Peer Reviewed Articles of Mass Media Influence Behavior

• Periodical List
• J Med Cyberspace Res
• 5.22(7); 2020 Jul
• PMC7373377

J Med Internet Res. 2020 Jul; 22(vii): e19982.

Influence of Mass and Social Media on Psychobehavioral Responses Amongst Medical Students During the Downward Trend of COVID-19 in Fujian, Cathay: Cantankerous-Sectional Study

Monitoring Editor: Gunther Eysenbach and Guy Fagherazzi

Yulan Lin, Doctor, MSc, PhD,¹ Zhijian Hu, Physician, MSc, PhD, ⁱ Haridah Alias, BSc, MSc,² and Li Ping Wong, BSc, MSc, PhD^{1, 2}

¹ Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Schoolhouse of Public Wellness, Fujian Medical University, Fuzhou, China,

² Centre for Epidemiology and Testify-Based Practice, Department of Social and Preventive Medicine, Kinesthesia of Medicine, Academy of Malaya, Kuala Lumpur, Malaysia,

Zhijian Hu, Section of Epidemiology and Wellness Statistics, Fujian Provincial Primal Laboratory of Environment Factors and Cancer, Schoolhouse of Public Wellness, Fujian Medical Academy, ane Xue Yuan Road, University Town, Fuzhou, 350122, China, Phone: 86 (0)591 2286 ext 2573, Electronic mail: nc.ude.umjf@naijihzuh.

Yulan Lin

¹ Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Schoolhouse of Public Health, Fujian Medical University, Fuzhou, People's republic of china,

Zhijian Hu

ⁱ Department of Epidemiology and Health Statistics, Fujian Provincial Primal Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Prc,

Haridah Allonym

² Centre for Epidemiology and Prove-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,

Li Ping Wong

¹ Department of Epidemiology and Health Statistics, Fujian Provincial Central Laboratory of Surround Factors and Cancer, School of Public Health, Fujian Medical Academy, Fuzhou, China,

^two Eye for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,

Received 2020 May eight; Revisions requested 2020 Jun 18; Revised 2020 Jun 23; Accepted 2020 Jun 25.

Abstract

Background

An extensive amount of information related to the novel coronavirus (COVID-19) pandemic was disseminated by mass and social media in Communist china. To engagement, in that location is limited evidence on how this infodemic may influence psychobehavioral responses to the crunch.

Objective

The aim of this report is to assess the psychobehavioral responses to the COVID-19 outbreak and examine their associations with mass and social media exposure.

Methods

A cross-sectional study amid medical and health sciences students from the Fujian Medical University in Fuzhou, China, was conducted between April 6-22, 2020.

Results

A total of 2086 completed responses were received. Multivariable analyses demonstrated that four constructs of the Wellness Belief Model (HBM)—higher perception of susceptibility (odds ratio [OR] 1.44; 95% CI 1.07-1.94), severity (OR 1.32; 95% CI 1.10-1.59), cocky-efficacy (OR 1.61; 95% CI 1.21-2.15), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.09-1.59)—were significantly associated with a college mass media exposure score, whereas only three constructs—college perception of severity (OR 1.43; 95% CI 1.xix-1.72), self-efficacy (OR 1.85; 95% CI 1.38-2.48), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.08-1.58)—were significantly associated with a higher social media exposure score. Lower emotional consequences and barriers to conduct out prevention measures were also significantly associated with greater mass and social media exposure. Our findings on anxiety levels revealed that 38.1% (n=795; 95% CI 36.0-twoscore.2) of respondents reported moderate-to-severe anxiety. A lower feet level was significantly associated with higher mass and social media exposure in the univariable analyses; withal, the associations were not pregnant in the multivariable analyses.

Conclusions

In essence, both mass and social media are useful means of disseminating health messages and contribute to the betterment of psychobehavioral responses to COVID-19. Our findings stress the importance of the credibility of data shared through mass and social media outlets and viable strategies to counter misinformation during a pandemic.

