Journal of Media Studies, Vol 37, No 1 (2022)

Font Size:  Small  Medium  Large

Exposure to Multiple Communication Channels and Preventive Behaviors during COVID-19 in Pakistan: An Application of Extended Parallel Process Model

Muhammad Awais, Farahat Ali, Asma Kanwal


COVID-19 has been declared as a pandemic in March 2020. Pakistan became the 20th most-affected country as of June, the same year. This study attempts to explore the relationship between exposure to different communication channels and preventive behaviors during COVID-19. The study finds its conceptual roots in the Extended Parallel Process Model (EPPM) which described the two components (i.e. threat, efficacy) through which communication could influence the adoption of preventive behaviors during a health crisis. A Survey of 620 students was collected in the month of May and June from different Pakistani universities. The study extended the EPPM model to be used on measuring the behavioral effect of the exposure to multiple communication channels along with suggesting the health professional and government officials take into account the four components of threat and efficacy during COVID-19 to effectively implement the strategies about preventive behaviors. Findings show a positive association between exposure to different communication channels and preventive behaviors. Moreover, the components of the theoretical underpinning positively mediated the relationship.


Abroms, L. C., & Maibach, E. W. (2008). The effectiveness of mass communication to change public behavior. Annual Review Of Public Health, 29(1), 219-234. 

Avery, E. (2010). Contextual and audience moderators of channel selection and message reception of public health information in routine and crisis situations. Journal of Public Relations Research, 22(4), 378-403. doi:10.1080/10627261003801404

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. doi:10.1177/1090198104263660

Barnett, D. J., Balicer, R. D., Thompson, C. B., Storey, J. D., Omer, S. B., Semon, N. L., ... & Norbin, J. A. (2009). Assessment of local public health workers' willingness to respond to pandemic influenza through application of the extended parallel process model. PloS one, 4(7), e6365.

Basil, M., Basil, D., Deshpande, S., & Lavack, A. M. (2013). Applying the extended parallel process model to workplace safety messages. Health Communication, 28(1), 29-39. Doi:10.1080/10410236.2012.708632

Batchelder, A., & Matusitz, J. (2014). "Let's Move" campaign: Applying the extended parallel process model. Social Work in Public Health, 29(5), 462-472. doi:10.1080/19371918.2013.865110

Beckerle, C. M., & Lavin, M. A. (2013). Association of self-efficacy and self-care with glycemic control in diabetes. Diabetes Spectrum, 26(3), 172-178.

Birmingham, W. C., Hung, M., Boonyasiriwat, W., Kohlmann, W., Walters, S. T., Burt, R. W., ... & Hill, D. A. (2015). Effectiveness of the extended parallel process model in promoting colorectal cancer screening. PsychoOncology, 24(10), 1265-1278.

Carcioppolo, N., Jensen, J. D., Wilson, S. R., Collins, W. B., Carrion, M., & Linnemeier, G. (2013). Examining HPV threat-to-efficacy ratios in the extended parallel process model. Health Communication, 28(1), 20-28. doi:10.1080/10410236.2012.719478

Covello, V. T., von Winterfeldt, D., & Slovic, P. (1987). Communicating scientific information about health and environmental risks: Problems and opportunities from a social and behavioral perspective. In Uncertainty in risk assessment, risk management, and decision making (pp. 221-239). Springer, Boston, MA.

Dehghani-Tafti, A., Mahmoodabad, S. S. M., Morowatisharifabad, M. A., Ardakani, M. A., Rezaeipandari, H., & Lotfi, M. H. (2015). Determinants of self-care in diabetic patients based on health belief model. Global Journal Of Health Science, 7(5), 33.

Dinesh, P. V., Kulkarni, A. G., & Gangadhar, N. K. (2016). Knowledge and self-care practices regarding diabetes among patients with Type 2 diabetes in Rural Sullia, Karnataka: A community-based, cross-sectional study. Journal Of Family Medicine And Primary Care, 5(4), 847.

Evans, R. E., Beeken, R. J., Steptoe, A., & Wardle, J. (2012). Cancer information and anxiety: applying the Extended Parallel Process Model. Journal Of Health Psychology, 17(4), 579-589.

Hong, H. (2011). An extension of the extended parallel process model (EPPM) in television health news: The influence of health consciousness on individual message processing and acceptance. Health Communication, 26(4), 343-353. doi:10.1080/10410236.2010.551580

Huynh, G., Nguyen, T. N. H., Vo, K. N., & Pham, L. A. (2020). Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pacific Journal of Tropical Medicine, 13(6), 260.

