A situational test of the health belief model: How perceived susceptibility mediates the effects of the environment on behavioral intentions

Existing evidence regarding the role of perceived susceptibility in shaping preventative health behavior is mixed in the Health Belief Model (HBM). To clarify whether and under which conditions perceived susceptibility affects preventative behavior, this study aims to better understand how situational environmental factors affect perceived susceptibility, thereby shaping health decisions, and whether this mediation relationship is conditioned by other HBM cognitions, namely perceived benefits, and severity. Therefore, we employed a scenario-based experiment in a large, representative sample of the German population (N = 4802) in April 2022. Respondents were presented with a fictional invitation to a social gathering, which mimicked a post in a messenger group chat. The invitation included five experimentally manipulated scenarios: no preventative measures implemented, a COVID-19 test is required; either testing negative, being vaccinated, or being recovered from COVID-19 is required (known as 3G in the German context); reduced number of attendees; or the social gathering occurred outside. Moreover, perceived susceptibility to contract COVID-19 at the social gathering and perceived severity and benefits (independent of the scenario) were measured. We found evidence that perceived susceptibility mediates the relationship between each implemented preventative measure and willingness to attend a social gathering. The effect of the preventative measures on perceived susceptibility and the indirect effect of the preventative measure on attendance via perceived susceptibility were moderated by perceived benefits. However, there is lack of robust evidence that perceived severity moderates the effect of perceived susceptibility on attendance. In summary, our study provides evidence that individuals perceive and adapt their perceptions and behavior to preventive measures in a given situation, which speaks to the dynamic nature of the cognition perceived susceptibility. Moreover, our findings suggest a promising avenue forward for the HBM is to examine how the cognitions and the environment together shape preventative health behavior.