Psychology, Health & Medicine

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The impacts of vulnerability, perceived risk, and

fear on preventive behaviours against COVID-19

Murat Yıldırım , Ekmel Geçer & Ömer Akgül

To cite this article: Murat Yıldırım , Ekmel Geçer & Ömer Akgül (2021) The impacts of
vulnerability, perceived risk, and fear on preventive behaviours against COVID-19, Psychology,
Health & Medicine, 26:1, 35-43, DOI: 10.1080/13548506.2020.1776891

To link to this article: https://doi.org/10.1080/13548506.2020.1776891

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PSYCHOLOGY, HEALTH & MEDICINE
2021, VOL. 26, NO. 1, 35–43
https://doi.org/10.1080/13548506.ci2020.1776891

The impacts of vulnerability, perceived risk, and fear on

preventive behaviours against COVID-19
a,b c c
Murat Yıldırım , Ekmel Geçer and Ömer Akgül
a
Department of Psychology, Ağrı İbrahim Çeçen University, Ağrı, Turkey; bDepartment of Neuroscience,
Psychology and Behaviour, University of Leicester, Leicester, UK; cDepartment of Psychology, University of
Health Sciences, Istanbul, Turkey

ABSTRACT ARTICLE HISTORY

The world has been under the negative effect of the COVID-19 Received 27 April 2020
pandemic for the last few months. While people may take many Accepted 26 May 2020
preventive behaviours to minimize the risk, very little is known KEYWORDS
about the factors that can increase preventive behaviours during COVID-19; perceived risk;
the COVID-19 pandemic. This study examined the effects of vulner­ fear; vulnerability; preventive
ability, perceived risk, and fear on preventive behaviours of COVID- behaviours
19.
The study used a sample of 4,536 Turkish adults (M = 30.33 ±
10.95 years) recruited from 17 March through 1 April 2020.
Vulnerability, perceived risk, fear, and preventive behaviours were
measured with self-rating scales.
Participants mostly engaged in avoidance of public transporta­
tion and frequent handwashing as preventive behaviours. Women
had a significantly higher vulnerability to, perceived risk, and fear of
new coronavirus compared to men. Correlation results indicated
that age, gender, education level, vulnerability, perceived risk, and
fear were related to preventive behaviours. Regression results
demonstrated that vulnerability, perceived risk, and fear accounted
for a significant amount of variance in preventive behaviours over
and above the effects of demographic variables.
The results suggest that vulnerability, perceived risk, and fear can
significantly increase engagement in preventive behaviours during
the novel coronavirus pandemic. The results have important impli­
cations for research and practice.

Introduction
Currently, the world is under threat of rapidly spreading novel coronavirus (COVID-19).
Millions of people have been affected by COVID-19. There are studies investigating the
nature of the virus and providing evidence preventing the spread of the virus (Chinazzi et al.,
2020; Laia et al., 2020; Wu & McGoogan, 2020; Zhi, 2020). Like SARS and MERS, the severity
of COVID-19 can cause serious respiratory diseases, such as acute respiratory syndrome
(Lancet, 2020). Perception of the risk was significantly related with preventive behaviours
such as engagement in social distancing and handwashing behaviours (Wise et al., 2020), and
coronavirus severity, coronavirus self-efficacy, and mental health (Yıldırım & Güler, 2020).

CONTACT Murat Yıldırım muratyildirim@agri.edu.tr Department of Psychology, Science and Letters, Ağri
İbrahim Çeçen University, Erzurum Yolu 4 Km 04100, Merkez, Ağrı, Turkey
© 2020 Informa UK Limited, trading as Taylor & Francis Group
36 M. YILDIRIM ET AL.

Studies also showed a high prevalence of psychological stress, yet greater levels of compliance
with personal hygiene practices (Yang et al., 2020), and high levels perceived susceptibility,
perceived severity, and anxiety (Kwok et al., 2020).
The COVID-19 has high potential to cause psychological distress such as anxiety and
depression (Wang et al., 2020). It is important to determine psychological factors which can
be helpful in managing and mitigating the impact of pandemic on human functioning.
Previous research has demonstrated that demographic differences (e.g., being older, female,
and more educated) and psychological factors (e.g., perceived susceptibility to and perceived
severity of the diseases) are significantly associated with engagement in protective behaviours
(Bish & Michie, 2010). Currently, there is scarcely evidence of the psychological factors
influencing preventive behaviours toward the COVID-19 pandemic. Some studies showed
that perceived personal risk, fear, and vulnerability are related to engagement in preventive
behaviours (Liao, Wu, Wing Tak Lam, Cowling, & Fielding, 2019; Oh et al., 2020; De Zwart
et al., 2009). Thus, it is necessary to determine the role of demographic and psychological
factors on preventive behaviours for the current COVID-19 pandemic. The aims of this
study were to unravel whether the age, gender, education level, fear, personal risk, and
vulnerability acted as predictors of preventive behaviour among adults. Also, the study
aimed to identify the associations between these variables. This study sought to test the
following hypotheses.

