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*Corresponding author: E-mail: prince@std.uestc.edu.cn; 
 
 
 

Asian Journal of Immunology 
 
4(1): 96-105, 2021; Article no.AJI.73786 
 

 
 

 

 

COVID-19 and Actor Well-being: A Serial Mediated 
Moderation of Mask Usage and Personal Health 

Engagement  
 

Addo Prince Clement1*, Gumah Bernard2, Ato Kwamena Sagoe1, 
Ohemeng Asare Andy3, Kulbo Nora Bakabbey2, Takyi Nyankom Lydia1 

and Kulbo Bassamar Dora4 
 

1
Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Ghana.  

2
School of Management and Economic, Chengdu, University of Electronic Science and Technology of 

China, P.R. China. 
3
Centre for Business, George Brown College, Canada. 

4
School of Business, Kwame Nkrumah University of Science and Technology, Zambia. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. All authors read and approved the final 

manuscript. 
 

Article Information 
 

Editor(s): 
(1) Dr. Wagner Loyola, Brazilian Agricultural Research Corporation (Embrapa), Brazil. 

(2) Dr. Cynthia Aracely Alvizo Báez, Autonomous University of Nuevo Leon, Mexico. 
Reviewers: 

(1) Ekta Damani (Malvania), AMC Dental College and Hospital, India. 
(2) Mohammad Salem Hareedy, Assiut University, Egypt. 

(3) Sudhir Kumar Atri, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, India. 
Complete Peer review History: https://www.sdiarticle4.com/review-history/73786 

 
 
 
 

Received 30 August 2021  
Accepted 08 September 2021 
Published 14 September 2021 

 
 

ABSTRACT 
 

Wearing of face mask has become the new norm and a requirement for accessing public spaces. 
The current study explored the drives of self-regulation towards the purchase and use of face 
masks for actor wellbeing and public safety. The study adopted a cross-sectional survey approach. 
Data from 1859 participants sampled specifically from lockdown areas are the backbone of this 
study. We drew inspiration from the self-regulation theory and the trending slogan "any mask is 
better than no mask" to propose a model based on the fear of COVID-19 and actor wellbeing. We 
adopted Hayes' PROCESS macro in analyzing the proposed model. The findings confirmed that 
the fear of COVID-19 (β=.78, p<.001) invokes actors' self-regulation and alters attitudes (β=.521 

Original Research Article 



 
 
 
 

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97 

 

p<.001) to drives mask purchase intentions and use significantly. We also re-echoed the role of 
self-efficacy in the behavioral change decision-making under threatening conditions. The models 
explained a total variance of 80% in explaining how the fear of COVID-1D invokes an individual's 
behavioral change towards public safety and actor wellbeing. Policymakers, wellbeing 
psychologists, and healthcare practitioners can leverage the finding in this work to understand the 
antecedents that promote people's behavioral change towards psychological and physical 
wellbeing, such as that which come with COVID-19 and mask use. In particular, face mask 
advocates can leverage this paper's fear and wellbeing understanding in their promotional and 
educational exercises. We recommend reconsidering mask use protocols to support the slogan 
"Any Mask is Better Than No Mask." 
 

 
Keywords: COVID-19; fear of COVID-19; face mask; self-regulation; actor wellbeing. 
 

1. INTRODUCTION 
 
The world has practically come to a standstill in 
recent times because of COVID-19 and the 
strategies to fight it. Individuals, scientists, 
nations, and governments have channelled 
resources into saving lives and the economy 
from the grips of the 2019-novel SARS-2 virus 
known as the COVID-19. The outbreak of 
COVID-19 has affected the wellbeing and health 
of individuals and societies all over the world. 
This has imposed physical, cognitive, 
psychological, and social challenges with 
pressure on the service industry as much as on 
other sectors. When engaging with service 
providers, customers are crowned with fear for 
their health [1]. Logistics service quality and 
other sectors such as education, transportation, 
tourism, and hospitality were greatly affected 
while new markets, including online shopping, 
door-to-door services delivery, and live streaming 
businesses, spike to record heights [2]. Many of 
these are due to the fear of COVID-19, change in 
consumer behavior and lifestyle, and individuals' 
self-efficacy to succeed in handling and adapting 
to new and complex behavioral risky situations, 
and the self-regulation in the avoidance of 
disease has become vital to survival [3]. People 
will voluntarily or otherwise develop a behavioral 
immune system that drives change in response 
to survival [4]. This behavior change is crucial to 
managers, service providers, and public 
institutions responsible for controlling and 
managing infectious diseases.  
 
