Original Research

SAGE Open
July-September 2023: 1–13
Ó The Author(s) 2023
The Impact of Social Media on DOI: 10.1177/21582440231184969
journals.sagepub.com/home/sgo
Preventive Behavior During the COVID-
19 Outbreak in South Korea: The Roles
of Social Norms and Self-Efficacy

Doo-Hun Choi1 and Ghee-Young Noh2

Abstract
Social media are important channels to propagate health information and influence preventive behavior during a public health
crisis, as witnessed during the coronavirus pandemic (COVID-19). This study explored the association between social media
use and preventive behavior during the outbreak of COVID-19 in South Korea. Using the national survey data (N = 1,500), the
study examined the mediating role of social norms in the association between social media use for news and information about
COVID-19 and preventive behavior. In addition, the study tested the moderating effect of self-efficacy on the mediating path of
social media use for preventive behavior via social norms. Conducting a moderated mediation analysis method, this study
found that social norms mediated the relationship between social media use and preventive behavior (b = 0.046). Moreover,
the study revealed that the indirect relationship between social media use and preventive behavior through social norms
becomes stronger as an individual’s level of self-efficacy decreases (low: b = 0.044, middle: b = 0.036, and high: b = 0.030). The
study provides empirical evidence of the beneficial impact of social media use on preventive behavior. The findings of the study
recommend promoting messages on social norms through social media for facilitating preventive behavior.

Keywords
COVID-19, social media, preventive behavior, social norms, self-efficacy

The novel coronavirus disease (COVID-19) has infected
more than 500 million people, with over six million death
worldwide, resulting in the declaration of a global pan-
demic by the World Health Organization (2020). South
Korea reported over 17 million infections and more than
23 thousand deaths since the first case of COVID-19 in
the country was announced in January 2020 (Korea
Centers for Disease Control and Prevention [KCDC,],
2020). According to the Centers for Disease Control and
Prevention (Centers for Disease Control and Prevention
[CDC,], 2020), COVID-19 is transmitted from person to
person through respiratory droplets when in close con-
tact, and can cause symptoms such as fever, dry cough,
and/or sore throat. Public health experts and government
agencies have recommended several specific preventive
measures, such as wearing masks, washing hands, and
cough etiquette, to prevent the transmission of the disease
(Adhikari et al., 2020; CDC, 2020; Omer et al., 2020).
In situations where public health issues such as
COVID-19 emerge, it is essential for people to receive
timely and appropriate public health information to per-
ceive the threats to public health and successfully prevent
transmission (D. H. Choi et al., 2017). Social media, in
particular, has played an important role during the pre-
vious outbreaks of infectious diseases such as the Middle
East Respiratory Syndrome (MERS) and H1N1, in con-
veying disease-related information and sharing it among
users (Jang & Baek, 2019). For example, a survey
showed that 71.5% of the respondents used social media
primarily to acquire MERS-related information (S. Kim
& Yang, 2015). Interestingly, it was observed that people
used social media to obtain information relevant to the
1
Gachon University, Gyeonggi-do, South Korea
2
Hallym University, Chuncheon, South Korea
Corresponding Author:
Ghee-Young Noh, Media School, Hallym University, 1 Hallymdaehak-gil,
Chuncheon, Gangwon-do 24252, South Korea.
Email: gnoh@hallym.ac.kr

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2 SAGE Open
Figure 1. Proposed research model.
contagious disease because they thought that they would
not receive necessary information from traditional
media, such as television and newspapers, during the
MERS outbreak in South Korea. (W. Yoo et al., 2016).
During the U. S. measles outbreak in 2019, social media
were extensively used to express and receive measles-
related information and share personal experiences
about the infectious disease (S. C. Kim & Hawkins,
2020; Meadows et al., 2019).
As more and more people choose social media (e.g.,
Twitter or Facebook) to find public health-related infor-
mation such as news updates and medical information
(Seo, 2019; Tang et al., 2018), it is evident that social
media use has the potential to facilitate behavioral
responses, such as preventive behaviors. Although the
existing literature has demonstrated that social media
use has a positive relationship with preventive behaviors,
such as in the contexts of the 2019 U.S. measles outbreak
(S. C. Kim & Hawkins, 2020) and food safety crises in
China (Mou & Lin, 2014), the question of how social
media use could influence preventive behaviors has not
yet been fully explored. To bridge this gap in research,
the current study examines the mediating role of social
norms in the relationship between social media use and
preventive behaviors.
Social norms can affect people’s preventive behavior
(Latkin et al., 2013) while social media provide the
opportunity to learn social norms (Spartz et al., 2017).
