Perceived Beliefs, Uncertainty, and Behavioral Responses During the COVID-19 Outbreak in China: Findings From a Convenience Sample.

Wu, Dan; Rockett, Ian R H; Yang, Tingzhong; Yang, Xiaozhao Yousef; Wang, Mengmeng; Jiao, Can

PURPOSE To investigate perceived beliefs, uncertainty, and behavioral responses among Chinese residents toward the COVID-19 outbreak, and explore their relationships amid an incipient pandemic. DESIGN A cross-sectional correlational survey with a combination of a convenience and snowball sampling design. SETTING This study was conducted online from February 7 to 14, 2020, the third week after the lockdown of Wuhan city on January 23. PARTICIPANTS A total of 2,654 residents was contacted, 2,534 agreed to participate, and 2,215 completed valid questionnaires. The sample covered 30 provinces, municipalities, autonomous regions of China, and a broader region. MEASURES The Uncertainty About COVID-19 Scale was applied to assess perceived public uncertainty. Five dimensions of health beliefs about COVID-19 and 12 health-related response behaviors were measured. ANALYSIS Univariate analysis and multiple linear regression models were used to identify associations. Mediation was assessed by a bootstrapping technique. RESULTS Five constructs of health beliefs were found to be significant predictors of multiple response behaviors. Uncertainty about COVID-19 has a direct relationship with general response behaviors (β=-0.119**) and sanitization practices (β=-0.068**). Emergency coping behaviors aside, uncertainty also partially mediated associations between perceived susceptibility, perceived effectiveness, and perceived barriers influencing general response behaviors and sanitization practices, respectively. CONCLUSION Findings provide evidence-based information to government and policymakers for designing effective health communication messages and intervention strategies by targeting the key constructs of the health belief model and reducing perceived uncertainty about COVID-19. They support public health-related response behaviors to prevent COVID-19 spread among the population.