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The COVID-19 pandemic poses a major challenge to people’s everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service–related affective reactions and anticipated behaviors during the COVID-19 pandemic.
The aim of this study was to identify key factors that are associated with individuals’ concerns about hygiene in hospitals and the postponement of surgeries.
We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis.
We found that anxiety had a direct effect on people’s concerns about safety (β=−.12, 95% CI −.20 to −.05) and hygiene in hospitals (β=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors.
Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients.
In Germany, the first COVID-19 case was confirmed at the end of January 2020, and COVID-19 incidence rates rose in the following 3 months. In response, the Robert Koch Institute (ie, the German federal government agency and research institute responsible for disease control and prevention) and the Federal Centre for Health Education made the following recommendations to slow the interpersonal transmission of SARS-CoV-2: limit social contact, refrain from traveling unless absolutely necessary, work from home wherever possible, encourage the use of medical masks and gloves, and strengthen hand hygiene practices [
An example of an affective reaction resulting from a concern about an impending or anticipated threat is worrying about the lack of personal protective equipment in hospitals. Various factors, such as sociodemographic characteristics and personal values, can be used to predict affective reactions [
Based on previous pandemics, it is known that segmenting the population into subgroups (ie, sociodemographic subgroups) is important for designing and delivering messages about health risks and health protection measures [
We hypothesized that individuals with low levels of openness, high levels of conscientiousness, low levels of extraversion, low levels of agreeableness, high levels of neuroticism, low levels of risk-taking behavior, and high levels of anxiety would experience high levels of negative affective reactions and exhibit high levels of anticipated preventive behaviors in response to hospitalization and medical service provision.
This cross-sectional, web-based survey study took place between March 19 and April 17, 2020. To ensure that our survey was highly visible to potential respondents, it was distributed via social media, email, direct communication methods, and advertisements in various digital communication channels. The recruitment of participants mainly took place at the Department of Psychology of Witten/Herdecke University. All participants were residents of Germany who were aged ≥16 years. All procedures in this study were performed in accordance with the ethical standards of the institutional review board of the Department of Psychology and Psychotherapy of Witten/Herdecke University and those of the American Psychology Association [
Prior to the survey, we screened potentially eligible test instruments and scales to assess their suitability for answering the hypotheses. We selected validated scales (ie, whenever possible) for measuring the different survey constructs. We also developed new scales to measure the COVID-19–specific aspects of the survey, as no validated instruments were available at the time of the survey. The development of survey items was based on existing scales from other behavioral domains.
The following survey items, which were answered by using a visual analog scale that ranged from 0 (ie, not at all) to 100 (ie, absolutely), served as dependent variables: affective reactions and anticipated behaviors.
Affective reactions [
Anticipated behaviors were measured with two items for assessing people’s decisions to postpone their own surgery or advise a person close to them against surgery during the pandemic. These items were in line with previous studies [
The following survey items served as independent variables: personality, risk-taking behaviors, and anxiety.
People’s personalities were measured with the Big Five Inventory (BFI)-10, which is the short version of the BFI-44 [
Risk-taking behaviors were assessed with the readiness to take risk/search for competition scale of the Hamburger Personality Inventory (HPI), which includes 14 items that are evaluated with a 4-point Likert scale (eg, “Ultimately, I am also unstoppable by massive threats”). HPI item scores are added to calculate a risk-taking score [
Anxiety was measured with the German version of the Spielberger State-Trait Anxiety Inventory (STAI), which is one of the most commonly used standard tools for measuring anxiety. In research, STAI scores also function as an indicator of distress. The state anxiety portion of the STAI consists of 20 items that are evaluated on a 4-point Likert scale (eg, “I feel worried”). All item scores are added to calculate a state anxiety score [
To assess whether people’s risk of contracting COVID-19 and information-seeking behaviors (ie, those related to COVID-19) had an impact on their worries and anticipated behaviors, the following constructs were included in our analysis as covariates: risk profile and information-seeking behaviors.
