The Impact of Perception and Fear on the Adoption of Protective Measures Against COVID-19: A Mediation Analysis
DOI:
https://doi.org/10.37609/srinmed.71Keywords:
COVID-19, risk perception, fear, adults, TürkiyeAbstract
Objective: COVID-19 has had physical, mental, and social impacts worldwide, yet uptake of protective behaviors varied. We aimed to assess how COVID-19 disease perception and fear relate to adoption of precautions among adults in Türkiye.
Methods: After ethics approval, we conducted a cross-sectional online survey in Türkiye (March 1–April 1, 2021) using researcher networks for recruitment. Measures included the COVID-19 Disease Perception Scale (dangerousness and contagiousness) and the Fear of COVID-19 Scale. Adherence to COVID-19 precautions (ACP) was self-reported and scored as the number of preventive measures adopted (0–11).
Results: Of 4,477 responses, 4,011 participants were included after removing duplicates and incomplete entries (56.4% female; n=2,261). Mean (SD) ACP score was 5.99 (2.25) (median 6.0). Adherence was higher among females; those with a university degree; married participants; those not living in a separated/divorced family structure; those reporting good income; participants with chronic disease; non-smokers and non-drinkers; and those reporting a COVID-19 related death in their family or close social circle. Higher perceived contagiousness was associated with greater adoption of preventive measures, with perceived dangerousness and fear mediating this relationship.
Conclusion: Public health efforts that strengthen accurate perceptions of infectious disease dangerousness and contagiousness, and address related fear, may increase use of protective measures and help reduce transmission in future pandemics.
References
World Health Organization (WHO). WHO COVID-19 dashboard [Internet]. [cited 2026 Jan 27]. Available from: https://data.who.int/dashboards/covid19/deaths
Tomar A, Gupta N. Prediction for the spread of COVID-19 in India and effectiveness of preventive measures. Sci Total Environ. 2020 Aug 1;728:138762. https://doi.org/10.1016/j.scitotenv.2020.138762
Ditekemena JD, Nkamba DM, Muhindo HM, Siewe JNF, Luhata C, Van Den Bergh R, et al. Factors associated with adherence to COVID-19 prevention measures in the Democratic Republic of the Congo (DRC): Results of an online survey. BMJ Open. 2021 Jan 1;11(1):e043356. https://doi.org/10.1136/bmjopen-2020-043356
Guo D, Habich‐Sobiegalla S, Kostka G. Emotions, crisis, and institutions: Explaining compliance with COVID‐19 regulations. Regul Gov. 2024;18(1):177-202. https://doi.org/10.1111/rego.12509
Durmuş V. Epidemic trends of COVID-19 in 10 countries compared with Turkey. Vacunas. 2021;22(1):10-9. https://doi.org/10.1016/j.vacun.2020.08.003
Wise T, Zbozinek TD, Michelini G, Hagan CC, Mobbs D. Changes in risk perception and self-reported protective behaviour during the first week of the COVID-19 pandemic in the United States. R Soc open Sci. 2020;7(9):200742. https://doi.org/10.1098/rsos.200742
Yıldırım M, Geçer E, Akgül Ö. The impacts of vulnerability, perceived risk, and fear on preventive behaviours against COVID-19. Psychol Health Med. 2021;26(1):35-43. https://doi.org/10.1080/13548506.2020.1776891
Pakpour AH, Griffiths MD. The fear of COVID-19 and its role in preventive behaviors. J Concurr Disord. 2020;2(1):58-63. https://doi.org/10.54127/WCIC8036
Montenovo L, Jiang X, Lozano-Rojas F, Schmutte I, Simon K, Weinberg BA, et al. Determinants of disparities in early COVID-19 job losses. Demography. 2022;59(3):827-55. https://doi.org/10.1215/00703370-9961471
Schimmenti A, Billieux J, Starcevic V. The four horsemen of fear: An integrated model of understanding fear experiences during the COVID-19 pandemic. Clin Neuropsychiatry. 2020;17(2):41.
Jaureguizar J, Redondo I, Galende N, Ozamiz N. Factors related to compliance with the COVID-19 health regulations among young people. World J Psychiatry. 2021;11(12):1247. https://doi.org/10.5498/wjp.v11.i12.1247
Galende N, Redondo I, Dosil-Santamaria M, Ozamiz-Etxebarria N. Factors Influencing Compliance with COVID-19 Health Measures: A Spanish Study to Improve Adherence Campaigns. Int J Environ Res Public Health. 2022;19(8):4853. https://doi.org/10.3390/ijerph19084853
Cori L, Bianchi F, Cadum E, Anthonj C. Risk perception and COVID-19. Vol. 17, International journal of environmental research and public health. MDPI; 2020. p. 3114. https://doi.org/10.3390/ijerph17093114
Malecki KMC, Keating JA, Safdar N. Crisis communication and public perception of COVID-19 risk in the era of social media. Clin Infect Dis. 2021;72(4):697-702. https://doi.org/10.1093/cid/ciaa758
Geniş B, Gürhan N, Koç M, Geniş Ç, Şirin B, Çırakoğlu OC, et al. Development of perception and attitude scales related with COVID-19 pandemia. Pearson J Soc Sci. 2020;5(7):306-28. https://doi.org/10.46872/pj.127
Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. 2020;1-9. https://doi.org/10.1037/t78404-000
Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. Int J Ment Health Addict. 2021;19:1980-8. https://doi.org/10.1007/s11469-020-00294-0
Talic S, Shah S, Wild H, Gasevic D, Maharaj A, Ademi Z, et al. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. bmj. 2021;375. https://doi.org/10.1136/bmj-2021-068302
Turkish Ministry of Health. Koronavirüs Riskine Karşı 14 Kural Kamu Spotu [Internet]. [cited 2026 Jan 28]. Available from: https://covid19.saglik.gov.tr/TR-66177/koronavirus-riskine-karsi-14-kural-kamu-spotu.html
Hayes AF. PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. University of Kansas, KS; 2012.