H1: Male and female would significantly report different levels of engagement in pre­
ventive behaviours for the current COVID-10 pandemic.

H2: Female would significantly report greater levels of fear, perceived risk, and vulner­
ability than males.

H3: Age, gender, education level, fear, perceived risk, and vulnerability would be sig­
nificantly linked to preventive behaviours.

H4: Fear, perceived risk, and vulnerability would significantly predict preventive beha­
viours over and above the demographic variables.

Method
Participants
This was a cross-sectional study with a convenience sample of 4,536 adults. The study
included volunteers who were meeting the inclusion criteria of a minimum age of
18 years old and using social networking sites. Online survey was used to collect data
as it appears to be the most realistic and feasible method during pandemic.
 PSYCHOLOGY, HEALTH & MEDICINE 37

Measures
Preventive behaviours
Eight items were used to measure preventive behaviours rated on a 5-point scale ranging
from 1 = decreased substantially to 5 = increased substantially. A sample item is ‘I avoid
using public transportation’. The complete list of preventive behaviours is presented in
Table 2. Higher scores indicate greater engagement in preventive behaviours toward
COVID-19. The Cronbach’s α was .67.

Fear
We used three items to evaluate respondents’ levels of fear about the novel coronavirus.
Items are answered on a 5-point scale ranging from 1 = not at all to 5 = great an extent.
Sample items included ‘I am afraid of novel coronavirus’ and ‘I am terrified by a novel
coronavirus’. Higher scores indicated greater fear. The Cronbach’s α was .73.

Perceived personal risk

Risk was measured with an item, ‘Compared to most people your age and sex, what
would you say your chances are for developing novel coronavirus’ (Weinstein, 1982),
using a 5-point scale ranging from 1 = much lower than average to 5 = much higher than
average. Higher scores indicate greater risk.

Vulnerability
Vulnerability was measured with an item ‘In your opinion, what is the probability of
developing coronavirus disease during the coronavirus outbreak?’ using a 5-point scale
ranging from 1 = improbable to 5 = highly probable. Higher scores indicate greater
vulnerability to coronavirus.

Procedure
The survey was electronically distributed by creating a link where respondents had to
click the link to access the survey. A consent form was presented to all participants
through the first page of the electronic survey, where they had to provide their agreement
before proceeding the survey. Those who indicated to contribute the study could
proceed. All participants provided online consent and they were assured about anonym­
ity and confidentiality of responses.

Analytic procedures
Descriptive statistics were reported to summarise features of participants on the study
variables. Independent sample t-test was used to compare the differences in mean scores of
the study variables between males and females. Pearson correlation was used to explore the
relationship between the study variables. Regression analysis was performed to assess the
effect of basic demographic variables, vulnerability, perceived personal risk, and fear on
overall reported preventive actions. All data analyses were conducted using SPSS (v.24.0).
38 M. YILDIRIM ET AL.

Results
General characteristics of the sample
The sample included 4,536 Turkish adults ranged in age between 18 and 88 years
(M = 30.33 ± 10.95 years). As reported in Table 1, most participants (69.78%) were
females, university graduate (63.34%), and single (58.13%).

Preventive behaviours
Avoidance of public transportation and frequent handwashing were the most prominent
preventive behaviours (see Table 2). Although the remaining preventive behaviours were
highly practiced by the respondents, keeping a regular bedtime routine and avoidance of
public places were relatively less practiced.

Table 1. Participants’ characteristics (n = 4,536).

