Impact of Risk Perception about COVID-19 on the Coping Behavior of the Elderly:Mediating Role of Self-Efficacy

Lin Cai,Zhi-Han Mei,Tian-Liang Fan,Qing-Jun Li,Yu Yao,Hui-Xia Yan,Deng-Hui Lu

1School of Marxism,Sichuan Institute of Industrial Technology,Sichuan,China.

Abstract Objective:This study aimed to explore the mediating role of self-efficacy on the relationship between risk perception and the coping behavior of the elderly during the coronavirus disease 2019 (COVID-19) pandemic.Methods:The study employed the convenience sampling method to select a total of 550 elderly from Chongqing,Chengdu and Luohe in China.A questionnaire composed of the perception scale,self-efficacy scale,and coping behavior scale was used to collect data.Results:Risk perception exerted a significantly direct effect on positive coping behavior and avoidant coping behavior.Moreover,it positively predicted the components of self-efficacy.In turn,self-efficacy positively predicted the components of positive coping behavior,which confirm that it plays a partial mediating role in the relationship between risk perception and positive coping behavior.Moreover,self-efficacy negatively predicted the components of avoidant coping behavior,which confirms that it also plays a partial mediating role in the relationship between risk perception and avoidant coping behavior.Conclusion:A simple mediation model revealed that self-efficacy partially mediated the direct and indirect effects of risk perception on coping behavior.Based on the results,the study recommended several countermeasures and suggestions for enhancing the positive coping behavior of the elderly during the COVID-19 pandemic.

Keywords:COVID-19,Mental health,Risk perception,Self-Efficacy,Positive coping behavior,Avoidant coping behavior,Psychopathology,Elderly

Introduction

A large outbreak of unusual cases of viral pneumonia(coronavirus disease 2019,[COVID-19]) was first reported in December 2019 in Wuhan,China.Although the situation in Mainland China was controlled,the disease continues to spread abroad.The COVID-19 outbreak was an unprecedented pandemic,which was particularly dangerous and potentially life-threatening for the elderly.Since the beginning of the outbreak,older people compared with younger ones were evidently at higher risk to contract the infection and to develop more severe diseases with poor prognosis [1].Thus,the study aimed to explore the mechanism of influence of the risk perception about COVID-19 on the coping behavior of the elderly in China.The study was conducted based on the health action process approach [2] to investigate the mediating role of self-efficacy in the relationship between risk perception and coping behavior.

Coping behavior is defined as a set of cognitive efforts and behavioral use in the face of emotional,physical,psychological,and social stressors [3,4].This behavior can be positive or negative [5].Specifically,positive coping behavior is an active coping style that focuses on transforming the stressful situation and taking constructive actions and is associated with effective emotion regulation and problem-solving behavior [6].Positive coping behavior is considered a better means of addressing stress [7].Conversely,negative coping behavior is a maladaptive style centered on emotional expression and negative appraisals,social isolation,and escape from stressful situations [6].It is considered to be an adverse factor,whereas positive coping behavior exerts a protective effect on certain psychological disorders,such as depression,anxiety,and sleep disorders[8].

Risk perception is the use of intuition to determine the magnitude and degree of risk [9].The behavior of people during threatening scenarios may be dependent on their perception of risk [10].Moreover,the relationship between coping behavior and risk perception is controversial.Several experts find that people's defenses against natural disasters are partially influenced by perceptions of high risk [11],whereas other argue that risk perception exerts a positive impact on active disaster response behavior [12–14].Nevertheless,risk perception is an important predictor of coping behavior [15].For example,Bruine and Bennet [16] demonstrate that individuals at high risk for COVID-19 are more likely to engage in protective behavior.Moreover,risk perception exerts a positive predictive effect on positive coping behaviors.In other words,the higher the individual’s risk perception,the higher the frequency of its positive coping behavior[17].In other scenarios,Schaefer et al.[18] conducted a longitudinal study and demonstrated that HIV risk perception was predictive of condom use in East Zimbabwe.