Narayana G, Pradeepkumar B, Ramaiah JD, Jayasree T, Yadav DL, Kumar BK. Knowledge, perception, and practices towards COVID-19 pandemic among general public of India: a cross-sectional online survey. Curr Med Res Pract. 2020;10(4):153-9.
Sulistyawati S, Rokhmayanti R, Aji B, Wijayanti SPM, Hastuti SKW, Sukesi TW, et al. Knowledge, attitudes, practices and information needs during the COVID-19 pandemic in Indonesia. Risk Manag Healthc Policy. 2021;163-75. https://doi.org/10.2147/RMHP.S288579
Clark C, Davila A, Regis M, Kraus S. Predictors of COVID-19 voluntary compliance behaviors: An international investigation. Glob transitions. 2020;2:76-82. https://doi.org/10.1016/j.glt.2020.06.003
Yan E, Lai DWL, Lee VWP, Ng HKL. Predicting public adherence to COVID-19 preventive measures: A cross-sectional study in Hong Kong. Int J Environ Res Public Health. 2021;18(23):12403. https://doi.org/10.3390/ijerph182312403
Recio-Vivas AM, Mansilla-Domíngez JM, Belzunegui-Eraso Á, Peña-Otero D, Díaz-Pérez D, Lorenzo-Allegue L, et al. Compliance with COVID-19 Prevention Measures in the Spanish Population during the New Normal: Will the Need for Greater Community Involvement Be One of the Lessons Learned? Int J Environ Res Public Health. 2022;19(23):15983. https://doi.org/10.3390/ijerph192315983
Bwire GM. Coronavirus: why men are more vulnerable to Covid-19 than women? SN Compr Clin Med. 2020;2(7):874-6. https://doi.org/10.1007/s42399-020-00341-w
Almutairi AF, BaniMustafa A, Alessa YM, Almutairi SB, Almaleh Y. Public trust and compliance with the precautionary measures against COVID-19 employed by authorities in Saudi Arabia. Risk Manag Healthc Policy. 2020;753-60. https://doi.org/10.2147/RMHP.S257287
Lee G Bin, Jung SJ, Yiyi Y, Yang JW, Thang HM, Kim HC. Socioeconomic inequality in compliance with precautions and health behavior changes during the COVID-19 outbreak: an analysis of the Korean Community Health Survey 2020. Epidemiol Health. 2022;44:e2022013. https://doi.org/10.4178/epih.e2022013
Li S, Xu Q. Family support as a protective factor for attitudes toward social distancing and in preserving positive mental health during the COVID-19 pandemic. J Health Psychol. 2022;27(4):858-67. https://doi.org/10.1177/1359105320971697
Zaildo T, Santino TA, Chaves G, da Silva BAK, Alchieri JC, Patino CM, et al. Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis. Eur Respir Rev. 2023;32(168). https://doi.org/10.1183/16000617.0238-2022
Hanna EZ, Yi H ye, Dufour MC, Whitmore CC. The relationship of early-onset regular smoking to alcohol use, depression, illicit drug use, and other risky behaviors during early adolescence: results from the youth supplement to the third national health and nutrition examination survey. J Subst Abuse. 2001;13(3):265-82. https://doi.org/10.1016/S0899-3289(01)00077-3
Mendoza-Jiménez MJ, Hannemann TV, Atzendorf J. Behavioral risk factors and adherence to preventive measures: evidence from the early stages of the COVID-19 pandemic. Front public Heal. 2021;9:674597. https://doi.org/10.3389/fpubh.2021.674597
Monnig MA, Padovano HT, Sokolovsky AW, DeCost G, Aston ER, Haass-Koffler CL, et al. Association of substance use with behavioral adherence to centers for disease control and prevention guidelines for COVID-19 mitigation: cross-sectional web-based survey. JMIR public Heal Surveill. 2021;7(11):e29319. https://doi.org/10.2196/29319
Roberts JA, David ME. Improving predictions of COVID-19 preventive behavior: Development of a sequential mediation model. J Med Internet Res. 2021;23(3):e23218. https://doi.org/10.2196/23218
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Scientific Reports in Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal and content of this website is licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License. This is in accordance with the Budapest Open Access Initiative (BOAI) definition of open access. The Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allows users to copy, distribute and transmit unmodified article, and make noncommercial use of the article. The CC BY license permits non-commercial re-use of an open access article, as long as the author is properly attributed.
