Applying the Protection Motivation Theory in Predicting Motivation for COVID-19 Preventive Behaviors among Thai People in Health Region 3

Abstract

A worldwide pandemic of coronavirus disease 2019 (COVID-19) has impacted both population health and socio-economic aspects. Thailand has strived against various waves of the COVID-19 pandemic, of which around 4 million total confirmed cases, and almost 30,000 deaths have been reported. The COVID-19 preventive behaviors, such as hand washing, mask-wearing, social distancing, and temperature testing have been recommended as effective measures for people to protect themselves from disease infection, and these have been required for persistent practice.  However, the report on the practice of COVID-19 preventive behaviors among Thai people still revealed inadequate practices, indicating the need for communication intervention for changing behaviors. The protection motivation theory (PMT) is a psychosocial model of preventive health behavior which can be applied to explore factors mediating an individual’s protection motivation and overt preventive actions.  Previous studies among Thai people on COVID-19 preventive behaviors applying the PMT and investigating its predictive efficacy are still very few. This study, therefore, aimed to investigate the extent to which how well the factors based on the cognitive appraisal process of the PMT could predict the motivation for COVID-19 preventive behaviors. A cross-sectional study design was used. The study was approved by the Ethical Committee for Human Research, Faculty of Public Health, Mahidol University, Thailand  (MUPH 2021-106, October 11, 2021) and conducted between March and April 2022.  A sample of 633 Thai people aged ≥15 years from the responsible area of Health Region 3, Thailand, were randomly selected using a multistage sampling technique.  A self-administered questionnaire that assessed its content validity and reliability was used for data collection. It consisted of two sections: personal characteristics, i.e., sex, age, marital status, education, income, residential area, and occupation. The PMT scale with a 5-point Likert scale, i.e., motivation for COVID-19 preventive behaviors (α = 0.82); the six constructs of cognitive appraisal process including perceived vulnerability (α = 0.83), perceived severity (α = 0.86,), perceived reward (α = 0.90), response efficacy (α = 0.72), self-efficacy (α = 0.73), and perceived response cost (α = 0.93). Multiple regression analysis, using enter method, was used to serve the study objective. A total of 628 respondents were finally analyzed. Most respondents were female (60.0%), married (62.9%), aged ≥40 years (63.5%), completed elementary and vocational levels of education (87.9%), had low income (46.2%), worked as an agriculturist and general employee (62.4%), and lived in the municipal area (62.4%). The mean score, as the total score ranged from 1 to 5, of factors regarding the motivation for COVID-19 preventive behaviors, perceived vulnerability, perceived severity, perceived reward, response efficacy, self-efficacy, and perceived response cost were 4.37, 3.60, 3.68, 3.16, 4.30, 4.20 and 2.81, respectively.  The regression of the motivation for the COVID-19 preventive behaviors on six factors of the PMT constructs account for 45% of the variance and was significant at the 0.001 level (F = 86.000, p < 0.001; adjusted R² = 0.449).  Among six factors of the PMT constructs except for the perceived reward, were determined as significant predictors.  Self-efficacy was the strongest predictor (b = 0.357, p < 0.01), followed by response efficacy (b = 0.273, p < 0.01), perceived vulnerability (b = 0.200, p < 0.01), perceived response cost (b = -0.179, p < 0.01), and perceived severity (b = 0.092, p < 0.05) respectively. The considerably moderate degree of prediction by six factors of the PMT constructs indicates a potential application of the PMT for understanding COVID-19 preventive behaviors, mediated by the protection motivation. The result additionally suggests that key messages of preventive communication should emphasize increasing self-efficacy, perceived response efficacy, and perceived vulnerability, as well as decreasing the perceived response cost of performing preventive behaviors.  Further studies, however, need to be conducted in different settings and times.