Factors Influencing the Maintenance of Public Health Behaviors After an Epidemic: Cross-Sectional Study

The maintenance of public health behaviors stands as a critical issue within the realm of public health. COVID-19, a major global emergency, has profoundly impacted the sustainability of public health behaviors. However, there is currently a gap of empirical studies examining the status and influencing mechanisms of public health behavior maintenance after the pandemic, especially those adopting a multifactorial and integrated approach.

This study aims to investigate the current status of public health behavior maintenance in China after the COVID-19 pandemic. It integrates the complementary advantages of the Multi-Theory Model (MTM) and the Protective Action Decision Model (PADM) to conduct a comprehensive analysis of the multi-factorial mechanisms influencing the maintenance of public health behaviors. The findings are expected to provide empirical evidence and strategic recommendations for the formulation of public health policies and the promotion of national health.

An integrated model was developed based on the MTM and the PADM. Data were collected from the Chinese public between October and November 2023 via the online survey panel Sojump (Changsha Ranxing Information Technology Co., Ltd.). The questionnaire included items on health behavior maintenance, variables from the MTM and the PADM, sociodemographic and personal disease, and health characteristics. Univariate analysis, correlation analysis, multivariate regression analysis, and structural equation modeling were performed to explore the determinants of health behavior maintenance.

This study collected 1216 valid samples, including 726 females and 490 males, with an average age of 27.38 (SD 8.52) years, and most of them had been infected with COVID-19 at least once (1054/1216, 86.68%). The public maintenance of health behaviors was at a fairly low level (Mean 2.88, SD 0.45). Multivariate regression analysis revealed that those with high monthly incomes, married individuals, and who were more concerned about their health after the COVID-19 pandemic had higher levels of health behavior maintenance. These variables, along with others from the MTM and the PADM, accounted for 45.5% of the variance in health behavior maintenance. Structural equation modeling indicated that efficacy perception had the most significant positive influence on health behavior maintenance (β=.386, P<.001), followed by emotional transformation and practical changes (both β=.213, P<.001). Risk perception had a slightly negative effect on health behavior maintenance (β=-.099, P=.013). Variables such as social cues, warning messages, and information sources also indirectly influenced the public maintenance of health behaviors.

This study indicates a slight decline in public health behavior maintenance following the COVID-19 pandemic, and our analysis has explored some of its influencing factors. Attention should be given to broadening information channels and appropriately explaining the risks of unhealthy behaviors. In addition, integrating external support and bolstering the public's efficacy in maintaining health behaviors can promote sustainable healthy practices.