Assessing willingness to wear face masks to guide protection strategies in future pandemics

Assessing willingness to wear face masks to guide protection strategies in future pandemics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing willingness to wear face masks to guide protection strategies in future pandemics Changhyun Nam, Ho Yeol Yu, Juyoung Lee, Elizabeth Wachira This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7075786/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Face masks have been widely used to prevent disease transmission during outbreaks. In the United States, their use was initially limited due to cultural stigma and associations with criminal behavior. However, rising mortality rates and evidence of their effectiveness in preventing illnesses like the flu have increased their acceptance. Pandemic-related isolation also worsened mental health issues, emphasizing the need for evidence-based responses. This study explores the factors influencing perceptions and intentions to wear face masks within a proposed conceptual framework. Therefore, this study aimed to identify the factors that affect the perspective and intention to wear face masks in a proposed conceptual framework. Methods A total of 404 surveys were completed by people in the United States who wore face masks during the COVID-19 pandemic. Results In terms of the hypotheses testing, perceived knowledge significantly affected coping and threat appraisal. Only coping appraisal significantly affected moral obligation. Threat appraisal had significant and positive effects on social approval and moral obligation. Perceived intention to wear a face mask was only significantly associated with moral obligation but not social approval. Finally, the perceived intention to wear a face mask significantly affected perceived behavior. Conclusions These findings suggest that perceived knowledge, threat appraisal, coping appraisal, moral obligation, and perceived intention to wear a face mask are important factors influencing the behavior of wearing face masks. protection motivation theory pandemic face mask moral obligation public health Figures Figure 1 1. Background The novel coronavirus disease 2019 (COVID-19) is the greatest global health crisis to date, and as of December 2024, approximately 776 million people have been infected, and 7 million people have lost their lives due to the virus [1]. In the United States, approximately 103 million people have been infected, and 1.2 million died [2]. The initial COVID-19 response efforts relied on non-pharmaceutical interventions (NPI), defined as strategies to limit disease spread until other pharmaceutical measures, such as vaccines, became available [3, 4]. NPI includes social distancing, contact tracing, quarantine, and mandatory indoor masking (4). The three major universal COVID-19 preventive behaviors promoted for adoption included wearing a face mask, frequent handwashing, and social distancing [5-7]. This study defines a face mask as any material used to cover the nose and mouth. Face masks (e.g., surgical masks, N95 respirators, face shields) have been used to curb disease transmission during outbreaks. Although underutilized in the United States, where they are primarily viewed as medical devices, rising mortality rates have renewed their usage due to their proven effectiveness in preventing the spread of infectious diseases, such as the common cold and influenza [5, 8-10]. Despite this, face masks have long been considered taboo due to cultural connotations of criminal behaviors (robbery, theft, murder, etc.) in the United States, especially when wearing certain types of attire, such as a hooded sweatshirt, a baseball hat, or a face mask daily [11-12]. The effectiveness of NPIs, particularly face masks, was acknowledged as many countries mandated their use as part of mitigation efforts [13]. Early pandemic response efforts rely on the quick adoption of NPI measures to curb disease spread before pharmaceutical control measures become available [8]. Unfortunately, despite changes in public perceptions of face mask mandates, people are still skeptical due to variations in individual perceptions of threats related to the pandemic [13]. Scholars believe these variations are due to differences in personal knowledge, experience, social approval, and moral obligation in wearing face masks [14-17]. Albeit effective, NPIs (physical distancing) were linked to negative outcomes that had detrimental effects on wellbeing due to loss of social connections and relationships during peak pandemic times [8, 18]. Furthermore, studies show that pandemic mitigation efforts that isolated people led to an increased prevalence of anxiety and depression as well as more psychological distress for those with existing mental health conditions [18,19]. These findings, coupled with the long-term societal, economic, and public health impact of COVID-19, underscore the importance of evidence-based decision-making during pandemic response efforts. Therefore, this study aimed to identify the factors that affect the perspective and intention to wear face masks in a proposed conceptual framework. Future pandemics are inevitable, making this research essential for preparing effective public health responses [12, 20]. The findings will inform strategies to reduce disease transmission and guide campaigns that encourage the adoption of NPIs. 1.1. Protection Motivation Theory The protection motivation theory (PMT) developed as “a framework for understanding the impact of fear appeals” sheds light on social cognitive processes explaining the motivation to respond to health threats, crises, and dangers [21, 22]. According to PMT, individuals, when faced with a threat, decide whether to engage in protective behavior through two distinct cognitive processes: threat appraisal and coping appraisal [22]. Threat appraisal involves assessing threat vulnerability, severity, and maladaptive rewards, influencing individuals’ adaptive actions [23, 24]. For instance, a high severity and vulnerability perception prompts risk-preventative behaviors, while a high reward perception tends to diminish such behaviors (24). Coping appraisal, on the other hand, focuses on an individual’s ability to execute protective behaviors when faced with a threat [25]. Its components include response efficacy, self-efficacy, and response cost [22]. For individuals to adopt recommended behaviors, perceiving a low cost of performing preventive measures is crucial [22]. For example, Huang et al. demonstrated that high levels of coping appraisal were positively associated with vaccine uptake [16]. Thus, by understanding these factors, researchers can identify potential barriers to behavior change and develop targeted interventions to promote the adoption of protective behaviors, ultimately contributing to efforts to control COVID-19. 1.2. Hypotheses Development The COVID-19 pandemic poses a significant threat to individuals’ health. When faced with a health threat, individuals assess severity and vulnerability based on their perceived knowledge, forming an estimated threat and coping appraisal. A coping appraisal, rooted in previous experience, is formed by assessing self-efficacy and response efficacy. The interaction of threat appraisal and coping appraisal leads to determined protective motivation, subsequently prompting the enactment of protective behavior [26]. Previous research found that Top of FormBottom of Formperceived knowledge has shown a significant association with coping appraisal [16]. Also, greater knowledge among university students regarding COVID-19 has been linked to adherence to social restriction policies [15, 27]. Given that appraisal may depend on individuals’ perceived knowledge and experience, understanding such knowledge is crucial in explaining the willingness to adopt protective behaviors during health crises, such as COVID-19 vaccination uptake [16, 28, 29]. As shown in Figure 1, therefore, the proposed conceptual framework of this study was adopted and incorporated the PMT [21] with the theory of reasoned action (TRA) [30] for understanding fear-based messages and making decisions related to health behaviors (individuals’ attitudes and subjective norms). The PMT process is activated when individuals use perceived knowledge and experience to evaluate the threat or coping associated with wearing a face mask. In other words, individuals are more likely to engage in face-mask behaviors if they perceive a pandemic as having serious negative consequences, activating the protective motivation mechanism. Also, perceived knowledge influenced protection intention, improved engagement in precautionary behavior, and increased coping appraisal [14,15, 17]. Individuals may engage in precautionary or protective behaviors in response to environmental stimuli, indicating an adaptive response [16, 31]. In PMT, threat and coping appraisals are pivotal elements, shaping an individual’s motivation and intention to perform protective behavior. In coping appraisal, response efficacy gauges the perceived effectiveness of recommended behaviors to minimize the impact of COVID-19, while self-efficacy is an individual’s perceived ability to perform the recommended behaviors [32, 33]. Concerning COVID-19 threat appraisal, perceived vulnerability represents the individual’s perceived susceptibility to the COVID-19 threat, while perceived severity indicates the individual’s perceived seriousness of the potential threat posed by COVID-19. Studies have suggested that accurate coping appraisal may strengthen adaptive responses, facilitating individuals in taking protective health behavior [16, 22]. It is crucial to study PMT constructs regarding subsequent adaptive responses and changing behavioral patterns that have emerged during the pandemic or epidemic [23]. For example, evaluating threats and coping ability influences emotions and protective behavior [34, 35]. Therefore, the process of coping appraisal could lead to either social approval or moral obligation in adaptive responses for wearing face-mask behaviors, utilizing the protective motivation mechanism. The following hypotheses were proposed: H1: Perceived knowledge has a positive/negative effect on (a) coping and (b) threat appraisal. H2: Coping appraisal has a positive/negative effect on (a) social approval and (b) moral obligation. H3: Threat appraisal has a positive/negative effect on (a) social approval and (b) moral obligation. 