Self-efficacy represents the individual's perceived ability to accomplish a given task to achieve the desired effect.Perceived self-efficacy is unrelated to the number of skills of an individual.Instead,it is related to one’s belief about one’s abilities to utilize skills in any given situation [19].Self-efficacy is a significant predictor of coping behavior and emotional health,among other outcomes,and is currently attracting increased special attention in the field of psychology [20].Self-efficacy and competence are frequently used in an interchangeable manner.Self-efficacy determines all characteristics of coping behavior,such as when and whether a response strategy will be initiated,how long it will last,and what response resources will be used [21].Coping self-efficacy reflects one's confidence in one's ability to cope with stress,setbacks,and challenges [22].Individuals with high levels of coping self-efficacy are expected to better mediate potential stressors and challenges[23].Previous studies confirm the important role of risk perception,which influences behavior through attitude,social influence,and self-efficacy[24,25].

The health action process approach states that risk perception alone is insufficient for the formation of behavioral intentions.However,it can help trigger the formation and elaboration of ideas,consequences,and capabilities required to initiate behavioral change [2].Perceived self-efficacy is another factor that mediates the relationship between risk perception and coping behavior [26].These findings suggest that in an effort to promote healthy behavior,the concepts of risk perception and self-efficacy should be examined simultaneously.

Subjects and methods

Subjects

Using the convenience sampling method,the study selected individuals from the elderly population in Jintang County in Chengdu City,Sichuan Province(region A),Yongchuan District in Chongqing municipality (region B),and Linying County in Luohe City,Henan Province (region C) and requested to complete a questionnaire.Within each region,3–4 villages were randomly selected,whereas 2–3 communities were randomly selected from each rural area.The subjects random surveys in the study sites.The research team is composed of students majoring in psychology,management,sociology,and economy with sufficient training.Data collection was conducted from September 2020 to October 2020.The questionnaire was completed by the elderly who met the following inclusion criteria:

(1) Fully informed of the relevant aspects of the survey,including its objectives and methodology;

(2)Aged 60 years and above;

(3)Voluntary participation;

(4)Normal language organization and cognitive skills.

Design of the questionnaire

Risk perception scale.The study adopted the risk perception scale,which was compiled by Xie et al.[27] and revised by Wen [28] according to risk perception during the COVID-19 pandemic.Using a five-point Likert-type scale(1=Completely agree;5=Completely disagree),the respondents were tasked to rate the questionnaire items according to four dimensions,namely,uncontrollable epidemic (internal consistency coefficient [ICC]=0.62),unknown epidemic (ICC=0.68),severity of epidemic (ICC=0.69),and possibility of infection(ICC=0.71).

Self-efficacy scale.The study utilized the self-efficacy scale developed by Wei et al.[29].Items were scored using a seven-point Likert-type scale(1=Strongly disagree;7=Strongly agree).The higher the score,the higher the level of self-efficacy.In this sample,the ICC value reached 0.71.

Coping behavior scale.The coping response inventory was compiled according to Moos [30].The items were rated using a five-point Likert-type scale(1=Completely agree;5=Completely disagree),including two dimensions of active coping and avoidance coping.The ICC values of active and avoidance coping were 0.70 and 0.66,respectively.

Statistical methods

SPSS statistics software 22.0 and MPLUS7.0 were used for analysis.Deviations from common methods were tested using Harman’s single factor test.Descriptive analysis was performed on the scores of each variable.Pearson’s product–moment correlation coefficient was used to investigate the relationship between risk perception and coping behavior in the elderly as mediated by self-efficacy.MPLUS7.0 was used to establish a structural equation model,and a bootstrap program was used to verify the mediating effect of self-efficacy on the relationship between risk perception and coping behavior.