Research has established that humans are 
rooted in self-organizing structures that, during a 
critical event like a pandemic, are triggered to 
adjust, endure, and develop to manage the 
circumstances. With Covid-19, social and 
physical distancing and mask use have been one 
of such structures triggered towards surviving 
and consumer safety, which require agility and 

efficiency [5]. Several papers in the service 
industry have drawn the need for consumer and 
actor safety first from the hierarchy of needs 
theory [6, 7]. This study examined how fear of 
COVID-19 alters the behavior, attitude, and 
intention in using and purchasing face masks 
towards consumer wellbeing.  
 
This research will be among the first to bridge the 
existing theoretical, conceptual, and practical gap 
by examining influential factors of individuals' 
behavioral intention (fear of COVID-19) and the 
practicalities of behavior change (mask use) in 
examining the intentions of face mask purchase 
towards the actor and public safety and wellbeing. 
The researchers anticipate that this study's 
results will correspondingly provide a practical 
analysis for governments, and policymakers, to 
understand individuals' behavioral intentions to 
the use of face masks before any investment in 
face masks or applying face masks policies and 
measures, especially now that many countries 
are experiencing a second wave of COVID-19. 
 

1.1 Self-Regulation 
 
Self-regulation has multiple dimensions 
(conscious or automated process) with several 
definitions [8,9,10,11]. Self-regulation in this 
study is, however, operationalized according to 
the definition by [11], stating that self-regulation 
is a conscious process in which the individual 
dedicates the needed effort to override a natural 
response or behavior and substitute it with a 
more effortful behavior or response that is more 
consistent with a targeted goal(s). Refraining 
from unsafe sex and over-eating, resisting urges 
to drinking and smoke might all be considered 
examples of self-regulation. From this definition, 
self-regulation may be simplified as the ability to 
change oneself and control an inner process for 
a better result. Self-regulation is, therefore, a key 
indicator to success when viewed from a cultural, 



 
 
 
 

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interpersonal, or biological perspective. The 
Economic and social detriments of self-regulation 
failure are numerous, including unsafe sex, drug 
abuse, AIDS and other transmittable diseases, 
obesity, unethical business practices, gang, and 
violence. Following these downsides of self-
regulatory failure, people's consciousness and 
subconsciousness are always on the lookout for 
signals that may cost lives, social and economic 
damages, and ready to avert them [12]. The 
relationship between fear and self-regulation is 
consistent in the literature [13,14]. The fear of 
infectious disease can lead to several problems 
beyond the mere presence of fear itself. 
Literature relating to the Zika virus argues that 
fear causes individuals to more easily condition 
themselves for self-regulation and a self-
reinforcing cycle of avoidance [15]. several other 
studies also found links between fear. They 
committed compliance and that actors will 
comply with specific directives and personal 
goals because of fear (ref). in effect, the fear of 
COVID-19 will cause actors and consumers to 
adhere to specific guidelines such as wear of 
face mask to override the consequences of 
contracting COVID-19.  
 

1.2 Fear, Attitudinal Change, Intention, 
and Well-Being  

 
Emotion (in our case, fear of COVID-19) is the 
underlying precursor of regulation: in the 
absence of the occurrence of emotion, there is 
nothing to regulate [16]. Studies on the drive 
model have established that fear creates and 
drives tension. This tension increases 
acceptance and attitudinal change. Similarly, an 
initial increasing level of fear is argued to 
correlate with an increasing message 
acceptance [17, 18]. The literature argues that 
fear motivates behavior change, including 
adaptive control actions (attitudinal change and 
message acceptance) and maladaptive control 
actions (behavioral change including avoidance 
and reactance) [19]. Maladaptive control actions 
are enshrined in the theory of self-regulation to 
avoid disease contraction [3]. 
 
The causative effect of fear on attitudinal change 
is not new in the literature.  Fear proves to have 
a positive correlation with attitude documented in 
both experimental and non-experimental studies, 
such that the sturdier the fear, the more 
persuasive it is, resulting in a change in attitude 
[20,19]. Although existing studies have measured 
attitude in a wide range of ways, all point to some 

correlation based on fear, fear appeal, and fear 
manipulation. In the context of consumer safety 
and wellbeing, fear constitutes the motivation 
that triggers human's cognitive, psychological, 
physical, and social-behavioural change towards 
survival [21,22,23]. As argued in the literature, 
avoidance is among the most effective ways of 
self-regulation due to fear because prevention is 
much easier than stopping an event once it is 
underway [24]. At the centre of COVID-19 
prevention is a face mask. 

 

We proposed the following hypothesis to 
understand the wellbeing purchase relationship 
between fear of COVID-10 and face mask 
purchase intention. 