Keywords: psychobehavioral, COVID-nineteen, mass media, social media, medical students, China

Introduction

With rapid increases in the number of net users, both mass and social media have a prominent role to play in modern society. In Red china, in that location were approximately 688 million internet users, of whom 75.i% were anile 10-39 years, in 2015 [1]. Every bit the general public becomes more health witting, the popularity of social media every bit a means of acquiring wellness-related information has been growing in recent years [2,3]. Of note, social media tools are readily accessible on the net and have get even easier to access via apps on smartphones. Equally a result, the role of social media equally a pathway to news is very popular [four]. However, social media users may be exposed to untrustworthy news or information of questionable accurateness. Inaccurate information acquisition could have detrimental effects, since passive conquering through social media, peculiarly through WeChat Moments, is an important medium for health information acquisition amid college students in China [2]. (WeChat is the virtually popular social media platform in Prc and includes instant messaging and service platforms to carry out payment, marketing, and promotion activities. WeChat Moments is an interactive platform that allows users to share information/news manufactures, photos, and video.) Moreover, nigh 60% of social media users admitted that internet-based health data impacted their health management strategy [5]. Mass media, in contrast, provides more credible information and has been used as a means of communication of scientifically accurate information near wellness more often than social media. Mass media can influence health behaviors and promote health behavior change in the public [6].

In late Dec 2019, an unknown form of pneumonia—acquired by a novel coronavirus—surfaced in Wuhan, China, and quickly spread across the world. By the stop of April, the overall number of the coronavirus affliction (COVID-19) cases worldwide increased to ii,878,196 and the death count reached 198,668 [7]. China, after over 3 months of battling COVID-19, has managed to control the outbreak. Nonetheless, the community at large in Prc remains vulnerable, and prevention from rebound is essential since lockdown regulations have been relaxed. During the early phase and the pinnacle of the COVID-19 epidemic in Mainland china, various issues surrounding mental distress amongst the general public caught the attention of researchers. Studies showed that a bang-up proportion of the general public was institute to have severe depressive symptoms, fifty-fifty during the early on phase of the outbreak [8,ix]. It is important to address mental health issues during a affliction outbreak, as information technology may weaken social and other areas of functioning, including an impairment in prevention measures [10,11]. Psychobehavioral responses have been understudied after the abeyance of the COVID-19 outbreak in China and this warrants attending. The lay public's psychobehavioral responses during a disease outbreak play an important office in bringing the outbreak under control [10]. Hence, to avoid a resurgence of infections, investigation into preventive behavioral responses in addition to the psychological well-being of the public post–COVID-19 warrant attention. Attitude is a key factor that determines behavioral intention. The Wellness Belief Model (HBM) has been used as the theoretical framework to explain the health behaviors of individuals. It includes the following concepts: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to activity, and self-efficacy [12,13]. Adopting the HBM to explain psychobehavioral changes during the COVID-19 outbreak is essential.

One study in Red china, conducted during the early stage of the outbreak, institute a high prevalence of mental wellness issues among the public, which was positively associated with frequent exposure to social media [fourteen]. To the best of our noesis, little research has been conducted on social or mass media exposure now that Communist china has entered the downward tendency of COVID-xix manual. Thus, an investigation of exposure to both mass and social media and linkage to the psychobehavioral wellness outcomes of the public is needed. Accurate information-seeking behaviors during the COVID-19 outbreak has important implications for health-related behavior change and may strengthen infection prevention and control. The traditional mass media is message-driven; in contrast, social media is conversation-driven, and during the COVID-xix outbreak, it is unclear which form of media influences the public and shapes their psychobehavioral responses. Therefore, this study aimed to (1) assess the level of mass and social media exposure related to COVID-19 and (2) identify the association between both forms of media exposure with HBM constructs, psychological and behavioral responses, and anxiety levels.

Methods

Participants and Report Blueprint

An bearding internet-based, cross-sectional, open survey was distributed to medical and health sciences students at Fujian Medical University, Fuzhou, China, betwixt April 6-22, 2020. Convenience sampling was used to recruit subjects for this study. The link to the survey questions was sent to administrators or lecturers of all departments to exist disseminated to registered students at the university. In an endeavor to accomplish comprehensive recipient coverage, the link to the survey was also sent to students' social media groups and forums. All respondents were informed that their participation was voluntary, and consent was implied through their completion of the questionnaire. No incentives were provided to the study participants.

The questionnaire was adult in English language, and so translated into Chinese. Local experts performed face validation on the content of the questionnaire. The online questionnaire was later pilot tested for readability and clarity of items on 30 participants from the general public. A small revision was fabricated based on the results of the pilot written report. The revised questionnaire was further pretested before field administration. The survey consisted of questions that assessed demographic background, mass media and social media exposure, constructs from the HBM, psychological and behavioral responses, and anxiety levels associated with the COVID-xix outbreak.