1.3. Theory of Reasoned Action (Adaptive responses) Theory of Reasoned Action (TRA) is a commonly used theory explaining a broad of behavioral studies regarding face mask wearing [8, 30, 36-39]. The TRA explains that the most influential or immediate predictor of intentional behavior is one’s behavioral intention, which is shaped by both individual and normative influences [40]. The influence on intention is represented by an individual’s attitude toward performing the intentional behavior, and the normative influence is the perceived social pressure that individuals perceive from their social environment about a particular behavior [40]. Subjective n orm (Social approval). A subjective norm is social pressure and an individual’s belief about what other people perceive about whether that person should engage in the specified target behavior [38, 40]. A subjective norm is influenced by normative beliefs – the perceived expectations from significant individuals concerning one’s voluntary behavior – and the motivation to adhere to these beliefs [40]. The higher the individual’s subjective norm, the more likely they are to align their behavior with the expectations of others like friends, family, or co-workers [38]. Additionally, masking behavior was diminished by the frequency of respondents observing others not wearing a face mask and the frequency of observing others expressing disdain for masking [41]. It is important to acknowledge the effect of social norms on mask-wearing behaviors. Attitude (Moral obligation) and behavioral intention. An attitude is a balanced or affective response toward the performance of a particular behavior, and an individual’s inclination to engage in a specific behavior is influenced by their beliefs concerning that behavior [40]. Typically, these beliefs connect certain attributes and either a voluntary behavior or an attitude [42]. The attitude towards voluntary behavior is determined by evaluating whether the associated attributes are considered positive or negative [40, 42]. Prior research has defined moral obligation as influenced by individual attitudes, representing an internal motivation to align behavior with personal moral self-expectations based on individual values [43]. The role of moral obligation is crucial in sustaining behaviors that involve personal sacrifices and promoting actions that contribute to the well-being of the collective [43]. Yang and Ren found that both moral obligation and public leadership, along with their constituent indicators, positively contributed to collective actions, and moral obligation and public leadership mutually reinforced each other’s positive influence on collective efforts for COVID-19 prevention and control [44]. Based on the previous research, it can be argued that moral obligation plays a significant role in determining the behavioral intention of wearing a mask. Many social and health psychology theories propose that intentions play a causal role in shaping behaviors [45]. It is natural to argue that behavioral intention positively affects actual behaviors. Therefore, the following hypotheses were proposed: H4: Social approval (subjective norm) positively affects behavioral intention. H5: Moral obligation (attitude) positively affects behavioral intention. H6: Behavioral intention has a positive effect on behavior. 2. Materials and Methods The online survey collected a nationwide convenience sample of consumers in the United States through Amazon Mechanical Turk. The Institutional Review Board at the primary investigator’s institution (Florida State University) approved the study in the United States. 2.1. Participants The online survey took approximately 10 minutes to complete. 587 surveys were initially completed by people in the United States who wore a face mask during the pandemic. The final sample was reduced from 587 to 404 surveys due to the deletion of cases with incomplete questionnaires and failure to qualify. Further, this study examined the data to detect multivariate outliers. Specifically, the data were screened for detecting outliers utilizing a combination of z-scores [46]. For the z-score, raw scores were transformed into z-scores and the values that exceeded |2.58| of z-scores were removed ( n = 44). After removing the outliers, 360 questionnaires were used for further analysis. 2.2. Instrument The survey questionnaire consists of two sections: demographics and the constructs with multiple-item measurements adapted and modified from previous research [16, 17, 47, 48]. To test the hypothesized paths in the proposed conceptual framework, multiple-item measurements: perceived knowledge, threat appraisal, coping appraisal, social approval, moral obligation, perceived intention, and perceived behavior were anchored on a 7-point Likert-type scale. 2.3. Data Analyses With SPSS 29, descriptive analysis was adopted to analyze the preliminary test results and determine the sample demographics. Using Mplus 8, confirmatory factor analysis (CFA) was also conducted to validate the psychometric properties of the measured variables, while structural equation modeling (SEM) was used to test hypotheses. 3. Results 3.1. Demographic analysis Of the 360 respondents, male participants were 48.3% ( n = 174) with an average age of 43.78, while 30% ( n = 108) had annual incomes between $50,000 and $74,999. The majority of the respondents were full-time employees and had a college degree ( n = 216). 74.7% of respondents were Caucasian, followed by Asian (13.3%) and African American (6.1%). 3.2. Preliminary analysis Mardia’s coefficients were used to construct multivariate skewness and kurtosis to test the multivariate normality assumption. Multivariate skewness ( z = 270.184, SD = 1.92, p < 0.001) and multivariate kurtosis ( z = 1442.32, SD = 4.30, p < 0.001) were found to be significant, indicating a violation of the multivariate normality assumption. To mitigate the non-normal distribution, we used a robust estimation technique, which is maximum likelihood mean-adjusted estimation, in the data analyses (MLR) [49]. 3.3. Measurement Validation The psychometric properties of the measurement model are reported in Table 1. The internal consistency of the latent variables was examined using Cronbach's Alpha. All variables Cronbach’s Alpha coefficients were greater than 0.70. In addition, composite reliability values were greater than 0.70. Factor loadings (l) for each item within the measured latent variables were assessed to examine the strength of the relation between the latent variable and item (l > 0.50) [50]. One item in the coping appraisal was removed due to the low factor loading. The revised measurement was assessed and revealed that all factor loadings were greater than the suggested threshold of 0.50. The average variance extracted (AVE) was also assessed to understand whether the factor explains more variance than error [51]. All AVE values of the latent variables were greater than 0.50. Based on the results, the convergent validity was ensured in this study. Moreover, discriminant validity was tested using the Heterotrait-Monotrait ratio of the correlations [52]. According to Henseler et al [53], there is an issue with discriminant validity when HTMT values are higher than .85. In this study, discriminant validity was ensured because all HTMT values were lower than .85 (see Table 2). Finally, the measurement model showed an acceptable fit of the data (S-B χ 2 = 792.73, df = 351, S-Bχ 2 / df = 2.51, CFI = 0.933, RMSEA = 0.06, SRMR = 0.05). [INSERT Table 1] [INSERT Table 2] 3.4. Exploratory results After confirming the psychometric properties of the measurement model, we proceeded with SEM to test the hypotheses in this study. The SEM demonstrated acceptable fit (S-B χ 2 = 1142.43, df = 449, S-Bχ 2 / df = 2.54, CFI = 0.909, RMSEA = 0.06, SRMR = 0.07). In terms of the hypotheses testing, SEM showed that perceived knowledge had a significant effect on coping appraisal (H1a; β = 0.989, SE = 0.017, p = 0.000) and threat appraisal (H1b; β = 0.665, SE = 0.052, p = 0.000). Only coping appraisal had a significant effect on moral obligation (H2b; β = 0.673, SE = 0.064, p = 0.000), but there was no significant effect on social approval (H2a; β = 0.175, SE = 0.120, p = 0.110). Threat appraisal positively affected social approval (H3a; β = 0.605, SE = 0.010, p = 0.000) and moral obligation (H3b; β = 0.287, SE = 0.070, p = 0.000). Perceived intention to wear a face mask was only significantly associated with moral obligation (H5; β = 0.807, SE = 0.063, p = 0.000), but not social approval (H4; β = 0.114, SE = 0.075, p = 0.127). Lastly, the perceived intention to wear a face mask significantly affected perceived behavior (H6; β = 0.843, SE = 0.046, p = 0.000). Additional post-hoc analyses investigating the mediating effects were conducted. Perceived knowledge did not have significant positive effects on perceived behavior through coping appraisal, social approval, and perceived intention to wear a face mask ( β = 0.013, SE = 0.016, p = 0.417; CI [-0.016; 0.075]) and through threat appraisal, social approval, and perceived intention to wear a face mask ( β = 0.071, SE = 0.051, p = 0.165; CI [-0.006; 0.101]). In contrast, perceived knowledge had significant positive effects on perceived behavior through threat