While health-related awareness has been extensively studied, the concept of health uncertainty in the general population remains inadequately conceptualized and operationalized. This study aims to develop a conceptual framework and measurement tool for health uncertainty, and to examine its associations with health anxiety and health behaviors. The research comprised two studies conducted in China. Study 1 developed and validated a health uncertainty scale using data from 709 participants. The scale, which comprises dimensions of health status uncertainty, health changes unpredictability, and health threat and information ambiguity, demonstrated good reliability and validity. Study 2 employed a questionnaire-based approach with 345 participants and showed that health uncertainty negatively predicted health behaviors, with health anxiety acting as a mediator. The findings highlight the impact of health uncertainty on psychological and behavioral responses, emphasizing the need for strategies to reduce uncertainty during public health crises to promote healthier behaviors and achieve public health goals.
AhlbrechtMWeberM (1997) An empirical study on intertemporal decision making under risk. Management Science43(6): 813–826.
2.
AkbariMSpadaMMNikčevićAV, et al. (2021) The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation. Clinical Psychology & Psychotherapy28(6): 1354–1366.
3.
AlbertsNMSharpeDKehlerMD, et al. (2011) Health anxiety: Comparison of the latent structure in medical and non-medical samples. Journal of Anxiety Disorders25(4): 612–614.
4.
Al-DmourHMasa’dehRSalmanA, et al. (2020) Influence of social media platforms on public health protection against the COVID-19 pandemic via the mediating effects of public health awareness and behavioral changes: Integrated model. Journal of Medical Internet Research22(8): e19996.
5.
AlmanasrehEMolesRChenTF (2019) Evaluation of methods used for estimating content validity. Research in Social and Administrative Pharmacy15(2): 214–221.
6.
AndersonLRStaffordSL (2009) Individual decision-making experiments with risk and intertemporal choice. Journal of Risk and Uncertainty38(1): 51–72.
7.
AsmundsonGJAbramowitzJSRichterAA, et al. (2010) Health anxiety: Current perspectives and future directions. Current Psychiatry Reports12(4): 306–312.
8.
BerriganDDeanDSenft EversonN, et al. (2023) Uncertainty: A neglected determinant of health behavior?Frontiers in Psychology14:1145879.
9.
BrashersDE (2001) Communication and uncertainty management. Journal of Communication51(3): 477–497.
10.
BrownRJSkellyNChew-GrahamCA (2020) Online health research and health anxiety: A systematic review and conceptual integration. Clinical Psychology Science and Practice27(2): 20.
11.
BrownSPWestbrookRAChallagallaG (2005) Good cope, bad cope: Adaptive and maladaptive coping strategies following a critical negative work event. Journal of Applied Psychology90(4): 792–798.
12.
CarletonRN (2016) Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders39: 30–43.
13.
CelanoCMDaunisDJLokkoHN, et al. (2016) Anxiety disorders and cardiovascular disease. Current Psychiatry Reports18(11): 101.
14.
ChiuH-YChang LiaoN-FLinY Jr, et al. (2021) Perception of the threat, mental health burden, and healthcare-seeking behavior change among psoriasis patients during the COVID-19 pandemic. PLoS One16(12): e0259852.
15.
DattiloTMRobertsCMFisherRS, et al. (2021) The role of avoidance coping and illness uncertainty in the relationship between transition readiness and health anxiety. Journal of Pediatric Nursing59: 125–130.
16.
Delgado-OrtizLCarsinA-EMerinoJ, et al. (2023) Changes in population health-related behaviors during a COVID-19 surge: A natural experiment. Annals of Behavioral Medicine57(3): 216–226.
17.
DeVellisRFThorpeCT (2021) Scale Development: Theory and Applications. Sage Publications.
18.
DogonchiMMohammadzadehFMoshkiM (2022) Investigating the relationship between health locus of control and health behaviors: A systematic review. Open Public Health Journal15(1): e187494452208010.
19.
DuffyME (1986) Primary prevention behaviors: The female-headed, one-parent family. Research in Nursing and Health9(2): 115–122.
20.
FariasJPilatiR (2023) COVID-19 as an undesirable political issue: Conspiracy beliefs and intolerance of uncertainty predict adhesion to prevention measures. Current Psychology42(1): 209–219.
21.
FloydDLPrentice-DunnSRogersRW (2000) A meta-analysis of research on protection motivation theory. Journal of Applied Social Psychology30(2): 407–429.
22.
GiovannettiAMBrambillaLTorri ClericiV, et al. (2017) Difficulties in adjustment to multiple sclerosis: Vulnerability and unpredictability of illness in the foreground. Disability and Rehabilitation39(9): 897–903.
23.
Gold-SpinkESherTGTheodosV (2000) Uncertainty in illness and optimism in couples with multiple sclerosis. International Journal of Rehabilitation Health Communication5: 157–164.
24.
GouldSJ (1990) Health consciousness and health behavior: The application of a new health consciousness scale. American Journal of Preventive Medicine6(4): 228–237.
25.
GuilfordJP (ed.) (1956) Fundamental Statistics in Psychology and Education, 3rd edn. McGraw-Hill.
26.
HanPKJBabrowAHillenMA, et al. (2019) Uncertainty in health care: Towards a more systematic program of research. Patient Education and Counseling102(10): 1756–1766.
27.
HeilmanRMCrişanLGHouserD, et al. (2010) Emotion regulation and decision making under risk and uncertainty. Emotion10(2): 257–265.
28.
HerbertCMeixnerFWiebkingC, et al. (2020) Regular physical activity, short-term exercise, mental health, and well-being among university students: The results of an online and a laboratory study. Frontiers in Psychology11: 00509.
29.
HoggMA (2007) Uncertainty–identity theory. Advances in Experimental Social Psychology39: 69–126.
