In December 2019, several cases of pneumonia with unknown causes were reported in Wuhan, the capital of Hubei Province in central China. The pneumonia was later diagnosed to be caused by a novel coronavirus and named Coronavirus Disease-19 (COVID-19) by the World Health Organization . Since then, COVID-19 has broken out from Hubei Province, particularly from Wuhan city, and spread across mainland China rapidly. Later, COVID-19 has spread outside China, posing risks to countries beyond its origin. At the end of January 2020, The World Health Organization has declared the outbreak of COVID-19 in China a Public Health Emergency of International Concern . At the beginning of February 2020 right before the current survey commenced, COVID-19 has caused thousands of diagnosed cases and hundreds of deaths. The Chinese government has actively adopted a variety of measures to control COVID-19, including implementing effective medical treatment, monitoring the progress, issuing factsheets and precautionary guidelines, and even controlling the mobility of the population within the city and between cities. However, citizens received the information about COVID-19 from various channels and might have different knowledge about COVID-19. In addition, the numbers of suspicious and diagnosed cases and mortality were still increasing in most provinces before this study was conducted, which also affected the public’s perception about the severity and controllability of COVID-19. Individuals with different knowledge and perception of COVID-19 could show different emotional and behavioural reactions towards COVID-19.
A timely understanding of the public’s knowledge and perception of COVID-19 as well as their associations with individuals’ emotion and behaviour was still lacking before this study. Public’s knowledge, perception, precautionary behaviour and active social participation have been found to be important in the control of epidemics, as learned regarding severe acute respiratory syndrome (SARS), Ebola, and H1N1 [3-5]. Nevertheless, every public health concern occurs at different periods in different places and each country/region possesses different magnitudes of resources to reduce the detriment it brings. In this sense, there could be both commonalities and variations in the emotional and behavioural reactions caused by different events of public health concern. Therefore, it is necessary to investigate the public’s emotional and behavioural outcomes and their antecedents in the encounter of COVID-19. Hopefully, the findings may deepen the understanding of the public’s appraisal processes in the encounter of emergent public health concern and provide early evidence to relevant stakeholders, policy-makers, and practitioners to better develop and deliver tailor-made psychological aids to the public affected by COVID-19. In sum, drawing upon the proposition that cognitive appraisal as a process of coping stress [6, 7], the present research aims to examine the public’s perceived severity, perceived controllability, and knowledge, of COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour.
Cognitive appraisal and emotional and behavioural reactions
Studies on SARS have indicated that the outbreak of an unprecedented virus can cause immense stress to the public of different age, professionals, and regions [8-11]. Encounter of environmental stress may induce individuals to use different methods to cope with the stress and maintain their health and well-being. Cognitive appraisal, as a core process in coping stress, is supposed to closely associate with immediate and long-term outcomes .
Cognitive appraisal is a process through which the person evaluates whether a particular encounter with the environment is relevant to his or her well-being, and if so, in what ways . It consists of two stages. Primary appraisal refers to a person’s estimate of whether he or she has anything at stake in the encounter . Encounters can be evaluated as irrelevant, benign-positive (beneficial) or stressful . For instance, is the encounter potentially harmful or beneficial to a person’s well-being or health? Assessment of a person’s evaluation of what is at stake in the outcome of the encounter is a critical indicator of the primary appraisal, such as assessing how disturbing, threatening or challenging of the encounter is [13, 14]. Secondary appraisal refers to a person’s evaluation of what can be done to overcome/prevent harm or to increase the benefit; this process involves a complex assessment of a person’s coping options . Evaluation of the extent to which a situation requires more information and how controllable the situation is has been regarded as crucial indicators of the secondary appraisal .