appraisal, moral obligation, and perceived intention to wear a face mask ( β = 0.149, SE = 0.036, p = 0.000; CI [0.135; 0.459]) and through coping appraisal, moral obligation, and perceived intention to wear a face mask ( β = 0.394, SE = 0.062, p = 0.000; CI [0.274; 0.514]). [INSERT Figure 1] 4. Discussion The findings of this study offered valuable insights for both theoretical advancements in health behavior research and practical strategies for promoting mask-wearing behavior in real- life world situations. H1a and H1b were supported, indicating that perceived knowledge significantly affects both coping and threat appraisal. This suggests that individuals with higher perceived knowledge are more likely to view the situation as manageable (coping appraisal) and as a threat (threat appraisal) in protection motivation. Only coping appraisal (H2b) had an effect on moral obligation (e.g., government policies or public rules), implying that individuals who perceive the situation as manageable are more likely to feel morally obligated to wear face masks [16, 23]. No significant effect of coping appraisal on social approval (H2a) was found, suggesting that social approval may be influenced by other factors, such as cultural or religious beliefs [54, 55]. Threat appraisal significantly influenced both social approval (H3a) and moral obligation (H3b), indicating that individuals who perceive the situation as a threat are more likely to seek social approval and feel morally obligated to wear face masks. Perceived intention to wear a face mask was significantly associated with moral obligation (H5), suggesting that individuals who feel morally obligated are more likely to intend to wear face masks. However, there was no significant effect on social approval (H4), implying that individual beliefs, cultural norms, and risk perceptions regarding face masks may not directly influence perceived intention. Finally, perceived intention to wear a face mask significantly affected actual behavior (H6), indicating that individuals who intend to wear face masks are more likely to exhibit the behavior of wearing a face mask [36, 38]. Also, the study explored the mediating effects of various factors on perceived behavior. Perceived knowledge had significant positive effects on perceived behavior through threat appraisal, moral obligation, and perceived intention to wear a face mask, and through coping appraisal. This suggested that individuals with higher perceived knowledge are more likely to translate their knowledge into actual behavior in the proposed framework. 4.1. Theoretical implications A proposed conceptual framework of this study extended the PMT by incorporating the TRA emphasis on attitudes (moral obligation), subjective norms (social approval) in the adaptive responses, and behavioral intention. By considering protection motivation and adaptive responses, the study sheds light on the wearer's intention and behavior related to wearing a face mask. Thus, the framework of this study allows for the examination of cognitive and affective processes that underlie behavior change and enables researchers to explore complex pathways and interactions among variables, such as the mediating role of coping and threat appraisals in the relationship between perceived knowledge and behavioral intentions. 4.2. Practical implications The main implication of these findings is that public health campaigns can be designed to enhance individuals’ perceived knowledge about the importance of mask-wearing, emphasizing its efficacy in coping with the threat of infectious diseases. Messages regarding wearing a face mask in the health campaign should also highlight individuals' moral obligation toward protecting themselves and others. Understanding the differential effects of coping and threat appraisals on moral obligation and social approval can inform targeted interventions. For instance, public health messages could emphasize moral responsibility and the collective benefits of mask-wearing to resonate with broader community values [44]. Encouraging individuals to endorse mask-wearing behavior publicly can influence social approval perceptions and foster a sense of collective responsibility. Research shows that social norms within one’s social network can shape health behaviors, so interventions that equip trusted community gatekeepers to facilitate discussions on vaccination or masking can shape social norms that influence the uptake of pandemic preventive behaviors [6]. In addition, another way to shape social norms is through messaging campaigns that feature influential figures who can positively change perceptions and behaviors related to disease prevention [41]. Furthermore, government authorities and public health organizations establish and enforce the rules governing face masks at the national, state, or local levels. These policies are crucial in shaping consumers' adherence to face-mask guidelines, especially during infectious disease outbreaks. For example, rules could focus on increasing the wearing of masks, educating about their effectiveness, and implementing positive behaviors. Educational initiatives targeting specific populations (e.g., schools, workplaces, community groups) can incorporate information about the importance of mask-wearing and strategies to enhance coping appraisals. These programs can empower individuals with the knowledge and skills to make informed decisions about mask-wearing. 5. Conclusion The study demonstrated that perceived knowledge influenced coping and threat appraisals, which in turn shaped the moral obligation to wear masks. While coping appraisal affected moral obligation, it did not impact social approval. In contrast, threat appraisal influenced both social approval and moral obligation. Additionally, the perceived intention to wear a mask predicted actual behavior, with higher perceived knowledge driving increased mask-wearing through these pathways. This study underscored the importance of integrating theoretical insights to promote adaptive behaviors. Lessons from past pandemics emphasized the need for evidence-based response efforts. These findings provide valuable guidance for designing interventions and policy recommendations that enhance public health messaging, raise disease awareness, and strengthen social norms, ultimately fostering a greater moral obligation to protect others. Declarations Acknowledgments The author(s) would like to express gratitude to the Jim Moran College of Entrepreneurship, Health and Human Performance, and the School of Human Sciences for their support and encouragement throughout this endeavor. Authorship statement Conceptualization, C.N., H.Y.Y., J.L.; methodology, formal analysis, data curation, C.N., H.Y.Y.; investigation, C.N.; Writing, original draft preparation, C.N., H.Y.Y., J.L.; Review and editing, C.N., H.Y.Y., J.L., E.W. All authors have read and agreed to the published version of the manuscript. Declaration of Conflicting Interests The authors declare that they have no conflicts of interest regarding the publication of this article. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Ethics approval This study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided informed consent prior to participation. The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Florida State University (STUDY# 00002266). References World Health Organization. Coronavirus Disease (COVID-19) [cited June 11, 2024]. Available from https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19) World Health Organization. COVID-19 Epidemiological Update [cited January 15, 2025]. https://www.who.int/publications/m/item/covid-19-epidemiological-update-edition-172 Brüssow H. 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The influence of social conformity on mask-wearing behavior during the COVID-19 pandemic. Heliyon. 2023;9(3).1-11. https://www.cell.com/heliyon/fulltext/S2405-8440(23)01703-6 Zlobina A, Dávila MC. Preventive behaviours during the pandemic: The role of collective rituals, emotional synchrony, social norms and moral obligation. British Journal of Social Psychology . 2022;61(4):1332-1350. https://doi.org/10.1111/bjso.12539 Yang L, Ren Y. Moral obligation, public leadership, and collective action for epidemic prevention and control: Evidence from the corona virus disease 2019 (COVID-19) emergency. International Journal of Environmental Research and Public Health . 2020; 17(8):1-16. https://doi.org/10.3390/ijerph17082731 Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin . 2006;132(2):249-268. https://doi.org/10.1037/0033-2909.132.2.249 Field, A. 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Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research . 1981;18(1):39-50. https://doi.org/10.1177/002224378101800104 Voorhees CM, Brady MK, Calantone R, Ramirez E. Discriminant validity testing in marketing: an analysis, causes for concern, and proposed remedies. Journal of the Academy of Marketing Science. 2016;44:119-134. https://doi.org/10.1007/s11747-015-0455-4 Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the academy of marketing science. 2015;43:115-135. https://doi.org/10.1007/s11747-014-0403-8 Ma M, Raza SH, Yousaf M, Zaman U, Jin Q. Investigating the psychological, social, cultural, and religious predictors of COVID-19 vaccine uptake intention in digital age: A media dependency theory perspective. Vaccines . 2023;11(8):1-22. https://doi.org/10.3390/vaccines11081338 Roy DN, Biswas M, Islam E, Azam MS. Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review. PloS One . 