 

H1: Fear of COVID-19 has a positive 
relationship with face mask use attitude 

H2: Fear of COVID-19 has a positive 
association with the purchase intention of 
any face mask 

H3: Fear of COVID-19 has a positive 
relationship with the intention to use any 
face mask  

H4: Face mask use attitude partially mediates 
the relationship between the fear of 
COVID-19 and mask purchase intention. 

H5: Face mask use intention partially mediates 
the relationship between the fear of 
COVID-19 and mask purchase intention. 

H6: Face mask use attitude has a positive 
association with mask use intention 

H7: Face mask use attitude partially mediates 
the relationship between fear of COVID-19 
and mask use intention. 

H8: Face mask use attitude has a positive 
association with mask purchase intention 

H9: Face mask use intention has a positive 
association with mask purchase intention 

H10: Face mask use intention partially mediates 
the relationship between mask use attitude 
and mask purchase intention. 

H11: Self-efficacy in face mask use positively 
moderates the association between fear of 
COVID-19 and Mask purchase intention. 

H12: Self-efficacy in face mask use positively 
moderates the association between fear of 
COVID-19 and mask use attitude. 

H13: self-efficacy in face mask use positively 
moderates the association between fear of 
COVID-19 and mask use intention. 

 
The hypotheses are summarized in Fig. 1. 

 



 
 
 
 

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Fig. 1. Summary of Hypotheses 
 

2. METHODS 
 
A cross-sectional survey approach was used to 
recruit a total of 1937 participants through an 
online public survey using a link generated from 
google forms and distributed through social 
media and email contacts. Location-filter 
questions, including region, district, and city/town, 
were asked at the end of the survey to ensure 
only respondents in the target study areas were 
included. To ensure the quality of responses, 
participants were asked if they do not understand 
or feel any of the items were ambiguous. Two 
"yes" respondents were excluded. Next, since 
respondents were from varied backgrounds, we 
checked their English proficiency with a self-
reported scale, and all respondents with scores 
below average were excluded in the final data 
set to endure the items were well comprehended. 
We also observed all response patterns and 
eliminated respondents, with over 90% repeated 
responses (e.g., strongly agree or uncertain 
throughout). Data analysis, thus, was based on 
1859 samples. 
 

2.1 Measures 
 
To measure the variables used in this work, we 
adopted and modified existing measurements in 
some instances. The seven-item fear of COVID-
19 scale [25] was used to measure the fear of 
COVID-19 (Cronbach's α =.77). Purchase 
intention was measured using the five-item 
intention to buy scale by Dodd, Monroe, and 
Grewal [26] (Cronbach's α =.92). The 6-item face 

mask use scale (FMUS) [27] was modified and 
used to measure mask use attitude (Cronbach's 
α =.85). The general self-efficacy scale [28] was 
modified to reflect an individual's self-efficacy to 
withstand the effects of COVID-19 (Cronbach's α 
=.87).  We adopted and modified Bryan, 
Rocheleau, Robbins, and Hutchison's [29] safer 
sex intention scale and the behavioral intentions 
towards future condom use [30] to measure 
mask use intention (Cronbach's α =.90). 
Respondents' consents were obtained with the 
inclusion of two related questions in the 
questionnaire and were guaranteed 
confidentiality and the anonymity of the data. 
Participants were free to terminate and exit the 
survey at any point. 
 

3. RESULTS 
 
The analysis is based on a serially moderated 
mediated regression analysis supported by the 
Hayes' process macro extension of SPSS v26 
[31]. Key variables that are known to affect 
consumer decision-making (price, age, and 
location) were controlled. 
 
Table 1 shows the study variables' reliability 
statistics, including the CFI and RMSEA, 
indicating the latent variables measured what 
they intend to measure. The correlation analysis 
(Table 2) shows that the independent and 
mediating variables have statistically significant 
and positive relationships with mask purchase 
intention.  

 



 
 
 
 

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100 

 

Table 1. Reliability and validity of measures 
 

Variables No. of 
Items 

Items 
retained 

α GFI CFI NFI RMSEA Factor Loadings  

Mask Purchase 
intention 

5 5 .92 .92 .92 .96 .05 .53 ― .84 

Fear of COVID-19 7 4 .77 .98 .97 .99 .04 .51 ― .75 
Mask use attitude 6 5 .90 .91 .93 .97 .05 .55 ―.75 
Mask use intention 6 4 .85 .95 .92 .96 .06 .50 ―.78 

 
Table 2. Bivariate correlation analysis 

 

