Currently submitted to: JMIR Aging
Date Submitted: Apr 15, 2026
Open Peer Review Period: Apr 15, 2026 - Jun 10, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Post–COVID-19 Preventive Behaviors Among Disadvantaged Older Adults in Hong Kong: A COM-B Analysis
ABSTRACT
Background:
The COVID‑19 pandemic profoundly reshaped health practices, especially among older adults who are at higher risk of infection. During the pandemic, Hong Kong government measures such as the Vaccine Pass accelerated vaccine uptake, but little is known about how underprivileged older adults’ preventive behaviors and attitudes will be in the post‑pandemic era.
Objective:
To examine the facilitators and barriers to older adults’ capability, opportunity, and motivation to sustain preventive behaviors and accept future vaccinations.
Methods:
From March 2023 to July 2024, we conducted baseline surveys and in‑depth semi‑structured interviews with 54 older adults (mean age = 76.02 years; 79.6% female) who participated in the Generations Connect project. Demographic and vaccination data were analyzed using descriptive statistics, while interview transcripts underwent thematic analysis. Themes were mapped against the COM‑B (Capability, Opportunity, Motivation–Behavior) framework.
Results:
Three themes were identified: (1) Normalization of preventive measures, with mask‑wearing, hand hygiene, and occasional self‑testing integrated into daily routines, even after mandates were lifted; (2) Beliefs and perceptions, where trust in vaccines and antivirals coexisted with vaccine hesitancy; and (3) Health and ageing context, including difficulties distinguishing long COVID from chronic conditions and reliance on traditional Chinese medicine (TCM) or folk remedies. Mapping the findings onto the COM‑B model revealed major facilitators. Facilitators encompassed capability, opportunity, and motivation (e.g., hygiene routines and TCM access). In contrast, barriers included mistrust, limited health literacy, and culturally rooted beliefs.
Conclusions:
Underprivileged older adults in Hong Kong continue precautionary routines shaped by COVID‑19 but face barriers in vaccine acceptance and limited health literacy. Promotion of vaccination in this group should strengthen capability through tailored education, increase accessibility via timely services, and build motivation by highlighting the benefits of vaccines and fostering trust. Grounding future interventions in the COM‑B framework may sustain prevention and improve resilience in aging populations. Clinical Trial: NA
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.