Risk profiles were adapted in accordance with previous studies [
Information-seeking behaviors were adapted in accordance with a previous study [
Participants who fully completed the questionnaires were included in the statistical analysis. Descriptive statistical analyses were performed to describe the sample’s characteristics in terms of the variables that were included in this study. In addition, bivariate correlation values were computed to examine associations among the variables. A saturated path model [
The hypothesized path model for identifying associations between independent variables (ie, personality traits, risk-taking behaviors, and anxiety) and dependent variables (ie, worries about safety, worries about hygiene, and anticipated behaviors). The model used data from 929 participants. We did not display the control variables (ie, risk profiles, information-seeking behaviors, age, gender, and education) to keep the model overview simple. Dotted lines refer to
Age, gender, and educational level (ie, a dichotomous variable that accounted for primary and secondary education) were introduced in the model as covariates that needed to be controlled. All variables in the model were allowed to covary. Standardized regression coefficients (ie, βi) for the path model (ie, the model for predicting affective reactions) and anticipated behaviors were calculated with the decomposition equation of correlations (ie,
Of the 1059 participants who took part in our survey, 929 (87.7%) had complete data sets. Thus, these 929 participants were included in the analyses. As indicated in
Descriptive statistics and correlations among the variables in the path model are reported in
The sample’s sociodemographic characteristics.
Sociodemographic variables | Value | ||
Age (years), mean (SD) | 35.3 (12.9) | ||
Age (years), median (range) | 32 (16-82) | ||
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Male | 137 (14.7) | |
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Female | 792 (85.3) | |
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No school degree | 3 (0.3) | |
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Secondary school | 6 (1.7) | |
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Secondary modern education | 108 (11.6) | |
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Vocational baccalaureate | 75 (8.1) | |
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General baccalaureate | 223 (24) | |
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Applied science university diploma | 116 (12.5) | |
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Bachelor’s degree | 181 (19.5) | |
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Master’s degree | 172 (18.5) | |
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Doctorate degree or higher | 34 (3.7) | |
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Not infected | 890 (95.8) | |
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I was under suspicion | 17 (1.8) | |
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I am under suspicion | 15 (1.6) | |
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I was infected | 5 (0.5) | |
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I am infected | 2 (0.2) | |
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No risk factors | 683 (73.5) | |
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Aged >60 years | 50 (5.4) | |
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Chronic lung disease | 112 (12.1) | |
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Autoimmune disease | 66 (7.1) | |
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Diabetes | 31 (3.3) | |
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Cancer | 15 (1.6) | |
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Immunodeficiency | 56 (6) | |
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Intake of immunosuppressants | 43 (4.6) | |
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Friends and family | 369 (39.7) | |
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Television | 553 (59.5) | |
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Internet in general | 401 (43.2) | |
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Social media | 402 (43.3) | |
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Dedicated websites | 758 (81.6) | |
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Newspapers | 495 (53.3) | |
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Tabloid press articles | 29 (3.1) | |
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Yes | 884 (95.2) | |
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No | 45 (4.8) |
Bivariate correlations (ie, r values) among variables.
