DETERMINANTS OF HEALTH BEHAVIOURS IN OLDER ADULTS POST-COVID-19: EVIDENCE FROM THAILAND
Keywords:
coronavirus, COVID-19, health behaviors, Health Belief Model, older adultAbstract
Health behaviors of older adults have gained increasing attention following coronavirus infection due to their heightened vulnerability and unique recovery challenges, making it important to understand the factors that influence post‑infection health behaviors to guide effective interventions for optimal recovery and well‑being. This study examined the factors influencing the health behaviors of older adults after the COVID‑19 pandemic, using the Health Belief Model as a theoretical framework. A descriptive cross‑sectional study was conducted with 110 adults aged 60 years and older who were at least one-year post‑COVID infection. Data were collected using demographic, health behavior, and health belief perception questionnaires and analyzed using descriptive statistics, Pearson’s correlation, and stepwise regression. The participants demonstrated excellent health behaviors (M = 104.60, SD = 8.65). Health behaviors correlated positively with perceived self‑efficacy in health behaviors (r = 0.628, p<0.001), severity of illness (r = 0.532, p<00.001), susceptibility to illness (r = 0.464, p<0.001), and benefits of health behaviors (r = 0.220, p<0.05), and negatively with perceived barriers to health behaviors (r = −0.290, p<0.001). Regression analysis showed that perceived self‑efficacy in health behaviors (β = 0.397, p<0.001), severity of illness (β = 0.292, p<0.001), and susceptibility to health behaviors (β = 0.219, p<0.005) significantly predicted health behaviors, explaining 50.6% of the variance, while the perceived benefits and barriers of health behaviors were non‑significant in the adjusted model. In conclusion, perceived self‑efficacy, severity, and susceptibility are key determinants of older adults’ post‑COVID health behaviors, suggesting that interventions that explicitly strengthen these perceptions may yield greater behavioral gains and more efficient rehabilitation and chronic‑care outcomes than approaches centered primarily on benefit and barrier messaging.
References
Alizadeh, S., Iranpour, A., Yazdinejad, T., Borhaninejad, V., & Saber, M. (2022). Investigating the structures of the health belief model following a COVID-19 outbreak in Iran. Journal of Public Health and Development, 20(3), 121–133. https://doi.org/10.55131/jphd/2022/200310
Aree-Ue, S., & Youngcharoen, P. (2020). The 6-item cognitive function test–Thai version: Psychometric property testing. Nursing Research and Innovation Journal, 26(2), 188–202.
Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology & Health, 13(4), 623–649. https://doi.org/10.1080/08870449808407422
Chou, Y.-H., Lin, C., Lee, S.-H., Lee, Y.-F., & Cheng, L.-C. (2024). User-friendly chatbot to mitigate the psychological stress of older adults during the COVID-19 pandemic: Development and usability study. JMIR Formative Research, 8, Article e49462. https://doi.org/10.2196/49462
Crook, H., Raza, S., Nowell, J., Young, M., & Edison, P. (2021). Long COVID—Mechanisms, risk factors,
and management. BMJ, 374, Article n1648. https://doi.org/10.1136/bmj.n1648
Davis, H. E., Assaf, G. S., McCorkell, L., Wei, H., Low, R. J., Re’em, Y., Redfield, S., Austin, J. P., & Akrami, A. 2021). Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine, 38, Article 101019. https://doi.org/10.1016/j.eclinm.2021.101019
De Pue, S., Gillebert, C., Dierckx, E., Vanderhasselt, M.-A., De Raedt, R., & Van den Bussche, E. (2021). The impact of the COVID-19 pandemic on wellbeing and cognitive functioning of older adults. Scientific Reports, 11, Article 4636. https://doi.org/10.1038/s41598-021-84127-7
DeDonno, M. A., Longo, J., Levy, X., & Morris, J. D. (2022). Perceived susceptibility and severity of COVID-19 on prevention practices, early in the pandemic in the state of Florida. Journal of Community Health, 47(4), 627–634. https://doi.org/10.1007/s10900-022-01090-8
Demeco, A., Marotta, N., Barletta, M., Pino, I., Marinaro, C., Petraroli, A., Moggio, L., & Ammendolia, A. (2020). Rehabilitation of patients post-COVID-19 infection: A literature review. Journal of International Medical Research, 48(8), 1–10. https://doi.org/10.1177/0300060520948382
Division of Health Education. (2023). Health behavior assessment tool for the prevention of infectious and major non-communicable diseases among older adults. Department of Health Service Support.
