Our data shows that during the first wave of COVID-19 pandemic, elderly people residing in a city of the south of Europe had a moderate risk perception of being infected by SARS-CoV-2, and men more often than women perceived this risk as high or very high. Risk perception was positively associated with age and significant level of depression, and the higher the risk perception of being infected by SARS-CoV-2, the greater the number of preventive measures adopted.
Regarding the risk perception of being infected by SARS-CoV-2, only 36.5% of our participants (mean age 79.54 ± 5.04 years) reported their risk as being high or very high, whereas in the Wang X study carried out in China (mean age 33.0 ± 12.5 years), this was reported by 49.4% of the subjects evaluated [12]. The risk perception of our population may be lower due to the fact that at the time of data collection, Portugal was still at the beginning of the first wave and the number of deaths and infected people was still low, while China had already crossed the peak of the first wave. Another explanation for this, according to Brewer [28], is that some people may perceive their risk of being infected as being lower because they had already adopted the recommended preventive measures. Van der Velden reports that people may perceive the risk as high and therefore take measures, however, the opposite may also be true, people may perceive the risk as low because they took measures [9]. This is in line with our results since 94.1% of the participants reported staying home as much as possible to protect themselves, and this probably reduced their risk perception.
We found a significant positive correlation between risk perception and age, which may be due to the fact that in Portugal news were very focused on the risk to the elderly population and deaths in nursing homes by Covid 19. Our resulta are consistente with other studies, showing that the elderly were more likely to have higher risk perception regarding contracting COVID-19 [12, 17, 33, 40, 46]. In contrast, Bruine de Bruin found that in the elderly population they evaluated, people considered themselves to have a lower risk of being infected with SARS-CoV-2 but reported having a higher risk of dying if infected [43]. Factually, the death rate from COVID-19 is higher among the elderly than among the young and middle-aged [47].
We also found that men perceived the risk of infection as high or very high more often than women, which is not consistent with previous findings showing higher levels of risk perception among the “female gender” [9, 10, 11, 14, 29, 30]. One explanation for this result may be that men have spent more time exposed to pandemic-related news, which may lead to a higher risk perception, according to the study by Lanting Wu et al. [37] which reported that the duration of attention to pandemic-related news has a predictive effect on people’s risk perception. Culturally, women of this age in Portugal will be less exposed to journals and TV news than men. Furthermore, according to the results of Ahrenfeldt LJ et al. in 10 regions of Europe (including Portugal), the relative risk of dying from COVID-19 was higher for men than for women in almost all age groups and in all regions [48]. Thus, if men had access to such information, it could justify their higher risk perception.
On the other hand, risk perception did not vary with marital status or education level in our sample, contrasting with the results of previous studies which showed that “single people” [31] and those with “a higher education level” [9, 12, 29] had a higher risk perception. Most of our participants have a medium-low education level, which may justify the fact that the education level did not significantly influence risk perception in our sample. Furthermore, only 10.6% of our participants are single (a very reduced number), so that may be the reason why our results are so different from the expected.
Another finding of this study was that risk perception was positively associated with “a significant level of depression”. A possible explanation for this may be related to the fact that people with depressive symptomatology tend to focus more on the negative aspects of life, which may lead to a greater concern and awareness about the pandemic situation, instilling a greater perception of risk. Our result agrees with another study conducted among COVID-19 patients, which concluded that risk perception was positively related to “depressive states” [33]. In addition, as mentioned by Zhong Y. et al. [33], this can mean that people with mental health issues could be more vulnerable to the negative impact of the COVID-19 pandemic, so it is crucial that risk-related communications are adapted to mentally vulnerable individuals.
Moreover, a positive correlation between risk perception and “number of preventive measures adopted” was observed, showing that the higher the risk perception of being infected by SARS-CoV-2, the greater the number of preventive measures adopted. This is consistent with other studies, which showed that people with a higher perception of risk tend to significantly increase their involvement in preventive behaviors [e.g., 8- 17]. This result is extremely important, because it suggests the role that risk perception plays in the adoption of preventive measures in the elderly population. It is therefore crucial that risk-related communications focus on increasing personal perception of risk in order to increase adherence to preventive measures, while simultaneously preventing pathological fears that can increase mental health problems.
Regarding the adoption of preventive measures to control the pandemic, and comparing to a research with elderly people carried out in Brazil (May 2020) [49], we noticed that, in our study, the percentage of the participants who reported “staying at home “was higher and the percentage of “mask use “and “ hand washing” was lower. It is important to highlight that at the time of data collection the use of a mask was not yet mandatory in public establishments in Portugal and there was some difficulty to access protective equipment due to the high demand. Moreover, the country was under mandatory lockdown, which may have “encouraged” people to stay at home.
One of the important issues of our study is that in this group of persons the evaluation of risk and the adoption of appropriate measures to contain the disease is important: 64,7% of our volunteers considered their risk of infection to be medium or high, and the adoption of measures was directly related to the risk perception. In future we may need to increase risk perception in this age group considering they are in fact one of the groups that suffer more from the SARSCOV 2 infection. The other issue relates to the fact that , if a well performed campaign is done to this group, no forced lockdowns would be necessary, since people will be able to take the measures needed to contain the disease. Considering all the negative effects that the pandemic brought to this group of subjects when forced to a lockdown, this could be important in future threats, to prevent the secondary effects of very restrictive policies. (50, 51, 52).
It was not possible to access the participants' clinical data and we were unable to compare their individual diagnoses (namely those that can make participants more vulnerable to COVID-19) with the vulnerability factors that they themselves mentioned (respiratory and heart disease, having diabetes or hypertension), which is one of the limitations of our study. We are aware that the sample used is smaller than what is desirable, since it is part of a longitudinal study, in which we had to restrict ourselves to the participants of CAS. Furthermore, other dimensions that affect both risk perception and the adoption of preventive measures were not considered. It should be noted that the data was collected during the initial phase of the pandemic in Portugal, when the number of infected people and consequent deaths was reduced, with no deaths from SARS-CoV-2 in the city of Covilhã, which may have influenced the risk perception and the adoption of preventive measures.
The potential of this study lies in the random sample stratified by gender and age group, being inserted in a longitudinal study, and having been carried out via telephone interviews (because through online questionnaires it would not be possible to reach the target population, who is unable to use them). The previous process of aleatorization of the subjects allow for a generalization of our findings to a larger population.