IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v383y2025ics0277953625006410.html

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

Author

Listed:
  • Huang, Yi-Hui Christine
  • Cai, Qinxian
  • Wang, Xiaohui
  • Sun, Jie

Abstract

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.

Suggested Citation

  • Huang, Yi-Hui Christine & Cai, Qinxian & Wang, Xiaohui & Sun, Jie, 2025. "What drives public support for health policies ? The protection-motivated mediating model of institutional trust and risk paradox," Social Science & Medicine, Elsevier, vol. 383(C).
  • Handle: RePEc:eee:socmed:v:383:y:2025:i:c:s0277953625006410
    DOI: 10.1016/j.socscimed.2025.118310
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625006410
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2025.118310?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Yi-Hui Christine Huang & Xiao Wang & Ivy Wai-Yin Fong & Qiudi Wu, 2021. "Examining the Role of Trust in Regulators in Food Safety Risk Assessment: A Cross-regional Analysis of Three Chinese Societies Using an Integrative Framework," SAGE Open, , vol. 11(4), pages 21582440211, November.
    2. Christine Huang, Yi-Hui & Lu, Yuanhang & Kao, Lang & Ying Choy, Christine Hiu & Chang, Yu-tzung, 2020. "Mainframes and mandarins: The impact of internet use on institutional trust in East Asia," Telecommunications Policy, Elsevier, vol. 44(2).
    3. Torsten Grothmann & Fritz Reusswig, 2006. "People at Risk of Flooding: Why Some Residents Take Precautionary Action While Others Do Not," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 38(1), pages 101-120, May.
    4. Gisela Wachinger & Ortwin Renn & Chloe Begg & Christian Kuhlicke, 2013. "The Risk Perception Paradox—Implications for Governance and Communication of Natural Hazards," Risk Analysis, John Wiley & Sons, vol. 33(6), pages 1049-1065, June.
    5. Soo Tan & Siok Tambyah, 2011. "Generalized Trust and Trust in Institutions in Confucian Asia," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 103(3), pages 357-377, September.
    6. Fengwan Zhang & Xueling Bao & Xin Deng & Wei Wang & Jiahao Song & Dingde Xu, 2022. "Does Trust Help to Improve Residents’ Perceptions of the Efficacy of Disaster Preparedness? Evidence from Wenchuan and Lushan Earthquakes in Sichuan Province, China," IJERPH, MDPI, vol. 19(8), pages 1-15, April.
    7. Ling, Mathew & Kothe, Emily J. & Mullan, Barbara A., 2019. "Predicting intention to receive a seasonal influenza vaccination using Protection Motivation Theory," Social Science & Medicine, Elsevier, vol. 233(C), pages 87-92.
    8. Lee, Yin-Yang & Lin, Julia L., 2009. "The effects of trust in physician on self-efficacy, adherence and diabetes outcomes," Social Science & Medicine, Elsevier, vol. 68(6), pages 1060-1068, March.
    9. repec:spo:wpmain:info:hdl:2441/61ih2qtadc8g1894enmudd2f09 is not listed on IDEAS
    10. Deana Grobe & Robin Douthitt & Lydia Zepeda, 1999. "A Model of Consumers' Risk Perceptions Toward Recombinant Bovine Growth Hormone (rbGH): The Impact of Risk Characteristics," Risk Analysis, John Wiley & Sons, vol. 19(4), pages 661-673, August.
    11. Wouter Poortinga & Nick F. Pidgeon, 2003. "Exploring the Dimensionality of Trust in Risk Regulation," Risk Analysis, John Wiley & Sons, vol. 23(5), pages 961-972, October.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Joop de Boer & W. J. Wouter Botzen & Teun Terpstra, 2015. "More Than Fear Induction: Toward an Understanding of People's Motivation to Be Well‐Prepared for Emergencies in Flood‐Prone Areas," Risk Analysis, John Wiley & Sons, vol. 35(3), pages 518-535, March.
    2. Sisira S. Withanachchi & Ilia Kunchulia & Giorgi Ghambashidze & Rami Al Sidawi & Teo Urushadze & Angelika Ploeger, 2018. "Farmers’ Perception of Water Quality and Risks in the Mashavera River Basin, Georgia: Analyzing the Vulnerability of the Social-Ecological System through Community Perceptions," Sustainability, MDPI, vol. 10(9), pages 1-26, August.
    3. Ling Jia & Queena K. Qian & Frits Meijer & Henk Visscher, 2020. "Stakeholders’ Risk Perception: A Perspective for Proactive Risk Management in Residential Building Energy Retrofits in China," Sustainability, MDPI, vol. 12(7), pages 1-25, April.
    4. Tianlong Yu & Hao Yang & Xiaowei Luo & Yifeng Jiang & Xiang Wu & Jingqi Gao, 2021. "Scientometric Analysis of Disaster Risk Perception: 2000–2020," IJERPH, MDPI, vol. 18(24), pages 1-19, December.