2022;17(3):1-22. https://doi.org/10.1371/journal.pone.0265496 Tables Table 1. Psychometric properties of the measurement model Construct & Item l CR AVE Perceived Knowledge I know exactly how the face mask will protect me from the pandemic I know exactly by what kind of mechanism the face mask will activate to protect my mouse and nose against the COVID-19 viruses The face mask plays an important role in protecting our lives 0.63 0.55 0.89 0.74 0.50 Threat Appraisal If I get a flu-like symptom tomorrow, I will be very worried In the past experience, I will be worried that I might get pandemic or epidemic Compared to other people, I think it is likely that I will get pandemic or epidemic the in future 0.79 0.79 0.77 0.83 0.62 Coping Appraisal Wearing a face mask is going to reduce the possibility to get COVID-19 Wearing a face mask is important to me Wearing a face mask will significantly reduce the possibility of getting COVID-19 Wearing a face mask will have a positive influence on my health status 0.78 0.84 0.86 0.82 0.89 0.69 Social Approval Wearing a face mask helps me gain social approval Wearing a face mask makes a good impression on others Wearing a face mask affects how people perceive me Wearing a face mask makes me feel accepted by others 0.88 0.88 0.67 0.91 0.90 0.71 Moral Obligation I feel obligated to wear a face mask for my health I feel obligated to wear a face mask for my family’s health I feel obligated to wear a face mask for other people’s health Everybody should be obligated to wear a face mask in public settings Wearing a face mask should keep me or others safe in public settings 0.86 0.88 0.90 0.87 0.81 0.93 0.75 Perceived Intention to Wear a Face Mask I am willing to wear a face mask in a public setting I am ready to wear a face mask in a public setting I will make an effort to wear a face mask in a public setting Before the pandemic, I will prepare a face mask for an emergency Before the pandemic, I will prepare a face mask as an emergency plan 0.76 0.73 0.93 0.88 0.73 0.86 0.56 Perceived Behavior I have been wearing a face mask in a public setting I have been wearing a face mask behavior for the pandemic/epidemic I have been recommending my (relative) families wear a face mask I have been recommending my friends wear a face mask I have been recommending people wear a face mask on social media 0.76 0.73 0.93 0.88 0.73 0.90 0.66 Notes. l= standardized loading; C.R. = composite reliability; AVE = average variance extracted. Table 2. Assessment of discriminant validity using HTMT PKW TA COA SOA MOB WEAR PB PKW - TA 0.53 - COA 0.83 0.63 - SOA 0.44 0.71 0.55 - MOB 0.63 0.71 0.84 0.65 - WEAR 0.62 0.67 0.77 0.55 0.79 - PB 0.58 0.73 0.75 0.70 0.79 0.76 - Note. PKW = perceived knowledge; TA = threat appraisal; COA = coping appraisal; SOA = social approval; MOB = moral obligation; WEAR = perceived intention to wear a face mask; PB = perceived behavior to wear a face mask. Additional Declarations No competing interests reported. Supplementary Files DataFaceCoverings.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7075786","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503096191,"identity":"51e4289b-d050-4fec-acb3-64e084f94c08","order_by":0,"name":"Changhyun Nam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYLCCDzxAgvkAiMlMnA7GGSAtbAkkaGEG6SBeC//s5qebbWS2yTOwsT+TYKiwTmwgpEXizjGz2zk8tw0b2HjMJBjOpBPWYiCRANaSwCDfwybB2HaYGC3p325bgLSAHMb4jygtOWa3GcBaGMwkGBuI0CJxI6fsZg/QL21sPMYWCcfSjQlq4Z+Rvu3Gz57b8vxs7A9vfKixliWoBQwYe4DRAmIkEKUcDH4Qr3QUjIJRMApGIAAACEA3YKlLYscAAAAASUVORK5CYII=","orcid":"","institution":"Florida State University","correspondingAuthor":true,"prefix":"","firstName":"Changhyun","middleName":"","lastName":"Nam","suffix":""},{"id":503096192,"identity":"9b066b6a-cb20-4480-b9e7-12e796612716","order_by":1,"name":"Ho Yeol Yu","email":"","orcid":"","institution":"East Texas A\u0026M University","correspondingAuthor":false,"prefix":"","firstName":"Ho","middleName":"Yeol","lastName":"Yu","suffix":""},{"id":503096193,"identity":"f8ff0ae7-12fd-492d-8cc1-e24d07cb0912","order_by":2,"name":"Juyoung Lee","email":"","orcid":"","institution":"Mississippi State University","correspondingAuthor":false,"prefix":"","firstName":"Juyoung","middleName":"","lastName":"Lee","suffix":""},{"id":503096194,"identity":"684548f0-9fe4-406b-abe6-b99314fb98dc","order_by":3,"name":"Elizabeth Wachira","email":"","orcid":"","institution":"East Texas A\u0026M University","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Wachira","suffix":""}],"badges":[],"createdAt":"2025-07-08 14:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7075786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7075786/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89585306,"identity":"a6643396-585f-43a6-9db5-d35b2e195a59","added_by":"auto","created_at":"2025-08-21 14:59:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":176290,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eHypothesis testing for indirect and direct paths in the proposed conceptual framework.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7075786/v1/e06fc546901212d89292c9c7.png"},{"id":95526012,"identity":"8c9fd4d5-8571-4266-9b90-c81203272fe3","added_by":"auto","created_at":"2025-11-10 10:06:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":984562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7075786/v1/20cbebfe-3d63-4b58-9ca8-c53f96598879.pdf"},{"id":89585309,"identity":"44dff46c-abea-4326-ab81-1308eb63dfb4","added_by":"auto","created_at":"2025-08-21 14:59:31","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":319662,"visible":true,"origin":"","legend":"","description":"","filename":"DataFaceCoverings.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7075786/v1/270c3c5b41d094dfeedf9fe9.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing willingness to wear face masks to guide protection strategies in future pandemics","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe novel coronavirus disease 2019 (COVID-19) is the greatest global health crisis to date, and as of December 2024, approximately 776 million people have been infected, and 7 million people have lost their lives due to the virus [1]. In the United States, approximately 103 million people have been infected, and 1.2 million died [2]. The initial COVID-19 response efforts relied on non-pharmaceutical interventions (NPI), defined as strategies to limit disease spread until other pharmaceutical measures, such as vaccines, became available [3, 4]. NPI includes social distancing, contact tracing, quarantine, and mandatory indoor masking (4). The three major universal COVID-19 preventive behaviors promoted for adoption included wearing a face mask, frequent handwashing, and social distancing [5-7].\u003c/p\u003e\n\u003cp\u003eThis study defines a face mask as any material used to cover the nose and mouth. Face masks (e.g., surgical masks, N95 respirators, face shields) have been used to curb disease transmission during outbreaks. Although underutilized in the United States, where they are primarily viewed as medical devices, rising mortality rates have renewed their usage due to their proven effectiveness in preventing the spread of infectious diseases, such as the common cold and influenza [5, 8-10]. Despite this, face masks have long been considered taboo due to cultural connotations of criminal behaviors (robbery, theft, murder, etc.) in the United States, especially when wearing certain types of attire, such as a hooded sweatshirt, a baseball hat, or a face mask daily [11-12].\u003c/p\u003e\n\u003cp\u003eThe effectiveness of NPIs, particularly face masks, was acknowledged as many countries mandated their use as part of mitigation efforts [13]. Early pandemic response efforts rely on the quick adoption of NPI measures to curb disease spread before pharmaceutical control measures become available [8]. Unfortunately, despite changes in public perceptions of face mask\u003c/p\u003e\n\u003cp\u003emandates, people are still skeptical due to variations in individual perceptions of threats related\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eto the pandemic [13]. Scholars believe these variations are due to differences in personal\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eknowledge, experience, social approval, and moral obligation in wearing face masks [14-17].\u003c/p\u003e\n\u003cp\u003eAlbeit effective, NPIs (physical distancing) were linked to negative outcomes that had detrimental effects on wellbeing due to loss of social connections and relationships during peak pandemic times [8, 18]. Furthermore, studies show that pandemic mitigation efforts that isolated people led to an increased prevalence of anxiety and depression as well as more psychological distress for those with existing mental health conditions [18,19]. These findings, coupled with the long-term societal, economic, and public health impact of COVID-19, underscore the importance of evidence-based decision-making during pandemic response efforts. Therefore, this study aimed to identify the factors that affect the perspective and intention to wear face masks in a proposed conceptual framework. Future pandemics are inevitable, making this research essential for preparing effective public health responses [12, 20]. The findings will inform strategies to reduce disease transmission and guide campaigns that encourage the adoption of NPIs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1. Protection Motivation Theory\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protection motivation theory (PMT) developed as \u0026ldquo;a framework for understanding the impact of fear appeals\u0026rdquo; sheds light on social cognitive processes explaining the motivation to respond to health threats, crises, and dangers [21, 22]. According to PMT, individuals, when faced with a threat, decide whether to engage in protective behavior through two distinct cognitive processes: threat appraisal and coping appraisal [22]. Threat appraisal involves assessing threat vulnerability, severity, and maladaptive rewards, influencing individuals\u0026rsquo; adaptive actions [23, 24]. For instance, a high severity and vulnerability perception prompts risk-preventative behaviors, while a high reward perception tends to diminish such behaviors (24). Coping appraisal, on the other hand, focuses on an individual\u0026rsquo;s ability to execute protective behaviors when faced with a threat [25]. Its components include response efficacy, self-efficacy, and response cost [22]. For individuals to adopt recommended behaviors, perceiving a low cost of performing preventive measures is crucial [22]. For example, Huang et al. demonstrated that high levels of coping appraisal were positively associated with vaccine uptake [16].