Given this background, this study focused on 646 people over 55 years old during period of the COVID-19 outbreak in China (February 21, 2020-March 15, 2020). The study asked these questions:
(1) What was the risk perception of COVID-19 among older people during the outbreak?
(2) What was the health information search behavior of older people during the outbreak?
(3) What is the relationship between health risk perception and health information search behavior for older people?
A social network is a relationship network formed by interactions between individuals or families and their relatives, friends, colleagues, neighbors, etc.. With the development of information technology and the emergence of social media, the online social network has become the mapping of users' interpersonal relationships in virtual space. These networks include those created with instant messaging software and dating software, blog or other online network platforms, media-sharing networks, and short videos. In recent years, diverse social networks have provided the most extensive channels for the generation, access, and sharing of health information.
The term "health risk perception," which derives from "risk perception," has not achieved a unified definition in academic circles. Health risk perception is an important concept composed of health and risk transmission and has been confirmed to have a high correlation with health behavior, which plays an important role in health behavior theory. Some scholars have paid attention to the public risk perception when new infectious diseases occur, such as MERS or H1N1, and some scholars have developed a public risk perception scale for public health emergency events. Other investigators have identified risk perceptions as being linked to information activities.
Risk perception is a multidimensional concept. Research on the dimensions of health risk cognition is still not unified or systematic. Table 1 shows various dimensions of health risk cognition used by some scholars in recent years.
In summary, in order to better understand the health risk perception of older people in the early stage of the COVID-19 outbreak, this study refers to the existing research conclusions to construct health risk perception variables from the four dimensions of perceived probability, perceived severity, perceived controllability, and perceived familiarity.
Health information search behavior derives from information search behavior. The definition of information searching behavior that is widely recognized by scholars is, "Information searching behavior refers to the information searching activities conducted by users to meet certain target needs," as proposed by Wilson. More recently, the development of user-centered online social networks has not only constructed a complex virtual interpersonal network for users, meeting their interaction and entertainment needs, but also formed a complex information base that greatly expands the health information search behaviors of users.
Many scholars have carried out numerous studies on the representation, content, influencing factors, search barriers, and other aspects of health information search behavior in online social networks, and drawn many scientific and effective conclusions. Both Manafo and Wong and Hutto et al. found that older adults do not have enough experience to construct effective online searches, that they search for information based only on their previous experience, lack the ability to evaluate the health information in social networks.
Therefore, we focus our research on older people and try to explore the relationship between older people's health risk perception and their health information search behavior.
Griffin et al. proposed the Risk Information Search and Processing (RISP) model in 1999 based on psychology and information communication theories: the Heuristic Systematic Model and the Theory of Planned Behavior. The RISP model's main variables are perceived hazard characteristics, affective response, information sufficiency, information subjective norm, perceived information-gathering capacity, and relevant channel beliefs.
"Perceived hazard characteristics" are individuals' assessment and prediction of risk status, including perceived probability, perceived severity, institutional trust, and personal control. "Affective response" in the RISP model refers to the uncertainty, worry, and fear generated by perceived risk characteristics. "Information sufficiency" is the central variable in the RISP model, and refers to the confidence in information an individual needs to deal with a risk event [i.e., the information sufficiency threshold ]. It is reflected in the individual's grasp of their own risk information in the face of risks, and represents the gap between the information the individual has available and the information necessary to effectively deal with the risk. "Information subjective norm" refers to the social pressure that an individual feels when taking a specific behavior. "Perceived information-gathering capacity" measures an individual's self-efficacy in information collection. "Relevant channel beliefs" reflect the trust level of social media.
The RISP model proposes that an affective response generated by perceived risk characteristics will affect the confidence one wants to have in one's knowledge about the risk (information sufficiency threshold), and that one will be motivated to have more information-seeking behavior. The specific path of the model is shown in Figure 1.
Since the RISP model was proposed, the Griffin team and other scholars have used this model to carry out a number of studies: Griffin et al. verified the impact of risk perception, worry, and subjective norms on information sufficiency in drinking water safety risk perception and fish product consumption research. Hunnrne et al. conducted a comparative study of information search and processing behavior for public safety risks between American and Dutch citizens and found that the RISP model has applicability and effectiveness in different cultural backgrounds. Hovick et al. validated cancer risk information with the RISP model.
Thus, the RISP model has good adaptability and should also be suitable for the study of health risk perception, providing a theoretical basis for the situational study of health information user behavior. However, some variables in the RISP model may not have a significant impact on this study and will need adjustment, as described in the following.