Prior research has associated indicators of primary and secondary appraisals with a wide range of emotional and behavioural outcomes. For example, Peacock and Wong found that when individuals perceive an encounter to be more threatening, uncontrollable and stressful, they reported higher levels of psychological symptoms and dysphoric mood . Oliver and Brough revealed that perceived controllability was predictive of individuals’ well-being . In another research, Gomes, Faria, and Lopes found that perceptions of threat, control, and challenge of stressful encounters were significantly related to mental health problems . Besides, cognitive appraisal has also been applied to the study of the public’s emotion and behaviour during the outbreak of emergent public health concerns. For instance, in Dorfan and Woody’s study, they measured individuals’ appraisal of danger, germ spread and responsibility and associated them with a number of emotion and behaviour towards the outbreak and transmission of SARS, including avoidance, disgust, anxiety, urge to wash, washing duration, and wipes taken . Their findings disclosed that appraisal of danger of SARS was significantly related to emotional and behavioural responses. Another research found that knowledge and perception of SARS were related to precautionary behaviour . In addition, Yang and Chu found that perceived risk of virus was related to higher levels of negative emotion (i.e., fear, anxiety, disgust, and anger) about the outbreak of Ebola in the U.S. public .
Some studies have directly examined cognitive appraisal factors and emotional and behavioural reactions during the outbreak of COVID-19. For instance, prior studies have conducted descriptive research to examine the levels of knowledge, attitude, preventive behaviour and risk perception regarding COVID-19, revealing that most participants reported high levels of knowledge of COVID-19 and had strong intention to engage in preventive behaviour [18, 19]. Some studies have also carried out epidemiological survey about individuals’ mental health, psychological distress, and well-being during the outbreak of COVID-19, revealing that most citizens reported substantial mental health problems and [20, 21]. Besides, some studies have also disclosed that perceiving COVID-19 to be severe was associated with more mental health problems (e.g., depressive symptoms and anxiety) [22-24], and more preventive behaviour . In addition, prior research also found that high levels of knowledge were related to stronger intention to follow and actual engagement in preventive behaviour [25, 26]. However, there were also a few inconsistent findings which revealed that more knowledge about COVID-19 and perceiving COVID-19 to be severe were associated with less preventive behaviour [27, 28].
Based on the existing literature reviewed above, we learn that most studies that examined the cognitive appraisal factors regarding COVID-19 primarily focused on knowledge and perceived severity of COVID-19 and that most studies examined these cognitive appraisal factors separately. From a theoretical aspect, cognitive appraisal includes both primary (e.g., perceived severity) and secondary (e.g., perceived controllability) appraisal. However, scant research has investigated the role of perceived controllability, a crucial secondary appraisal factors in stress coping, in the emotional and behavioural outcomes towards the outbreak of COVID-19. From a methodological aspect, different types of cognitive appraisal factors could be overlapped and the association between a single cognitive appraisal factor and the outcomes could be inflated without considering them simultaneously. This study, although conducted at the early stage of the outbreak of COVID-19 in early February 2020, contributes to the literature in that it examines three types of cognitive appraisal factors (i.e., perceived severity, knowledge, and perceived controllability) at the same time, which allows us to control for the covariance between these factors and thus we may obtain a more nuanced estimation of the associations between these appraisal factors and the outcomes. In addition, we also examine some more outcomes that have received comparatively less attention in past studies, such as social participation and mobile phone use. In sum, the findings of this study are expected to shed light on the mitigation of negative and the promotion of positive emotional and behavioural reactions during the outbreak of COVID-19.
The current study
Drawing upon the cognitive appraisal theory, this study aims to understand the public’s perceived severity, perceived controllability, and knowledge of COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour. In this study, we consider the public’s perceived severity as the primary appraisal, as it relates to an individual’s evaluation of how likely their health and well-being is at stake in the encounter of COVID-19, and we consider the public’s perceived controllability and knowledge of COVID-19 as secondary appraisal, as they reflect as the intellectual and mental resources to cope with the stress and disturbance caused by COVID-19. In light of the literature reviewed above, these cognitive appraisals are supposed to be related to a number of emotional and behavioural reactions. Since the numbers of diagnosed cases and the rate of mortality of COVID-19 differ greatly among different regions in China, the public’s emotional and behavioural responses, social participation, and precautionary behaviour could vary as well. To take this into account, we recruited sample from a wide array of provinces in mainland China. We took into account a number of demographic variables as well to control for their potential effects on the outcomes.