The Appraisal and Endorsement of Individual and Public Preventive Measures to Combat COVID-19 and the Associated Psychological Predictors among Chinese Living in Canada

1. INTRODUCTION

Since the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, it has swept across the world. In order to combat the spread of the disease, worldwide lockdown and physical distancing measures have been implemented at both individual (e.g., wearing a face mask, handwashing, and disinfection) and societal levels (e.g., quarantine, social isolation and distancing, and lockdown). The Canadian federal government announced a 5-week lockdown on March 13, 2020 [1], and then Ontario declared a provincial state of emergency and began to order the closure of certain businesses and facilities on March 17, 2020 [2]. Individuals have been urged to comply with recommended preventive behavioural measures such as individual personal hygiene (e.g., handwashing, disinfection, wearing a face mask), along with the public health measures such as social distancing, school closure, and quarantine. The effectiveness of these measures largely depends on the voluntary compliance of the public. Given the lack of official regulations and monitoring, its optimal enforcement might be a challenge due to economic and civic rights concerns. Thus, it is important to identify the critical factors that affect the appraisal and endorsement of these measures and take these factors into consideration when developing new policies or measures. This is especially important for Chinese residents in Canada, considering their heightened vulnerability and the lower infection rate in East Asians compared to other ethnical groups [3]. Identifying the factors that contribute to the positive appraisal and active endorsement of the preventive health measures in this population will well inform the development of effective epidemiological regulation policies to battle the virus.

2. MATERIALS AND METHODS

3. RESULTS

Most of the participants who completed the demographic questions were Ontario residents (88%), from Mainland China (97%), female (73%), married/cohabited (83%), with a university degree or higher (76%), living in a self-owned house (80%) and with at least 3 people in a household (74%). Approximately half of them have lived in Canada for at least 15 years (50%) and were Canadian citizens (58%). Table 1 presents the sample characteristics of those who completed the questions involved in the final analysis.

As shown in Table 1 and further illustrated in Fig. (1), the median, interquartile range (IQR), and Wilcoxon mean score of each attitude variable were reported by the sociodemographic variables. The Kruskal Wallis test for each pair of variables showed that compared to their counterpart groups, individuals in older age (65 years or older) or retired reported lower susceptibility (ps ≤ 0.02); females (p = 0.044), those with lower education (p = 0.001), or those born in Mainland China (p = 0.033) were more likely to report a higher level of fear; those in a larger household (p = 0.003) or those with the highest education (p = 0.003) perceived less severity of the pandemic. Confusion about COVID-19 information was not related to any sociodemographic variables. These significant results were also depicted in Fig. (1).

Table 2 shows the adjusted model to evaluate the impact of COVID perception on the health measure appraisal and compliance. After controlling for sociodemographic variables, individual measure appraisal was negatively associated with perceived susceptibility (B[SE]: -0.070 [0.033], p = 0.032) and positively associated with perceived severity (B[SE]: 0.116 [0.041], p = 0.005). Compared to males, females showed more positive appraisal of individual behaviours (B[SE]: 0.136 [0.062], p = 0.029). Those with a university or graduate degree showed a lower appraisal compared to high school graduates (B[SE]: -0.306 [0.113], p = 0.007; -0.350 [0.122], p = 0.004, respectively). Those born in Mainland China perceived the individual measures as more effective compared to those born elsewhere (B [SE]: 0.330 [0.107], p = 0.002).

After controlling for sociodemographic variables, public preventive measure endorsement was only positively associated with perceived severity (B[SE]: 0.148 [0.038], p < .001). Lower measure endorsement was found in mid-aged (i.e., 45-54 years of age) compared to older adults (i.e., 65 years and above), B[SE]: -0.281 (0.141), p = 0.047. Those who were employed showed a stronger measure endorsement relative to those who were retired, B[SE]: 0.240 [0.117], p = 0.040.

4. DISCUSSION

The present study aimed to understand the effect of risk perception and attitudes toward COVID-19 on preventive measure appraisal and endorsement among Chinese living in Canada. It was found that older adults or those retired reported less susceptibility to the virus. Females, those with higher education, or those with non-student employment status, and those born in Mainland China, reported a higher level of fear towards COVID-19 compared to their counterpart groups. Those living in households with larger sizes and with higher education levels perceived less severity of the pandemic. Overall, the individual measure appraisal was negatively associated with perceived susceptibility and positively associated with perceived severity of COVID-19, whereas public measure was positively associated with perceived severity. Females, those born in Mainland China, or those with lower education tend to show higher individual measures appraisal. Being 65 years of age and above (versus aged 45-54), presently being employed (versus retired) were associated with higher endorsement of public preventive measures.

A higher level of perceived susceptibility was related to lower individual measure appraisal but had no impact on the public measure endorsement, suggesting that high-risk perception might call for more strict and effective measures in place and thus make them devalue the effectiveness of the existing individual measures. Driven by their collective cultural value, the Chinese endorsed the public health measures equally well regardless of their personal infection risk perception. This speculation, however, needs to be further tested.

Increased perception of personal threat (severity) predicts both higher individual measure appraisal and higher public measure endorsement. This supports research on the Extended Parallel Process Model (EPPM) in that increased risk perception could act as a motivating factor when associated with increased efficacy of preventive measures [18, 19]. Increased severity perception can serve as a motivational factor to endorse preventive measures to prevent potential losses [16, 20, 21]. The higher severity was reported by those living alone and those with lower education relative to their corresponding counterpart groups. Presumably, individuals living in larger households might have more social or family support, which may mitigate their negative affective responses, such as feelings of loneliness and anxiety [22, 23], thus reducing their severity perception. Higher education may increase the overall sense of agency, which may reduce their perceived vulnerability to environmental threats [5, 6].

Participants from Mainland China reported a higher level of fear and rated the individual behaviour measures as more effective compared to those born elsewhere. This might be due to the social amplification of COVID-19 information from friends and family in the homeland, which may affect the attitudes of Chinese living in Canada [13]. Moreover, the heightened fear in Mainland Chinese echoes the previous finding of increased fear and risk perception with increased proximity to Wuhan, the original outbreak city [17]. Participants may experience a psychological closeness to the homeland, which may have elicited similar risk perceptions [17, 24, 25]. Another factor to consider is the social stigma that might affect preventive behaviour endorsement. Since the declaration of COVID-19 as a global pandemic, there has been an increase in racialized discrimination towards Chinese individuals in Canada and the United States [7, 26-28]. It could be that there is an increased level of fear resulting from the threat of racialized assaults that are compounded with the perceived threat of the COVID-19 virus.

It should be noted that this study also has some limitations. First, data were collected using a self-report method. Therefore the reliability of the responses needs to be considered when interpreting the results. Moreover, using an online survey may increase the likelihood of a sampling bias as some people may not have access to computers or a reliable internet connection. The study also did not assess a range of affective states. Instead, it primarily focused on fear as it related to preventive behaviour endorsement. Future studies may follow up to examine how other affective states, such as anxiety or worry, relate to risk perception and endorsement of preventive behaviours.

CONCLUSION

Individual behaviour measure appraisal was predicted by lower perceived susceptibility and higher perceived severity, whereas public health measure endorsement was related to higher perceived severity. These results inform the public and the policymakers about the critical factors that affect the preventive measure appraisal and endorsement.

REFERENCES