Highlights
- •Perceived susceptibility, severity, subjective norms, and perceived behavioral control had indirect effects on behaviors.
- •Intention had a direct effect on behaviors.
- •It is necessary to increase adolescents’ adherence to COVID-19 preventive behaviors by evidence-based education.
Abstract
Purpose
COVID-19's infection rate among adolescents is increasing; hence, it is important
to prevent it as it can spread in the community through transmission in schools. It
is crucial to determine the extent to which adolescents follow COVID-19 preventive
measures and identify factors relating to such behaviors to implement more effective
health education. This study aimed to understand factors related to COVID-19 preventive
behaviors using the theory of planned behavior (TPB) and the health belief model (HBM)
among adolescents in South Korea.
Design and methods
A cross-sectional face-to-face questionnaire survey was conducted among 272 adolescents
in South Korea. Structural equation modeling was used to examine the relationships
between perceived susceptibility, perceived severity, attitude, subjective norms,
perceived behavioral control, intention, and COVID-19 preventive behaviors.
Results
Among adolescents' COVID-19 preventive behavior scores, wearing masks was the highest
and distancing was the lowest. Adolescents' adherence to COVID-19 preventive behaviors
was directly or indirectly associated with their perceived susceptibility, perceived
severity, subjective norms, perceived behavioral control, and intention.
Conclusions
Attention to mitigate social isolation is important to improve compliance with COVID-19
preventive behaviors. Perceived susceptibility, perceived severity, subjective norms,
perceived behavioral control, and intention explained 61.3% of adolescents' COVID-19
preventive behaviors, there is a need for education to promote relevant factors.
Practice implications
To increase adolescent awareness of COVID-19 and increase attitudes, subjective norms,
and perceived behavior control, nurses need to provide education including the evidence
for COVID-19 preventive behavior to increase adolescents' understanding and active
implementation of those behaviors.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Perception-based influence factors of intention to adopt COVID-19 epidemic prevention in China.Environmental Research. 2020; 190: 109995
- The theory of planned behavior.Organizational Behavior and Human Decision Processes. 1991; 50: 179-211
- Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control.Journal of Experimental Social Psychology. 1986; 22: 453-474
- Structural equation modeling in practice: A review and recommended two-step approach.Psychological Bulletin. 1988; 103: 411-423
- The theory of planned behavior as a predictor of HIV testing intention.American Academy of Health Behavior. 2017; 41: 147-151
- Integration of two models, or dominance of one?.Journal of Health Psychology. 2005; 10: 19-21
- Factors associated with preventive behaviours of COVID-19 among hospital staff in Iran in 2020: An application of the Protection Motivation Theory.The Journal of Hospital Infection. 2020; 105: 430-433
- Comparative fit indexes in structural models.Psychological Bulletin. 1990; 107: 238-246
- Children and young people remain at low risk of COVID-19 mortality.Lancet Child and Adolescent Health. 2021; 5: e12-e13
- The COVID-19 preventive behaviors index: Development and validation in two samples from the United Kingdom.Evaluation & the Health Professions. 2021; 44: 77-86
- COVID-19 parental resources kit – Adolescence.(Retrieved from)https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/parental-resource-kit/adolescence.htmlDate: 2020Date accessed: January 15, 2021
- Basic guidelines for distancing in daily life.(Retrieved from) (Accessed July 1, 2020)
- The factors related to mothers’ intention to vaccinate against hepatitis A: Applying the theory of planned behavior.Child Health Nursing Research. 2019; 25: 1-8
- Nursing perspectives on the impacts of COVID-19.The Journal of Nursing Research. 2020; 28 (Article e85)
- Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients.Nature Communications. 2020; 11: 2800
- Factors affecting MERS-related health behaviors among male high school students.Journal of the Korean Society of School Health. 2015; 28: 150-157
- Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis.Lancet. 2020; 395: 1973-1987
- The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis.Psychological Methods. 1996; 1: 16-29
- Applicability of the theory of planned behavior for predicting alcohol use in Spanish early adolescents.International Journal of Environmental Research and Public Health. 2020; 17: 8539
- Preparedness and preventive behaviors for a pandemic disaster caused by COVID-19 in Serbia.International Journal of Environmental Research and Public Health. 2020; 17: 4124
- Epidemiology of COVID-19 among children in China.Pediatrics. 2020; 145 (Article e20200702)
- COVID-19 pandemic impact on children and adolescents’ mental health: Biological, environmental, and social factors.Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2021; 106: 110171
- Evaluating structural equation models with unobservable variables and measurement error.Journal of Marketing Research. 1981; 18: 39-50
- Forming attitudes that predict future behavior: A meta-analysis of the attitude–behavior relation.Psychological Bulletin. 2006; 132: 778-822
- Multivariate data analysis.7th ed. Pearson, 2009
- Developmental tasks and education.3rd ed. Longman Inc., 1972
- Cognitive determinants of influenza preventive behaviors among students: An application of the health belief model (HBM).International Journal of Pediatrics. 2018; 6: 7833-7841