Instruments

Mass Media and Social Media Exposure

Questions on mass media (eight items) and social media (10 items) exposure queried participants virtually types of information acquisition. The response options were scored on a 4-point Likert scale (0=never, 1=rarely, ii=sometimes, and 3=often). The scores were summed, with college scores representing higher usage. The possible score range for mass media exposure and social media exposure was 0-24 and 0-30, respectively. The participants were informed that the term "mass media" refers to both traditional and online mass media (written or broadcast), including tv, radio, advertizement, newspapers, magazines, and newsfeeds. In contrast, "social media" refers to websites and apps such every bit WeChat, Weibo, and Youku, which are among the virtually commonly used social media platforms in Mainland china. Weibo shares features similar to Twitter (eg, allows users to share content upwards to a 140-Chinese-character limit). On the other mitt, Youku, oftentimes chosen the YouTube of China, is an online video and streaming service platform.

HBM Constructs

Questions related to HBM constructs include perceived severity, perceived susceptibility, perceived efficacy, and perceived control or intention [12,13,15]. Perceived severity was measured using a 1-item question (How serious practise you remember COVID-nineteen is?) on a iv-indicate scale (not at all serious to very serious). Perceived susceptibility was a 1-detail question (What do you think are your chances of getting COVID-19?) on a iv-signal scale (not at all to very large hazard). Perceived efficacy was measured using a 1-particular question (Do you remember that you will manage to deport out prevention measures currently recommended by the authorities?) on a iv-point scale (certainly cannot to almost certainly yeah). Perceived command or intention was measured using a 1-item question (Would you carry out prevention measures currently recommended past the authorities?) on a iv-point scale (certainly cannot to nearly certainly yes).

Psychological and Behavioral Responses

Psychological responses measure out the emotional consequences of the COVID-19 outbreak. The emotional consequences consist of questions about feelings of fear, avoidance, keeping a underground, embarrassment, and stigma associated with COVID-xix (five items). Optional answers were on a 4-betoken Likert scale, with the items scored as 1 (strongly disagree), 2 (disagree), three (hold), or 4 (strongly concord). The possible total emotional consequences score ranged from 5-xx, with college scores representing higher levels of emotional consequences.

Behavioral response measures relating to preventive barriers consist of 5 sections (8 items) that comprise questions well-nigh personal protection (3 items), cough etiquette (3 items), and contact precautions (2 items). The question queried participants' level of difficulty in practicing concrete prevention measures. A four-indicate Likert calibration was used to study responses, with scores of one (very easy), 2 (easy), 3 (difficult), or 4 (very difficult). The total physical prevention barriers score ranged from viii-32, with higher scores representing higher difficulty levels of concrete prevention.

Anxiety

Anxiety was measured using the six-item state version of the State-Trait Anxiety Inventory (STAI-6) [16,17]. The respondents rated the frequency of experiencing 6 emotional states (ie, existence calm, tense, upset, relaxed, content, and worried) as a result of the COVID-xix outbreak. A 4-point calibration was used (ie, 1=not at all, 2=somewhat, 3=moderately, and 4=very much). The scores on the iii positively worded items were reverse-coded. The total summed scores were prorated (multiplied past twenty/vi) to obtain scores that were comparable with those from the full 20-particular STAI (giving a range of 20-eighty) [17]. A cut-off score of 44 was used to indicate moderate-to-severe symptoms [10,18].

Statistical Assay

The reliability of the scales used was evaluated by assessing the internal consistency of the items representing the scores. The mass media and social media exposure items had a reliability (Cronbach α) of 0.958 and 0.940, respectively. The emotional consequences and prevention barrier behavior items had a reliability (Cronbach α) of 0.794 and 0.840, respectively. The reliability computed for the STAI-6 items in the assessment of anxiety was 0.793.

Multivariable logistic regression analysis, using a simultaneous forced-entry method, was used to determine the factors influencing mass media and social media exposure. Multivariable logistic regression analyses were performed on all variables plant to take a statistically significant association (two-tailed, P<.05) in the univariable analyses. Odds ratios (ORs), 95% CIs, and P values were calculated for each independent variable. All statistical analyses were performed using SPSS, version 20.0 (IBM Corporation). The level of significance was set at P<.05.

Ethical Considerations

This research was approved by the Enquiry Ethics Committee of the Fujian Medical University. Written informed consent was not acquired from participants. The committee approved that consent was implied through questionnaire completion and submission.