Variable Level Frequency Percent
Gender Female 3165 69.78
Male 1371 30.22
Education level High school or below 488 10.76
Bachelor’s degree 2873 63.34
Master’s degree 937 20.66
Doctoral degree 238 5.25
Marital status Married 1765 38.91
Single 2637 58.13
Divorced/widowed 134 2.95
Socioeconomic level Lower than average 565 12.46
Average 3490 76.94
Higher than average 481 10.60
Number of children None 2982 65.74
1 537 11.84
2 627 13.82
3 288 6.35
3 or more 102 2.25
Number of siblings 1 or none 257 5.67
2 1378 30.38
3 1358 29.94
4 760 16.75
5 or more 783 17.26
Household members 1 241 5.31
2 588 12.96
3 1018 22.44
4 1345 29.65
5 or more 1344 29.63

Table 2. Descriptive statistics for the complete list of preventive behaviours (n = 4,536).
Preventive behaviours Mean SD
1. Avoid public transportation 4.19 0.87
2. Avoid close contact with people who cough or sneeze 3.92 0.98
3. Washing hands frequently with soap and water or alcohol-based hand rub 4.19 0.79
4. Frequent washing groceries 3.78 0.81
5. Avoid eating or drinking outside 3.65 1.09
6. Keep a regular bedtime routine 3.22 0.68
7. Avoid public places 3.27 1.48
8. Having a healthy diet 3.69 0.80
 PSYCHOLOGY, HEALTH & MEDICINE 39

Table 3. Comparison of gender across the study variables (n = 4,536).

Variable Gender N Mean SD t df p
Preventive behaviours Female 3165 30.21 4.22 7.22 4534 0.00
Male 1371 29.22 4.17
Vulnerability Female 3165 3.72 0.76 5.53 2539.53 0.00
Male 1371 3.58 0.78
Perceived risk Female 3165 3.77 0.78 6.89 4534 0.00
Male 1371 3.60 0.78
Fear Female 3165 10.68 1.85 9.63 4534 0.00
Male 1371 10.10 1.85

Effect of gender on the study variables

The results of t-test showed that females significantly engaged in preventive behaviours,
reported to be more vulnerable, had higher levels of perceived risk and fear than males (see
Table 3).

Factors relating to preventive behaviours of the novel coronavirus

People reported greater engagement in preventive behaviours, vulnerability, perceived
risk, and fear about novel coronavirus. Younger people and females tended to report
higher levels of preventive behaviours, vulnerability, perceived risk, and fear. A higher
level of education was correlated with more practicing preventive behaviours and less
fear. Vulnerability, perceived risk, and fear were significantly related to preventive
behaviours (see Table 4).

Effects of fear, perceived risk, and vulnerability on preventive behaviours

Hierarchical regression showed that in Step 1, the overall model explained 1% of the
variance of preventive behaviours. In this model, gender and education level were
significant predictors of preventive behaviours. The overall model in Step 2 explained
30% of the variance in preventive behaviours. Vulnerability, perceived risk, and fear were
significant predictors of preventive behaviours (see Table 5).

Discussion
This study examined the role of demographic factors, vulnerability, perceived risk, and
fear in explaining preventive behaviours toward COVID-19. The results indicated that

Table 4. Correlation coefficients of the study variables (n = 4,536).

Variable Mean SD Skew Kurt 1. 2. 3. 4. 5. 6. 7.
1.Gender - - - - 1
2.Education level - - - - .08** 1
3.Age 30.32 10.95 1.07 0.69 .37** .37** 1
4.Preventive behaviours 29.91 4.23 −0.04 0.06 −.11** .04** −.03* 1
5.Vulnerability 3.68 0.77 −0.31 0.49 −.08** −.00 −.09** .44** 1
6.Perceived risk 3.72 0.78 −0.18 0.08 −.10** .01 −.10** .45** .63** 1
7.Fear 10.50 1.87 0.21 0.84 −.14** −.04** −.13** .51** .64** .62** 1
**. p < 0.01. *. p < 0.05
40 M. YILDIRIM ET AL.

Table 5. Hierarchical multiple regression analysis with the overall preventive behaviours as dependent
variable and demographic variables, vulnerability, perceived risk, and fear as predictor variables
(n = 4,536).
Model Variable B SE β t p R R2 ΔR2
Step 1 F (3, 4535) = 19.78, p <.001 .11 .01 .01
Age 0.00 0.01 0.00 −0.30 0.76
Gender −0.97 0.15 −0.11 −6.66 0.00
Education level 0.25 0.09 0.04 2.66 0.01
Step 2 F (6, 4535) = 327.38, p <.001 .55 .30 .29
Age 0.02 0.01 0.05 3.32 0.00
Gender −0.46 0.12 −0.05 −3.74 0.00
Education level 0.23 0.08 0.04 2.91 0.00
Vulnerability 0.65 0.10 0.12 6.86 0.00
Perceived risk 0.91 0.09 0.17 9.80 0.00
Fear 0.75 0.04 0.33 19.00 0.00