Considering the context of COVID-19, the study focuses on the characteristics of sudden public health events [e.g., high levels of attention to health information ], the impossibility of offline investigation under strict control measures, and the group characteristics of the older people (e.g., limited energy). Therefore, we deleted three variations: "information subjective norm," "relevant channel beliefs," and "perceived information-gathering capacity," and replaced "perceived hazard characteristics" with "health risk perception." The reasons for our changes are as follows: (1) With the RISP model, the "information subjective norm" is an important motivation to seek out and deal with non-personal risks. This study focuses on the risk perception of older people, which is directly related to individuals. Some studies did not consider the "information subjective norm" when they applied the RISP model to study health risk cognition, like Johnson. (2) Griffin et al. added media images into the RISP model and used "relevant channel beliefs" to reflect the trust level of social media. This study focuses on the relationship between risk perception and health information search behavior in older people facing COVID-19 and did not involve a differentiated study of various information channels. Therefore, "relevant channel beliefs" are not considered in this study. (3) Many studies have found that older people have ambiguous cognition of their own information collection ability. Other studies have found that self-efficacy is related to perceptions of the effectiveness of medications and confidence in self-knowledge, which is consistent with the "perceived familiarity" and "perceived controllability" of "health risk perception." Therefore, "perceived information-gathering capacity" is classified as "health risk perception" and will not be studied separately. We retained the variables of "affective response" and "information sufficiency," which will be discussed in Section Research model and hypotheses.
Based on RISP theory, we propose a model of health risk perception and health information search behavior based on study of older people's online information searching behavior during the COVID-19 outbreak. Figure 2 provides a research framework for how health risk perception affects health information search behavior.
Risk is commonly defined as a multiplicative combination of the probability of a hazardous event occurring and the severity of the resulting negative consequences. Dai et al. found that individuals have different perceptions of a risk and that their perceptions vary from one risk to another. Perceived severity of risk refers to an individual's assessment of the degree of harm associated with the risk. At the end of 2019, COVID-19 had the characteristics of being a highly unknown disease, highly contagious and having a high mortality rate. Severely ill patients were mostly older people and those with underlying diseases. Many older people began to pay attention to the risk of infection to themselves, their families, and the other people surrounding them, as well as the serious consequences after infection. Therefore, this study believes that perceived severity and perceived probability are very important parts of older people's assessment of the health risks caused by COVID-19.
In the objective result of risk, the greater the individual's ability to control the risk result, the more his risk perception will be inclined to the favorable side of the risk uncertainty result. Slovic proposed that the two dimensions of perceived possibility and risk severity (proposed in the psychometric paradigm of risk cognition) are not enough to fully reveal the characteristics of health risk cognition, and that risk controllability is also an important influencing variable. In their diabetes research, Walker et al. defined personal risk control as a means of behavior control taken by individuals to achieve health. In addition, public resources, especially medical resources provided by the government, public health funds, etc., affect the level of public health risk awareness. Since the outbreak of COVID-19, the Chinese government has continuously publicized a series of specific measures to prevent the spread of the virus, including wearing masks, reducing gatherings, etc. The media has continued to report on the progress of drug and vaccine research and development, and the current situation of the epidemic in various places. However, the home isolation measures taken by the government during the epidemic period made it difficult for older people to obtain information through offline information access channels, so as to assess the effectiveness of various prevention and control measures taken by the government and other public departments against the epidemic. Therefore, this study proposes that perceived risk controllability is also an important part of older people's evaluation of the health risk caused by COVID-19.
Risk familiarity is an important factor in risk assessment. Many scholars have found that risk perception is closely related to people's risk experience and knowledge of risk events. Slovic proposed in his risk cognition model that familiarity is an important factor affecting risk cognition, and defined familiarity as people's understanding or the visibility of risk events. The severity of the negative consequences that an infectious disease may cause, the possibility of contracting the infectious disease, and the ability to control its spread may all be relevant aspects of the public's assessment of the possible health risks of the infectious disease. COVID-19 was a sudden, new infectious disease. In the early days of the epidemic, the public had little knowledge of COVID-19. Limited by cognitive ability and the ability to search for information, the understanding of the infectious disease in older people was far below the average level. The familiarity of older people with COVID-19 directly affects their awareness of potential health risks.
Therefore, considering the reactions of older people during the COVID-19 outbreak as the context of this study, the first hypothesis of the study is developed:
H1. Health risk perception is a second-order factor of perceived probability, perceived severity, perceived controllability, and perceived familiarity.
Risk perception has been confirmed to be associated with information search behavior. In the health field, Patel found that risk perception has an impact on health information search behaviors in cases of breast cancer. With the development of social networks, Guo et al. found that risk perception significantly affects the health information behavior of social media users.
