2) response times of <1 minute or >30 minutes. 78 79 Quality control 80 To reduce bias, the following quality control was carried out: (1) each item was set as a mandatory 81 question to ensure the integrity of the data; (2) each internet protocol (IP) address was limited to 82 The motivations of participants towards their health behaviours were mainly divided into 109 individual motivation and social motivation, which were measured by 6 items ( five-point Likert scale, ranging from 1 (never) to 5 (always). The higher the score, the greater the 125 perceived stress of residents during the COVID-19 epidemic. When the total score was higher 126 than 25, the perceived stress would impact health, which was defined as 'health risk stress' 17 . Sociodemographic characteristics 165 In total, 2533 participants completed the questionnaires; 2449 of these were valid. The final extended IMB model (Fig. 2) Therefore, the government advise the public on correct health behaviours, such as wearing masks, 237 washing hands and the use of disinfectants, so that residents can obtain these skills to reduce the 238 risk of infection. It is also necessary to guarantee the supply of protective materials. 239 In the face of public health emergencies, the level of anxiety will be related to the severity of 240 the disease 25 . The results found that 39.9% of residents suffered from health risk stress. Health risk 241 stress is negatively related to health behaviours, information and behavioural skills, which showed 242 that excessive stress is not conducive to positive health behaviours, and that nervousness and 243 being out of control can lead to negative coping styles. Individuals who maintain a high level of 244 awareness of the danger and maintain a moderate level of stress are the most likely to adopt 245 appropriate health behaviours 14 . Therefore, it is necessary for relevant departments to guide 246 residents to treat the epidemic objectively, calmly and rationally, and to take effective intervention 247 measures to reduce stress and anxiety in the population. The authors thank all individuals who volunteered to participate in this study and are grateful to 277 ELSEVIER services in manuscript language polishing. 278 The study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Empirical tests of an 332 information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and 333 heterosexual university students Coping with the threat of severe acute respiratory 335 syndrome: Role of threat appraisals and coping responses in health behaviors Perceived stress in general public during 338 prevalence of severe acute respiratory syndrome and it impact on health behavior National Health Commission of the People's Republic of China. Coronavirus disease 341 (COVID-19 ) knowledge of prevention Coronavirus disease (COVID-19) advice for the public Greek version of PSS-14:a global measure of perceived stress Assessing Reliability and Stability in Panel 350 Structural Equation Modelling Guidelines for 352 Forgotten key players in public health: news 354 media as agents of information and persuasion during the COVID-19 pandemic Predicting condom use 357 using the Information-Motivation-Behavioral Skills (IMB) model: a multivariate latent growth 358 curve analysis Longitudinal 360 Assessment of Community Psychobehavioral Responses During and After the 2003 Outbreak 361 of Severe Acute Respiratory Syndrome in Hong Kong Analysis and Simulation an Mass Psychology by CAS 364 Coronavirus disease 2019 2) Health risk stress (i.e. the impact that perceived stress has on health) was negative factor on health behaviours.3) Behavioural skills were the most important factor influencing health behaviour.4) 39.9% of residents experienced health risk stress.