This EPPM-based study was conducted to assess the risk perceptions, behavioral responses, overall perceived fear and tension, and danger and fear control processes among Iranian people during the early stages of the COVID-19 pandemic. The study provides a timely assessment of and initial evidence related to the risk perceptions and psychological responses individuals have had to COVID-19 during its early stages, with more than 3,700 individuals across the country taking part in the study. According to EPPM, two cognitive appraisals are initiated after a person learns about a health risk: one related to the threat it poses and a second related to the efficacy of the recommended responses. When the threat of COVID-19 threat is perceived to be more significant, people are motivated to do act to protect themselves. According to level of perceived efficacy, people have two responses: those who perceive the responses to have high levels of efficacy are motivated to protect themselves by controlling the threat of COVID-19; those who perceive low levels of efficacy levels, those who doubt their ability to adhere to the health care recommendations, and those who doubt that said recommended responses can really avert the threat use psychological defense to control their fear . Our results show that 56.4% of respondents were motivated by danger control responses and 43.6% by fear control responses. This indicates that more than half of all participants had high perceived efficacy (i.e., self-efficacy and response efficacy) scores. Self-efficacy scores were significantly higher among participants who were older, female, single, lived in rural areas, or had good economic status. A current study from China showed an association between self-efficacy and social support among patients who had been treated for coronavirus . This is inconsistent with our results, which show that participants with a history of coronavirus had lower self-efficacy scores. Respondents who had a family member with coronavirus and those with three or more comorbidities had lower self-efficacy scores for controlling COVID-19. Self-efficacy is a positive mental state that is part of the cognitive appraisal process reducing stress and tension . Our assessment of overall stress and tension levels also indicated that stress and tension were significantly lower among respondents who were older, had no diseases, lived in rural areas, were widowed/divorced, or had good economic status. According to our results, respondents with high self-efficacy scores are better able to control their emotions.
According to the results, efficacy responses were significantly higher among respondents who were well-educated and had good economic status. It seems that these individuals believe they can carry out the recommended responses to protect themselves from COVID-19.
Our results also showed that respondents who were male, older, well-educated, and married had significantly higher perceptions of susceptibility. In fact, these individuals were simply thinking about the threat of COVID-19 and believed that the threat was relevant to them. According to the WHO, older people are at higher risk of contracting COVID-19 . The Iranian health care system and media provided significant coverage of the COVID-19 pandemic, recommending that all people—and especially older people—take care themselves. This likely resulted in older people learning that they were more susceptible to the disease.
Individuals usually use psychological defense strategies to control their fears. These strategies include denial, avoidance, and reactance. Our results showed that lower defensive response scores correlated with better responses from participants. Defensive avoidance occurs when individuals block out feelings and thoughts about a threat or ignore further information about it, for example, switching the television channel or skipping COVID-19-related news. People in younger age groups (15–29 years) had higher avoidance scores and lower self-efficacy scores, indicating that younger people tended to take more risks and ignore health recommendations . Illiterate people had the lowest self-efficacy and highest defensive responses. The results of our study suggest that socioeconomic and demographic factors are the main determinants of psychological responses to controlling the COVID-19 pandemic.
Strengths and limitations
The greatest strength of this study is its format: the online method allows for the timely gathering of information from a wide range of community groups. Since the pandemic made other data collection methods were unsafe and difficult for both the researchers and the study participants, the online sampling method was particularly convenient. We asked participants to complete the questionnaire for any family members who were illiterate or had no internet access. Because of the online nature of the study, we were unable to reach people who weren’t interested in or who did not have access to the study questionnaire. Another strength is that this study is the first to record the behavioral responses of people to early information about COVID-19, before they later became saturated with COVID-19 news and information.