Motivation and emotion/Book/2022/Protection motivation theory and COVID-19

Overview
Case study Bella is a 35-year-old woman that lives at home with her husband, two kids as well as her 70-year-old mother who suffers from a chronic lung disease. As her husband is a nightclub owner and nightclubs are currently all closed due to COVID-19, she is currently the only stream of income for her household. Bella has been experiencing high levels of anxiety over COVID-19, as she has been watching the news and keeping up with the increasing prevalence of this disease, as well as the mortality rate amongst an older generation. She is worried for her family and if she gets infected, that will cause a lot of financial stress for her household. As a result of this fear, Bella has been partaking in a lot of protective, preventative behaviours against COVID-19. She has only been leaving her house for essential places such as work and groceries and has been ensuring that she has been practicing social distancing. The stress of this disease has also motivated her to always wear a face mask and consistently wash her hands.



The contagious disease COVID-19 (see figure 1.) has the potential to infect many people very quickly. The disease's unfavourable effects are extreme and linked to mortality as well as immediate respiratory issues. Preventative measures appear to be imperative as there is currently no cure for this illness. Overall, concepts of health behaviours can assist us in identifying the variables associated with protective factors to create programs for health promotion.

Rogers first proposed the Protection Motivation Theory (PMT) in 1975, and it has since been broadly utilized as a paradigm for predicting protective behaviours. According to PMT, a person's motivation to protect oneself is what determines whether they would engage in a protective behaviour against health concerns (Maddux & Rogers, 1983). It can be useful to plan and implement appropriate interventions to promote the community towards protective behaviours by identifying the processes involved in protective health behaviours. In light of this, the current research using the Protection Motivation Theory (PMT) was sought to foresee COVID-19 preventative behaviours.

Focus questions-
 * 1) What is COVID-19?
 * 2) What is PMT?
 * 3) How does PMT apply to managing COVID-19?
 * 4) Implications

What is COVID-19?
COVID-19 also known as Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a deadly contagious disease which emerged in Wuhan, China in December 2019. On March 11, 2020, the respiratory infection was announced as a global pandemic by the World Health Organization (WHO) causing over 6 million deaths globally. The virus has had an immense impact on the economy globally and has put a vast amount of pressure on healthcare organizations (Cascella et al., 2022).

Individuals most at risk of contracting the disease are those who are over the age of 60, and individuals with health issues such as kidney disease, cancer, respiratory issues, or those that smoke (Cascella et al., 2022). Symptoms of COVID-19 include but are not limited to, cough, sore throat, fever, fatigue, headache, and diarrhoea (ALIMOHAMADI et al., 2020).

What is Protection Motivation Theory (PMT)?


R.W. Rogers established The Protection Motivation Theory (PMT) (see figure 2.) in 1975, which is based off how motivated people are to protect themselves against threat or how they handle a situation based on fear. According to the PMT of Fear Appeal, threat (fear) assessment and coping evaluation may result in protection motivation, which would enhance or decrease wellness activities to fend off prospective hazards. Threat appraisal which includes perceived severity and perceived susceptibility evaluates the likelihood that one will contract the disease and the seriousness of the disease and the seriousness of it, whereas coping appraisal evaluates the likelihood that performing the advised behaviour will successfully lessen or eliminate the threat which includes perceived self-efficacy and perceived response efficacy.

How does PMT apply to managing COVID-19?
PMT is generally split into threat and coping appraisal. Threat appraisal emphasises the seriousness and susceptibility of the risk, whereas coping appraisal refers to the person's awareness of the effectiveness of their reaction to the threat and their capacity to carry out the advice which refers to as self-efficacy (Norman et al.,2015). Both threat appraisal and coping appraisal determine intention itself. COVID-19 has the potential to infect a large number of people very quickly.

The disease's unfavourable effects are severe and linked to mortality as well as immediate respiratory issues. However, preventative measures appear to be crucial as there is now no known cure for this illness. Generally speaking, theories of healthy behaviour can assist us in identifying the variables associated with protective behaviours to create programs for health promotion. The PMT is typically used to evaluate people's propensity for protecting themselves. PMT can be applied to managing COVID-19 through various ways which are further investigated below in different categories.

Social distancing
With COVID-19, additional social isolation measures were used to postpone and shrink the pandemic phase, lessening the strain on healthcare systems and those providing direct care, but also lessen the danger of transmission among high-risk populations. As theory-based trials are likely to be more effective, applying behavioural theories to understanding social distancing is guaranteed. Our comprehension of social distancing attitudes in the wake of the COVID-19 pandemic, which takes into account not just contamination anxiety but also other personal and social indicators that serve as drivers of social distancing can be strengthened with applying PMT.

Individual motivation to engage in risk prevention activity is likely to be increased by a higher impression of severity and vulnerability, whereas risk prevention behaviour will be inhibited by a growing recognition of benefits from present practises. For example, people may be more motivated to pursue preventative measures (such as social isolation) to reduce or prevent their risk of contracting COVID-19, if they realise that it is a serious illness with a high mortality rate and that they have a higher chance of contracting the disease. In a study based on university students in Malaysia during COVID-19, the motive to take part in some social distancing correlated behaviours was firmly associated with perceived self-efficacy and perceived response efficacy (Yu et al., 2022).