Results

A total of 2086 completed responses were received. Figure 1 shows the number of daily new cases in China since the starting time of the COVID-nineteen outbreak [19] and the elapsing of our information drove menstruation. As shown in Figure i, data drove was carried out past the superlative of the COVID-19 outbreak.

Daily new cases in China since the first of the coronavirus affliction (COVID-19) outbreak and throughout this study's data drove menstruation.

As shown in Table 1, more than one-half of the participants were 18-20 years sometime (northward=1197, 57.iv%). Nearly 2-thirds of the birthplaces of participants were in rural areas (n=1369, 65.6%). Most participants reported that their annual family income was beneath CNY 50,000 (n=978, 46.9%) or in the CNY 50,000-120,000 category (due north=775, 37.2%). The distribution by university yr was approximately equal.

Table i

Demographic characteristics of participants (N=2086).

Characteristic			Count, northward (%)
Age group (years)
	eighteen-20		1197 (57.4)
	21-22		714 (34.2)
	23-29		175 (viii.four)
Birthplace
	Urban		717 (34.4)
	Rural		1369 (65.6)
Annual family income (CNY)
	<50,000		978 (46.9)
	50,000-120,000		775 (37.two)
	>120,000		333 (sixteen.0)
Yr
	1		662 (31.seven)
	two		490 (23.v)
	three		606 (29.one)
	iv and postgraduate		328 (15.7)
Wellness Belief Model
	Perceived susceptibility
		Certainly no/probably no/probably yep	2001 (95.9)
		Certainly aye	85 (4.ane)
	Perceived severity
		Not at all/slightly serious/serious	1101 (52.viii)
		Very serious	985 (47.ii)
	Perceived self-efficacy
		Certainly no/probably no/probably yep	580 (27.8)
		Certainly yes	1506 (72.2)
	Perceived control or intention to acquit out preventive measures
		Certainly no/probably no/probably yes	788 (37.8)
		Certainly yes	1298 (62.2)
Psychological and behavioral response
	Emotional consequences
		Scores 5-9	1004 (48.1)
		Scores 10-20	1082 (51.9)
	Barriers to carry out preventive measures
		Scores viii-xv	986 (47.three)
		Scores 16-32	1100 (52.vii)
Feet level
	State-Trait Feet Inventory
		Scores xx-43	1291 (61.ix)
		Scores 44-fourscore	795 (38.1)

Mass Media and Social Media Exposure

Figure 2 shows the proportion of often responses and its respective 95% CIs for mass and social media use. The majority of participants relied on mass media for staying upwards-to-date with information about the number of confirmed COVID-19 cases or deaths (northward=1224, 58.7%), followed by data seeking related to prevention (northward=1204, 57.7%), transmission (n=1145, 54.nine%), symptoms (due north=1105, 53%), and gamble (n=1012, 48.five%) associated with COVID-xix. The most common reasons to utilise social media were to obtain information about prevention (due north=1065, 51.1%), transmission (n=1048, 50.2%), and symptoms (n=1015, 48.seven%) of COVID-xix.

Proportion of participants who "oft" used mass media and social media (Due north=2086).

The mean total mass media exposure was 19.iii (SD 4.9; range 0-24) out of a possible score of 24. The median was 20.0 (IQR 16.0-24.0). The total mass media exposure scores were categorized into two groups (20-24 or 0-23), based on the median split up; as such, a full of 1113 (53.five%; 95% CI 51.2-55.5) were categorized as having a score betwixt 20-24 and 973 (46.half dozen%; 95% CI 44.5-48.8) had a score between 0-23. The mean full social media exposure was 23.2 (SD 5.8; range 0-xxx) out of a possible score of 30. The median was 23.0 (IQR 20.0-29.0). The total social media exposure scores were categorized into two groups (23-30 or 0-22), based on the median split; as such, a total of 1096 (52.5%; 95% CI fifty.4-54.vii) were categorized as having a score betwixt 23-xxx and 990 (47.5%; 95% CI 45.3-49.6) had a score between 0-22.

HBM Constructs

In total, 1558 participants (74.7%; 95% CI 72.8-76.5) reported certainly yes/probably yes for perceived susceptibility of getting infected with COVID-xix. A relatively lower proportion perceived COVID-19 every bit very serious (n=985, 47.2%; 95% CI 45.ane-49.four). The bulk also reported certainly yes (north=1506, 72.two%; 95% CI 70.ii-74.i) in their ability to conduct out recommended prevention measures. A relatively lower proportion reported certainly yep (n=1298, 62.2%; 95% CI 60.ane-64.three) about their intentions to comport out the recommended prevention measures.

