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Background  In an outbreak of an infectious disease especially, online media would usually be an important channel for people to get first-hand knowledge and evaluate risks of the specific emergency. Although there has been increasing attention to the effect of social media use during epidemics and outbreaks, relatively little is known about the underlying mechanism by which social media plays a role in people's cognitive, affective and preventive responses.    Objective  With an objective to advance current knowledge surrounding social media effects on people's cognition, affection and health protective behaviors during epidemics, we aim to examine the associations between social media exposure to COVID-19 risks related information and preventive behavior of the public, and also the role that situation awareness and crisis emotions including anxiety and fear played.    Methods  An online cross-sectional survey was conducted in China a total of 632 participants were recruited. Measures included exposure to COVID-19 information through social media, situation awareness, anxiety, fear and protective behaviors that participants have taken. We have performed the descriptive statistical analysis, correlation and mediation analysis to test the research hypotheses.    Results  Findings indicated that situation awareness was positively associated with social media use (B = 0.54,  p  &amp;lt; 0.001), anxiety (B = 0.95,  p  &amp;lt; 0.001) and fear (B = 0.87,  p  &amp;lt; 0.001), and preventive behavior (B = 0.68,  p  &amp;lt; 0.001). Social media use would also have an indirect effect on anxiety (indirect effect = 0.40; 95% CI = [0.34, 0.46]) and fear (indirect effect = 0.35; 95% CI = [0.29, 0.42]) through situation awareness. The serial mediation effect of situation awareness and fear in the correlation between social media use and preventive behavior has been testified (indirect effect = 0.04, 95% CI = [0.01, 0.08]).    Conclusions  Social media use might influence the adoption of preventive behaviors through triggering situation awareness and fear. Therefore, health communication regarding COVID-19 prevention should target people with less internet access and low eHealth literacy. Understanding the positive role of negative crisis emotions during outbreaks could also help communicators and policymakers develop appropriate strategies to make people proactive to avoid the remaining health hazard.

frontiers in public health

Exploring the Mediating Role of Situation Awareness and Crisis Emotions Between Social Media Use and COVID-19 Protective Behaviors: Cross-Sectional Study