The Underlying Structure of Preventive Behaviors and Related Factors During the COVID-19 Pandemic: A Comprehensive Network Analysis

Background Various strategies against COVID-19 have been adopted in different countries, with vaccination and mask-wearing being widely used as self-preventive interventions. However, the underlying structure of these behaviors and related factors remain unclear.Purpose In this study, we aimed to explore the network structure of preventive behaviors during the COVID-19 pandemic and their underlying factors, incorporating age and sex in the network.Methods We used a multi-center sample of 20,863 adults who were vaccinated against COVID-19 in China between April 1, 2021, and June 1, 2021. Networks were estimated using unregularized partial correlation models. We also estimated the accuracy and stability of the network.Results The preventive behaviors related to network factors revealed that self-initiated vaccination was more connected with cognition factors, and mask-wearing was more connected with personal profiles. The two clusters were linked through information-seeking and political beliefs. Moreover, self-initiated vaccination was negatively connected with vaccine hesitancy and concerns about COVID-19 vaccines and positively connected with trust in the vaccines, pandemic-related altruism, political beliefs, and being married. Mask-wearing was negatively connected with being a professional/white collar worker and higher education level and positively connected with regular physical examination, self-rated health, migration, being married, and better family relationships. Incorporation of age and sex into the network revealed relevant associations between age and mask-wearing and age and self-initiated vaccination. The network was highly accurately estimated. The subset bootstrap showed that the order of node strength centrality, betweenness, and closeness were all stable. The correlation stability coefficient (CS-coefficient) also showed the stability of this estimate, with 0.75 for node strength, 0.75 for betweenness, and 0.67 for closeness.Conclusions The internal structures of vaccination and mask-wearing behaviors were quite different, the latter of which were mainly affected by socioeconomic status and health-related behaviors and the former by knowledge about vaccines and political beliefs. Information-seeking and family relationships were the bridge factors connecting these two self-preventive behavior clusters, suggesting the direction of future efforts. This study focused on the map of connections and eventual dynamic influences among preventive behaviors and their underlying factors during the COVID-19 pandemic. The findings provide novel insights into the complex relationships among infection prevention behaviors and related factors. Being vaccinated and mask-wearing seem to be similar self-preventive behaviors but function in different patterns. Mask-wearing behaviors were found to be mainly affected by participants' personal profiles, including SES and health-related behaviors, whereas self-initiated vaccination behavior was more related to vaccine knowledge and hesitancy, political beliefs, and pandemic-related altruism. Information-seeking and family relationships were bridge factors connecting those two self-preventive behavior clusters. Our study findings suggest differentiated strategies to promote self-initiated vaccination and proactive mask-wearing. We also suggest a targeted information strategy focusing more on vaccination safety and efficacy and advocating the protection of family members and others by engaging in these self-preventive behaviors.