Heat-protective behavior in pregnancy: Extending Protection Motivation Theory with environmental and social factors

Pregnant women are particularly vulnerable to heat-related health risks, yet little is known about heat-protective behavioral adaptation during pregnancy. We extended Protection Motivation Theory (PMT) by incorporating environmental and social factors to examine their associations with heat-protective behavioral intentions and behavioral adaptation among pregnant women in Germany.

We used confirmatory factor analysis and structural equation modeling to estimate integrated path models for 10 distinct heat-protective behaviors based on the PMT using a cross-sectional sample of 474 pregnant women in Germany.

Coping appraisal consistently showed the strongest associations with behavioral intentions across behaviors, whereas threat appraisal showed limited and inconsistent associations. Indoor thermal perception was positively associated with perceived vulnerability, while the highest self-reported outdoor temperature experienced was linked to indoor thermal perception. Cues to action, including prompts from family members and maternal health professionals, were associated with behavioral adaptation in nine of 10 behaviors.

Findings suggest that interventions targeting heat-protective behavior in pregnant women should prioritize enabling adaptive capacity rather than relying primarily on risk communication. The role of cues to action highlights the importance of considering social influences in behavioral adaptation, which remain underrepresented in PMT-based heat adaptation research.