COVID-19 related knowledge, protective behaviors and moderating role of primary information sources: results of an online cross-sectional survey in the United States – Kim – 2021 – Health Services Research


Research objective

To assess the moderating effects of the main sources of information on COVID-19 on the association between knowledge and protective behaviors against COVID-19.

Study design

This is a secondary analysis of data from an online COVID-19 cross-sectional survey of American adults in April 2020 using recruitment based on social media advertising. A total of 6,518 people responded to the survey. Linear regression analysis was performed on the knowledge and protective behavior scores of COVID-19. An interaction term between knowledge and the main source of information was included to examine the moderating effects of the source of information on the relationship between knowledge and protective behaviors. The analysis was adjusted for demographic and socio-economic factors and was performed using R software (version 3.6.3).

Study population

Adult population (age> 18 years) living in the United States.

Main conclusions

Overall, a higher level of knowledge related to COVID-19 was associated with a higher level of self-reported engagement in protective behaviors. Specifically, our results indicate that the primary source of information altered the association between knowledge and protective behaviors. The most effective sources of information for translating incremental knowledge into increased engagement in protective behaviors were interpersonal communication and social media. Official sources such as the US government, CDC, and WHO websites had significantly weaker effects. Our results also showed that respondents with lower knowledge scores preferred social media or interpersonal communication as the primary source for researching information related to COVID-19.


This study shows the important role that different sources of COVID-19 information can play in influencing people’s engagement in protective behaviors while providing knowledge related to COVID-19.

Implications for policy or practice

Overflowing information and misinformation influences the degree to which people engage in protective behaviors against COVID-19. Policy makers need to carefully monitor the use of different sources of information by the public so that they can effectively target, influence decision making and promote behavior change to simultaneously tackle the current pandemic and the infodemic.


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