age, gender, education level, vulnerability, perceived risk, and fear were associated with
preventive behaviours.
We found that people were highly engaged in preventive behaviours, particularly
avoidance of public transportation and frequent handwashing. Previous studies about
the SARS demonstrated that those who contacted the infected people felt fear, angry, sad,
and guilty because of the possibility of catching the disease (Brooks et al., 2020). Females
reported greater vulnerability, perceived risk, fear, and preventive behaviours than males.
Previous research reported that gender has a significant effect on the correlates, pre­
dictors, and outcomes of health and illness (Vlassoff, 2007). Vulnerability, fear, and
perceived risk were related to preventive behaviours of COVID-19. Similar results have
been reported previously (Oh et al., 2020; Zhong et al., 2020).
Despite demographic differences, those who believed they were vulnerable, perceived
a high risk of infection and feared of virus, were more likely to engage in preventive
behaviours, suggesting that developing the ability of a person to cope with the impact of
COVID-19 can boost adoption of preventive behaviours. These results are in the line
with the extant literature suggesting that risk perception and demographic factors can
influence the levels of individuals' preventive behaviours (Gamma, 2019; Van der Pligt,
1996)

Implications and recommendations

The present findings can facilitate health professionals and officials to better understand
the links between some demographic and psychological factors and preventive beha­
viours as well as allowing them to develop strategies focusing on the promotion of
psychological resources that can help individuals to engage in preventive behaviours
and develop effective coping behaviours toward COVID-19 pandemic.
It is important that health officials should transparently inform public about COVID-
19 and the effectiveness of the measures taken to stop the virus. Informing public through
psychological support will help them to develop resistance to illnesses and recover
quickly. For example, COVID-19 scientific councils, which are available in many coun­
ties should be strengthened with scientists from diverse backgrounds such as psychology,
psychiatry, sociology, pedagogy, and education to assess the impact of taken measures on
 PSYCHOLOGY, HEALTH & MEDICINE 41

public. Because COVID-19 pandemic necessitates online therapies, psychologists and

psychiatrists should support those with greater vulnerability, perceived risk, and fear
through digital sessions to mitigate their psychological distress. Psychological immunity
of the society and its maintenance is as important as the maintenance of physical health.
Fear, perceived personal risk, anxiety, and other psychological factors are also contagious
like diseases and they have a significant impact on the well-being of individuals and
society. Like governments, individuals should also take responsibilities to prevent the
spread of viruses and other infections by adopting preventive behaviours such as practi­
cing proper social distancing and self-isolation.
The current study has two main strengths. First, the data collection held between
17 March –1 April 2020 was completed within two weeks right after the announcement
of the Turkey’s outbreak on 17 March 2020. This early data collection procedure allows us
to timely assess how public engaged in preventive behaviours which are helpful to inform
health officials. Second, a large sample size was recruited via online survey and this helped
us to reach a wide range of participants from different socioeconomic backgrounds.
The study is not without limitations. First, as we used an online approach to collect
data, those who were unable to use internet or have limited access to internet were not
sufficiently represented. Nevertheless, collecting data via online survey is a practical
approach to adopt as a face-to-face interview or inviting people into a lab is not feasible
during the COVID-19 outbreak. Second, only a limited number of psychological vari­
ables were examined in this study. Future research should consider investigating other
psychological factors that can affect preventive behaviours such as perceived severity,
perceived control, and self-efficacy.

Conclusion
In conclusion, avoidance of public transportation and frequent handwashing were
among the most adopted preventive behaviours. In comparison to males, females were
more vulnerable, had greater risk and fear and engagement in preventive behaviours.
Vulnerability, perceived risk, and fear uniquely predicted preventive behaviours over and
above the effects of demographic variables.

Acknowledgments
Authors would like to thank all participants who involved in this study.

Disclosure statement
The authors declared no conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The authors received no financial support for the research, authorship, and/or publication of this
article.
42 M. YILDIRIM ET AL.

ORCID
Murat Yıldırım http://orcid.org/0000-0003-1089-1380
Ekmel Geçer http://orcid.org/0000-0003-3367-2236
Ömer Akgül http://orcid.org/0000-0002-2614-6476

Ethical approval
All procedures performed in studies involving human participants were in accordance with the
ethical standards of the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent
Consent was obtained from all participants included in the study.

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