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThus, by understanding these factors, researchers can identify potential barriers to behavior change and develop targeted interventions to promote the adoption of protective behaviors, ultimately contributing to efforts to control COVID-19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2. Hypotheses Development\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe COVID-19 pandemic poses a significant threat to individuals\u0026rsquo; health. When faced with a health threat, individuals assess severity and vulnerability based on their perceived knowledge, forming an estimated threat and coping appraisal. A coping appraisal, rooted in previous experience, is formed by assessing self-efficacy and response efficacy. The interaction of threat appraisal and coping appraisal leads to determined protective motivation, subsequently prompting the enactment of protective behavior [26]. Previous research found that Top of FormBottom of Formperceived knowledge has shown a significant association with coping appraisal [16]. Also, greater knowledge among university students regarding COVID-19 has been linked to adherence to social restriction policies [15, 27]. Given that appraisal may depend on individuals\u0026rsquo; perceived knowledge and experience, understanding such knowledge is crucial in explaining the willingness to adopt protective behaviors during health crises, such as COVID-19 vaccination uptake [16, 28, 29]. As shown in Figure 1, therefore, the proposed conceptual framework of this study was adopted and incorporated the PMT [21] with the theory of reasoned action (TRA) [30] for understanding fear-based messages and making decisions related to health behaviors (individuals\u0026rsquo; attitudes and subjective norms).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe PMT process is activated when individuals use perceived knowledge and experience to evaluate the threat or coping associated with wearing a face mask. In other words, individuals are more likely to engage in face-mask behaviors if they perceive a pandemic as having serious negative consequences, activating the protective motivation mechanism. Also, perceived knowledge influenced protection intention, improved engagement in precautionary behavior, and increased coping appraisal [14,15, 17].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndividuals may engage in precautionary or protective behaviors in response to\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eenvironmental stimuli, indicating an adaptive response [16, 31]. In PMT, threat and coping appraisals are pivotal elements, shaping an individual\u0026rsquo;s motivation and intention to perform protective behavior. In coping appraisal, response efficacy gauges the perceived effectiveness of recommended behaviors to minimize the impact of COVID-19, while self-efficacy is an individual\u0026rsquo;s perceived ability to perform the recommended behaviors [32, 33]. Concerning COVID-19 threat appraisal, perceived vulnerability represents the individual\u0026rsquo;s perceived susceptibility to the COVID-19 threat, while perceived severity indicates the individual\u0026rsquo;s perceived seriousness of the potential threat posed by COVID-19. Studies have suggested that accurate coping appraisal may strengthen adaptive responses, facilitating individuals in taking protective health behavior [16, 22]. It is crucial to study PMT constructs regarding subsequent adaptive responses and changing behavioral patterns that have emerged during the pandemic or epidemic [23]. For example, evaluating threats and coping ability influences emotions and protective behavior [34, 35]. Therefore, the process of coping appraisal could lead to either social approval or moral obligation in adaptive responses for wearing face-mask behaviors, utilizing the\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eprotective motivation mechanism. The following hypotheses were proposed:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH1:\u003c/strong\u003e Perceived knowledge has a positive/negative effect on (a) coping and (b) threat appraisal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH2:\u003c/strong\u003e Coping appraisal has a positive/negative effect on (a) social approval and (b) moral\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eobligation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH3:\u003c/strong\u003e Threat appraisal has a positive/negative effect on (a) social approval and (b) moral obligation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3. Theory of Reasoned Action (Adaptive responses)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTheory of Reasoned Action (TRA) is a commonly used theory explaining a broad of behavioral studies regarding face mask wearing [8, 30, 36-39]. The TRA explains that the most influential or immediate predictor of intentional behavior is one\u0026rsquo;s behavioral intention, which is shaped by both individual and normative influences [40]. The influence on intention is represented by an individual\u0026rsquo;s attitude toward performing the intentional behavior, and the normative influence is the perceived social pressure that individuals perceive from their social environment about a particular behavior [40].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubjective\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eorm (Social approval).\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eA subjective norm is social pressure and an individual\u0026rsquo;s belief about what other people perceive about whether that person should engage in the specified target behavior [38, 40]. A subjective norm is influenced by normative beliefs \u0026ndash; the perceived expectations from significant individuals concerning one\u0026rsquo;s voluntary behavior \u0026ndash; and the motivation to adhere to these beliefs [40]. The higher the individual\u0026rsquo;s subjective norm, the more likely they are to align their behavior with the expectations of others like friends, family, or co-workers [38].\u0026nbsp;Additionally, masking behavior was diminished by the frequency of respondents observing others not wearing a face mask and the frequency of observing others expressing disdain for masking [41].\u0026nbsp;It is important to acknowledge the effect of social norms on mask-wearing behaviors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAttitude (Moral obligation) and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ebehavioral intention.\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eAn attitude is a balanced or\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eaffective response toward the performance of a particular behavior, and an individual\u0026rsquo;s\u0026nbsp;\u003c/p\u003e\n\u003cp\u003einclination to engage in a specific behavior is influenced by their beliefs concerning that behavior [40]. Typically, these beliefs connect certain attributes and either a voluntary behavior or an attitude [42]. The attitude towards voluntary behavior is determined by evaluating whether the associated attributes are considered positive or negative [40, 42].\u003c/p\u003e\n\u003cp\u003ePrior research has defined moral obligation as influenced by individual attitudes, representing an internal motivation to align behavior with personal moral self-expectations based on individual values [43]. The role of moral obligation is crucial in sustaining behaviors that involve personal sacrifices and promoting actions that contribute to the well-being of the collective [43]. Yang and Ren found that both moral obligation and public leadership, along with their constituent indicators, positively contributed to collective actions, and moral obligation and public leadership mutually reinforced each other\u0026rsquo;s positive influence on collective efforts for COVID-19 prevention and control [44]. Based on the previous research, it can be argued that moral obligation plays a significant role in determining the behavioral intention of wearing a mask. Many social and health psychology theories propose that intentions play a causal role in shaping behaviors [45]. It is natural to argue that behavioral intention positively affects actual\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ebehaviors. Therefore, the following hypotheses were proposed:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH4:\u003c/strong\u003e Social approval (subjective norm) positively affects behavioral intention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH5:\u003c/strong\u003e Moral obligation (attitude) positively affects behavioral intention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH6:\u003c/strong\u003e Behavioral intention has a positive effect on behavior.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eThe online survey collected a nationwide convenience sample of consumers in the United States through Amazon Mechanical Turk. The Institutional Review Board at the primary investigator\u0026rsquo;s institution (Florida State University) approved the study in the United States.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. Participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe online survey took approximately 10 minutes to complete. 