Psychological and Behavioral Responses

Figure three shows the proportion and corresponding 95% CIs of responses for items on emotional consequences. Nearly half of the participants answered strongly concur/concord in regard to abstention behavior (n=962, 46.1%); 21.2% (northward=443) and 17.9% (n=374) strongly agreed or agreed that they felt embarrassment or fearfulness, respectively. The hateful total emotional consequences score was ix.four (SD 2.seven; range 5-xx). The median was 10 (IQR 7-11). The full emotional consequences scores were categorized into two groups (10-20 or 5-9), based on the median split; as such, a full of 1082 (51.ix%; 95% CI 49.seven-54.0) were categorized equally having a score betwixt 10-20 and 1004 (48.1%; 95% CI 46.0-l.iii) were categorized every bit having a score betwixt 5-9.

Proportion of participants who answered "agree/strongly agree" for questions related to emotional consequences and "difficult/very difficult" for questions related to carrying out preventive measures (Northward=2086).

The proportions of hard/very difficult responses and the corresponding 95% CIs for difficulties in carrying out preventive measures are also shown in Figure 3. The greatest difficulty reported was avoiding touching one'due south optics, nose, and oral fissure (n=1000, 47.9%). Difficulties in avoiding proximity with other people and wearing a mask all the time were as well reported by 21.8% (north=454) and 12.8% (n=267) of participants, respectively. The mean total score for barriers to carry out preventive measure was fifteen.0 (SD three.7; range 8-32). The median was 16 (IQR 12-17). The total score for barriers to carry out preventive measures was categorized into two groups (16-32 or 8-fifteen), based on the median split; equally such, a total of 1100 (55.vii%; 95% CI 50.half dozen-54.ix) were categorized as having a score betwixt 16-32, and 986 (47.iii%; 95% CI 45.i-49.four) were categorized as having a score between eight-xv.

Anxiety

The mean overall anxiety score was 40.4 (SD 10.viii; range 20-lxxx). Using a cut-off score of 44 for the STAI score, a full of 38.one% (n=795) (95% CI 36.0-twoscore.2) of participants reported moderate-to-astringent anxiety (score=44-80). Participants in the 18-20 years historic period group (due north=477, 39.8%) reported the highest amount of moderate-to-severe anxiety, followed those who were 21-22 years old (north=270, 37.8%) and 23-29 years former (n=48, 27.four%) (χ^two ₂=10.027, P=.007). At that place was a gradual decrease in the proportion of moderate-to-severe anxiety by university year, whereby 41.iv% (due north=274) of year i participants reported moderate-to-severe anxiety compared to twoscore.0% (n=196) among twelvemonth 2, 39.8% (n=241) among year 3, and only 25.6% (n=84) amongst year 4 (χⁱⁱ ₃= 26.198, P<.001).

Influence of Mass and Social Media on Psychobehavioral Responses

As shown in Table 2, multivariable regression analysis of factors influencing a higher score of mass media exposure showed significant associations with all the HBM constructs. Higher perception of severity (OR 1.33; 95% CI 1.10-1.60), self-efficacy (OR 2.03; 95% CI one.64-two.52), and perceived control or intention to carry out prevention measures (OR i.29; 95% CI 1.07-1.56) were significantly associated with a college mass media exposure score. Lower emotional consequences (OR 1.51; 95% CI i.25-1.83) and barriers to carry out preventive measures (OR 1.l; 95% CI ane.26-i.84) were likewise significantly associated with a college mass media exposure score.

Table 2

Factors associated with mass media and social media exposure (Northward=2086).