Variable 1 2 3 4 5 

Mask purchase intention 1     
Fear of COVID-19 .378

#
 1    

Mask usage attitude .129* .403
#
 1   

Mask usage intention .269
#
 .299

#
 .521

#
 1  

Self-efficacy .027** .069* .373
#
 .415

#
 1 

SD 1.053 1.206 .690 .735 .854 
Mean 2.884 3.045 1.535 1.533 2.076 

Significance level *p<.05, **p<.01, 
#
p<.001 

 

 
 

Fig. 2. Hypotheses testing for direct effects 
 

In Fig 2, mask use intention and mask use 
attitude (β=.521 p<.001). Self-efficacy with mask 
use intention (β=.415, p<.001) and mask use 
attitude (β=.373, p<.001). The fear of COVID-19 
and masks purchase intention (β=.78, p<.001) 
indicates that, as an individual's fear of COVID 
increases, the intention to buy any mask to stay 
safe increases supporting H2. 
 
Similarly, mask use attitude (β=.69, p<.001) and 
mask use intention (β=.68, p<.001) both have 
their respective positive effects on mask 

purchase intention. This provides support for H3 
and H5. There is also a direct and positive 
association between mask use intention and 
mask use attitude (β=.68, p<.01), supporting H6. 

 

Fig. 2 illustrates the direct effects, as stated in H1 
to H6, which are all supported. After controlling 
for price, age, and location, the model produced 
a total variance of 80% (c` = .54; p<.01).  From 
the mediation analysis (Table 3), the positive 
effect (β=.74, p<.01) on mask purchase intention 
supported H7, (β=.31, p<.05), and (β=.38, p<.01) 
for H8, H9, and H10.  



 
 
 
 

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Table 3. Serial Mediation effect of mask use attitude and intention on fear of COVID-19 and 
mask purchase intention 

 

 Path B SE 95% CI Remarks 

LL UL 

H7 Fear of COVID ―> Mask use attitude ―> 
Mask use intention 

.46* .08 .0742 .2486 Supported 

H8 Fear of COVID―> Mask use 
attitude―>mask purchase intention  

.74** 0.10 .6341 .8380 Supported 

H9 Fear of COVID―> Mask use 
intention―>mask purchase intention  

.31* .06 .1314 .4905 Supported 

H10 Mask use attitude ―> Mask use 
intention―>mask purchase intention 

.38*  .06  .2257  .5447 Supported 

 
Table 4. Moderator effect on mask purchase intention 

 

Hypotheses Path  95% CI  

B SE LLCI ULCI Remarks 

H11 Mask usage intention*self-
efficacy―>mask purchase intention 

.39# .1386 .1647 .6228 Supported 

H12 Fear of COVID-19*self-
efficacy―>mask purchase intention 

.071** .053 .0282 .1802 Supported 

H13 Mask usage attitude*self-
efficacy―>mask purchase intention 

.12** .0461 .0256 .2071 Supported 

*p<.05, **p<.01, #p<.001 

 
There is a moderation effect (Table 4) of self-
efficacy (β=.071, SE .053, p<.05) on the 
relationship between fear of COVID-19 and mask 
purchase intention. The interaction terms 
predicted mask purchase intention (β = .12, SE 
=.0461 p < .05 and β= .39, SE= .1386, p < .001) 
supporting H11, H12, and H13.  
 

4. DISCUSSION 
 
First, we established that face masks' purchase 
intention is positively associated with the fear of 
COVID-19. Fear is a known influencer in 
determining behavioral change, especially 
regarding public health and wellbeing [32]. 
COVID-19 has caused economic, social, and 
health-related fears the world has never seen 
before. From the works of Ahorsu et al. [25], fear 
of COVID-19 has uttered human activities 
globally, and individuals are becoming more 
conscious of safety precautions and general 
wellbeing. Our result echoed this view and 
supported previous studies that linked fear to 
attitudinal change  [32,20,33,19]. With the 
recommendation of face masks as one of the 
cheapest and easiest means to prevent COVID-
19, the related fear has a higher tendency to 
trigger people's inherent self-regulation towards 
the use of face masks, more so, any face mask 
amidst a global shortage of medical face mask. 
 

Fear is said to have a reasonably good and 
reliable effect on attitudes, intentions, and 
behaviors. Fear, if leveraged under the right 
circumstance, will motivate behavior change. In 
this work, we re-echoed the association between 
fear and purchase intention of the corresponding 
averting kit (face mask). The literature argues 
that the perceived loss of life and physical and 
psychological wellbeing will lead people to act to 
avert any possible outcome [34,35]. We                     
argued that the higher the fear of COVID-19,                  
the more significant the quest to stay alive,                 
thus, will increase the purchase intention of 
masks. 
 