    5. S. A. Mashi & A. I. Inkani & Oghenejeabor Obaro & A. S. Asanarimam, 2020. "Community perception, response and adaptation strategies towards flood risk in a traditional African city," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 103(2), pages 1727-1759, September.
    6. aus dem Moore, Nils & Brehm, Johannes & Breidenbach, Philipp & Ghosh, Arijit & Gruhl, Henri, 2022. "Flood risk perception after indirect flooding experience: Null results in the German housing market," Ruhr Economic Papers 976, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    7. Kevin Fox Gotham & Richard Campanella & Katie Lauve‐Moon & Bradford Powers, 2018. "Hazard Experience, Geophysical Vulnerability, and Flood Risk Perceptions in a Postdisaster City, the Case of New Orleans," Risk Analysis, John Wiley & Sons, vol. 38(2), pages 345-356, February.
    8. Manqing Wu & Guochun Wu, 2020. "An Analysis of Rural Households’ Earthquake-Resistant Construction Behavior: Evidence from Pingliang and Yuxi, China," IJERPH, MDPI, vol. 17(23), pages 1-14, December.
    9. Nguyen, Canh Phuc & Nguyen, Binh Quang, 2025. "Do natural threats matter for natural resources rents? Global evidence," Resources Policy, Elsevier, vol. 102(C).
    10. Eoin O'Neill & Finbarr Brereton & Harutyun Shahumyan & J. Peter Clinch, 2016. "The Impact of Perceived Flood Exposure on Flood‐Risk Perception: The Role of Distance," Risk Analysis, John Wiley & Sons, vol. 36(11), pages 2158-2186, November.
    11. Michal Titko & Jozef Ristvej & Zenon Zamiar, 2021. "Population Preparedness for Disasters and Extreme Weather Events as a Predictor of Building a Resilient Society: The Slovak Republic," IJERPH, MDPI, vol. 18(5), pages 1-24, February.
    12. Shi-yu Hu & Miao Yu & Ting Que & Gang Fan & Hui-ge Xing, 2022. "Individual willingness to prepare for disasters in a geological hazard risk area: an empirical study based on the protection motivation theory," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 110(3), pages 2087-2111, February.
    13. Lisa Dillenardt & Philip Bubeck & Paul Hudson & Bianca Wutzler & Annegret H. Thieken, 2024. "Property-level adaptation to pluvial flooding: An analysis of individual behaviour and risk communication material," Mitigation and Adaptation Strategies for Global Change, Springer, vol. 29(6), pages 1-26, August.
    14. Adwin Bosschaart & Wilmad Kuiper & Joop Schee & Judith Schoonenboom, 2013. "The role of knowledge in students’ flood-risk perception," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 69(3), pages 1661-1680, December.
    15. repec:plo:pone00:0186455 is not listed on IDEAS
    16. Philip Bubeck & W. J. Wouter Botzen & Jonas Laudan & Jeroen C.J.H. Aerts & Annegret H. Thieken, 2018. "Insights into Flood‐Coping Appraisals of Protection Motivation Theory: Empirical Evidence from Germany and France," Risk Analysis, John Wiley & Sons, vol. 38(6), pages 1239-1257, June.
    17. Guadalupe Ortiz & Pablo Aznar-Crespo & Antonio Aledo, 2024. "Developing and pilot-testing warning messages for risk communication in natural disasters," Environment Systems and Decisions, Springer, vol. 44(2), pages 239-258, June.
    18. Catherine E. Lambert & Jason R. Holley & Katherine A. McComas & Natalie P. Snider & Grace K. Tucker, 2021. "Eroding Land and Erasing Place: A Qualitative Study of Place Attachment, Risk Perception, and Coastal Land Loss in Southern Louisiana," Sustainability, MDPI, vol. 13(11), pages 1-16, June.
    19. Efrat Blitstein-Mishor & Eran Vigoda-Gadot & Shlomo Mizrahi, 2023. "Navigating Emergencies: A Theoretical Model of Civic Engagement and Wellbeing during Emergencies," Sustainability, MDPI, vol. 15(19), pages 1-16, September.
    20. Ting Que & Yuxin Wu & Shiyu Hu & Jianmin Cai & Nan Jiang & Huige Xing, 2022. "Factors Influencing Public Participation in Community Disaster Mitigation Activities: A Comparison of Model and Nonmodel Disaster Mitigation Communities," IJERPH, MDPI, vol. 19(19), pages 1-18, September.
    21. Javed Mallick & Roquia Salam & Ruhul Amin & Abu Reza Md. Towfiqul Islam & Aznarul Islam & Md. Nur Alam Siddik & G. M. Monirul Alam, 2022. "Assessing factors affecting drought, earthquake, and flood risk perception: empirical evidence from Bangladesh," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 112(2), pages 1633-1656, June.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:383:y:2025:i:c:s0277953625006410. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.