Search Results (760)

This study examines how consumers’ perceptions of threat severity and anxiety during public health crises influence their motivation to protect themselves and, subsequently, their intentions to purchase protection insurance products. Drawing on Protection Motivation Theory (PMT), we develop an integrated framework that links cognitive risk assessments and emotional responses to financial protection decisions. Using survey data collected from 437 respondents in Taiwan during the COVID-19 pandemic, the research model is tested through partial least squares structural equation modeling (PLS-SEM). The empirical results indicate that both perceived severity and anxiety significantly enhance protection motivation, with perceived severity exerting a stronger effect. These two antecedents also directly strengthen consumers’ intentions to purchase protection insurance. Furthermore, protection motivation partially mediates the effects of perceived severity and anxiety on purchase intention. These findings extend the application of PMT to the financial and insurance domains by demonstrating how cognitive and affective factors jointly shape demand for protection insurance in high-risk environments. The practical implications of these results for insurers include risk communication strategies, product positioning, and the development of crisis-responsive insurance solutions. Full article

This study examines the relationship between greenwashing and firm risk among listed Australian firms from 2014 to 2023. We construct a firm-level greenwashing score as the residual based on regressions of composite ESG on Scope 1–2 CO₂ emissions; positive residuals indicate overstated sustainability relative to emissions. Using realized volatility as a measure of firm risk and applying the Generalized Method of Moments (GMM) regression framework, we uncover three key findings. First, contemporaneous greenwashing significantly lowers volatility, which is consistent with legitimacy and signalling theory, as overstated ESG credentials create a temporary perception of stability. Second, the risk-reducing effect is strongest with a one-period lag, likely reflecting delayed ESG and emissions reporting cycles and investor reaction times. Third, by the two-period lag, the effect reduces in magnitude, suggesting that markets eventually recognize the misalignment between ESG claims and environmental performance. Robustness checks with the E-pillar confirm these dynamics. Additional tests excluding the COVID-19 period (2020 and 2021) reveal that the risk-mitigating effects of greenwashing are even stronger during normal market conditions, implying that pandemic-related volatility may have muted the signalling power of ESG narratives. While firm fundamentals (e.g., book-to-market) explain part of risk variation, greenwashing-driven effects are economically meaningful yet short-lived. The findings underscore that greenwashing offers only temporary risk mitigation; as transparency improves and regulatory enforcement strengthens, firms relying on inflated ESG narratives face diminishing benefits and potential long-term risk penalties. Full article

Background/Objective: While no human monkeypox (MPXV) infections have been reported in Palestine, the rapid global increase in cases, including in neighboring countries, necessitates proactive public health preparedness. This study aimed to assess Palestinians’ willingness to receive MPXV vaccination and to identify associated predictors in the context of a potential outbreak. Methods: A cross-sectional online survey was conducted in September 2024. The questionnaire gathered data on participants’ sociodemographic characteristics, risk perceptions, Vaccine Trust Indicator (VTI) scores, vaccination history, and willingness to receive an MPXV vaccine. Bivariate analyses were performed using Pearson’s chi-square test, and a multivariate logistic regression model was employed to identify the determinants of MPXV vaccination willingness. Results: The overall willingness to receive MPXV vaccination was low (28.8%). Key findings included significant public misconceptions and concerns: 33% of respondents believed that natural immunity from infection was sufficient, while 43% expressed concerns about potential adverse effects, similar to those associated with COVID-19 vaccines. Furthermore, nearly 60% of participants stated they would decline a free MPXV vaccine. Multivariate analysis revealed that prior COVID-19 vaccination (aOR = 3.07, p < 0.05), a moderate VTI score (aOR = 6.65, p < 0.05), and prior influenza vaccination (aOR = 4.00, p < 0.05) were significant predictors of MPXV vaccination willingness. Willingness to pay for the vaccine also positively influenced vaccination intent. One of the common misconceptions found was the belief that having received a smallpox vaccination prior reduces the need for an MPXV vaccination. Conclusions: The willingness to receive an MPXV vaccine in Palestine is suboptimal. Prior vaccination behaviors and general trust in vaccines are key determinants of acceptance. These findings underscore the critical need for public health strategies focused on strengthening trust in vaccine efficacy and safety, along with targeted health education to enhance community preparedness for a potential MPXV outbreak. Full article