Variable			Univariate analysis (mass media exposure score 20-24 vs 0-xixa)		Multivariable logistic regression (mass media exposure score 20-24 vs 0-19a)	Univariate analysis (social media exposure score 23-thirty vs 0-22b)		Multivariable logistic regression (social media exposure score 23-30 vs 0-22b)
			Loftier score (20-24) (n=1113)	P value	ORc (95%CI)	High score (23-30) (northward=1096)	P value	OR (95%CI)
Demographic characteristics
	Historic period grouping (years)
		18-20	615 (51.4)		—d	625 (52.2)		—
		21-22	397 (55.6)	.10	—	377 (52.viii)	.92	—
		23-29	101 (57.7)		—	94 (53.7)		—
	Birthplace
		Urban	402 (56.i)	.08	—	395 (55.1)	.09	—
		Rural	711 (51.9)		—	701 (51.2)		—
	Annual family income (CNY)
		<50,000	503 (51.4)		—	497 (50.8)		Refeast
		fifty,000-120,000	421 (54.3)	.xix	—	404 (52.1)	.048	1.01 (0.83-1.24)
		>120,000	189 (56.viii)		—	195 (58.half dozen)		1.28 (0.98-1.66)
	Year
		1	338 (51.1)		Ref	338 (51.one)		—
		two	234 (47.viii)		0.94 (0.73-1.20)	239 (48.8)	.07	—
		iii	345 (56.9)	.001	1.xxx (i.03-1.64)f	333 (55.0)		—
		4 and postgraduate	196 (59.8)		1.31 (0.99-1.74)	186 (56.7)		—
Health Belief Model
	Perceived susceptibility
		Certainly no/probably no/probably yes	1056 (52.8)		Ref	1033 (51.6)		Ref
		Certainly yes	57 (67.1)	.01	1.1 (0.75-1.96)	63 (74.ane)	<.001	1.75 (1.05-2.93)
	Perceived severity
		Non at all/slightly serious/serious	524 (47.6)	<.001	Ref	509 (46.two)	<.001	Ref
		Very serious	589 (59.8)		i.33 (1.10-1.60)g	587 (59.6)		1.41 (i.17-ane.69)h
	Perceived self-efficacy
		Certainly no/probably no/probably aye	205 (35.three)	<.001	Ref	199 (34.3)	<.001	Ref
		Certainly yes	908 (60.3)		two.03 (1.64-2.52)h	897 (59.6)		2.01 (i.67-ii.58)h
	Perceived control or intention to carry out preventive measures
		Certainly no/probably no/probably aye	293 (49.9)	.01	Ref	386 (49.0)	.01	Ref
		Certainly aye	720 (55.5)		1.29 (1.07-1.56)one thousand	710 (54.vii)		one.27 (ane.05-one.53)f
Psychological and behavioral response
	Emotional consequences
		Scores five-9	625 (62.3)	<.001	1.51 (1.25-1.83)h	607 (60.5)	<.001	one.50 (1.24-1.67)h
		Scores x-20	488 (45.i)		Ref	489 (45.2)		Ref
	Barriers to deport out preventive mensurate
		Scores eight-15	618 (62.7)	<.001	one.5 (1.26-1.84)h	608 (61.vii)	<.001	1.39 (1.fifteen-one.67)k
		Scores xvi-32	495 (45.0)		Ref	488 (44.4)		Ref
Anxiety level
	Country-Trait Anxiety Inventory
		Score 20-43	731 (56.6)	<.001	1.xvi (0.96-1.40)	713 (55.two)	.002	one.11 (0.90-1.34)
		Score 44-80	382 (48.1)		Ref	383 (48.2)		Ref

Multivariable regression analysis of factors influencing a higher score of social media exposure showed significant associations with 3 of the HBM constructs. Higher perception of severity (OR ane.41; 95% CI ane.17-1.69), self-efficacy (OR two.01; 95% CI 1.67-2.58), and perceived control or intention to carry out prevention measures (OR 1.27; 95% CI one.05-1.53) were significantly associated with a higher social media exposure score. Besides, lower emotional consequences (OR ane.50; 95% CI one.24-i.67) and barriers to carry out preventive measures (OR 1.39; 95% CI one.fifteen-1.67) were also significantly associated with a higher social media exposure score.

A lower anxiety score was significantly associated with higher mass and social media exposure in the univariable analyses; even so, the associations were non meaning in the multivariable analyses.

Word

Principal Findings

This written report assessed both mass and social media exposure related to COVID-19 and investigated the association between media exposure and HBM constructs, psychological and behavioral responses, and anxiety levels. This study targeted university students, as university students are among the biggest users of the internet and social media [xx]. Since this report was conducted when the land was experiencing a turn down in COVID-19 cases, it has the advantage of identifying detrimental psychobehavioral factors to provide insight for interventions to prevent a resurgence of infections. Of note, during the data collection period, the nationwide lockdown and movement control had started to ease; nevertheless, schools and universities in China had non notwithstanding reopened.

