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Factors influencing COVID-19 health protective behaviours in Zambian university students with symptoms of low mood

Ncheka, Joyce M.; Menon, J. Anitha; Davies, E Bethan; Paul, Ravi; Mwaba, Sydney O. C.; Mudenda, John; Wharrad, Heather; Toutounchi, Parisa; Glazebrook, Cris


Joyce M. Ncheka

J. Anitha Menon

E Bethan Davies

Ravi Paul

Sydney O. C. Mwaba

John Mudenda

Professor of Elearning and Health Informatics

Parisa Toutounchi


Health protective behaviours are crucial in the prevention of the spread of COVID-19, particularly in university students who typically live and study in large groups. Depression and anxiety are common in students and can impact young people’s motivations to follow health advice. The study aims to assess the relationship between mental health and COVID-19 health-protective behaviours in Zambian university students with symptoms of low mood.

The study was a cross-sectional, online survey of Zambian university students. Participants were also invited to take part in a semi-structured interview to explore views about COVID-19 vaccination. Invitation emails were sent explaining the study aims and directed students who self-identified as having low mood in the past two weeks to an online survey. Measures included COVID-19 preventive behaviours, COVID-19-related self-efficacy, and Hospital and Anxiety Depression scale.

A total of 620 students (n=308 female, n=306 male) participated in the study, with a mean participant age of 22.47±3.29 years (range 18–51). Students reported a mean protective behaviour score of 74.09/105 and 74% scored above the threshold for possible anxiety disorder. Three-way ANOVA showed lower COVID-19 protective behaviours in students with possible anxiety disorder (p=.024) and those with low self-efficacy (p<0.001). Only 168 (27%) said they would accept vaccination against COVID-19, with male students being twice as likely to be willing to accept COVID-19 vaccination (p<0.001). Of 50 students interviewed. 30 (60%) expressed fears about the vaccination and 16 (32%) were concerned about a lack of information. Only 8 (16%) participants expressed doubts about effectiveness.

Students who self-identify as having symptoms of depression have high levels of anxiety. The results suggest that interventions to reduce anxiety and promote self-efficacy might enhance students’ COVID-19 protective behaviours. Qualitative data provided insight into the high rates of vaccine hesitancy in this population.


Ncheka, J. M., Menon, J. A., Davies, E. B., Paul, R., Mwaba, S. O. C., Mudenda, J., …Glazebrook, C. (2023). Factors influencing COVID-19 health protective behaviours in Zambian university students with symptoms of low mood. BMC Public Health, 23(1), Article 336.

Journal Article Type Article
Acceptance Date Jan 17, 2023
Online Publication Date Feb 15, 2023
Publication Date Feb 15, 2023
Deposit Date Mar 2, 2023
Publicly Available Date Mar 2, 2023
Journal BMC Public Health
Print ISSN 1471-2458
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 23
Issue 1
Article Number 336
Keywords Mental health, COVID-19 protective behaviours, Self-efficacy, Gender
Public URL
Publisher URL


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