Background: Vaccine hesitancy and refusal are growing public health challenges, reflecting individual decisions and social inequalities. The COVID-19 pandemic reshaped vaccine perceptions and may have amplified pre-existing differences. This study analyzed the evolution of vaccine hesitancy and refusal among adults in the Community of Madrid (Spain) between 2019 and 2024. We also explored the associated sociodemographic profiles. Methods: A retrospective observational study was conducted using data from the Non-communicable Disease Risk-Factor Surveillance System through a computer-assisted telephone interview (CATI) survey, targeting adults aged 18–64 years. Four waves (2019, 2020, 2021, 2024) were analyzed. Prevalence rates with 95% confidence intervals (95%CI) were calculated. The associations with sociodemographic variables (sex, age, country of birth, education, and employment status) were assessed using Poisson regression models to obtain crude and adjusted prevalence ratios (aPR). Results: A total of 7978 participants were included (49.1% men; mean age 41.97 years). Vaccine hesitancy increased from 3.8% (95% CI: 3.0–4.7) in 2019 to 18.5% (95% CI: 16.8–20.2) in 2024; vaccine refusal increased from 2.1% (95% CI: 1.6–2.8) to 8.0% (95% CI: 6.9–9.3). Vaccine hesitancy and refusal adjusted for socioeconomic variables increased in 2024 compared to 2019 (PRa: 5.04; 95% CI: 3.96–6.41 and aPR: 4.00; 95% CI: 2.86–5.59, respectively). Hesitancy was associated with female sex and middle age in 2019, to middle age in 2020, to intermediate education and migrant origin in 2021, and to education and migrant status in 2024. Vaccine refusal showed a similar pattern to that of vaccine hesitancy, highlighting the association with socioeconomic vulnerability. Conclusion: Between 2019 and 2024, vaccine hesitancy and refusal increased, and the association with socioeconomic vulnerability has also increased. Equity-based vaccination strategies are needed in order to strengthen institutional trust and reduce structural barriers to vaccine acceptance. Full article

Wastewater monitoring is a well-established form of community-based public health surveillance technology that gained renewed attention during the COVID-19 pandemic as an early warning system for SARS-CoV-2 infection trends. For monitoring data to be effectively translated into public health action, however, communication strategies that address public risk perceptions and foster cooperation are essential. This study focuses on wastewater monitoring in the context of COVID-19 and provides an evidential basis for developing targeted public health messages by segmenting the population into risk perception profiles. A survey of 332 Colorado residents was analyzed using latent class analysis (LCA), revealing four profiles: the worrisome (48%), the practical (19%), the community-oriented (11%), and the minimally concerned (22%). LCA with covariate analysis showed that communal coping orientation, belief in misinformation, and attitudes and knowledge of wastewater monitoring, along with age, education, and political ideology, were associated with these profiles. Findings highlight how communication strategies for community-based public health surveillance can be tailored to different population subgroups. Full article

Health professionals’ safety is directly linked to organizational culture, and during the COVID-19 pandemic, weaknesses at organizational, emotional, professional, and structural levels became evident. This study aimed to assess health professionals’ perceptions of their safety in facing the COVID-19 pandemic. A cross-sectional, descriptive, and analytical study was conducted with professionals from the public health network of a Brazilian municipality who had taken medical leave due to COVID-19. Data were collected between October and December 2022 using the validated Questionnaire on Health Professional Safety in the COVID-19 Pandemic (QSP COVID-19), which consists of 30 items distributed across four domains: organizational, emotional, professional, and structural. A cut-off score ≥75 was considered a positive perception. Associations were tested using the chi-square test followed by the Bonferroni post hoc test, and multivariate logistic regression was applied to identify associated factors. Significance level: 5%. A total of 235 professionals participated, mostly women (81.7%), working in primary health care (68.1%), and employed under statutory contracts (74.5%). Only 50.6% reported an overall positive perception of safety. The emotional domain showed the highest score (85.5%), followed by the professional domain (74.0%). Organizational (50.6%) and structural (33.6%) domains had the lowest scores, reflecting shortcomings in infrastructure, human resources, and material supplies. In the multivariate analysis, temporary contracts, a 20 h workweek, and specific training were protective factors, whereas belonging to a risk group and being female increased the likelihood of negative perception in the structural dimension. Health professionals’ safety is supported by continuous education, emotional support, adequate infrastructure, professional recognition, participatory leadership, and strengthening of the safety culture. Full article