Eshete, A., Getye, B., Aynaddis, G., Tilaye, B., Mekonnen, E., Taye, B., Zeleke, D., Deresse, T., Kifleyohans, T., & Assefa, Y. (2023). Association between illness perception and medication adherence in patients with diabetes mellitus in North Shoa Zone: A cross-sectional study. Frontiers in Public Health, 11, Article 1214725. https://doi.org/10.3389/fpubh.2023.1214725
Hongpanich, P. (2021). Factors influencing COVID-19 preventive behaviors among people in Pathum Thani Province. The Journal of Pacific Institute of Management Science, 7(3), 175–185.
Hu, Y., Liu, Y., Zheng, H., & Liu, L. (2023). Risk factors for long COVID in older adults. Biomedicines, 11(11), Article 3002. https://doi.org/10.3390/biomedicines11113002
Kerari, A., Bahari, G., Alharbi, K., & Alenazi, L. (2024). The effectiveness of the chronic disease self-management program in improving patients’ self-efficacy and health-related behaviors: A quasi-experimental study. Healthcare, 12(7), Article 778. https://doi.org/10.3390/healthcare12070778
Maertl, T., De Bock, F., Huebl, L., Oberhauser, C., Coenen, M., Jung-Sievers, C., & the COSMO Study Team. (2021). Physical activity during COVID-19 in German adults: Analyses in the COVID-19 Snapshot Monitoring Study (COSMO). International Journal of Environmental Research and Public Health, 18(2), Article 507. https://doi.org/10.3390/ijerph18020507
Mahmoud, M., Carmisciano, L., Tagliafico, L., Muzyka, M., Rosa, G., Signori, A., Bassetti, M., Nencioni,
A., Monacelli, F., & GECOVID Study Group. (2021). Patterns of comorbidity and in-hospital mortality in older patients with COVID-19 infection. Frontiers in Medicine, 8, Article 726837. https://doi.org/10.3389/fmed.2021.726837
Maneemai, O., Thanomnim, S., Sanhatham, N., & Ob-un, K. (2023). Preventive behaviors during the coronavirus disease 2019 (COVID-19) pandemic: Application of the Health Belief Model in Thailand. Journal of Health Science, 32(4), 682–691.
Mansell, V., Hall Dykgraaf, S., Kidd, M., & Goodyear-Smith, F. (2022). Long COVID and older people. The Lancet Healthy Longevity, 3(12), e849–e854. https://doi.org/10.1016/S2666-7568(22)00245-8
Mueller, A. L., McNamara, M. S., & Sinclair, D. A. (2020). Why does COVID-19 disproportionately affect older people? Aging, 12(10), 9959–9981. https://doi.org/10.18632/aging.103344
Nalbandian, A., Sehgal, K., Gupta, A., Madhavan, M. V., McGroder, C., Stevens, J. S., Cook, J. R., Nordvig, A. S., Shalev, D., Sehrawat, T. S., Ahluwalia, N., Bikdeli, B., Dietz, D., Der-Nigoghossian, C., Liyanage-Don,
N., Rosner, G. F., Bernstein, E. J., Mohan, S., Beckley, A. A., ... & Wan, E. Y. (2021). Post-acute COVID-19 syndrome. Nature Medicine, 27(4), 601–615. https://doi.org/10.1038/s41591-021-01283-z
Napattaradechanon, K., Phattharasirisomboon, P., & Pronlerttaveekun, S. (2024). Factor influencing prevention of COVID-19 infection among older adults in Chaiyaphum Province. Journal of the Royal Thai Army Nurses, 25(1), 230–238.
National Institutes of Health. (2024). Coronavirus disease 2019 (COVID-19) treatment guidelines.
Pholphirul, P., & Srijamdee, K. (2025). Buddhist practices and mental health outcomes in Thailand. Journal of Religion and Health. Advance online publication. https://doi.org/10.1007/s10943-025-02354-y
Remelli, F., Volpato, S., & Trevisan, C. (2022). Clinical features of SARS-CoV-2 infection in older adults.
