The document discusses a study examining the role of risk perception and affective response in COVID-19 preventive behaviors among young adults in the Netherlands, published in the BMJ Open journal. The study utilized a mixed methods approach, incorporating both quantitative surveys and qualitative interviews, to analyze the relationship between perceived risk, emotional responses, and adherence to preventive measures. Major findings indicate that higher risk perception and worry among participants correlated with increased adherence to COVID-19 guidelines, though overall adherence varied significantly among different behaviors.

1. 49th Annual National Conference of IAPSM &
23rd Joint IAPSM & IPHA Conference, Maharashtra Chapter 2022
JOURNAL CLUB COMPETITION
Dr. IMMANUEL JOSHUA
Junior Resident-II
Dept. of Community Medicine
Banaras Hindu University
Varanasi-221005

2. TITLE
The role of risk perception and affective response in the COVID-19
preventive behaviours of young adults: A mixed methods study of
university students in the Netherlands
 Journal name – BMJ Open
 Type of Journal – International Journal
 Date of publication – January 25, 2022
 Impact factor – 2.692
 DOI– 10.1136/bmjopen-2021-056288
 Authors – Jelena Kollmann, Paul L Kocken, Elena V Syurina, Femke Hilverda
 Funding – No specific funding for this work
ABOUT
THE
JOURNAL:

3. PROBLEM STATEMENT
On Jan 30 2020, the WHO declared COVID-19 as a Global Public Health Emergency
Due to a lower percentage of hospitalisation and death induced by COVID-19,
young adults might underestimate their risk of COVID-19
Preventive guidelines have been implemented in order to prevent its spread
Young adults (20-40 years) appear to be at lower risk than older adults
and adults with comorbidity
Research shows that most new COVID-19 infections originate from the
younger population (ages 20–49 years)

4. PURPOSE OF STUDY:
A knowledge gap exists on the factors that drive young adults’
preventive behaviors and adherence to COVID-19 guidelines,
while an increased infection rate among young adults is found
Research shows an overestimation of harm
regarding COVID-19 and an underestimation of
capabilities to minimise infection
Studies have shown that risk perceptions may evoke an
affective response that can in turn elicit preventive behaviours

5. RESEARCH HYPOTHESIS:
The perception of risk and affective response (worry) among young
adults (who are university students in Netherlands) has a role in their
COVID-19 preventive behaviors

6. OBJECTIVE:
To explore the role of risk perception and affective response in the
preventive behaviors of young adults during the COVID-19 outbreak
Perceived risk
Perceived vulnerability
(how likely one thinks one can be
infected with COVID-19)
Perceived severity
(perceived seriousness of the
symptoms of COVID-19)
Affective response: General psychological state of an individual
(e.g: worry)

7. MATERIALS AND METHODS
• Study Design : Convergent Mixed Methods design
• Study Type : Descriptive (Exploratory) study
• Target Population : Young adults (20-40 years)
• Study Period : 5 months (April-May 2020 _and_ May-August 2020)
• Place of study : Netherlands
Quantitative
component
Qualitative
component

8. QUANTITATIVE METHODOLOGY
• Sample size : 1081 young adults
• Sampling technique : Voluntary participation
• Inclusion criteria : 1. University students of Netherlands
2. Young adults (20-40 years)
• Exclusion criteria : Non-interested participants

9. Recruitment of participants:
Recruitment of interested participants
Informed consent obtained digitally prior to data collection
Mailing list of universities Canvas digital environment Targeted distribution
The participants were informed about the aim of the study, the methods of
data collection and data protection and storage

10. • Data collection technique: Online survey questionnaire
• Data analysis: Survey data were analysed using IBM SPSS (V.26)
ONLINE SURVEY
Perceived Risk
Preventive behavior
Affective response
2. How worried are you about getting
COVID-19?
3. Adherence to six preventive measures
1. Do you estimate yourself to be in a
vulnerable group for COVID-19? Yes/No…Why?
Likert Scale of 0=not at all to 5=highly worried
Likert scale ranging from always (1) to never (5)