587 surveys were initially completed by people in the United States who wore a face mask during the pandemic. The final sample was reduced from 587 to 404 surveys due to the deletion of cases with incomplete questionnaires and failure to qualify. Further, this study examined the data to detect multivariate outliers. Specifically, the data were screened for detecting outliers utilizing a combination of z-scores [46]. For the z-score, raw scores were transformed into z-scores and the values that exceeded |2.58| of z-scores were removed (\u003cem\u003en\u003c/em\u003e = 44). After removing the outliers, 360 questionnaires were used for further analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Instrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey questionnaire consists of two sections: demographics and the constructs with multiple-item measurements adapted and modified from previous research [16, 17, 47, 48]. To test the hypothesized paths in the proposed conceptual framework, multiple-item measurements: perceived knowledge, threat appraisal, coping appraisal, social approval, moral obligation,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eperceived intention, and perceived behavior were anchored on a 7-point Likert-type scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Data Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith SPSS 29, descriptive analysis was adopted to analyze the preliminary test results and determine the sample demographics. Using Mplus 8, confirmatory factor analysis (CFA) was also conducted to validate the psychometric properties of the measured variables, while \u0026nbsp;structural equation modeling (SEM) was used to test hypotheses.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Demographic analysis \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 360 respondents, male participants were 48.3% (\u003cem\u003en\u003c/em\u003e = 174) with an average age of 43.78, while 30% (\u003cem\u003en\u003c/em\u003e = 108) had annual incomes between $50,000 and $74,999. The majority of the respondents were full-time employees and had a college degree (\u003cem\u003en\u003c/em\u003e = 216). 74.7% of respondents were Caucasian, followed by Asian (13.3%) and African American (6.1%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Preliminary analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMardia\u0026rsquo;s coefficients were used to construct multivariate skewness and kurtosis to test the multivariate normality assumption. Multivariate skewness (\u003cem\u003ez\u003c/em\u003e = 270.184, \u003cem\u003eSD\u003c/em\u003e = 1.92, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and multivariate kurtosis (\u003cem\u003ez\u003c/em\u003e = 1442.32, \u003cem\u003eSD\u003c/em\u003e = 4.30, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) were found to be significant, indicating a violation of the multivariate normality assumption. To mitigate the non-normal distribution, we used a robust estimation technique, which is maximum likelihood mean-adjusted \u0026nbsp;estimation, in the data analyses (MLR) [49].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Measurement Validation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe psychometric properties of the measurement model are reported in Table 1. The internal consistency of the latent variables was examined using Cronbach\u0026apos;s Alpha. All variables Cronbach\u0026rsquo;s Alpha coefficients were greater than 0.70. In addition, composite reliability values were greater than 0.70. Factor loadings (l) for each item within the measured latent variables were assessed to examine the strength of the relation between the latent variable and item (l \u0026gt; 0.50) [50]. One item in the coping appraisal was removed due to the low factor loading. The revised measurement was assessed and revealed that all factor loadings were greater than the suggested threshold of 0.50. The average variance extracted (AVE) was also assessed to understand whether the factor explains more variance than error [51]. All AVE values of the latent variables were greater than 0.50. Based on the results, the convergent validity was ensured in this study. Moreover, discriminant validity was tested using the Heterotrait-Monotrait ratio of the correlations [52]. According to Henseler et al [53], there is an issue with discriminant validity when HTMT values are higher than .85. In this study, discriminant validity was ensured because all HTMT values were lower than .85 (see Table 2). Finally, the measurement model showed an acceptable fit of the data (S-B \u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 792.73, \u003cem\u003edf\u003c/em\u003e = 351, S-B\u0026chi;\u003csup\u003e2\u003c/sup\u003e/\u003cem\u003edf =\u003c/em\u003e2.51, CFI = 0.933, RMSEA = 0.06, SRMR = 0.05). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[INSERT Table 1]\u003c/p\u003e\n\u003cp\u003e[INSERT Table 2]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4. Exploratory results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter confirming the psychometric properties of the measurement model, we proceeded with SEM to test the hypotheses in this study. The SEM demonstrated acceptable fit (S-B \u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 1142.43, \u003cem\u003edf\u003c/em\u003e = 449, S-B\u0026chi;\u003csup\u003e2\u003c/sup\u003e/\u003cem\u003edf =\u003c/em\u003e2.54, CFI = 0.909, RMSEA = 0.06, SRMR = 0.07). In terms of the hypotheses testing, SEM showed that perceived knowledge had a significant effect on coping appraisal (H1a; \u003cem\u003e\u0026beta;\u003c/em\u003e = 0.989, \u003cem\u003eSE\u003c/em\u003e = 0.017, \u003cem\u003ep\u003c/em\u003e = 0.000) and threat appraisal (H1b; \u003cem\u003e\u0026beta;\u003c/em\u003e = 0.665, \u003cem\u003eSE\u003c/em\u003e = 0.052, \u003cem\u003ep\u003c/em\u003e = 0.000). Only coping appraisal had a significant effect on moral obligation (H2b;\u003cem\u003e\u0026nbsp;\u0026beta;\u003c/em\u003e = 0.673, \u003cem\u003eSE\u003c/em\u003e = 0.064, \u003cem\u003ep\u003c/em\u003e = 0.000), but there was no significant effect on social approval (H2a;\u003cem\u003e\u0026nbsp;\u0026beta;\u003c/em\u003e = 0.175, \u003cem\u003eSE\u003c/em\u003e = 0.120, \u003cem\u003ep\u003c/em\u003e = 0.110). Threat appraisal positively affected social approval (H3a; \u003cem\u003e\u0026beta;\u003c/em\u003e = 0.605, \u003cem\u003eSE\u003c/em\u003e = 0.010, \u003cem\u003ep\u003c/em\u003e = 0.000) and moral obligation (H3b;\u003cem\u003e\u0026nbsp;\u0026beta;\u003c/em\u003e = 0.287, \u003cem\u003eSE\u003c/em\u003e = 0.070, \u003cem\u003ep\u003c/em\u003e = 0.000). Perceived intention to wear a face mask was only significantly associated with moral obligation (H5;\u003cem\u003e\u0026nbsp;\u0026beta;\u003c/em\u003e = 0.807, \u003cem\u003eSE\u003c/em\u003e = 0.063, \u003cem\u003ep\u003c/em\u003e = 0.000), but not social approval (H4; \u003cem\u003e\u0026beta;\u003c/em\u003e = 0.114, \u003cem\u003eSE\u003c/em\u003e = 0.075, \u003cem\u003ep\u003c/em\u003e = 0.127). Lastly, the perceived intention to wear a face mask significantly affected perceived behavior (H6;\u003cem\u003e\u0026nbsp;\u0026beta;\u003c/em\u003e = 0.843, \u003cem\u003eSE\u003c/em\u003e = 0.046, \u003cem\u003ep\u003c/em\u003e = 0.000).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditional post-hoc analyses investigating the mediating effects were conducted. Perceived knowledge did not have significant positive effects on perceived behavior through coping appraisal, social approval, and perceived intention to wear a face mask (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.013, \u003cem\u003eSE\u003c/em\u003e = 0.016, \u003cem\u003ep\u003c/em\u003e = 0.417; CI [-0.016; 0.075]) and through threat appraisal, social approval, and perceived intention to wear a face mask (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.071, \u003cem\u003eSE\u003c/em\u003e = 0.051, \u003cem\u003ep\u003c/em\u003e = 0.165; CI [-0.006; 0.101]). In contrast, perceived knowledge had significant positive effects on perceived behavior through threat appraisal, moral obligation, and perceived intention to wear a face mask (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.149, \u003cem\u003eSE\u003c/em\u003e = 0.036, \u003cem\u003ep\u003c/em\u003e = 0.000; CI [0.135; 0.459]) and through coping appraisal, moral obligation, and perceived intention to wear a face mask (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.394, \u003cem\u003eSE\u003c/em\u003e = 0.062, \u003cem\u003ep\u003c/em\u003e = 0.000; CI [0.274; 0.514]). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[INSERT Figure 1]\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe findings of this study offered valuable insights for both theoretical advancements in \u0026nbsp;health behavior research and practical strategies for promoting mask-wearing behavior in real-\u003c/p\u003e\n\u003cp\u003elife world situations. H1a and H1b were supported, indicating that perceived knowledge significantly affects both coping and threat appraisal. This suggests that individuals with higher perceived knowledge are more likely to view the situation as manageable (coping appraisal) and as a threat (threat appraisal) in protection motivation. Only coping appraisal (H2b) had an effect on moral obligation (e.g., government policies or public rules), implying that individuals who perceive the situation as manageable are more likely to feel morally obligated to wear face masks [16, 23]. No significant effect of coping appraisal on social approval (H2a) was found, suggesting that social approval may be influenced by other factors, such as cultural or religious beliefs [54, 55]. Threat appraisal significantly influenced both social approval (H3a) and moral obligation (H3b), indicating that individuals who perceive the situation as a threat are more likely to seek social approval and feel morally obligated to wear face masks. Perceived intention to wear a face mask was significantly associated with moral obligation (H5), suggesting that individuals who feel morally obligated are more likely to intend to wear face masks. However, there was no significant effect on social approval (H4), implying that individual beliefs, cultural norms, and risk perceptions regarding face masks may not directly influence perceived intention. Finally, perceived intention to wear a face mask significantly affected actual behavior (H6), indicating that individuals who intend to wear face masks are more likely to exhibit the behavior of wearing a face mask [36, 38]. Also, the study explored the mediating effects of various factors on perceived behavior. Perceived knowledge had significant positive effects on perceived behavior through threat appraisal, moral obligation, and perceived intention to wear a face mask, and through coping appraisal. This suggested that individuals with higher perceived knowledge are more likely to translate their knowledge into actual behavior in the proposed framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1. Theoretical implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA proposed conceptual framework of this study extended the PMT by incorporating the TRA emphasis on attitudes (moral obligation), subjective norms (social approval) in the adaptive responses, and behavioral intention. By considering protection motivation and adaptive responses, the study sheds light on the wearer\u0026apos;s intention and behavior related to wearing a face\u0026nbsp;mask.\u0026nbsp;Thus, the framework of this study allows for the examination of cognitive and affective processes that underlie behavior change and enables researchers to explore complex pathways and interactions among variables, such as the mediating role of coping and threat appraisals in the relationship between perceived knowledge and behavioral intentions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Practical implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main implication of these findings is that public health campaigns can be designed to enhance individuals\u0026rsquo; perceived knowledge about the importance of mask-wearing, emphasizing its efficacy in coping with the threat of infectious diseases. Messages regarding wearing a face mask in the health campaign should also highlight individuals\u0026apos; moral obligation toward protecting themselves and others.\u0026nbsp;Understanding the differential effects of coping and threat appraisals on moral obligation and social approval can inform targeted interventions. For instance, public health messages could emphasize moral responsibility and the collective benefits of mask-wearing to resonate with broader community values [44]. Encouraging individuals to endorse mask-wearing behavior publicly can influence social approval perceptions and foster a sense of collective responsibility. Research shows that social norms within one\u0026rsquo;s social network can shape health behaviors, so interventions that equip trusted community gatekeepers to facilitate discussions on vaccination or masking can shape social norms that influence the uptake of pandemic preventive behaviors [6]. In addition, another way to shape social norms is through messaging campaigns that feature influential figures who can positively change perceptions and behaviors related to disease prevention [41].\u003c/p\u003e\n\u003cp\u003eFurthermore, government authorities and public health organizations establish and enforce the rules governing face masks at the national, state, or local levels. These policies are crucial in shaping consumers\u0026apos; adherence to face-mask guidelines, especially during infectious disease outbreaks. For example, rules could focus on increasing the wearing of masks, educating about their effectiveness, and implementing positive behaviors. Educational initiatives targeting specific populations (e.g., schools, workplaces, community groups) can incorporate information about the importance of mask-wearing and strategies to enhance coping appraisals. These programs can empower individuals with the knowledge and skills to make informed decisions about mask-wearing.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe study demonstrated that perceived knowledge influenced coping and threat appraisals, which in turn shaped the moral obligation to wear masks. While coping appraisal affected moral obligation, it did not impact social approval. In contrast, threat appraisal influenced both social approval and moral obligation. Additionally, the perceived intention to wear a mask predicted actual behavior, with higher perceived knowledge driving increased mask-wearing through these pathways. This study underscored the importance of integrating theoretical insights to promote adaptive behaviors. Lessons from past pandemics emphasized the need for evidence-based response efforts. These findings provide valuable guidance for designing interventions and policy recommendations that enhance public health messaging, raise disease awareness, and strengthen social norms, ultimately fostering a greater moral obligation to protect others.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) would like to express gratitude to the Jim Moran College of Entrepreneurship, Health and Human Performance, and the School of Human Sciences for their support and encouragement throughout this endeavor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, C.N., H.Y.Y., J.L.; methodology, formal analysis, data curation, C.N., H.Y.Y.; investigation, C.N.; Writing, original draft preparation, C.N., H.Y.Y., J.L.; Review and editing, C.N., H.Y.Y., J.L., E.W. All authors have read and agreed to the published version of the manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Conflicting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest regarding the publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided informed consent prior to participation. The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Florida State University (STUDY# 00002266).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Coronavirus Disease (COVID-19) [cited June 11, 2024]. Available from https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19)\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. COVID-19 Epidemiological Update [cited January 15, 2025]. https://www.who.int/publications/m/item/covid-19-epidemiological-update-edition-172\u003c/li\u003e\n\u003cli\u003eBr\u0026uuml;ssow H. 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Explaining COVID-19 vaccination intention in younger adults using protection motivation theory. \u003cem\u003eHealth Psychology\u003c/em\u003e. 2023;42(8):577-583. https://doi.org/10.1037/hea0001231\u003c/li\u003e\n\u003cli\u003eFishbein M, Ajzen I. Belief, attitude, intention, and behavior: An introduction to theory and research. 1975. Boston, MA: Addison-Wesley Publishing.\u003c/li\u003e\n\u003cli\u003eTsai HY, Jiang M, Alhabash S, LaRose R, Rifon NJ, Cotten SR. Understanding online safety behaviors: A protection motivation theory perspective. Computers \u0026amp; Security. 2016;59:138-50. https://doi.org/10.1016/j.cose.2016.02.009\u003c/li\u003e\n\u003cli\u003ePlotnikoff RC, Trinh L. Protection motivation theory: is this a worthwhile theory for physical activity promotion?. \u003cem\u003eExercise and Sport Sciences Reviews\u003c/em\u003e. 2010;38(2):91-98. https://doi.org/10.1097/JES.0b013e3181d49612\u003c/li\u003e\n\u003cli\u003eWilcock A, Pun M, Khanona J, Aung M. 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The influence of self‐efficacy, subjective norms, and risk perception on behavioral intentions related to the H1N1 flu pandemic: A comparison between Korea and the US. \u003cem\u003eAsian Journal of Social Psychology\u003c/em\u003e. 2015;18(4):311-324. https://doi.org/10.1111/ajsp.12104\u003c/li\u003e\n\u003cli\u003eBarile JP, Guerin RJ, Fisher KA, Tian LH, Okun AH, Vanden Esschert KL, Jeffers A, Gurbaxani BM, Thompson WW, Prue CE. Theory-based behavioral predictors of self-reported use of face coverings in public settings during the COVID-19 pandemic in the United States. \u003cem\u003eAnnals of Behavioral Medicine\u003c/em\u003e. 2021;55(1):82-88. https://doi.org/10.1093/abm/kaaa109\u003c/li\u003e\n\u003cli\u003eSun Y, Qin B, Hu Z, Li H, Li X, He Y, Huang H. Predicting mask-wearing behavior intention among international students during COVID-19 based on the theory of planned behavior. \u003cem\u003eAnnals of Palliative Medicine\u003c/em\u003e. 2021;10(4):3633-3647. https://doi.org/10.21037/apm-20-2242\u003c/li\u003e\n\u003cli\u003eYasa NN, Rahmayanti PL, Telagawathi NL, Witarsana IG, Liestiandre HK. COVID-19 perceptions, subjective norms, and perceived benefits to attitude and behavior of continuous using of medical mask. \u003cem\u003eLinguistics and Culture Review\u003c/em\u003e. 2021;5(S2):1259-1280. https://doi.org/10.21744/lingcure.v5nS2.1805\u003c/li\u003e\n\u003cli\u003eZhao X, Knobel P. Face mask wearing during the COVID-19 pandemic: comparing perceptions in China and three European countries. \u003cem\u003eTranslational Behavioral Medicine\u003c/em\u003e. 2021;11(6):1199-204. https://doi.org/10.1093/tbm/ibab043\u003c/li\u003e\n\u003cli\u003eHale J. 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A meta-analysis of the experimental evidence. \u003cem\u003ePsychological Bulletin\u003c/em\u003e. 2006;132(2):249-268. https://doi.org/10.1037/0033-2909.132.2.249\u003c/li\u003e\n\u003cli\u003eField, A. \u003cem\u003eDiscovering statistics using IBM SPSS Statistics \u003c/em\u003e(4th ed.). 2013. Thousand Oaks, CA: Sage Publications Inc.\u003c/li\u003e\n\u003cli\u003eYadav R, Pathak GS. Determinants of consumers\u0026apos; green purchase behavior in a developing nation: Applying and extending the theory of planned behavior. Ecological economics. 