Variable | Conscientiousness | Extraversion | Agreeableness | Neuroticism | RTBa | Anxiety | Risk profile | Information profile | Feeling secureb | Hygieneb | Own surgeryc | Surgery of a close personc | |||||||||||||
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0.03 | 0.03 | 0.03 | −0.01 | 0.12e | 0.01 | 0.02 | −0.07e | 0.01 | 0.03 | 0.01 | <−0.01 | ||||||||||||
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.39 | .10 | .35 | .77 | <.001 | 0.7 | .57 | 0.05 | .78 | .38 | .73 | .91 | |||||||||||||
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—d | 0.12e | 0.08e | −0.15e | 0.12e | −0.12e | 0.03 | −0.08e | 0.02 | −0.04 | 0.02 | 0.06 | ||||||||||||
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— | <.001 | .02 | <.001 | <.001 | <.001 | .38 | .02 | .59 | .25 | .51 | .09 | |||||||||||||
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— | — | 0.13e | −0.30e | 0.22e | −0.22e | −0.01 | <0.01 | 0.05 | −0.11e | −0.01 | −0.02 | ||||||||||||
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— | — | <.001 | <.001 | <.001 | <.001 | .75 | .90 | .13 | <.001 | .88 | .57 | |||||||||||||
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— | — | — | −0.12e | −0.04 | −0.19e | −0.03 | 0.01 | 0.08e | -0.09e | −0.02 | <−0.01 | ||||||||||||
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— | — | — | <.001 | .23 | <.001 | .41 | .84 | .02 | .007 | .47 | .95 | |||||||||||||
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— | — | — | — | −0.32e | 0.48e | 0.03 | 0.03 | −0.05 | 0.13e | −0.01 | 0.01 | ||||||||||||
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— | — | — | — | <.001 | <.001 | .36 | .43 | .11 | <.001 | .69 | .79 | |||||||||||||
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— | — | — | — | — | −0.20e | 0.04 | −0.04 | 0.04 | −0.05 | −0.09e | −0.06 | ||||||||||||
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— | — | — | — | — | <.001 | .24 | .23 | .19 | .14 | .007 | .07 | |||||||||||||
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— | — | — | — | — | — | 0.09e | 0.07e | −0.14e | 0.21e | 0.08e | 0.06 | ||||||||||||
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— | — | — | — | — | — | .005 | .04 | <.001 | <.001 | .02 | .05 | |||||||||||||
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— | — | — | — | — | — | — | 0.06 | −0.07e | 0.12e | 0.02 | 0.07e | ||||||||||||
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— | — | — | — | — | — | — | .08 | .03 | <.001 | .47 | .04 | |||||||||||||
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— | — | — | — | — | — | — | — | <−0.01 | 0.04 | −0.01 | 0.05 | ||||||||||||
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— | — | — | — | — | — | — | — | .98 | .25 | .77 | .16 | |||||||||||||
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— | — | — | — | — | — | — | — | — | −0.40e | −0.13e | −0.13e | ||||||||||||
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— | — | — | — | — | — | — | — | — | <.001 | <.001 | <.001 | |||||||||||||
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— | — | — | — | — | — | — | — | — | — | 0.18e | 0.18e | ||||||||||||
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— | — | — | — | — | — | — | — | — | — | <.001 | <.001 | |||||||||||||
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— | — | — | — | — | — | — | — | — | — | — | 0.70e | ||||||||||||
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— | — | — | — | — | — | — | — | — | — | — | <.001 |
aRTB: risk-taking behavior.
bRefers to a worry.
cRefers to an anticipated behavior category.
dNot applicable.
eSignificant at a level of
Mean and SD values of variables.
Variable | Value, mean (SD) |
Openness | 7.60 (2.02) |
Conscientiousness | 7.15 (1.65) |
Extraversion | 6.66 (1.97) |
Agreeableness | 6.20 (1.58) |
Neuroticism | 6.26 (2.04) |
Risk-taking behavior | 31.26 (7.13) |
Anxiety | 43.91 (12.23) |
Risk profile | 0.40 (0.80) |
Information profile | 3.24 (1.36) |
Worries about feeling secure | 48.32 (28.23) |
Worries about hygiene | 57.33 (30.35) |
Anticipated behavior relating to own surgery | 80.46 (28.45) |
Anticipated behavior relating to the surgery of a close person | 77.32 (28.93) |
The path model predicted the associations between independent variables (ie, personality, risk-taking behaviors, and anxiety) and dependent variables (ie, feelings about security, worries about hospital hygiene and medical practices, and anticipated behaviors that relate to people’s decisions to postpone their own surgery or advise a person close to them against surgery).
The following model-data fit indices were obtained: Chi-square value (
Standardized regression coefficients of the path model, which was used to predict affective reactions and anticipated behaviors.