Background/Objectives: As survival improves in congenital heart defects (CHD), psychosocial support—particularly during crises—has become increasingly important. We examined how concerns of CHD patients and their relatives evolved during the Coronavirus Disease 2019 (COVID-19) pandemic, focusing on the influence of role (patient vs. relative), gender, and CHD complexity. Methods: The German National Register for Congenital Heart Defects (NRCHD) conducted two nationwide online surveys in April 2020 (Survey 1) and April 2021 (Survey 2). Free-text responses were analyzed using Mayring’s summarizing content analysis. Categories were coded per respondent (present/absent) for exploratory comparisons by year, role, sex, and CHD complexity. Analyses were cross-sectional and descriptive (p-values unadjusted). Results: In survey 1, 15.9%, and in survey 2, 19.3% of respondents provided qualitative information. In 2020, dominant themes included general COVID-19 information (37.3%), lack of CHD-specific information (30.4%), worry (24.1%), fear (23.2%), isolation (21.4%), and uncertainty (21.2%). By 2021, concerns shifted toward vaccination (24.1%) and vaccination prioritization (23.4%), while information gaps (21.8%) and fear (21.0%) persisted. Significant year-to-year changes included decreases in general information needs, concern, isolation, and uncertainty, and increases in prioritization (all p < 0.01). Relatives consistently reported higher psychological burden than patients (p ≤ 0.01). Conclusions: Concerns moved from early fear/uncertainty to vaccination and prioritization one year later, with persistent information needs across subgroups. Clear CHD-specific communication, caregiver-inclusive psychosocial support, and crisis-resilient care pathways (including telemedicine) are essential for this vulnerable population. Full article

Background/Objectives: Understanding the psychological determinants of vaccine uptake is critical for effective public health strategies, particularly during prolonged pandemics. The Health Belief Model is widely used to examine vaccine behavior, yet its applicability in longitudinal and policy-intensive contexts remains underexplored. This study assessed how two core Health Belief Model constructs—perceived severity of and susceptibility to COVID-19—related to vaccine intentions and uptake over time, and how these perceptions varied by demographic characteristics. Methods: Data came from Optimise, a longitudinal cohort study of adults in Victoria, Australia, conducted between September 2020 and August 2022. Perceived severity of and susceptibility to COVID-19 were measured monthly, alongside COVID-19 vaccine intentions and uptake. Generalized Estimating Equations evaluated associations between these two Health Belief Model constructs and vaccine outcomes over time. Separate models identified demographic predictors of perceived severity and susceptibility. Results: Perceived severity of COVID-19 was positively associated with intention to receive further COVID-19 vaccine doses (OR = 2.53, 95% CI: 1.26–5.07) and the total vaccine doses received (OR = 2.74, 95% CI: 1.58–4.76), with these associations changing over time as vaccine mandates were lifted and the pandemic context evolved. Perceived susceptibility to COVID-19 showed no significant associations with vaccine outcomes. Older age, presence of a chronic health condition, and lower employment status was associated with higher perceived severity. In contrast, perceived susceptibility was higher among high-income earners but lower among older adults and the unemployed. Conclusions: The predictive value of two Health Belief Model constructs was context- and time-dependent. Perceived severity consistently predicted vaccine uptake once mandates were lifted, while susceptibility did not. Our findings highlight the importance of context-sensitive behavioral frameworks when designing vaccine promotion strategies during extended public health crises. Full article

Background and Objectives: Unlike previous studies that have examined telemedicine primarily in pandemic contexts, this research adopts a dual-crisis perspective, assessing perceptions during both pandemics and armed conflicts. Recent health crises, including the COVID-19 pandemic and armed conflicts, have exposed vulnerabilities in health systems and underscored the need for evidence-based strategies to enhance resilience. Telemedicine has emerged as an essential tool for ensuring continuity of care, mitigating workforce shortages, and improving access for vulnerable groups. This study examines healthcare professionals’ perceptions of telemedicine in Romania across two exceptional contexts—pandemics and armed conflict—focusing on applicability, systemic integration, and limitations. Methods: A cross-sectional descriptive survey was conducted among 409 healthcare professionals. Perceptions were analyzed using a SWOT framework and descriptive statistics (percentiles, median) to identify strengths, weaknesses, opportunities, and threats in both scenarios. Results: Perceptions of telemedicine were shaped by prior experience, with strong support for its use in both contexts. Strengths included adaptability and improved access, while weaknesses highlighted technical barriers, insufficient training, and the risk of clinical errors. Threats referred to poor coordination across facilities and cultural or language barriers. Opportunities highlighted the potential for digital infrastructure and integration into preparedness frameworks. Conclusions: Telemedicine is positioned as a strategic tool for strengthening national health resilience. Adaptive, context-sensitive policies, combined with investments in infrastructure and workforce capacity, are essential for integrating telemedicine into emergency preparedness and ensuring sustainable, inclusive responses to future crises. This dual-crisis approach represents the novelty of our study, demonstrating how telemedicine can serve as a strategic tool for resilience in both epidemiological and conflict-related emergencies. Full article