Furthermore, to expand our understanding of how social
media use and social norms collaboratively impact peo-
ple’s preventive behaviors, this study investigates the
relationship between social media use, social norms, and
preventive behaviors and the extent to which this rela-
tionship is contingent on an individual’s level of self-
efficacy. As prior research showed, self-efficacy indicates
individual differences in influencing preventive behaviors
(D. H. Choi et al., 2017; W. Yoo et al., 2016). It is, there-
fore, possible that the impact of social norms on preven-
tive behavior through social media use could differ
depending on individual levels of self-efficacy.
Based on this perspective, this study examines the
moderated mediation relationships between social media
use, social norms, self-efficacy, and preventive behavior
using nationwide online survey data collected during the
outbreak of COVID-19 in South Korea. Specifically, the
study investigates how social media use affects preven-
tive behavior through social norms. Furthermore, this
study explores how the mediation path to preventive
behavior is influenced by self-efficacy. The results of this
study could provide significant implications for risk and
health communication by promoting preventive beha-
viors using social media in the context of an infectious
disease outbreak. Figure 1 illustrates the proposed asso-
ciations among the variables in this study.
Social Media Use and Preventive Behavior
When a public health crisis such as COVID-19 occurs,
one of the most important public responses is practicing
preventive behaviors. Preventive behaviors represent any
behaviors undertaken to avoid or decrease risks from dis-
eases or negative health outcomes (D. H. Choi et al.,
2018). In general, people participate in preventive beha-
viors, such as getting vaccinated, undergoing mammo-
graphy tests, and using contraceptives to inhibit serious
future problems and sustain their health (D. H. Choi
et al., 2018). In particular, in the case of an infectious dis-
ease outbreak, such as MERS or COVID-19, public
Choi and Noh
health experts and government agencies recommend sev-
eral specific preventive measures, such as wearing masks,
washing one’s hand, and covering one’s face when cough-
ing or sneezing with a tissue or cloth, to avoid transmis-
sion of the disease (CDC, 2020; J. S. Choi & Kim, 2016).
The public should, therefore, engage in preventive beha-
viors during the outbreak of an infectious disease, espe-
cially until pharmaceutical interventions such as vaccines
are accessible.
The use of social media for accessing health-related
news and information can impact an individual’s preven-
tive behavior. Since people would like to be informed
about the preventive measures to be taken, health and
risk communications need to offer them accurate infor-
mation on how to respond to the public health emer-
gency, thus promoting appropriate behavioral responses
(Verroen et al., 2013). Social media can help people in
obtaining health or disease-related news and informa-
tion, such as safety instructions or quarantine restric-
tions, and exchanging the information with existing
online social contacts, such as friends and family mem-
bers, in real-time, which can motivate people to engage
in preventive behaviors (Oh et al., 2021). For example,
during the 2015 MERS outbreak in South Korea, a sur-
vey found that social media use increases preventive
behaviors, such as wearing masks and handwashing
(Seo, 2019). More recently, a survey conducted in China
found that social media use was positively associated
with preventive behaviors, including handwashing and
following coughing etiquette during the COVID-19 pan-
demic (Li & Liu, 2020). On the other hand, another
study argues that social media use can decrease preven-
tive behavior during a pandemic (e.g., Allington et al.,
2021). These diverging views raise the following research
question:
RQ1: How is social media use associated with preven-
tive behaviors?
Mediating Role of Social Norms in Preventive
Behaviors
Social norms refer to codes of conduct that informally
govern members’ behavior in groups and societies (Rimal
& Real, 2003). Generally, people perceive social norms as
the thoughts, feelings, or behaviors that would typically
be demonstrated by close others, such as family mem-
bers, friends, or coworkers in a given situation (Turner,
1991). Specifically, social norms include perceptions
regarding what ought to be done in a certain way (i.e.,
injunctive norms; e.g., my family thinks that I should
engage in preventive behaviors) and perceptions of what
is commonly done by others in a specific situation (i.e.,
descriptive norms; e.g., how widespread practicing
3
preventive behaviors is among close ones; Carpenter &
Amaravadi, 2019; Cialdini et al., 1990). Social norms
play a significant role in helping people understand which
behaviors would be desirable or normative in a particular
circumstance (Lombardi et al., 2019).
More importantly, it has been demonstrated that
social norms can affect people’s behavioral change in the
area of public health (e.g., Lapinski et al., 2013;
Schoenaker et al., 2018). The notion of social norms sug-
gests that people’s behaviors are largely influenced by
perceptions of how other individuals in one’s social
group behave (Perkins & Berkowitz, 1986; Phua, 2013).
