Perceived access, fear, and preventative behavior: Key relationships for positive outcomes during the COVID‐19 health crisis

• Published date: 01 March 2022
• Author: Richard J. Vann,Emily C. Tanner,Elvira Kizilova
• Date: 01 March 2022
• DOI: http://doi.org/10.1111/joca.12439

SPECIAL ISSUE

Perceived access, fear, and preventative

behavior: Key relationships for positive

outcomes during the COVID-19 health crisis

Richard J. Vann

1

| Emily C. Tanner

2

| Elvira Kizilova

3

1

Black School of Business, Penn State

Behrend, School of Business

Administration, Gonzaga University,

Spokane, Washington, USA

2

John Chambers College of Business and

Economics, West Virginia University,

Morgantown, West Virginia, USA

3

Brennan School of Business, Dominican

University, River Forest, Illinois, USA

Correspondence

Emily C. Tanner, John Chambers College

of Business and Economics, West

Virginia University, Morgantown, WV,

USA.

Email: emily.tanner@mail.wvu.edu

Funding information

Penn State University; West Virginia

University

Abstract

The Coronavirus (COVID-19) pandemic reduced real

and perceived access to healthcare services, exacerbat-

ing pandemic fear, and thus influencing consumers'

adoption of preventative health behaviors. Extending

the EHBM, results from two studies show that per-

ceived access to health services and pandemic fear

impact an individual's general and COVID-preventative

health behaviors. High perceived access reduces pan-

demic fear through its buffering effects on perceived

health vulnerability and pandemic-related health sys-

tem concern, especially with telehealth usage during

the pandemic. While pandemic fear motivates COVID-

19 vaccination, pandemic fear reduces personal preven-

tative health behavior (e.g., healthy eating, exercising)

and has little effect on personal COVID-preventative

behaviors (e.g., wearing a mask, social distancing)

when individuals perceive high pandemic-related con-

trol. Moreover, the fear-behavior link does not hold for

preventative health visits; instead, perceived access

directly promotes preventative visits and screening.

This research informs public health stakeholders' com-

munication, education, and resource allocation during

health crises like the COVID-19 pandemic.

KEYWORDS

Coronavirus, fear, perceived access to health services

Received: 15 November 2020 Revised: 18 November 2021 Accepted: 12 January 2022

DOI: 10.1111/joca.12439

© 2022 American Council on Consumer Interests.

J Consum Aff. 2022;56:141–157. wileyonlinelibrary.com/journal/joca 141

1|INTRODUCTION

The Coronavirus (COVID-19) pandemic has changed the world, especially healthcare services.

Public health guidance in the initial wave of the pandemic (Center for Disease Control, 2020)

constrained healthcare, including canceling non-emergency procedures, moving office visits to

virtual settings, and sharply limiting family/caretaker involvement in healthcare encounters.

Because these changes altered how healthcare services are received, consumer perceptions of

their access to healthcare services also changed, altering consumer health and healthcare-

related behaviors.

For example, individuals responded to these constraints by accessing healthcare less, with

primary care visits down 70% (Cutler, 2020) and emergency room visits down 42%

(Hartnett, 2020). Delayed healthcare access due to pandemic-related fear is resulting in dra-

matic consequences for patients (e.g., higher pediatric mortality, Lazzerini & Putoto, 2020;

worsened mental health, Marroquín et al., 2020) and health system stability (e.g., increased hos-

pital closure risk, Fried et al., 2020; employee layoffs and negative hospital profit margins,

Teasdale & Schulman, 2020). However, these changes likely only represent the “tip of the

iceberg”for how the current crisis affects preventative health behavior.

These constraints also affected healthcare access perceptions which influence consumer

perceptions of their health vulnerability and overall health. Connecting social and behavioral

science to the public health crisis response (Arora & Grey, 2020; Van Bavel et al., 2020), this

research seeks to understand how healthcare access perceptions influence consumer behavior

during a public health crisis. Healthcare access perceptions are a global evaluation of one's

expectations and experiences for past and anticipated healthcare encounters (Tanner

et al., 2020). COVID-19 provides a challenging and fluid environment to understand better how

a crisis like the pandemic impacts these evaluations. These evaluations, in turn, affect down-

stream judgments and behaviors related to the pandemic and general health.

Specifically, we ask, how do access perceptions and pandemic fear affect health behavior

like personal preventative health behavior, personal COVID-preventative behavior, preventa-

tive health visits/screening, and COVID-19 vaccination behaviors? Do personal judgments like

pandemic-related control influence how access and fear relate to behavior? What impact do sys-

tem adjustments, such as telehealth, have on these perceptions?

Following an exploratory arc informed by research on perceived access to health services

(PAHS, Tanner et al., 2020) and the expanded health belief model (Burns, 1992), two studies

demonstrate three primary outcomes observed at two different stages of the pandemic. First,

high levels of PAHS can buffer individuals from personal health vulnerability and health system

concerns that arise during a global public health crisis. These reductions are especially

pronounced in individuals that use telehealth during the pandemic (health system response,

Study 2). Secondly, depending on an individual's perceived pandemic-related control,

pandemic-related fear has mixed effects for motivating individually-enacted health behaviors

such as personal preventative health (e.g., maintained a healthy weight, good sleep) and per-

sonal COVID-preventative behaviors (e.g., washing hands, delaying travel; Studies 1 and 2).

When individuals have high levels of perceived pandemic-related control, fear's motivating

effect for health-protective behavior is reduced, thus decreasing the likelihood of those behav-

iors. However, perceived pandemic control does not influence more health-system enacted

health behaviors; the fear-behavior link is unaffected for COVID-19 vaccination behaviors and

the fear-behavior link is not present for preventative health visits/screening, where perceived

health care access directly drives increased preventative behavior.

142 VANN ET AL.