The high mean full exposure score implies that academy students have high exposure to both mass media and social media during the COVID-19 outbreak. This finding replicates evidence from previous research, indicating high apply of online media (peculiarly social media) by the younger generation and specifically university students [21-24]. In this study, we also found that university students were exposed to equal amounts of COVID-xix–related information from both mass and social media. Both mass and social media were equally used as information sources for the prevention of infection, symptoms, take chances, and mode of transmission.

Despite China's downwardly COVID-19 trend, the study participants demonstrated a high perceived risk of COVID-nineteen infection. All the same, a relatively lower perception of the severity of COVID-19 infection was observed. Many participants also reported high self-efficacy in carrying out recommended prevention measures. During the early phase of the outbreak, the land carried out aggressive public health interventions, such as early on detection of cases, contact tracing, and population behavioral changes, which have been reported to have contributed enormously to containing the epidemic [25]. The positive psychobehavioral responses found in this study signal that population behavioral modify interventions have brought about positive behavioral as well as attitudinal changes up to the nowadays time, which is reflected in the success in curbing the spread of the virus to the wider community as observed in the continuous slowdown of COVID-19 cases in Mainland china.

The study also found an overall low level of emotional consequences amongst participants during the off-peak period of the COVID-19 outbreak, every bit shown by the depression hateful value of the full emotional consequences score. Despite the low level of emotional consequences, it should be noted that continuous mitigation of the emotional well-being of the public during an communicable diseases outbreak is important in controlling transmission [26]. During the astringent astute respiratory syndrome (SARS) epidemic, fearfulness and stigma may take instigated people to delay seeking intendance and remain in the customs undetected. Also, a noteworthy finding is that the almost prominent emotional consequence establish was avoidance behavior, as it was reported by nearly half of the study participants. It is important to note that cognitive avoidance contributes to a delay in taking precautions to forbid the spread of COVID-19. The implication of this is that prompt action by the public and immediate seeking of medical intendance upon suspicion of COVID-nineteen infection are still needed, regardless of the downward trend.

This study's participants establish minimal difficulty in carrying out preventive measures. The most prominent difficulty encountered was avoiding touching 1'southward optics, nose, and mouth; almost one-half the participants reported having experienced this difficulty. The importance of refraining from touching i's eyes, olfactory organ, and mouth with unwashed hands to prevent the transmission of COVID-19 has been noted previously [27]. Since habitual face-touching behavior has been commonly reported [28], hand hygiene compliance should be encouraged to avoid this route of manual. Public wellness interventions to promote and encourage desirable hand-hygiene–compliant behaviors are crucial even though the outbreak is largely under control.

During the early on stage of the pandemic, more than than half (53.8%) of the full general public in China reported the psychological impact associated with COVID-xix every bit being moderate or severe [viii]. In this written report, slightly over one-tertiary (38.ane%) of university students reported moderate-to-severe feet. Although relatively lower feet levels were observed after the peak of the outbreak, our results indicate that COVID-19 is still spurring fright in some parts of society. In the case of the Ebola outbreak, feet and depression were still prevalent 1 yr afterward the outbreak, particularly among those who had been in quarantine and witnessed expiry associated with the disease [29]. Findings from this study imply that COVID-19–related anxiety amid university students warrants special attention. Therefore, information technology is suggested that continuous cess and monitoring of COVID-19–associated mental wellness bug is essential when students resume their studies on campus. Mental wellness service provision or psychological intervention services to assist students who experience loss of family members or friends to COVID-19 should exist encouraged in all universities across the country, especially in Wuhan, China'southward coronavirus epicentre. Furthermore, the study also institute that younger university students were more vulnerable to moderate-to-severe anxiety; more attending from university authorities should be allocated to monitor the mental well-being of these students.

The results of the multivariate analyses of this written report provide prove of the of import function of both mass and social media in shaping individual wellness beliefs using the HBM constructs. Substantial mass media exposure was associated with having a higher perception of disease severity and a higher perceived control or intention to bear out prevention measures. Similarly, social media exposure shapes individual health beliefs using the HBM constructs. However, high social media exposure was associated with all the HBM constructs investigated, except for the perception of risk.

Previous reports have noted that emotional consequences such as fearfulness, stigma, and discrimination during the COVID-19 outbreak among people in China were fuelled by misinformation and unfounded rumors [30]. In our study, multivariate analyses revealed that greater mass and social media exposure were also associated with lower emotional consequences, namely, perception of avoidance, embarrassment, fright, and keeping the infection a hole-and-corner. This maybe implies that our study participants were exposed to credible and accurate data from both mass and social media, and hence were not negatively impacted. Of notation, the Chinese government implemented feasible strategies to counter misinformation and fake news during the pandemic such as immediate removal of simulated news in the media and strict penalties for offenders.