As an individual scans their social environment using
mediated sources such as direct interpersonal contact or
social media, it can lead to them making inferences
about the behavior of others, which they use to deter-
mine their own behavior (Spartz et al., 2017). While
some studies point out that social norms can play a role
in provoking risky behaviors, such as drinking and driv-
ing among young drivers (e.g., Geber et al., 2021) and
illicit drug use among college students (e.g., Kollath-
Cattano et al., 2020), other scholars in the field of health
communication have suggested the beneficial role of
social norms in promoting healthy behaviors. For exam-
ple, a survey study showed that perceived support for
human papilloma virus (HPV) vaccination from friends
and parents helped young women to decide to get the
vaccine (Visser et al., 2011). A multinational study con-
ducted in China, Singapore, and Canada also found that
social norms are positively associated with SARS-pre-
ventive behaviors, such as wearing facemasks or washing
hands with soap (Cheng & Ng, 2006).In particular, when
facing uncertainty in a social situation, such as that of
COVID-19, social norms provide context-appropriate
cues for behaving appropriately (Spartz et al., 2017).
Additionally, social norms can serve as a form of social
pressure that causes people to engage in specific beha-
viors (Wombacher et al., 2017), particularly for protect-
ing themselves from risks, by taking actions such as
wearing masks (e.g., Duong et al., 2021; Santana et al.,
2020). Based on these observations, the current study
states that social norms toward preventive behavior dur-
ing the outbreak of COVID-19 can play an important
role in promoting preventive behavior among people.
Social media use can have an impact on the formation
of perceived social norms. Social environments offer
meaningful cues regarding how individuals should
behave (Yanovitzky & Stryker, 2001). For example, as
an important aspect of the current social environment,
mass media (e.g., television and newspapers) play a sig-
nificant role in helping people to perceive social norms
(Chia & Gunther, 2006; Lapinski & Rimal, 2005).
Exposure to media content portraying diverse behaviors
can shape perceptions of the majority of the behavior
4 SAGE Open
(Wombacher et al., 2017). For instance, a survey found
that media use for obtaining information about condom
use is associated with perceptions of social norms regard-
ing safe sex behavior (Hong & Kim, 2020). In recent
years, as numerous people have opted for social media
for the consumption of news and information content, it
has the potential to influence perceptions of social norms
about a particular behavior (S. Kim et al., 2015).
Social norms are formed, spread, and reinforced
through communication among people (Wombacher
et al., 2017). In particular, as people communicate and
interact with important others, such as family members,
friends, and coworkers, they have the opportunity to dis-
cern which behavior is socially acceptable and expected
(Yanovitzky & Stryker, 2001). Social media can facilitate
such interaction and communication through online
social networks, allowing users to adopt behaviors that
are approved by significant others. This suggests that
social media are an effective means for making actions
visible to other users and provide an opportunity to
learn a specific behavior from friends and peers (Hynes
& Wilson, 2016). In particular, social media provide
social media metrics (e.g., the number of shares, likes,
and comments) displayed alongside content, such as
news articles or news blogs. This information helps infer
what other users think about the content (Lee & Su,
2020; Spartz et al., 2017). Moreover, social media metrics
can enable users to believe what is approved by other
users and implement the actions recommended (e.g.,
what ought to be done) in the content (Lee-Won et al.,
2016), which may function as a form of social pressure,
informing them how they should behave.
Based on the above discussion, this study argues that
social media use for the consumption of news and infor-
mation on COVID-19, including preventive behavior
methods, can impact the formation of perceptions of
social norms about preventive behavior. More specifi-
cally, this study suggests that social norms play a mediat-
ing role in the association between social media use and
preventive behavior. Social media use can help shape
social norms, which may, in turn, facilitate preventive
behavior. Thus, the following hypothesis is proposed:
H1: Social media use is positively associated with
social norms, which may have a positive relationship
with preventive behavior.
Moderating Role of Self-Efficacy
Self-efficacy refers to an individual’s belief in their own
ability to perform a particular behavior successfully
(Bandura, 1997). For example, in the context of health,
people may believe that they can control chain smoking
or habitual drinking. In particular, self-efficacy helps
individuals to handle certain difficult tasks they are fac-
ing (D. H. Choi et al., 2017). When public health emer-
gencies such as COVID-19 happen, self-efficacy can play
a major role in encouraging people to overcome social
difficulties (Bandura, 1997; D. H. Choi et al., 2017). In
addition, since self-efficacy results in favorable out-
comes, people with high self-efficacy anticipate these
results and behave accordingly (Bandura, 2004). More
importantly, it has been suggested that self-efficacy has
the potential to promote healthy behavior and contribute
to disease prevention (Grembowski et al., 1993; S. W.