Jang, K., & Park, N. (2018). The effects of repetitive information communication through multiple channels on prevention behavior during the 2015 MERS outbreak in South Korea. Journal Of Health Communication, 23(7), 670-678.

Kelly, B., Hornik, R., Romantan, A., Schwartz, J. S., Armstrong, K., DeMichele, A., . . . Wong, N. (2010). Cancer information scanning and seeking in the general population. Journal Of Health Communication, 15(7), 734-753. doi:10.1080/10810730.2010.514029

Kim, S. C., & Hawkins, K. H. (2020). The psychology of social media communication in influencing prevention intentions during the 2019 US measles outbreak. Computers in Human Behavior, 106428.

Kim, Y. C., Lim, J. Y., & Park, K. (2015). Effects of health literacy and social capital on health information behavior. Journal Of Health Communication, 20(9), 1084-1094.

Lael-Monfared, E., Tehrani, H., Moghaddam, Z. E., Ferns, G. A., Tatari, M., & Jafari, A. (2019). Health literacy, knowledge and self-care behaviors to take care of diabetic foot in low-income individuals: Application of extended parallel process model. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(2), 1535-1541.

Larki, A., Tahmasebi, R., & Reisi, M. (2018). Factors predicting self-care behaviors among low health literacy hypertensive patients based on health belief model in Bushehr District, South of Iran. International journal of hypertension, 2018(1), 1-7

La Torre, G., Di Thiene, D., Cadeddu, C., Ricciardi, W., & Boccia, A. (2009). Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009. Eurosurveillance, 14(49), 19432.

LaVoie, N. R., & Quick, B. L. (2013). What is the truth? An application of the extended parallel process model to televised Truth® ads. Health Communication, 28(1), 53-62. doi:10.1080/10410236.2012.728467

Li, R., Yuan, L., Guo, X. H., Lou, Q. Q., Zhao, F., Shen, L., ... & Sun, Z. L. (2014). The current status of foot self-care knowledge, behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China. International Journal of Nursing Sciences, 1(3), 266-271.

Liu, B. F., Austin, L., & Jin, Y. (2011). How publics respond to crisis communication strategies: The interplay of information form and source. Public Relations Review, 37(4), 345-353. doi:10.1016/j.pubrev.2011.08.004

Liu, B. F., Fraustino, J. D., & Jin, Y. (2016). Social media use during disasters: How information form and source influence intended behavioral responses. Communication Research, 43(5), 626-646.

Madhav, N., Oppenheim, B., Gallivan, M., Mulembakani, P., Rubin, E., & Wolfe, N. (2017). Pandemics: risks, impacts, and mitigation. In: DT Jamison, H Gelband, S Horton (Eds). Disease Control Priorities: Improving Health and Reducing Poverty, (pp. 315-345). Washington, DC: The World Bank

Madhavaram, S., Badrinarayanan, V., & McDonald, R. E. (2005). Integrated marketing communication (IMC) and brand identity as critical components of brand equity strategy: A conceptual framework and research propositions. Journal of Advertising, 34(4), 69-80. doi:10.1080/00913367.2005.10639213

Masoompour, M., Tirgari, B., & Ghazanfari, Z. (2017). The relationship between health literacy, self-efficacy, and self-care behaviors in diabetic patients. Evidence Based Care, 7(3), 17-25.

Nelissen, S., Beullens, K., Lemal, M., & Van den Bulck, J. (2015). Fear of cancer is associated with cancer information seeking, scanning and avoiding: a cross‐sectional study among cancer diagnosed and non‐diagnosed individuals. Health Information & Libraries Journal, 32(2), 107-119.

Niederdeppe, J., & Levy, A. G. (2007). Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiology and Prevention, 16(5), 998-1003. doi:10.1158/1055-9965

Niederdeppe, J., Hornik, R. C., Kelly, B. J., Frosch, D. L., Romantan, A.,Stevens, R. S., . . . Schwartz, J. S. (2007). Examining the dimensions of cancer-related information seeking and scanning behavior. Health Communication, 22(2), 153-167. doi:10.1080/10410230701454189

Ownby, R. L., Acevedo, A., Waldrop-Valverde, D., Jacobs, R. J., & Caballero, J. (2014). Abilities, skills and knowledge in measures of health literacy. Patient Education And Counseling, 95(2), 211-217.

Ren, S. Y., Gao, R. D., & Chen, Y. L. (2020). Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. World Journal Of Clinical Cases, 8(4), 652.