Background/Objectives: This study is part of an exploratory mixed-methods project investigating how companies and their employees in Germany dealt with adapted working conditions during the COVID-19 pandemic. Here, we identify predictive factors for employees’ attitudes towards the suitability of work-related technical, organisational, and personal SARS-CoV-2 infection control measures. Methods: In July 2021, when there was little evidence to suggest that the risk of work-related exposure to SARS-CoV-2 differed between occupations and workplaces, a standardised online and an optional paper-and-pencil survey were distributed across seven companies in southern Germany. Multivariate linear regression was used for analysis. Results: A total of 821 employees participated (average response rate: 24.5%). Most of the respondents (93%) worked in large companies, in the production industry (82%), with most of them having office jobs (82%). Around 29% reported doing most of their office work remotely during the pandemic. The perceived suitability of workplace infection control measures was rated quite high, with an overall mean score of 4.11 (SD 0.60) out of a possible 5. Workplace characteristics related to the COVID-19 pandemic as well as individual perception of SARS-CoV2 and COVID-19 in general were the most prominent predictors of attitudes towards the suitability of work-related SARS-CoV-2 infection control. For example, a higher COVID-19-specific reactance was negatively associated with attitudes towards technical (ß = −0.16), organisational (ß = −0.14), and personal (ß = −0.17) infection control measures (all p-values < 0.001). Furthermore, a higher rating of the employer’s commitment to occupational safety and health related to SARS-CoV-2, a higher individual disease perception, and a higher individual COVID-19-specific resilience had a positive association with attitudes towards the suitability of infection control measures. Finally, professional activity as well as company affiliation had statistically significant associations with employees’ attitudes towards the suitability of infection control measures. Conclusions: The results provide insight into factors relevant to pandemic prevention and control. In particular, our findings highlight the potential to implement organisational measures alongside compulsory technical occupational health measures. This could inform the development of pandemic preparedness strategies that prioritise adherence to established occupational infection control measures. Full article

The COVID-19 pandemic disrupted tourism systems worldwide, particularly ecologically sensitive and tourism-dependent regions such as the Galapagos Islands. This study investigated the impact of the pandemic on profiles of tourists visiting Santa Cruz Island by comparing an analysis from 2019 to data we gathered in 2021. Using survey-based data and cluster analysis, we identified significant shifts in tourist origin, travel modalities, and expenditure patterns. Results showed a marked increase in domestic tourism, with Ecuadorians becoming the dominant visitor group during the pandemic, primarily favoring land-based tourism and shorter stays. In contrast, international tourists remained present in niche, higher-spending segments associated with cruise-based and multi-island itineraries. These findings highlight a temporary yet meaningful transformation in the tourism dynamic, driven by changes in risk perception, economic factors, and policy restrictions. The emergence of these segments underscores the need for adaptive destination management strategies that align with sustainability goals, conservation priorities, and socioeconomic resilience. We also demonstrated the value of structured surveys as a cost-effective tool for evidence-based decision-making in resource-constrained settings. Full article

Cardiovascular diseases (CVDs) are among the most common comorbidities in COVID-19 patients. This multicenter cross-sectional study assessed knowledge, risk perception, precautionary measures, and psychological burden related to COVID-19 among Lebanese individuals with and without CVD during the pandemic’s first wave. A total of 485 CVD patients and 1033 control group (CG) participants completed standardized questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Coronavirus Anxiety Scale. Compared to CG, CVD patients demonstrated significantly lower COVID-19-related knowledge (86.4% vs. 90.0%, p < 0.001) and adherence to preventive measures (81.5% vs. 85.7%, p < 0.001). After stratification, limited knowledge was more common among CVD patients (45.7% vs. 31.8%), as was limited precautionary behavior (70.3% vs. 54.2%). Risk perception was suboptimal in both groups, with no significant difference (41.3% vs. 38.6%, p = 0.072). Anxiety (GAD-7 ≥ 10) and depression (PHQ-9 ≥ 10) were more prevalent among CVD patients (13.4% and 11.3%) than CG participants (9.5% and 16.5%). Survey outcomes were influenced by educational, socioeconomic, and psychosocial factors. These findings highlight the need to target CVD patients in public health campaigns to enhance preparedness and mental health support during pandemics. Full article