Yoo et al., 2018). The extended parallel process model
(EPPM) posits that self-efficacy can influence engaging
in health behaviors, such as preventive behaviors (e.g.,
Jang & Park, 2018; W. Yoo et al., 2016). According to
the EPPM, self-efficacy helps people estimate their abil-
ity to conduct the recommended behavior to avert a
health risk or threat. Compared to people with lower lev-
els of self-efficacy, those with higher levels of self-efficacy
are more likely to practice healthy behaviors, such as
taking preventive measures during the H1N1 pandemic,
doing aerobic exercise, or following a sensible diet,
(Bults et al., 2011; Grembowski et al., 1993; Ievers-
Landis et al., 2003). Thus, it is likely that individuals
with high levels of self-efficacy would engage in preven-
tive behaviors to protect themselves against COVID-19.
More interestingly, in addition to testing the mediat-
ing mechanism of social media use on preventive beha-
vior through social norms, the current study also
examines a moderated mediation mechanism by suggest-
ing that individual differences, such as self-efficacy, mod-
erate the mediating association between social media use
and preventive behavior through social norms. As self-
efficacy indicates individual differences in the extent to
which a person believes that they have the capability to
control a situation, the impact of social norms on preven-
tive behavior could differ according to individual levels
of self-efficacy. Therefore, investigating the moderating
role of self-efficacy could indicate the conditions under
which the mediating association would differ (Y. Kim &
Chen, 2015). For example, prior research has suggested
that self-efficacy can play a moderating role in the rela-
tionship between media messages and preventive beha-
vior, such as skin cancer self-examination (van ’t Riet
et al., 2010). It is plausible that since people have differ-
ent levels of self-efficacy, their perceptions of social
norms regarding preventive behaviors, obtained from
social media use about COVID-19, could produce differ-
ent levels of preventive behaviors. Given this consider-
ation, examining the moderating effect of self-efficacy in
the mediated association between social media and social
norms on preventive behavior represents an important
perspective in this area of research. Examining self-
efficacy as a moderator will provide a better
Choi and Noh
understanding of the role of individual differences in
increasing or weakening the impact of social media use
and social norms on preventive behavior. Because little
research has been conducted on the moderated mediation
relationship among social media use, social norms, and
self-efficacy in preventive behavior, a directional hypoth-
esis about the relationship could not be addressed. Thus,
this study proposes the following research question.
RQ2: How does self-efficacy moderate the impact of
social media use on preventive behavior through social
norms?
Methods
1
Data
The data used for this study were collected from a
national online panel survey of South Korean adults
conducted by Global Research, a major research firm in
South Korea, over 1 week from February 24 to March 3,
2020. The survey period coincided with one of the signifi-
cant peaks of the COVID-19 outbreak in South Korea.
The survey company secured an online panel of over one
million people with national representation on the basis
of age, gender, and region using a proportionate quota
sampling approach. Among the entire pool, 127,362
panel members, who were randomly chosen via a com-
puter algorithm, received the survey invitation email to
participate in the current study. Out of the total emails
sent, 2,225 individuals responded to the survey participa-
tion, and 725 cases out of these were excluded due to
inadequate or incomplete answers in the questionnaire.
As a result, 1,500 people finished the survey, producing a
completion rate of 67.4% and all 1,500 responses were
included in the analysis. This research was approved by
the Institutional Review Board of Hallym University,
South Korea (IRB no. HIRB-2020-015).
Measures
Social Media Use. The study measured social media use
by using a single item on a 5-point scale ranging from ‘‘1
= never’’ to ‘‘5 = very often,’’ when asked how often
the respondents had seen or heard news and information
in relation to preventive methods about COVID-19 on
social media, such as Instagram, Facebook, and Twitter
during the past month (M = 3.61, SD = 1.14).
Social Norms. Guided by Fishbein and Ajzen (2011)’s
recommendation, injunctive and descriptive norms were
combined as a measure of social norm. Social norms
were measured using a 5-point scale ranging from ‘‘1 =
strongly disagree’’ to ‘‘5 = strongly agree’’ by asking
respondents to rate their level of agreement with the
5
following four statements regarding preventive behavior:
(1) ‘‘Most people who are important to me (e.g., family
members and friends) think that I should practice
COVID-19 preventive behavior,’’ (2) ‘‘Most people who
are important to me expect that I will engage in COVID-
19 preventive behavior,’’ (3) ‘‘Most people who are
important to me want that I practice COVID-19 preven-
tive behavior,’’ and (4) ‘‘Most people who are important
to me engage in COVID-19 preventive behavior.’’ These
responses were averaged together to construct an index
of social norms (Cronbach’s alpha = .82, M = 4.28,
SD = 0.59).