Path predictors | Affective reactions | Anticipated behaviors | ||
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Feeling secure, β (95% CI) | Concerns about hygiene, β (95% CI) | Own surgery, β (95% CI) | Surgery of a close person, β (95% CI) |
Openness | <.01 (−.07 to .08) | .02 (−.05 to .09) | .02 (−.04 to .09) | −.02 (−.09 to .05) |
Conscientiousness | .01 (−.05 to .08) | −.03a (−.09 to .04) | .01 (−.06 to .08) | .03 (−.03 to .10) |
Extraversion | .03 (−.04 to .10) | −.07a (−.14 to <.01) | .01 (−.06 to .08) | −.02 (−.09 to .05) |
Agreeableness | .05 (−.02 to .12) | −.05a (−.11 to .02) | −.03 (−.10 to .05) | <.01 (−.06 to .07) |
Neuroticism | .05 (−.03 to .13) | .01 (−.07 to .09) | −.08b (−.16 to −.01) | −.02 (−.10 to .06) |
Risk-taking behavior | .01 (−.07 to .08) | <.01 (−.07 to .08) | −.09b (−.16 to −.01) | −.04 (−.12 to .03) |
Anxiety | −.12c (−.20 to −.05) | .16d (.08 to .23) | .08b (.01 to .16) | .05 (−.03 to .13) |
Risk profile | −.06 (−.14 to .01) | .08b (.02 to .14) | <.01 (−.07 to .08) | .01 (−.05 to .08) |
Information-seeking behavior | −.01 (−.09 to .07) | −.01 (−.07 to .05) | .01 (−.14 to .15) | .03 (−.05 to .10) |
Gendere | .09b (.02 to .17) | −.06a (−.12 to .01) | −.08a (−.16 to .01) | −.08b (−.15 to −.01) |
Age | −.05 (−.13 to .03) | .10c (.03 to .17) | .09b (.01 to .16) | .18d (.11 to .25) |
Educationf | .03 (−.05 to .11) | −.08b (−.16 to <−.01) | −.06 (−.16 to .04) | −.11c (−.19 to −.03) |
aSignificant at a level of
bSignificant at a level of
cSignificant at a level of
dSignificant at a level of
eIn the path model, women were given a value of 1 and men were given a value of 2.
fIn the path model, secondary education was given a value of 1 and tertiary education was given a value of 2.
As outlined in
To the best of our knowledge, our study is the first to investigate predictors of affective reactions that relate to hospital safety, hospital hygiene, and medical practices during the COVID-19 pandemic. We are also the first to investigate anticipated behaviors that relate to people’s decisions to postpone their surgery or advise a person close to them against surgery during the pandemic. Our findings are in line with those of a German-Austrian survey [
Aside from the strengths of our study (eg, its large sample size), several limitations also need to be mentioned. First, due to the dynamic nature of the pandemic, we decided to use a random sample. However, due to our survey dissemination methods, our sample may not be representative of the German population. The generalizability of our results is open to empirical debate, as our sample mostly consisted of middle-aged and well-educated women. Research has shown that compared to men, women are more likely to actively seek health-related information and pay more attention to potential worldwide pandemics [
Our results provide further insight into affective reactions and anticipated health-related behaviors during the COVID-19 pandemic. Our findings indicate that OCEAN personality traits are not associated with affective reactions and anticipated behaviors. Therefore, specific distinctions do not seem necessary when designing messages about health risks and health protection measures (ie, those related to hospital and medical practices during the COVID-19 pandemic). Even though future research is needed to confirm our results, health care workers should address the issues of patients with anxiety seriously and directly. Clear communication is necessary when providing information on the specific actions that hospitals and medical organizations perform to protect patients and health care workers. This could also help with preventing the cancellation of nonurgent surgeries in hospitals.
Big Five Inventory
Hamburger Personality Inventory
openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism
State-Trait Anxiety Inventory
TO, JR, and JG conceptualized this study. TO and TR designed the methodology of this study. JG, JR, and TO designed the survey. TO and TR performed the statistical analysis. TO, JG, and TR prepared the data. TO and TR wrote the initial manuscript draft. TO, JR, JG, and TR reviewed and edited the manuscript. TR created the figures and tables. TO supervised this study. All authors read and approved the published version of the manuscript.
None declared.