The public's perception of risk has an important impact on their information searching behavior in emergency situations. For example, Bish and Michie found that risk perception can promote protective motivation in public health emergency events, which increases preventive behavior during infectious disease outbreaks. In addition, the theory of planned behavior holds that the behavioral attitude and subjective norm affect individual behavioral intention, and behavioral intention leads to behavior, which is consistent with the logic that health risk perception affects health information search behavior. For older people, degenerative changes in human tissues and organs inevitably bring about a weakening of the function of the immune system, and the phenomenon of "survival with disease" is more common. Older people with various chronic and underlying diseases are at higher risk of death during public health emergency events. As a result, older people are more concerned about their health and life safety, and they are more active in searching for health information.
Therefore, this study makes the following hypothesis:
H2. Health risk perception is associated with the health information search behavior of older people during public health emergency.
The estimations and judgments made by individuals in the face of the same risk event are often different. The RISP model divides the process of an individual facing risk information into three stages: cognition, emotion, and information search and processing. When individuals have differences in their perception of the possibility of risk, the severity of the consequences, the degree of trust in the risk management organization, and their own assessment of their ability to control the risk, their affective states will also be different. Health risk perception is the basis for the rational response of the public to public health emergency events. Previous studies have shown that people with different health risk perceptions differ in their negative emotions about infectious diseases. A positive correlation between Koreans' perception of the epidemic's severity and their negative emotions was confirmed by a study of the 2015 MERS outbreak.
Older people are more vulnerable to the public health crisis caused by COVID-19 because of their physical and social vulnerability. They tend to be less confident about their own immunity, to believe that they have a high possibility of infection and serious consequences of infection, to not be confident in epidemic control, and to not be familiar with COVID-19. Therefore, they not only have concerns about infection damaging their health, but also have concerns and fears about maintaining their personal lives and mental health. More importantly and universally, a public health crisis also weakens their social support network. Under these effects, older people are more likely to experience excessive worry, anxiety, and other negative emotions.
Therefore, this study makes the following hypothesis:
H3. Health risk perception is associated with the affective response of older people during public health emergency.
Affective response, as a negative affective state, will affect the information sufficiency threshold, that is, the confidence one wants to have in one's information about the risk. This point has been verified by subsequent studies by numerous scholars. For example, Hovick et al. found that negative emotions such as anxiety mediate the relationship between health risk perception and information sufficiency, in their study on cancer risk information searching behavior. During the outbreak of an infectious disease, the public's negative emotions related to the disease, such as anxiety or fear, tend to be more intense, especially on social networks. Moreover, the panic caused by such public health emergencies can easily spread quickly, an effect that is more prominent in the information age of big data. For older people, their ability to process social network information is not as good as that of other age groups, and a large amount of health information will cause confusion over the information and health concerns.
On the other hand, the perception of aging among older people is more sensitive than that of other groups, and with the decline of physical function and the increase of health troubles, the concern about health is inevitably stronger than in other groups. During the COVID-19 outbreak, older people knew little about the newly emerged novel coronavirus and they were not confident in their own immunity. As a result, they had stronger negative emotions, such as anxiety and fear of contracting the disease and the serious consequences of infection. Negative emotions made older people more likely to have a lower understanding of health information and a greater demand for health information (i.e., higher thresholds of information sufficiency). In addition, home quarantine measures during the epidemic further limited the access of older people to information.
Therefore, this study makes the following hypothesis:
H4. Affective response is associated with the information sufficiency of older people during public health emergency.
The theory of RISP indicates that information sufficiency mediates the relationship between affective response and information search behavior. The threshold between the existing risk information and the information necessary to effectively respond to the risk gives individuals a strong need for information. It urges individuals to seek and process information more actively and systematically. Eventually, it affects the individual information search and processing methods. Subsequent studies by many scholars have confirmed that individuals often meet their subjective information needs through more active information search behaviors. Public health information needs tend to increase significantly during public health emergency events, as confirmed by a survey by Tausczik et al. during the H1N1 epidemic. Considering the health inequalities of older adults, these adults show more intense health information needs and desire for understanding of health information than other groups. During the COVID-19 outbreak, traditional health information access routes (e.g., newspapers) were interrupted due to Chinese governments' home isolation measures; people had more free time and could rely more on social networks to obtain COVID-19 information. These conditions were more likely to trigger health information search behaviors on social networks.
Therefore, this study makes the following hypothesis:
H5. Information sufficiency is associated with the health information search behavior of older people during public health emergency.