Self-efficacy. Self-efficacy regarding COVID-19 was
measured using three items on a 5-point scale ranging
from ‘‘1 = strongly disagree’’ to ‘‘5 = strongly agree’’ by
asking respondents how much they agree with the fol-
lowing statements: (1) ‘‘I can avoid COVID-19,’’ (2) ‘‘I
can recover even if I was infected from COVID-19,’’ and
(3) ‘‘I know how to avoid COVID-19.’’ The three items
were averaged together to create an index of self-efficacy
(Cronbach’s alpha = .74, M = 3.65, SD = 0.75). The
measurement items were adopted and modified from pre-
vious studies (e.g., Han et al., 2014; W. Yoo et al., 2016).
Preventive Behavior. Preventive behavior was assessed on
a 5-point scale ranging from ‘‘1 = not at all’’ to ‘‘5 =
very much’’ by asking how frequently respondents
engaged in the following preventive behaviors at that
time: (1) ‘‘I wear masks when I go out,’’ (2) ‘‘I wash my
hands frequently,’’ (3) ‘‘I do not touch my eyes, nose,
and mouth with unwashed hands,’’ and (4) ‘‘I comply
with recommended cough etiquette, such as covering my
mouth and nose with a sleeve or a tissue when I cough or
sneeze.’’ Responses to these four items were averaged to
construct an index of preventive behavior (Cronbach’s
alpha = .75, M = 4.39, SD = 0.54).
Control Variables. The study included the variables of
age, gender, education, income, political ideology, and
history of respiratory diseases in the analysis for control-
ling the potential confounding effects of the hypothesized
relationships. The mean age of the sample was 40.31
(SD = 10.91), 48.7% of the respondents were female; the
median of the participants’ education level was college
graduate, and the median monthly household income
level was KRW 4.00 to 5.00 million (approx. USD 4,000
to 5,000). Of the sample, 90.1% reported that they had
not experienced any respiratory diseases in the previous
year. Political ideology was measured using a 5-point
scale ranging from ‘‘1 = very liberal’’ to ‘‘5 = very con-
servative’’ (M = 2.82, SD = 0.75).
Table 1 presents the demographic characteristics of
the sample.
6 SAGE Open
Table 1. Socio-Demographic Profile.
Participants (%)
Age in years
19–29
30–39
40–49
50 over
Gender
Male
Female
Education
Less than high school graduate
College degree
Graduate degree or higher
Income (monthly household income)
¼ 2,000,000
Less than W
¼ 2,000,000–W
W ¼ 3,999,999
¼ 4,000,000–W
W ¼ 6,999,999
¼ 7,000,000 or more
W 14.2
Analysis
To investigate the hypothesized relationships in the sug-
gested model, a moderated mediation analysis was per-
formed using the SPSS PROCESS macro (Hayes, 2018).
The PROCESS macro simultaneously enables testing of
the direct effects between variables based on ordinary
least square regression and examining the indirect effects
with a bootstrapping method (Hayes, 2018). This study
employs the bias-corrected bootstrap method with 5,000
samples and a 95% confidence interval (CI). Specifically,
we use the PROCESS Model 4 was used to examine the
mediating relationship between social media use and pre-
ventive behavior through social norms. Furthermore, the
study employs the PROCESS Model 14 to estimate
whether the impact of social media use on preventive
behavior through social norms is contingent on self-
efficacy (i.e., the moderated mediation model).
Results
The present study used the PROCESS macro Model 4,
which produces both the direct relationship (see Figure
2) and the indirect effect among the variables (see Table
1). Figure 2 shows the unstandardized path coefficients
Table 2. Indirect Effect of Social Media Use on Preventive Behavior Through Social Norms.
Indirect Path
Social media use ! Social norms ! Preventive behavior
Note. Unstandardized regression coefficients and corresponding standard errors are reported; CIs are bias-corrected 95% confidence intervals for the
indirect effects (Bootstrap N = 5,000).
23.7
22.3
26.5
27.5
51.3
48.7
Figure 2. Mediation model of social media use, social norms,
21.6 and preventive behavior.