The behavioral influence of both mass and social media were evident in this study. More mass and social media exposure was as well associated with lower barriers to conveying out prevention practices. The findings imply the importance of continuously providing the public with authentic and credible data through mass and social media to enhance emotional well-existence and prevention behaviors. It is also vital for media regime to ensure the brownie of information shared in during an infectious pandemic to elevate negative psychological impact and enhance prevention behaviors. It has been suggested that quick and targeted interventions oriented to delegitimize sources of imitation information in the media are important to reduce negative consequences [31]. As such, the findings of this written report provide insights into the importance of developing prompt strategies to counter misinformation.

In short, our findings suggest that both mass and social media are useful ways of getting health letters across and contribute to improving psychobehavioral responses to COVID-xix. Although traditionally the trustworthiness and authenticity of information sourced from social media in relation to mass media has been an issue of concern, this written report demonstrated contrary results. Both mass and social media contributed similarly to favorable psychobehavioral responses to COVID-xix.

Interestingly, the univariable analyses also observed that both high levels of mass and social media usage were significantly associated with lower anxiety levels. Nonetheless, the clan was non significant in the multivariable analyses. Our finding contradicts recent findings that reported a loftier prevalence of mental health problems amid the public in Red china that was positively associated with frequent exposure to social media [fourteen]. Of annotation, our study participants were medical and health sciences students, and this peradventure implies that they were more proficient at identifying and consuming credible data on social media than the general public. In addition, our study has also demonstrated that students with higher exposure to mass and social media tend to accept lower negative emotional consequences and fewer barriers to carrying out prevention measures, which might partly contribute to their lower anxiety level. Thus, their increased social media usage does not result in a higher level of mental health bug. This possibly suggests that the proper utilise of social media for information purposes is beneficial is shaping psychological and behavioral responses during an infectious disease outbreak.

Limitations

This report has several limitations that should be considered. The first pertains to the use of convenience sampling and its cantankerous-exclusive nature. It cannot, therefore, exist used to infer causality. Despite of the recruitment of a large and various sample, the relatively loftier proportion of immature participants in this study may innovate a bias toward greater social media usage. 2d, the responses were based on cocky-written report and may exist subject to call back bias, self-reporting bias, and a tendency to report socially desirable responses. A third limitation is that the participants were medical and health sciences students; this warrants conscientious interpretation owing to their comprehensive noesis and attitude about COVID-19 as well as their higher affinity for health information. Next, the associations found in this study should be interpreted with caution as the psychobehavioral responses were obtained during the off-peak period of the COVID-19 outbreak. Despite these limitations, the study data contribute tremendously to the understanding of the influence of both mass and social media on psychobehavioral responses to the COVID-19 outbreak in China.

Conclusions

Higher exposure to both mass and social media related to the COVID-nineteen outbreak increased positive attitudes in all the domains of the HBM. Emotionalconsequences and behavioral prevention barriers too reduced with higher exposure to both mass and social media. In conclusion, based on our results, both mass and social media are useful means of disseminating wellness-related information to the public and contribute to improvements in psychobehavioral responses to COVID-19. Our findings imply that university students are skilful at identifying and consuming apparent information on social media. With much information circulating on the cyberspace, it is challenging for the public to stay informed with reliable, credible, and trustworthy information from the internet. The general public should be informed about proper online health information seeking during disease outbreaks to avert detrimental psychological and behavioral impacts that may deter outbreak management and control.

Acknowledgments

This written report was supported by The Pilot Project of Fujian Provincial Department of Science & Engineering (No. 2020Y0005), and Fujian Medical University's Rapid Response Funding Call for COVID-19 Related Inquiry (No. 2020YJ003).

Abbreviations

COVID-19	coronavirus disease
HBM	Health Conventionalities Model
OR	odds ratio
SARS	severe acute respiratory syndrome
STAI	State-Trait Feet Inventory

Footnotes

Contributed by

Authors' Contributions: LPW, YL, and ZH conceived the study. YL collected data. LPW and HA analyzed the data. LPW wrote the manuscript. All authors take approved the manuscript.

Conflicts of Interest: None declared.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373377/