11. QUALITATIVE METHODOLOGY
The qualitative methodology that was used in this study was Phenomenology
Young adults studied at the Erasmus University Rotterdam and were
recruited via multichannel strategy on voluntary basis
Potential participants were recruited using snowball strategy from them
• Sampling technique : Voluntary participation + Snowball technique
All participants were informed about the aim of the study, the methods of data collection
and received information about data protection, usage and storage
Participants gave verbal informed consent

12. • Data collection technique:
Interviews were conducted online via Skype
The interview guide was structured around the concepts
1. Risk perception, 2. Affective response and 3. Preventive behavior
The interviews were audio-recorded and transcribed
Data collection continued until data saturation of main themes occurred
3 additional interviews were conducted to ensure saturation.
This resulted in a total of 10 in-depth interviews

13. Interviews were coded by one coder and discussed with the research
team to enhance reliability
The interviews were analysed by performing a thematic analysis using ATLAS.ti (V.8)
Codebook was created based on the concepts risk perception,
affective response and preventive behavior
• Data analysis:
Codes were categorized under themes

14. MAJOR CONCLUSIONS
Quantitative results
90% of participants reported not to
be at risk of COVID-19
Young adults adhered more frequently to;
 Washing hands frequently
 Staying home as much as possible
 Maintaining distance when meeting
Young adults also reported little worry about COVID-19
(M=1.81, SD=1.24, range 0–5)
Adhered less frequently to;
 Avoiding touching eyes, nose and mouth
 Avoiding meeting with friends and family
 Wearing masks and/or gloves in public places
1. PERCEIVED RISK 2. AFFECTIVE RESPONSE
The more young adults perceived to be at risk of COVID-19 and the more they worried
about it, the higher their adherence to the preventive guidelines was.
3. PREVENTIVE MEASURE

15. MAJOR CONCLUSIONS
Quantitative results

16. MAJOR CONCLUSIONS
Qualitative results
‘I am relatively healthy.
Seeing my age and history I
think I would only get a
cold and be cured’
1. Risk perception:
‘I think the chance of
contamination without
following the guidelines would
be ninety-eight percent’
When not taking any preventive measures, young
adults perceived that their chances of being infected
with COVID-19 would be high
Most young adults perceived that the symptoms of
COVID-19 could be serious, but that the seriousness
also depended on the person.

17. 2. Affective response:
‘idea that I can infect
someone else, that
really scares me’
Young adults were aware of the high risk of COVID-19
to vulnerable others, which led to a high affective
response for these vulnerable others
Some of them expressed anxiety when
receiving risk information on COVID-19
‘I think if I go deep into it – like my
mother does – I will create deep anxiety
for it and I will probably go crazy’

18. 3. Preventive behavior:
The information young adults received on COVID-19 also
motivated them to adhere to the preventive guidelines
Young adults’ social surroundings motivated them to adhere to the
guidelines by seeing family adhere to the guidelines
Young adults adhered to the preventive guidelines
I definitely keep the one-and-
a-half meter distance,
especially when I see an
elderly person. I do try to use
the information about the
guidelines to guide my life’
‘In the beginning I thought it was
very extreme what my parents
were doing, but on the other
hand I do think it is good what
they are doing’

19. 3. Preventive behavior:
Uncertainty of the duration of the guidelines also
made it hard to stick to the guidelines
Young adults did not always practice social
distancing with family and friends
Some young adults experienced frustration when others
showed a high level of adherence to the guidelines
‘As soon as they say they don’t
know how much longer, people
become more ignorant or
impatient to the rules’
‘I’ll be honest, when I
see my friends I don’t
keep to those rules’
I just want to do my groceries calmly
without being reminded constantly
“corona corona corona”’

20. Online survey of 1081 participants
(May-August 2020)
(To investigate the relationships between
risk perception, affective response and
preventive behavior)
QUANTITATIVE
In-depth interviews of 10 participants
(April-May 2020)
(To further explore these relationships)
QUALIITATIVE
Quantitative data Qualitative data
Integration of data
SUMMARY
Regression
(SPSS)
Thematic Analysis
(ATLAS)