69.4
9.1
11.9 and statistical significance in the direct associations
31.8 among social media use, social norms, and preventive
32.0 behavior. The study results demonstrated a positive rela-
tionship between social media use and social norms
(b = 0.09, SE = 0.01, p \ .001). In response to RQ1,
social media use had a positive association with preven-
tive behavior (b = 0.03, SE = 0.01, p \ .001). Moreover,
the results indicate that social norms have a positive rela-
tionship with preventive behavior (b = 0.48, SE = 0.01,
p \ .001).
As presented in Table 2, the results point to the indi-
rect impact of social media use on preventive behavior
through social norms (b = 0.046, SE = 0.007, 95% CI
[0.032, 0.061]). Thus, the result supports H1.
Additionally, we ran the PROCESS macro Model 14
was used to find the moderated mediation effect, yielding
direct effects (see Figure 3) and the moderated mediated
effect (see Table 2). Figure 3 illustrates the direct effect
that social media use, social norms, self-efficacy, and the
interaction term (social norms ’ self-efficacy) were entered
in predicting preventive behavior. Social media use had a
positive relationship with social norms (b = 0.09,
SE = 0.01, p \ .001) and preventive behavior, (b = 0.03,
SE = 0.01, p \ .01), respectively. In addition, social
norms were found to be positively associated with pre-
ventive behavior (b = 0.72, SE = 0.08, p \ .001).
Furthermore, the data analysis found that self-efficacy
was positively related to preventive behavior (b = 0.50,
SE = 0.10, p \ .001). The interaction effect of social
norms and self-efficacy on preventive behavior was sta-
tistically significant (b = 20.08, SE = 0.02, p \ .001).
Estimate SE CI
0.046 0.007 0.032–0.061
Choi and Noh 7

Figure 3. Moderated mediation model of social media use, social norms, self-efficacy and preventive behavior.

Table 3. Moderated Mediation Model: Conditional Indirect Effects of Social Media Use on Preventive Behavior Through Social Norms
Moderated by Levels of Self-efficacy.

Mediator Moderator Condition Estimate SE CI

Social norms Low 0.044 0.007 0.030–0.059

Social norms Middle 0.040 0.006 0.028–0.054
Social norms High 0.037 0.006 0.025–0.051

Note. Unstandardized regression coefficients and corresponding standard errors are reported; Conditions for moderator (self-efficacy) are the mean and
one standard deviation below and above from the mean. CIs are bias-corrected 95% confidence intervals for the indirect effects (Bootstrap N = 5,000).

In response to RQ2, the results of the moderated med-
iation analysis demonstrate that there are significant
conditional indirect effects of social media use on pre-
ventive behavior. Table 3 presents the different degrees
of indirect effects of social media use on preventive beha-
vior through social norms according to the level of self-
efficacy. Specifically, the indirect effect of social media
use on preventive behavior through social norms was sig-
nificant for low (b = 0.044, SE = 0.007, 95% CI [0.030,
0.059]), middle (b = 0.036, SE = 0.006, 95% CI [0.024,
0.049]), and high (b = 0.030, SE = 0.006, 95% CI [0.019,
0.044]) levels of self-efficacy. The results indicate that the
indirect effect of social media use on preventive behavior
through social norms becomes stronger as the level of
self-efficacy decreases.
Discussion
The present study explored how social media use is asso-
ciated with preventive behavior through social norms as
well as how the mediating relationship differs depending
on an individual’s level of self-efficacy, by analyzing data
from a national online panel survey of South Koreans
for a week during the COVID-19 outbreak. Since social
media play an important role in propagating health
information during a public health crisis, this study
8 SAGE Open
argues that social media use can help people to engage in
preventive behavior to protect themselves from the out-
break of an infectious disease. The findings of the current
study advance the understanding of the impact of social
media on preventive behavior, particularly in promoting
preventive behavior for individuals with a lower level of
self-efficacy. This study suggests that social media can
assist in the development of beneficial health and risk
communication strategies for the public in the case of
future public health crises.
More specifically, this study identified an indirect
relationship model, wherein social norms mediate the
association between social media use and preventive
behavior. This finding suggests that individuals who use
social media more frequently for news and information
about COVID-19 are more likely to perceive preventive
behavior practices as social norms, which may, in turn,
be positively related to engaging in preventive behavior.