Reynolds, B., & Seeger, M. W. (2005). Crisis and emergency risk communication as an integrative model. Journal of Health Communication, 10 (1), 43-55. doi:10.1080/10810730590904571

Salita, C., Tiongco, R. E., & Kawano, R. (2020). Assessment of school teachers' disaster preparedness using the extended parallel process model: a cross-sectional study in Angeles City, Philippines. Journal of Public Health, 1-8.

Sarkar, U., Fisher, L., & Schillinger, D. (2006). Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?. Diabetes Care, 29(4), 823-829.

Seeger, M. W., Pechta, L. E., Price, S. M., Lubell, K. M., Rose, D. A., Sapru, S., ... & Smith, B. J. (2018). A conceptual model for evaluating emergency risk communication in public health. Health Security, 16(3), 193-203.

Sharoni, S. K. A., & Wu, S. F. V. (2012). Self‐efficacy and self‐care behavior of Malaysian patients with type 2 diabetes: a cross sectional survey. Nursing & Health Sciences, 14(1), 38-45.

Shim, M., Kelly, B., & Hornik, R. (2006). Cancer information scanning and seeking behavior is associated with knowledge, lifestyle choices, and screening. Journal Of Health Communication, 11(sup001), 157-172.doi:10.1080/10810730600637475

Smith, S. W., Rosenman, K. D., Kotowski, M. R., Glazer, E., McFeters, C., Keesecker, N. M., & Law, A. (2008). Using the EPPM to create and evaluate the effectiveness of brochures to increase the use of hearing protection in farmers and landscape workers. Journal Of Applied Communication Research, 36(2), 200-218. doi:10.1080/00909880801922862

Spinelli, A., & Pellino, G. (2020). COVID‐19 pandemic: perspectives on an unfolding crisis. The British Journal Of Surgery. 107(7), 785-787. Doi:10.1002/bjs.11627

Sutton, J., Palen, L., & Shklovski, I. (2008). Backchannels on the front lines: Emergent uses of social media in the 2007 southern California wildfires. In F. Fiedrich & B. Van De Walle (Eds.), Proceedings of the 5th international information systems for crisis response and management conference (pp. 1-8). Washington, DC.

Taghrir, M. H., Borazjani, R., & Shiraly, R. (2020). COVID-19 and Iranian Medical Students; A Survey on Their Related-Knowledge, Preventive Behaviors and Risk Perception. Archives Of Iranian Medicine, 23(4), 249-254.

Thackeray, R., Neiger, B. L., Smith, A. K., & Van Wagenen, S. B. (2012). Adoption and use of social media among public health departments. BMC Public Health, 12(1), 1-6.

Veil, S. R., Buehner, T., & Palenchar, M. J. (2011). A work‐in‐process literature review: Incorporating social media in risk and crisis communication. Journal Of Contingencies And Crisis Management, 19(2), 110-122.

Veil, S. R., Buehner, T., & Palenchar, M. J. (2011). A work‐in‐process literature review: Incorporating social media in risk and crisis communication. Journal Of Contingencies And Crisis Management, 19(2), 110-122.

Waller, J. O., Ostini, R., Marlow, L. A., McCaffery, K., & Zimet, G. (2013). Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Preventive Medicine, 56(1), 35-40.

Weber, M. C., Schulenberg, S. E., & Lair, E. C. (2018). University employees' preparedness for natural hazards and incidents of mass violence: An application of the extended parallel process model. International Journal Of Disaster Risk Reduction, 31, 1082-1091.


WHO. (2020a). WHO Coronavirus Disease (COVID-19). Dashboard. Retrieved from

Witte, K. (1992). Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs, 59(4), 329-349. doi:10.1080/03637759209376276

Witte, K. (1994). Fear control and danger control: A test of the extended parallel process model (EPPM). Communication Monographs, 61(2), 113-134. doi:10.1080/03637759409376328

Worldometer, (2020). COVID-19 CORONAVIRUS PANDEMIC. Retrieved from

Zhong, B. L., Luo, W., Li, H. M., Zhang, Q. Q., Liu, X. G., Li, W. T., & Li, Y. (2020). Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. International Journal Of Biological Sciences, 16(10), 1745.

Zonouzy, V. T., Niknami, S., Ghofranipour, F., & Montazeri, A. (2019). An educational intervention based on the extended parallel process model to improve attitude, behavioral intention, and early breast cancer diagnosis: a randomized trial. International Journal Of Women's Health, 11, 1.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Institute of Communication Studies
University of the Punjab, Quaid-e-Azam Campus, Lahore - 54590, Pakistan.

E-Mail :

Phone No. : 92-42-99231225