- The influence of perceived behaviour control, attitude and empowerment on reported condom use and intention to use condoms among adolescents in rural Tanzania.Reproductive Health. 2015; 12: 105
- Community responses during the early phase of the COVID-19 epidemic in Hong Kong.Emerging Infectious Diseases. 2020; 26: 1575-1579
- Schools’ response to MERS (MERS-CoV) outbreak: Schools’ discretionary response in absence of control tower.The Korean Society of School Health. 2015; 28: 188-199
- Advanced nursing statistics.Soomoonsa, 2016
- A structural equation model of pressure ulcer prevention action in clinical nurses.Journal of Korean Academy of Nursing. 2016; 46: 572-582
- The moderating effects of perceived severity on the generational gap in preventive behaviors during the COVID-19 pandemic in the U.S.International Journal of Environmental Research and Public Health. 2021; 18: 2011
- Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020.Journal of Anxiety Disorders. 2020; 74: 102258
- Adolescent risk and vulnerability: Concepts and measurement.The National Academies Press, 2001
- Knowledge, beliefs and preventive behaviors regarding influenza a in students: A test of the health belief model.Journal of Education and Health Promotion. 2013; 2: 23
- Effectiveness of school-based Smoking Prevention Education Program (SPEP) among nonsmoking adolescents: A quasi-experimental study.The Journal of School Nursing. 2019; OnlineFirsthttps://doi.org/10.1177/1059840519871641
- A bibliometric analysis of COVID-19 research published in nursing journals.Science Editing. 2020; 7: 118-124
- Adolescents’ motivations to engage in social distancing during the COVID-19 pandemic: Associations with mental and social health.The Journal of Adolescent Health. 2020; 67: 179-185
- Health belief model for the analysis of factors affecting hypertension preventive behavior among adolescents in Surakarta.Journal of Health Promotion and Behavior. 2017; 2: 183-196
- Perceived susceptibility to pregnancy and its association with safer sex, contraceptive adherence and subsequent pregnancy among adolescent and young adult women.Contraception. 2013; 87: 437-442
- Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use.Psychology & Health. 2011; 26: 1499-1520
- “I Hate This”: A qualitative analysis of adolescents’ self-reported challenges during the COVID-19 pandemic.The Journal of Adolescent Health. 2020; 68: 262-269https://doi.org/10.1016/j.jadohealth.2020.11.010
- Assessing preventive health behaviors from COVID-19: A cross sectional study with health belief model in Golestan Province, Northern of Iran.Infectious Diseases of Poverty. 2020; 9: 157
- Discomfort and exertion associated with prolonged wear of respiratory protection in a health care setting.Journal of Occupational and Environmental Hygiene. 2012; 9: 59-64
- Content validity index in scale development.Journal of Central South University. 2012; 37: 152-155
- Understanding the limitations of global fit assessment in structural equation modeling.Personality and Individual Differences. 2007; 42: 893-898
- A large COVID-19 outbreak in a high school 10 days after schools’ reopening, Israel, May 2020b.Euro Surveillance. 2020; 25 (Article 2001352)
- The effectiveness of a school-based adolescent depression education program.Health Education & Behavior. 2010; 37: 11-22
- The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana.PLoS One. 2020; 15 (Article e0233462)
- Optimism in early adolescence: Relations to individual characteristics and ecological assets in families, schools, and neighborhoods.Journal of Happiness Studies. 2015; 16: 889-913
- Why COVID-19 loneliness can be especially hard on teens.(Retrieved from)https://www.ualberta.ca/folio/2020/05/why-covid-19-loneliness-can-be-especially-hard-on-teens.html(Accessed June 10, 2020)Date: 2020
- Adolescents’ social norms across family, peer, and school settings: Linking social norm profiles to adolescent risky health behaviors.Journal of Youth and Adolescence. 2019; 48: 935-948
- Using a theory of planned behaviour framework to explore hand hygiene beliefs at the “5 critical moments” among Australian hospital-based nurses.BMC Health Services Research. 2015; 15: 59
- Child and adolescent mental health service provision and research during the COVID-19 pandemic: Challenges, opportunities, and a call for submissions.Child and Adolescent Psychiatry and Mental Health. 2020; 14: 19
- Practice of habitual and volitional health behaviors to prevent severe acute respiratory syndrome among Chinese adolescents in Hong Kong.The Journal of Adolescent Health. 2005; 36: 193-200
- Risk of nosocomial transmission of coronavirus disease 2019: An experience in a general ward setting in Hong Kong.The Journal of Hospital Infection. 2020; 105: 119-127
- Coronavirus disease (COVID-19) advice for the public.(Retrieved from) (Accessed June 29, 2020)
- Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial.Reproductive Health. 2019; 16: 124
- Predicting young adults’ intentions to get the H1N1 vaccine: An integrated model.Journal of Health Communication. 2015; 20: 69-79
- “It's frustrating” from the heatwave to the mask… Classroom where both students and teachers are breathtaking.(Retrieved from)
- The misunderstanding and prejudice of structural equation models.Hannare Publishing Co., 2014
- Determinants of COVID-19 prevention behavior in the elderly in Urmia: Application of health belief model.Open Access Macedonian Journal of Medical Sciences. 2020; 8: 646-650
Article info
Publication history
Published online: July 13, 2021
Accepted:
July 7,
2021
Received in revised form:
June 14,
2021
Received:
February 1,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.