Therefore, social media could serve as an important
source of social norms, helping people perceive norma-
tive cues about preventive behavior shown by other users
through online networks (Spartz et al., 2017; Yang &
Wu, 2021). This observation is positively related to prac-
ticing frequent preventive behavior against the infectious
diseases, such as COVID-19. That is, people who per-
ceived the performance and approval of preventive beha-
vior against COVID-19 were more likely to engage in
preventive behaviors. This perception encourages them
to comply with the behaviors of the majority in their
social group (Bandura, 2004). In particular, during the
infectious disease outbreaks, social norms may function
as a form of social pressure by encouraging people to
engage in preventive behavior, and social media play a
significant role in helping people to perceive such social
norms related to preventive behavior. The findings of
this study support the proposition that the significant
association between social media use and preventive
behavior is maintained in the context of social norms.
This suggests that social media use has a positive rela-
tionship with preventive behavior, particularly by pro-
viding important normative signals about the preventive
behavior of people close to them to protect themselves
against the infectious disease.
Furthermore, the study results indicated that the indi-
rect path to preventive behavior differed depending on
an individual’s level of self-efficacy. This finding supports
the notion that the impact of media use on behavioral
outcome variables can differ depending on individual dif-
ferences (e.g., Y. Kim & Chen, 2015). From a theoretical
perspective, this result advances that social norms func-
tion as a significant mediating mechanism, however, this
mediating relationship with preventive behavior is con-
tingent on individuals’ self-efficacy, indicating that self-
efficacy significantly moderates the mediating paths.
The relationship between social media use and preventive
behavior through social norms was higher for individuals
with a lower level of self-efficacy than for those with a
higher level of self-efficacy. Specifically, compared to
individuals with a higher level of self-efficacy regarding
COVID-19, those with a lower level of self-efficacy
regarding COVID-19 could benefit more from social
media, in this respect, despite the main effect of self-
efficacy being that respondents with a higher level of self-
efficacy engaged more frequently in preventive behavior
than those with a lower level of self-efficacy. When peo-
ple with a lower level of self-efficacy for COVID-19 use
social media often for news and information about the
corona virus, they are more likely to obtain greater bene-
fits from perceiving social norms on preventive behavior
than those with a higher level of self-efficacy, who
already perceive social norms that are positively associ-
ated with preventive behavior practice. It is possible that
individuals with low self-efficacy would use social norms
as a promoter to engage in preventive behaviors com-
pared to those with high self-efficacy. This finding may
suggest that social media would be a beneficial tool, par-
ticularly for people with low self-efficacy for COVID-19,
in perceiving social norms of preventive behavior and
helping them to practice more preventive behavior.
Limitations and Suggestions for Future
Research
Although the present study reveals important findings, it
has some limitations. First, this study is based on cross-
sectional survey data, and hence, it is difficult to justify
the causal claims of the associations observed. In other
words, the study results cannot build temporal order nor
eliminate the possibility of reverse causality of the rela-
tionships between social media use, social norms, and
preventive behavior. Nevertheless, as discussed above,
the present research model was suggested based on theo-
retical grounds, strong inferences, and empirical evidence
derived from previous studies. Although the current
interpretation of the findings is congruent with prior lit-
erature, future research needs to adopt a longitudinal
approach to establish stronger causal arguments.
Second, the study used self-reported preventive beha-
vior data rather than directly measuring actual actions.
Even though self-reported behavior measures have been
broadly employed in research, a self-reported measure-
ment may be limited because it is vulnerable to social
desirability bias. Nevertheless, the survey approach
adopted in this study may be suitable for further explor-
ing the association between social media use and preven-
tive behavior, which could offer more generalizable
nationwide results.
Choi and Noh
Third, the social media use measure used in the study
relied on respondents’ retrospective recall of exposure to
news and information about COVID-19 on social media.
It is possible that respondents’ memory could be biased
and inaccurate in capturing their behavior (Prior, 2009;
W. Yoo et al., 2020). Future studies should use real-time
behavioral data to gauge social media use. Additionally,
another shortcoming regarding the social media use mea-
sure is that this study used a single item to assess social
media use, which may raise a concern about reliability
and validity. However, some prior studies also have
employed a single item to investigate the impact of social
media as an information source in the contexts of health
and risk communication (e.g., Oh et al., 2021; W. Yoo
et al., 2020). Nevertheless, future research needs to use
more items to capture complete social media use, which
may yield robust outcomes.
