A Moderated Mediation Model Explaining the Relationship Between Risk-Group Membership, Threat Perception, Knowledge, and Adherence to COVID-19 Behavioral Measures

BACKGROUND: COVID-19 is a threat to individual and global health, thus, reducing the disease's spread is of significant importance. However, adherence to behavioral measures against the spread of COVID-19 is not universal, even within vulnerable populations who are at higher risk of exposure to the virus or severe COVID-19 infection. Therefore, this study investigates how risk-group membership relates to adherence to COVID-19 behavioral measures, whether perceived threat of COVID-19 is a mechanism explaining this relationship, and whether knowledge about COVID-19 moderates these effects. METHODS: We conducted a web-based survey (N = 4,096) representative of the adult population in Germany with regard to gender, age (18 to 74), and province. Therein, we assessed risk group membership with two indicators (risk of exposure to COVID-19 and risk of severe COVID-19 infection), perceived COVID-19 threat with the Perceived Coronavirus Threat Questionnaire, knowledge about COVID-19 with a knowledge test; and adherence to six behavioral measures to protect against the spread of COVID-19 (e.g., keeping distance, using mouth-nose protection, and following contact restrictions). We used moderated mediation models to test whether perceived threat mediates the relationship between risk-group membership and adherence and whether knowledge about COVID-19 moderates this relationship. RESULTS: We found that risk group members had more perceived COVID-19 threat and that knowledge about COVID-19 increased perceived threat. Moreover, risk group membership had a positive direct effect on adherence to most behavioral measures and risk group members with less knowledge about COVID-19 violated measures more frequently. Risk-group membership also had positive indirect effects on adherence via perceived COVID-19 threat. The moderated indirect effects of threat indicate that threat led to more adherence when knowledge was low, but lost relevance as knowledge increased. CONCLUSION: The results may help to evaluate disease-regulation measures and to combat the pandemic more effectively. For example, increasing COVID-19 knowledge in the general population could increase adherence to COVID-19 behavioral measures. However, policy makers should be mindful that this could also have negative mental health implications as knowledge increases perceived COVID-19 threat.