What drives public support for health policies ? The protection-motivated mediating model of institutional trust and risk paradox

This study examined how institutional trustworthiness shapes public attitudes toward the health policy across Mainland China, Taiwan, and Hong Kong. Using stratified quota sampling to recruit participants from each region (Ntotal = 4812), we applied Protection Motivation Theory (PMT) to explore the roles of threat appraisal (perceived probability and unfamiliarity) and coping appraisal (self-efficacy and response efficacy). Our findings showed that response efficacy was the strongest mediator in promoting favorable attitudes across all regions. Perceived probability was positively related to policy attitudes in all regions, while perceived unfamiliarity was negatively associated with attitudes in Mainland China only. Self-efficacy was not a significant mediator, suggesting that beliefs in personal ability were less impactful than the perceived effectiveness of the policy. These findings underscore the pivotal role of institutional trustworthiness and perceived effectiveness of health measures in public health communication. They also highlight the importance of addressing region-specific differences in risk perception to enhance public support for health policies. Furthermore, the results support PMT and shed light on the paradoxical effects of different dimensions of risk perception on policy attitudes.