A Model to Predict Fear Control and Covid-19 Risk Control Behaviors Among Patients With Diabetes: A Lesson for the Future; [مدلی برای پیش‌بینی رفتارهای کنترل ترس و کنترل خطر کووید-۱۹ در میان بیماران مبتلا به دیابت: درسی برای آینده] Publisher

Summary: What shapes responses to COVID risk? A survey found perceived effectiveness predicted protective action, while fear reactions had inverse links; further study is needed. #RiskCommunication #COVID19

Ghafari D ; Zamani Alavijeh F ; Salahshouri A ; Rahimi M ; Khanjani Veshki S ; Ghanbari S
Source: Journal of Health System Research Published:2026

Abstract

Background: The contagious respiratory disease outbreak is a recurring public health challenge, and the type of control responses, especially in people with chronic diseases, plays a significant role in its extent and severity. The public health system should learn from these experiences to prevent the recurrence of crises in the future. This study aimed to predict the behavioral responses of risk control of coronavirus disease 2019 (COVID-19) and fear control based on the extended parallel process model (EPPM) in patients with diabetes. Methods: This was a descriptive-analytical study conducted with the participation of 254 middle-aged patients with diabetes covered by Shahinshahr Comprehensive Health Centers (Isfahan Province, Iran) between 2021 and 2022. Samples were selected using simple random sampling. The data collection tool was a researcher-made questionnaire including demographic characteristics and questions related to EPPM, for the variables of fear control, risk control, perceptions, and fear; its validity was confirmed by experts and its reliability was also confirmed through test-retest method. The data were analyzed using statistical methods [t-test, analysis of variance (ANOVA), and structural equation modeling (SEM)] in SPSS software. Findings: Of the 254 participants, most were women (54.7%), had a diploma or higher education (65.8%), and were married (52.2%). Based on the obtained coefficients, favorable risk control responses were predictable by perceived efficiency (β = 0.649) with direct effect and fear control (β =-0.352) and fear (β =-0.153) responses with inverse effect (P < 0.05), but perceived threat (β = 0.11) had no significant effect on it (P > 0.05). Fear and negative emotions were significantly related to perceived threat (β =-0.32) and perceived efficiency (β = 0.30). Conclusion: Although the initial model of EPPM did not address the relationship between control responses, in the current study, an inverse relationship was found between fear control and risk control of the COVID-19 responses. This new result is likely to strengthen the original framework; however, the unexpected result was the inverse and significant relationship of perceived threat and the significant direct effect of perceived efficiency on fear, which requires more studies. © 2026, Isfahan University of Medical Sciences(IUMS). All rights reserved.