Self-efficacy has been at the center of fear-
behavior research. Self-efficacy is considered to 
affirm one's ability to combat the risk of threat 
and increases the likelihood of performing a 
recommended danger-control behavior [36]. In 
this study, we tested the moderating effects of 
self-efficacy on purchase intention amidst fear of 
COVID-19. Whiles self-efficacy and intention are 
not new in e-commerce [37,38,39,40], its 
relationship with mask buying and fear of 
COVID-19 for public safety and actor wellbeing is 
new. Like in previous studies, self-efficacy has a 
positive interactive effect in explaining the 
purchase of PPEs and disease prevention kits 
[41]. 
 



 
 
 
 

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Even though product price is a known influencer 
in consumer decision-making, it is not a concern 
in life-saving decision-making. Gender and 
location were equally not statistically significant 
in our model. This supports the findings of an 
earlier study on the purchase of PPEs in the 
wake of COVID-19, which suggests that, under 
life-threatening conditions, cost and location are 
less significant [32].  
 
Attitude and intention are the central ideas of 
behavioral change and health-risk prevention 
and management. They are also known to be 
among the critical purchase intention predictors 
[42]. Several studies argued and presented new 
trends in the wake of COVID-19 and 
actor/consumer behavioral change. However, it 
is novel to combine a newly developed scale 
(fear of COVID-19) in predicting the wellbeing 
purchase intention of face masks in a self-
regulatory context. The variables used here are 
not new; however, their application in the 
contexts of personal and public safety has not 
yet been explored by any existing study. This 
study, thus, provides a foundation for applying 
self-regulation theory in the area of purchase 
behavioral change and particularly towards 
actor/consumer wellbeing under pandemics like 
COVID-19. It is important to note that this article 
links attitude and purchase intention to actor 
wellbeing during disasters, such as the COVID-
19 pandemic. It provides a novel perspective, 
conceptualization, and connectivity between fear, 
attitude, and well-being-related buying [32]. 
Scholars should pay attention to these variables' 
interaction and interconnectedness in explaining 
actor/consumer wellbeing during disastrous 
situations. For example, the fear that comes with 
a pandemic determines people's readiness for 
attitudinal change to avert fetal outcomes. In 
times of disaster like the COVID-19, researchers 
should investigate how to achieve actor 
wellbeing from different perspectives [43,44]. 
 
Wearing face masks is not known to cause any 
detrimental physiological changes, and the 
possible life-saving benefits of wearing face 
masks outweigh any documented discomforts 
[45]. Therefore, policymakers, wellbeing 
psychologists, and healthcare practitioners must 
understand the antecedents that promote 
people's behavioral change towards 
psychological and physical wellbeing, such as 
that which comes with COVID-19. In particular, 
face mask advocates can leverage the fear-well-
being understanding in this paper in their 
promotional and educational exercises. 

Policymakers knowing consumers' willingness to 
use any mask that will offer protection, can 
advocate using any mask and accompany such 
campaigns with the recommended safety 
guidelines to ensure people use the mask of their 
choice well since any mask is better than no 
mask. 
 

5. CONCLUSION 
 
The current study highlighted the association 
between fear of COVID-19 and actor wellbeing 
purchase behavioral intention guided by the self-
regulation theory. While this work might not be 
the first of its kind, it is definitely among the few 
studies that adapted the fear of the COVID-19 
scale specifically to study mask purchase 
intention towards actor/consumer wellbeing. With 
the low COVID statistics from Africa and 
especially Ghana, where home-made-mask were 
dominant during the lockdown period, compared 
to other countries, a further look at the efficacy of 
home-made masks and their use in preventing 
COVID-19 will deepen public understanding of 
the effectiveness of masks (Any mask is better 
than no mask). Finally, we proposed a model that 
can be adopted, contingent on further 
investigation. 
 
Despite its initial reliability, the authors 
acknowledge the possibilities of deficiency or 
future modification and improvement in the scale. 
Also, a behavioral change tendency exists                   
after the lockdown when people are accustomed 
to prevention protocols. The generalization                 
of the findings should, therefore, be made 
cautiously. 
 

DISCLAIMER 
 

The products used for this research are 
commonly and predominantly use products in our 
area of research and country. There is absolutely 
no conflict of interest between the authors and 
producers of the products because we do not 
intend to use these products as an avenue for 
any litigation but for the advancement of 
knowledge. Also, the research was not funded by 
the producing company rather, it was funded by 
the personal efforts of the authors. 
 

CONSENT  
 
As per international standard or university 
standard, respondents’ written consent                          
has been collected and preserved by the 
author(s). 



 
 
 
 

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ETHICAL APPROVAL 
 

It is not applicable. 
 

COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 

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