2017; 134:114-122. https://doi.org/10.1016/j.ecolecon.2016.12.019\u003c/li\u003e\n\u003cli\u003eLi D, Cheng G, Wang C. The influence of moral identity on green consumption. Frontiers in psychology. 2022;13:1-11. https://doi.org/10.3389/fpsyg.2022.1020333\u003c/li\u003e\n\u003cli\u003eSatorra, A., Bentler, P. M. Corrections to test statistics and standard errors in covariance structure analysis. In A. von Eye \u0026amp; C. C. Clogg (Eds.), \u003cem\u003eLatent variables analysis: Applications for developmental research\u003c/em\u003e. 1994:399\u0026ndash;419. Thousand Oaks, CA: Sage Publications Inc.\u003c/li\u003e\n\u003cli\u003eKline, R. B. \u003cem\u003ePrinciples and practice of structural equation modeling (4th ed.)\u003c/em\u003e. 2016. New York, NY: Guilford Press.\u003c/li\u003e\n\u003cli\u003eFornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. \u003cem\u003eJournal of Marketing Research\u003c/em\u003e. 1981;18(1):39-50. https://doi.org/10.1177/002224378101800104\u003c/li\u003e\n\u003cli\u003eVoorhees CM, Brady MK, Calantone R, Ramirez E. Discriminant validity testing in marketing: an analysis, causes for concern, and proposed remedies. Journal of the Academy of Marketing Science. 2016;44:119-134. https://doi.org/10.1007/s11747-015-0455-4\u003c/li\u003e\n\u003cli\u003eHenseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the academy of marketing science. 2015;43:115-135. https://doi.org/10.1007/s11747-014-0403-8\u003c/li\u003e\n\u003cli\u003eMa M, Raza SH, Yousaf M, Zaman U, Jin Q. Investigating the psychological, social, cultural, and religious predictors of COVID-19 vaccine uptake intention in digital age: A media dependency theory perspective. \u003cem\u003eVaccines\u003c/em\u003e. 2023;11(8):1-22. https://doi.org/10.3390/vaccines11081338\u003c/li\u003e\n\u003cli\u003eRoy DN, Biswas M, Islam E, Azam MS. Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review. \u003cem\u003ePloS One\u003c/em\u003e. 2022;17(3):1-22. https://doi.org/10.1371/journal.pone.0265496\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 1.\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003ePsychometric properties of the measurement model\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eConstruct \u0026amp; Item\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003el\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003eAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived Knowledge\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eI know exactly how the face mask will protect me from the pandemic\u003c/p\u003e\n \u003cp\u003eI know exactly by what kind of mechanism the face mask will activate to protect my mouse and nose against the COVID-19 viruses\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe face mask plays an important role in protecting our lives\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eThreat Appraisal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eIf I get a flu-like symptom tomorrow, I will be very worried\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIn the past experience, I will be worried that I might get pandemic or epidemic\u003c/p\u003e\n \u003cp\u003eCompared to other people, I think it is likely that I will get pandemic or epidemic the in future\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCoping Appraisal\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eWearing a face mask is going to reduce the possibility to get COVID-19\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWearing a face mask is important to me\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWearing a face mask will significantly reduce the possibility of getting COVID-19\u003c/p\u003e\n \u003cp\u003eWearing a face mask\u0026nbsp;will have a positive influence on my health status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocial Approval\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eWearing a face mask helps me gain social approval\u003c/p\u003e\n \u003cp\u003eWearing a face mask makes a good impression on others\u003c/p\u003e\n \u003cp\u003eWearing a face mask affects how people perceive me\u003c/p\u003e\n \u003cp\u003eWearing a face mask\u0026nbsp;makes me feel accepted by others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMoral Obligation\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eI feel obligated to wear a face mask for my health\u003c/p\u003e\n \u003cp\u003eI feel obligated to wear a face mask for my family\u0026rsquo;s health\u003c/p\u003e\n \u003cp\u003eI feel obligated to wear a face mask for other people\u0026rsquo;s health\u003c/p\u003e\n \u003cp\u003eEverybody should be obligated to wear a face mask in public settings\u003c/p\u003e\n \u003cp\u003eWearing a face mask should keep me or others safe in public settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived Intention to Wear a Face Mask\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eI am willing to wear a face mask in a public setting\u003c/p\u003e\n \u003cp\u003eI am ready to wear a face mask in a public setting\u003c/p\u003e\n \u003cp\u003eI will make an effort to wear a face mask in a public setting\u003c/p\u003e\n \u003cp\u003eBefore the pandemic, I will prepare a face mask for an emergency\u003c/p\u003e\n \u003cp\u003eBefore the pandemic, I will prepare a face mask as an emergency plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived Behavior\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.0285%;\"\u003e\n \u003cp\u003eI have been wearing a face mask in a public setting\u003c/p\u003e\n \u003cp\u003eI have been wearing a face mask behavior for the pandemic/epidemic\u003c/p\u003e\n \u003cp\u003eI have been recommending my (relative) families wear a face mask\u003c/p\u003e\n \u003cp\u003eI have been recommending my friends wear a face mask\u003c/p\u003e\n \u003cp\u003eI have been recommending people wear a face mask on social media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.7764%;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.6437%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.4855%;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNotes.\u003c/em\u003e\u003c/strong\u003e l= standardized loading; C.R. = composite reliability; AVE = average variance extracted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 2.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eAssessment of discriminant validity using HTMT\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003ePKW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eCOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eMOB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eWEAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003ePB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003ePKW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eCOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eSOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eMOB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eWEAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003ePB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003ePKW = perceived knowledge; TA = threat appraisal; COA = coping appraisal; SOA = social approval; MOB = moral obligation; WEAR = perceived intention to wear a face mask; PB = perceived behavior to wear a face mask.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"protection motivation theory, pandemic, face mask, moral obligation, public health","lastPublishedDoi":"10.21203/rs.3.rs-7075786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7075786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFace masks have been widely used to prevent disease transmission during outbreaks. In the United States, their use was initially limited due to cultural stigma and associations with criminal behavior. However, rising mortality rates and evidence of their effectiveness in preventing illnesses like the flu have increased their acceptance. Pandemic-related isolation also worsened mental health issues, emphasizing the need for evidence-based responses. This study explores the factors influencing perceptions and intentions to wear face masks within a proposed conceptual framework. Therefore, this study aimed to identify the factors that affect the perspective and intention to wear face masks in a proposed conceptual framework.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 404 surveys were completed by people in the United States who wore face masks during the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn terms of the hypotheses testing, perceived knowledge significantly affected coping and threat appraisal. Only coping appraisal significantly affected moral obligation. Threat appraisal had significant and positive effects on social approval and moral obligation. Perceived intention to wear a face mask was only significantly associated with moral obligation but not social approval. Finally, the perceived intention to wear a face mask significantly affected perceived behavior.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings suggest that perceived knowledge, threat appraisal, coping appraisal, moral obligation, and perceived intention to wear a face mask are important factors influencing the behavior of wearing face masks.\u003c/p\u003e","manuscriptTitle":"Assessing willingness to wear face masks to guide protection strategies in future pandemics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 14:59:26","doi":"10.21203/rs.3.rs-7075786/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"915b2ab9-bbc7-4426-b8c3-bbd597865cc3","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-07T07:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-21 14:59:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7075786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7075786","identity":"rs-7075786","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}