21. CRITICAL APPRAISAL
STRENGTH WEAKNESS

22. STRENGTH WEAKNESS
• Simple terms used and its easy to understand.
• Title is meaningful.
• Reflects the objectives of the study.
• Indicates the variable (“risk perception”,
“affective response”, “preventive behaviours”)
involved in the study.
• Study design and Study setting is mentioned.
• Target population is mentioned.
• Broad domain terms are used (Affective
response)
TITLE

23. STRENGTH WEAKNESS
• It is comprehensive and informative.
• Information in the abstract matches with what is
present in the text.
• Word limit as per the rules of BMC Open (did not
exceed 350 words).
• It gives the gist of the paper.
• Abstract is not structured (Background and
keywords are missing)
ABSTRACT

24. STRENGTH WEAKNESS
• Need for study clearly mentioned.
• Brief review of the key literature is included
along with the research gap.
• Describes the overarching problem and justifies
the objectives of the study.
• Introduction is concise and one can understand
the purpose and significance of the study.
• Scientific background & rationale are satisfying.
• Variables in the study are explained
INTRODUCTION

25. STRENGTH
• This study was carried out in accordance with the ethical guidelines of the Declaration of Helsinki with
digital informed consent (survey) and verbal informed consent (interviews).
• Ethical approval by the Erasmus School of Health Policy and Management Examination Board.
• Well informed recruitment.
• Equal representation of gender.
• Data was collected till saturation was attained and saturation was ensured using additional interviews.
• Codes were discussed with research team for better reliability.
• Pre-formed themes were present and appropriate analysis was done (Thematic Analysis).
METHODOLOGY:

26. WEAKNESS
• The author has not mentioned if it’s a parallel study or sequential study.
• Qualitative strand (Apr-May 2020) was completed before Quantitative strand (May-Aug 2020).
• The study design is not of convergent type as mentioned, rather it is explanatory type.
• Waste of time exploring same variables in similar group of population. The author could have adopted
data-validation variant (within stage mixed model design).
• Sample size calculation is not done and no data on adequacy of sample size discussed.
• No sampling technique. This questions the geographic representation and affects external validity.
• There is a ‘why’ component in the item under perceived vulnerability. This questions the need for
separate QUAL component.
METHODOLOGY:

27. WEAKNESS
• Morse’s notation not mentioned for this mixed method study. Thus there is no information on degree
of Qualitative and Quantitative strands in the study.
• Selection bias in Qualitative methodology since the participants are selected from single university
(Erasmus University). Thus the results aren’t generalizable to young adults of Netherlands as a whole.
• There could not be the existence of relationships to be studied by Qualitative strand as mentioned in
the study since the Quantitative strand was completed before Qualitative strand.
• Non-response rate not mentioned.
• Pretesting of questionnaire was not done.
• Piloting of the study was not done. No mention of modifications as well.
METHODOLOGY:

28. WEAKNESS
• The respondents could have been labelled as R-1, R-2, Etc. instead of giving pseudonyms.
• Video recording is not available thus restricting in assessing the body language.
• The items were not tested for reliability and validity. Question of internal validity arises.
• Inadequate representation of young adults across age since the range of age is from 21 to 29 years.
Young adults of age 30-40 years are left out.
METHODOLOGY:

29. STRENGTH WEAKNESS
• Software used for analysis is mentioned and is
appropriate.
• Explored the Intention-Behavior gap.
• Findings may not be generalizable to other age
groups or to lower educational levels since study
group was university students.
• Socio-demographic tables are absent.
• Cultural barriers to preventive measures are not
presented.
• The bar diagram lacks axial labelling and header
making it difficult to grasp the data.
RESULTS

30. STRENGTH WEAKNESS
• Highlights the important findings in the study.
• Results were compared with the similar studies
across the appropriate and comparable studies.
• There is no conflict of interest.
• Limitations of the study are mentioned.
• There are no policy implications from this study
and it contributes negligibly to the expected
outcomes of the study.
• Only the ‘worry’ component of affective
response is discussed.
DISCUSSION and CONCLUSION

31. STRENGTH
• Vancouver style is adapted and is cited appropriately.
• Extensive articles related to psychological aspects are
cited which is relevant to the study and helps in cross
referencing the findings.
REFERENCES