This coping appraisal measurement is particularly important in making sure that people accept these strategies and are able and motivated to stick with them despite their own pain and perceived lack of outcomes (Adunlin et al., 2020).

Stay at home orders
Lockdowns to stay at home have been put in place to prevent the spread of COVID-19 by decreasing the number of infected pupils, overloaded healthcare systems don’t become overloaded and regulating the number of infections in a community. Based on research from a study of 1980 individuals in Japan from May 2020, in terms of staying home self-reported behaviour was analysed regarding the PMT. (Okuhara et al., 2020). Results showed that there were many people obeying the stay-at-home orders during this time which was predicted from self-efficacy and perceived severity. Strengthening the perceived severity of disease by COVID-19 and self-efficacy in exerting constraint regarding leaving the house may afterwards motivate people to remain at home during the pandemic and societal lockdown (Okuhara et al., 2020).

Food shopping behaviour and hand hygiene
Behaviour change including inclined adherence to tight hand hygiene rules and increased online grocery purchases, and the use meal delivery services to order food are some habits customers have been motivated to adhere to, by fearing they will catch COVID-19 (Gavilan et al., 2021). The fear of contamination has driven individuals to improve their hand hygiene practices after being in contact with shopping bags or food packages, to a great degree when returning home (Faour-Klingbeil et al.,2021a).



Important indicators of food purchasing behaviour included response efficacy and self-efficacy. Customers were satisfied in the effectiveness of purchasing goods from marketplaces or shops that sustained a high degree of sanitation and were not as crowded according to a study done by (Soon et al., 2022). According to (Soon et al., 2022) study, The likelihood of engaging in hand hygiene procedures was significantly predicted by perceived severity. Their research also revealed that customers in Malaysia and Indonesia who considered COVID-19 to be a severe hazard were far more willing to sanitise food containers to prevent cross-contamination and practice hand hygiene when they get home from the store. Participants in the study were certainly motivated to sanitise their hands after visiting the store due to the threat of contracting COVID-19 (Soon et al., 2022).

Covid-19 vaccinations
As enabling theory-based treatments to be developed to reach as many as feasible, it is crucial that standard concepts of health behaviour and health behaviour modification, such as PMT, be incorporated to COVID-19 vaccination intention in the general population. According to PMT, people's attitudes about engaging in or avoiding protective behaviours in the face of threats, such as being vaccinated, as well as their perceptions of the threat itself, determine how likely people are to take this action.



In a study conducted by (Reiter et al., 2020) on who would accept the COVID-19 vaccine, individuals were found to be more open to vaccination if they recorded a greater level of COVID-19 infection severity and perceived COVID-19 vaccine effectiveness. According to the study, among the PMT construct, perceived response efficacy is the main determinant of COVID-19 vaccination intention. Other investigations addressing the efficacy of the COVID-19 vaccination found that acceptance of the COVID-19 vaccine was highly influenced by beliefs in vaccine success (Pogue et al., 2020).

Self-efficacy is a factor in determining intention and action for practises like immunisation that do not require long-term adherence to treatment. Thus, it is necessary to focus on perceived response efficacy and perceived severity to promote the COVID-19 vaccination, so more people are encouraged. Understanding the factors impacting vaccination intention prior to the COVID-19 vaccine's accessibility will encourage the community to receive the vaccine because vaccination intention and actual vaccination uptake are related. Thereby, the PMT can serve as a theoretical foundation for future interventions to boost the adoption of the COVID-19 vaccination (Gargano et al., 2011).

Implications
The response cost of societal disruption from implementing fear to get individuals to adhere to lockdowns and staying at home orders, impacts individuals negatively, particularly for disadvantaged workers. Homelessness, suicide rates and food insecurity among these individuals are most likely to increase due to these consequences (Deluca & Kalish, 2020).

Conclusion
This research was conducted to predict how Protection Motivation Theory (PMT) applies to managing COVID-19. Findings were presented regarding how PMT affects behaviour through fear appraisals. Self-efficacy and response efficacy have been the study results two top predictors of protective behaviour. Motivations to adopt an advised preventive health practise were positively impacted by both the likelihood of a threat occurring and the success of a coping strategy. Further research should look into considering all cognitive aspects of how PMT impacts the management of COVID-19, and a larger population should be researched to gain a better understanding of how PMT can help manage COVID-19 instead of limiting the research to certain sample sizes, it can be expanded to the general population. In general, this theory has demonstrated that it can be used to find methods that could encourage adherence to public health regulations.

Review Quiz
{Which of the following is true about PMT? - PMT was established in 1965 - Coping appraisal emphasises the seriousness and susceptibility of the risk + PMT is split into threat and coping appraisals - None of the above
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