The COVID-19 pandemic created unprecedented conditions for examining how vaccination willingness evolves during prolonged health crises. This longitudinal mixed-methods study examines temporal dynamics in COVID-19 vaccination willingness across three phases of Germany’s vaccination campaign (N = 1063 survey respondents; n = 40 interview participants). Using mixed-effects models and thematic analysis, we tested whether institutional trust and personal risk perception predict vaccination willingness and how their relative importance changes over time. Results reveal that trust in scientific institutions emerges as the strongest predictor, outperforming political trust and becoming more influential over time, while risk perceptions become less predictive with time. Qualitative analysis identified a multitude of different argumentative themes for and against COVID-19 vaccination (as well as conditional acceptance), with 30% of participants expressing both. The themes complement the quantitative analysis by demonstrating a shift from analytical, risk-focused decision-making to heuristic, trust-based processing as vaccination campaigns progress, with important implications for adaptive public health communication strategies. Full article

This study examines the evolution of willingness to accept the monkeypox (Mpox) vaccine in Romania between 2022 and 2025. It explores key sociodemographic and behavioral predictors of vaccine acceptance and investigates how public perceptions—particularly concerning disease severity and conspiracy beliefs—have shifted across two independent cross-sectional samples. Two nationally distributed surveys were conducted in July 2022 (n = 820) and January–February 2025 (n = 1029), targeting Romanian residents aged 18 and above. Data were analyzed using descriptive statistics, Chi-square tests, Kolmogorov–Smirnov tests, and a Random Forest classification model to assess the relative importance of predictors of vaccine acceptance. Between 2022 and 2025, vaccine acceptance increased modestly, particularly among individuals aged 36–65 and those with prior experience of voluntary or COVID-19 vaccination. Random Forest analysis identified behavioral factors as the strongest predictors of acceptance in both years, while the influence of education and gender varied over time. Belief in conspiracy theories slightly declined and lost predictive relevance by 2025. Perceptions of pandemic potential and fear of infection also decreased, suggesting reduced risk salience and possible pandemic fatigue. Despite a slight upward trend, overall Mpox vaccine acceptance in Romania remains among the lowest in Europe. These findings highlight the need for targeted public health communication, particularly toward skeptical or demographically vulnerable groups. Prior vaccination behavior emerged as a key driver of acceptance, indicating that trust-building strategies should capitalize on existing pro-vaccination habits. Future research should adopt qualitative and longitudinal approaches to better capture the evolving psychosocial dynamics of vaccine hesitancy. Full article

Burnout, characterized by emotional exhaustion and depersonalization, is increasingly recognized as a significant mental health concern with psychiatric implications. This cross-sectional study explored variables associated with current burnout levels among 2004 teachers in 19 Latin American countries and Spain, drawing on retrospective perceptions of COVID-19 pandemic-related changes in work conditions and student behavior. Using a comprehensive survey, researchers gathered demographic information, work-related characteristics, and burnout levels measured by the Maslach Burnout Inventory. Participants were recruited through social media platforms and teacher groups. Participants reported high emotional exhaustion, with 45.9% exceeding the clinical threshold. Moderate depersonalization levels were observed, with 30.2% scoring above the clinical cutoff. Hierarchical regressions indicated that emotional exhaustion was significantly predicted by individual (e.g., gender, age, socioeconomic status, pre-existing mental and chronic illnesses), school (e.g., school level, sector, and workload), and student factors (e.g., behavior and social adjustment problems), accounting for 17.4% of the variance. Depersonalization was similarly associated with individual (e.g., gender, age, education, and pre-existing mental illness), school (e.g., workload and school level), and student characteristics (e.g., educational, behavioral, and family adjustment problems), explaining 6.5% of the variance. These findings contribute to psychiatric and psychological research by identifying specific risk profiles for chronic stress syndromes in educators—an occupational group facing long-term psychological impacts from the COVID-19 crisis. This study underscores the need for interdisciplinary psychiatric approaches to diagnose and prevent burnout and promote teacher well-being through clinical and policy-level interventions. Full article