Ethical approval and consent to participate

All participants provided consent to participate.Approval to conduct the study was obtained from the Ethics Committee of the Sichuan Institute of Industrial Technology (Decision No:GYKJ2020/058).The participants were informed about the theory and objective of the study as well as the outcome of their participation.Withdrawal from the study is possible at any time.When illiterate,the participants provided informed verbal consent.During transcription,identifiable personal information was removed to ensure anonymity.All participants are denoted only as ID numbers.

Results

A total of 597 questionnaires were disseminated out of which 550 were valid(region A=204;region B=189;and region C=157).The respondents were categorized into urban(n=292)and rural(n=258)elderly people.In terms of gender,293 and 257 participants were male and female,respectively,with ages ranging from 60 years to 95 years (average:71 ± 7 years).When grouped according to age group,271,215,and 64 respondents were aged 60 to 69 years,70 to 79 years,and 80 to 95 years,respectively.In terms of level of education,219,224,74,and 13 participants were illiterate or achieved primary school,junior middle school,and senior high school education,respectively.Living style was categorized as empty-nesters (314)and non-empty-nesters(236).

Table 1 provides the comparative results,which indicated that the three-factor model fits the data better than any alternative models based on a comparison of the fit indexes (χ2/df=2.173,comparative-fit-index(CFI)=0.955;Tucker–Lewis index(TLI)=0.958;root mean square error of approximation(RMSEA)=0.045;standardized root mean residual (SRMR)=0.050).Furthermore,Harman’s one-factor test was used to test for common method bias.The results of the principal component factor analysis without rotation demonstrated that six factors had eigenvalues greater than 1.The first factor explained 23.14% of variance,which is below the threshold of 40%.The results indicate that significant heterogeneity exists between variables.As such,the data could be viewed as evidencing low common bias.

Table 1 The comparative results of alternative models

The results illustrate that risk perception was positively correlated to self-efficacy (r=0.18,P<0.001) and positive coping behavior (r=0.16,P<0.001).However,it was negatively correlated to avoidant coping behavior (r=−0.10,P<0.001).Alternatively,self-efficacy was positively correlated to positive coping behavior (r=0.20,P<0.001) and negatively correlated to avoidant coping behavior (r=−0.15,P<0.001).Moreover,positive coping behavior was negatively correlated to avoidant coping behavior(r=−0.13,P<0.001).In terms of gender,a positive correlation was observed between risk perception and self-efficacy.Urban and rural households were negatively correlated with risk perception and avoidant coping behavior but positively correlated with positive coping behavior.Table 2 provides these results in detail.The hypothesized model was examined using structural equation modeling.MPLUS 7.0 was used to test the mediation model.Four latent variables (risk perception,self-efficacy,positive coping behavior,and avoidant coping behavior) were included in the hypothesized model.The study then used positive coping behavior and avoidant coping behavior as dependent variables;risk perception as the predictive variable;self-efficacy as the mediating variable;and gender and place of residence as control variables.Model fit indices wereχ2=15.18,df=11,χ2/df=1.38,CFI=0.99,TLI=0.99,RMSEA=0.03,SRMR=0.02.

Figure 1 presents the results of the model.Risk perception exerted a significant direct effect on positive coping behavior (β=0.135,P<0.01) and negative coping behavior (β=−0.181,P<0.001).Furthermore,it positively predicted the components of self-efficacy (β=0.195,P<0.001),whereas self-efficacy positively predicted the components of positive coping behavior(β=0.173,P<0.001).These results confirm that self-efficacy plays a partially mediating role in the relationship between risk perception and positive coping behavior.Conversely,self-efficacy negatively predicted the components of avoidant coping behavior (β=−0.115,P<0.01),which indicates that self-efficacy plays a partially mediating role in the relationship between risk perception and avoidant coping behavior.

Figure 1 Final structural equation model,which shows the standardized path coeffificients

The study selected the full information maximum likelihood procedure in MPLUS7.0 to analyze the significance of the mediating effects.Particularly,5,000 randomly sampled and replaced bootstrap samples from the data set were selected.Table 3 illustrates the indirect effects and related 95%confidence intervals (95% CI).The absence of zero in the 95% CI indicates that the mediated effect is statistically significant.Risk perception exerted an indirect predictive effect on positive coping behavior(effect=0.034) and avoidant coping behavior (effect=−0.022)via self-efficacy.