Fourth, this study did not distinguish between injunc-
tive norms and descriptive norms when examining the
effects of social norms on preventive behavior, regardless
of the fact that injunctive and descriptive norms can be
tested with a composite norm variable (Fishbein & Ajzen,
2011; M. Yzer, 2012). Even though both injunctive norms
and descriptive norms can foster one’s behavior by offer-
ing information about what represents desirable behavior
in a given context (Lapinski & Rimal, 2005), some studies
have also suggested that the two types of norms may play
different roles in impacting health-related behaviors (e.g.,
Ho et al., 2014; Smith-McLallen & Fishbein, 2008; Stok
et al., 2014). Future research may need to explore the dis-
tinctive roles of both injunctive and descriptive norms on
preventive behaviors in the context of COVID-19 by
including more items on such norms.
In future research, it would be an interesting topic to
examine how social media use affects people’s COVID-
19 vaccine uptake through social norms. Such research
would be important for understanding how to promote
COVID-10 vaccination as a preventive behavior.
Exploring the associations among social media use,
social norms, and self-efficacy could offer key implica-
tions for facilitating vaccination in future infectious dis-
ease outbreaks.
In addition, future research also needs to consider the
dynamics of each community, such as suburban or
urban, regarding the impact of social media on preven-
tive behavior. If the epidemic continues, tailored strate-
gies for each community in the area of public health and
health communication should be developed separately
for responding to the risk of the infectious disease.
Finally, future research should consider the impor-
tance of demographic factors, such as age and gender, in
9
affecting preventive behavior. For example, it would be
interesting to examine whether the younger age group or
older age group obtain a stronger benefit from social
media use to engage in preventive behavior. Future
research may contribute to understanding the differential
role of demographic factors. In this regard, exploring the
demographic factors may help establish tailored recom-
mendations for influencing preventive behavior.
Conclusion
With these considerations in mind, this study contributes
to a better understanding of the mechanism underlying
the relationship between social media use and preventive
behavior, particularly focusing on the mediating role of
social norms and the moderating role of self-efficacy.
Consistent with the findings of previous studies that
social media use has significant improvement in health
behavior change (Maher et al., 2014), this study provides
empirical evidence of the benefits of social media use on
preventive behavior for COVID-19, especially being
greater for individuals with lower self-efficacy. This study
elucidates the significant role of social norms derived
from social media use through the provision of a positive
pathway to preventive behavior. The study results have
critical implications given the concerns that some people
are reluctant to engage in preventive behavior during the
outbreak of a contagious disease.
In addition, the findings of the current study have
key practical implications for public health, underscor-
ing the importance of preventive behavior, during the
outbreak of a contagious disease. Given the new media
environment, where social media serve as an important
channel for disseminating health and risk information
to people, public health communication practitioners
and public health policymakers need to leverage the
role of social media for health communication inter-
vention in the event of future emergencies. Specifically,
when developing public campaigns to promote preven-
tive behavior, public health communicators need to
design social norms messages that portray commonly
accepted behavior by other people through social
media. In particular, public health communication
experts and public health policymakers need to utilize
the beneficial role of social media by targeting specific
segments of the general public, particularly for those
with a lower level of self-efficacy for COVID-19.
Effective health communication should help the public
to engage in appropriate preventive behavior to avoid
the spread of an infectious disease.
10
Appendix A
Construct Measurement items
Social norms 1. Most people who are
Preventive behavior important to me (e.g., family
members
and friends) think that I
should practice COVID-19
preventive
behavior.
2. Most people who are
important to me expect that I
will engage
in COVID-19 preventive
behavior.
3. Most people who are
important to me want that I
practice
COVID-19 preventive
behavior.
4. Most people who are
important to me engage in
COVID-19
preventive behavior.
Self-efficacy 1. I can avoid COVID-19.
2. I can recover even if I was
infected from COVID-19.
3. I know how to avoid COVID-
19.
Preventive behavior 1. I wear masks when I go out.
2. I wash my hands frequently.
3. I do not touch my eyes, nose,
and mouth with unwashed
hands.
4. I comply with recommended
cough etiquette, such as
covering
my mouth and nose with a
sleeve or a tissue when I
cough or
sneeze.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial sup-
port for the research, authorship, and/or publication of this
article: This research was supported by Hallym University
Research Fund, 2021 (HRF-202109-005).
Ethical Statement
The ethical approval was obtained from the Institutional
Review Board of Hallym University (IRB no. HIRB-2020-
SAGE Open
015). This study does not contain any unfair means or any
other criminal activity which damage human beings. Informed
consent was obtained from all participants before they agreed
to participate in the study. Participants were informed that they
could leave the study at any time without penalty, and all per-
sonal information was kept confidential.
ORCID iD
Doo-Hun Choi https://orcid.org/0000-0002-3339-4785
Note
1. The data that support the findings of this study are available
from the corresponding author upon reasonable request.
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