Clinics in Geriatric Medicine, 38(3), 483–500. https://doi.org/10.1016/j.cger.2022.03.001
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203
Ryan, M., Brindal, E., Roberts, M., & Hickson, R. I. (2024). A behaviour and disease transmission model: Incorporating the Health Belief Model for human behaviour into a simple transmission model. Journal of
the Royal Society Interface, 21(215), Article 20240038. https://doi.org/10.1098/rsif.2024.0038
Shahid, Z., Kalayanamitra, R., McClafferty, B., Kepko, D., Ramgobin, D., Patel, R., Aggarwal, C. S., Vunnam, R., Sahu, N., Bhatt, D., Jones, K., Golamari, R., & Jain, R. (2020). COVID-19 and older adults: What we know. Journal of the American Geriatrics Society, 68(5), 926–929. https://doi.org/10.1111/jgs.16472
Shahnazi, H., Ahmadi-Livani, M., Pahlavanzadeh, B., Rajabi, A., Hamrah, M. S., & Charkazi, A. (2020). Assessing preventive health behaviors from COVID-19: A cross-sectional study with the Health Belief Model in Golestan Province, Northern Iran. Infectious Diseases of Poverty, 9, Article 157. https://doi.org/10.1186/s40249-020-00776-2
Shi, G., Zhong, X., He, W., Liu, H., Liu, X., & Ma, M. (2021). Factors influencing protective behavior in the post-COVID-19 period in China: A cross-sectional study. Environmental Health and Preventive Medicine, 26, Article 95. https://doi.org/10.1186/s12199-021-01015-2
Siramaneerat, I., Mungkhamanee, S., Chawajaroenpan, W., Choolert, P., Sirisabjanan, L., & Mangkalamanee, O. (2022). The application of the Health Belief Model for the assessment of preventive behavior against COVID-19 among nursing students in Thailand. Journal of the Medical Association of Thailand, 105(10), 934–941. https://doi.org/10.35755/jmedassocthai.2022.10.13676
Soonthornchaiya, R. (2020). Resilience for psychological impacts of COVID-19 pandemic on older adults in Thailand. Journal of Gerontology and Geriatric Medicine, 6(2), Article 053. https://doi.org/10.24966/GGM-8662/100053
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson.
Tan, P. P. S., Sandhu, R. S., Zain, S. M., Hall, D., Tan, N. C., Lim, H. M., Daud, F., & Pung, Y. F. (2022). Health motivations and perceived barriers are determinants of self-care behaviour for the prevention of hypertension in a Malaysian community. PLOS ONE, 17(12), Article e0278761. https://doi.org/10.1371/journal.pone.0278761
Tana, C., Moffa, L., Falasca, K., Vecchiet, J., Tana, M., Mantini, C., Ricci, F., Ticinesi, A., Meschi, T., Cipollone, F.,
& Giamberardino, M. A. (2023). Approach to COVID-19 in older adults and indications for improving the outcomes. Annals of Medicine, 55(2), Article 2265298. https://doi.org/10.1080/07853890.2023.2265298
Tong, K. K., Chen, J. H., Yu, E. W., & Wu, A. M. S. (2020). Adherence to COVID-19 precautionary measures: Applying the Health Belief Model and generalised social beliefs to a probability community sample. Applied Psychology: Health and Well-Being, 12(4), 1205–1223. https://doi.org/10.1111/aphw.12230
Wang, T. J., Chau, B., Lui, M., Lam, G. T., Lin, N., & Humbert, S. (2020). Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. American Journal of Physical Medicine & Rehabilitation, 99(9), 769–774. https://doi.org/10.1097/PHM.0000000000001505
Wolf, M. S., Serper, M., Opsasnick, L., O’Conor, R. M., Curtis, L., Benavente, J. Y., Wismer, G., Batio, S., Eifler, M., Zheng, P., Russell, A., Arvanitis, M., Ladner, D., Kwasny, M., Persell, S. D., Rowe, T., Linder, J. A., & Bailey, S. C. (2020). Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: A cross-sectional survey. Annals of Internal Medicine, 173(2), 100–109. https://doi.org/10.7326/M20-1239
Wong, L. P., Alias, H., Wong, P. F., Lee, H. Y., & AbuBakar, S. (2020). The use of the Health Belief Model
to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay. Human Vaccines & Immunotherapeutics, 16(9), 2204–2214. https://doi.org/10.1080/21645515.2020.1790279
Yang, M. C., Singh, G., & Sakakibara, B. M. (2024). Social cognitive predictors of health promotion self-efficacy among older adults during the COVID-19 pandemic. American Journal of Health Promotion, 38(8), 1147–1152. https://doi.org/10.1177/08901171241256703
Yinghan, T., & Sasat, S. (2021). The effect of a health belief modification program on polypharmacy medication adherence among older persons with chronic illness. Royal Thai Navy Medical Journal, 48(2), 286–299.
Zewdie, A., Mose, A., Sahle, T., Bedewi, J., Gashu, M., Kebede, N., & Yimer, A. (2022). The Health Belief Model’s ability to predict COVID-19 preventive behavior: A systematic review. SAGE Open Medicine, 10, 1–10. https://doi.org/10.1177/20503121221113668