Table 2 The correlation matrix for ovariables

Table 3 Bootstrap Analysis Results for the Magnitude of the Indirect Effects Using the Final Model

Discussion

The study found that risk perception exerted a positive effect on positive coping behavior.In other words,the higher the perceived risk of COVID-19,the more likely an individual will take protective actions.This finding is basically consistent with those of previous studies [17,31,32],which indicates that appropriate risk communication,addressing one’s susceptibility to the virus,and the severity of the disease could enhance protective behaviors,such as the wearing of face masks,frequent washing of hands,and maintaining social distancing.Moreover,the study found that risk perception exerted a negative effect on avoidant coping behavior,which was also reported in previous studies[33].This result may be due to the fact that the elderly with high levels of risk perception may follow the media or read reports about the pandemic more frequently.Knowledge about the transmission of the virus and case fatality rates may influence the elderly’s risk perception of the pandemic [34].This finding suggests that avoidant coping behavior among the elderly can be improved by reducing individual risk perception during the COVID-19 pandemic.

The structural equation model demonstrated that self-efficacy plays a partially mediating role in the relationship between risk perception and positive coping behavior.In line with theory of the health action process approach [2],raising the individual's awareness of potential risks,emphasizing the positive effects of a healthy lifestyle,and addressing false beliefs about negative effects can direct the individual toward clear intentions.After the intention is formed,people can enter into the process of will.Individuals can benefit the most from strategic actions and coping planning interventions[35]to help translate their plans into actions.Once people perform a healthy behavior,self-regulatory skills become most relevant for their maintenance progress.This behavior is primarily guided by self-efficacy,which regulates the investment of energy and the management of persistence in the face of barriers and setbacks.

Furthermore,the structural equation model illustrated that self-efficacy plays a partially mediating role in the relationship between risk perception and avoidant coping behavior.Bandura [36] argued that controllability and predictability “are conducive to the enhancement of the self-percepts of efficacy” and high self-efficacy “judgments of how well one can execute courses of action required to deal with prospective situations” is beneficial for performance in various domains,such as health.Furthermore,fear appeals(persuasive messages that arouse fear) were found effective (i.e.,leading to behavioral changes) only when the individual feels capable of responding to the threat [37].In other words,when people feel powerful fear but remain helpless,the appeal may elicit a defensive response.

Therefore,the coping behavior of the elderly can be improved from two perspectives during the COVID-19 epidemic.The first is to increase elderly risk perception.Previous studies on the potential psychological factors of risk perception indicate that risk perception is influenced by the severity of consequences,unknown degrees of the exposed person,voluntariness,trust in experts,type of risk,and personal control.During the COVID-19 epidemic,specialists can reinforce education for the elderly about the situation to support their re-integration into the family [38].The elderly should consciously pay attention to the interpretation of the scenarios of the pandemic as reported by medical authorities and consciously identify false information.The second approach is increasing the self-efficacy of the elderly.According to Bandura[19],self-efficacy is modifiable,that is,positive emotions,self‐management,and social interactions could increase self-efficacy [39,40].Therefore,the study suggests that the elderly engage in the abovementioned activities to increase self-efficacy.

The main limitation of the study was the cross-sectional study design.Therefore,although statistical analysis pointed to an association between variables,it could not establish causation.In addition,the study indirectly analyzed the relationship between COVID-19 and the coping skills of the elderly.Thus,the result may be insufficient for reflecting the relationship between risk perception and coping behavior during the COVID-19 pandemic.

Conclusions

The study found that risk perception exerted a significant direct effect on positive coping behavior and avoidant coping behavior.Moreover,self-efficacy played a partially mediating role in the relationship between risk perception and positive coping behavior among the elderly.Lastly,self-efficacy played a partially mediating role between risk perception and avoidant coping behavior.