30.
HorensteinAHeimbergRG (2020) Anxiety disorders and healthcare utilization: A systematic review. Clinical Psychology Review81: 101894.
31.
HowellJLSweenyKHuaJ, et al. (2023) The role of uncertainty, worry, and control in well-being: Evidence from the COVID-19 outbreak and pandemic in US and China. Emotion23(5): 1458–1471.
32.
HuCHuangCLiJ, et al. (2022) Causal associations of alcohol consumption with cardiovascular diseases and all-cause mortality among Chinese males. American Journal of Clinical Nutrition116(3): 771–779.
33.
ImJMakSUpshurR, et al. (2019) ‘The future is probably now’: Understanding of illness, uncertainty and end-of-life discussions in older adults with heart failure and family caregivers. Health Expectations22(6): 1331–1340.
34.
JeongHLeeYParkJS, et al. (2024) Influence of illness uncertainty on health behavior in individuals with coronary artery disease: A path analysis. Journal of Korean Academy of Nursing54(2): 162–177.
35.
KuangKWilsonSR (2017) A meta-analysis of uncertainty and information management in illness contexts. Journal of Communication67(3): 378–401.
36.
LandisBJ (2009) Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness. Issues in Mental Health Nursing17: 217–231.
37.
LaNoueMDGerolamoAMPowellR, et al. (2020) Development and preliminary validation of a scale to measure patient uncertainty: The “Uncertainty Scale.” Journal of Health Psychology25(9): 1248–1258.
38.
LeeCJNaglerRHWangN (2018) Source-specific exposure to contradictory nutrition information: Documenting prevalence and effects on adverse cognitive and behavioral outcomes. Health Communication33(4): 453–461.
39.
LeeY-LGauB-SHsuW-M, et al. (2009) A model linking uncertainty, post-traumatic stress, and health behaviors in childhood cancer survivors. Oncology Nursing Forum36(1): E20–E30.
40.
LeeY-LSantacroceSJSadlerL (2007) Predictors of healthy behaviour in long-term survivors of childhood cancer. Journal of Clinical Nursing16(11C): 285–295.
41.
MasonJELeBouthillierDMAsmundsonGJG (2019) Relationships between health behaviors, posttraumatic stress disorder, and comorbid general anxiety and depression. Cognitive Behaviour Therapy48(3): 184–199.
42.
Maydeu-OlivaresAMillsapRE (2009) The Sage Handbook of Quantitative Methods in Psychology. Sage.
43.
MishelMH (1988) Uncertainty in illness. Image: The Journal of Nursing Scholarship20(4): 225–232.
44.
MishelMH (1990) Reconceptualization of the uncertainty in illness theory. Image the Journal of Nursing Scholarship22(4): 256–262.
45.
MoggKBradleyBP (2016) Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification. Behaviour Research and Therapy87: 76–108.
46.
MorrissJTupitsaEDoddHF, et al. (2022) Uncertainty makes me emotional: Uncertainty as an elicitor and modulator of emotional states. Frontiers in Psychology13: 777025.
47.
MozgovayaEIVodolazovaZMGorskyAA, et al. (2021) Healthy lifestyle of the population in the context of a pandemic: Expert opinions of researchers and employees of non-profit organizations. Problems of Social Hygiene, Public Health History of Medicine29(S1): 763–767.
48.
MullinsAJGamwellKLSharkeyCM, et al. (2017) Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses. Journal of American College Health65(5): 352–360.
49.
NaglerRHShiW (2022) Health information, conflicting and controversial. In: HoEYBylundCLvan WeertJCM, et al. (eds) The International Encyclopedia of Health Communication. Wiley-Blackwell, pp.1–6.
50.
NewbyJMHobbsMJMahoneyAEJ, et al. (2017) DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. Journal of Psychosomatic Research101: 31–37.
51.
NutbeamD (2000) Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International15(3): 259–267.
52.
OromHBiddleCWatersEA, et al. (2020) Causes and consequences of uncertainty about illness risk perceptions. Journal of Health Psychology25(8): 1030–1042.
53.
PappasGKiriazeIJGiannakisP, et al. (2009) Psychosocial consequences of infectious diseases. Clinical Microbiology and Infection15(8): 743–747.
54.
Prentice-DunnSRogersRW (1986) Protection motivation theory and preventive health: Beyond the health belief model. Health Education Research1(3): 153–161.
55.
RogowskaAMPavlovaIKuśnierzC, et al. (2020) Does physical activity matter for the mental health of university students during the COVID-19 pandemic?Journal of Clinical Medicine9(11): 3494.
56.
SeongMBaeK (2022) A study of pandemic prevention health behavior in adults. International Journal of Environmental Research and Public Health19(13): 8181.
57.
SimonovicNTaberJMScherrCL, et al. (2023) Uncertainty in healthcare and health decision making: Five methodological and conceptual research recommendations from an interdisciplinary team. Journal of Behavioral Medicine46(4): 541–555.
58.
SkojecTADavidsonTMKelechiTJ (2025) The relationship between uncertainty in illness and psychological adjustment to chronic illness. Journal of Health Psychology30(4): 622–637.
59.
StantonRToQGKhalesiS, et al. (2020) Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. International Journal of Environmental Research and Public Health17(11): 4065.
60.
SteptoeAWardleJ (2001) Locus of control and health behaviour revisited: A multivariate analysis of young adults from 18 countries. British Journal of Psychology92(4): 659–672.
61.
StrineTWChapmanDPKobauR, et al. (2005) Associations of self-reported anxiety symptoms with health-related quality of life and health behaviors. Social Psychiatry and Psychiatric Epidemiology40(6): 432–438.
62.
TangZYangXTanW, et al. (2024) Patterns of unhealthy lifestyle and their associations with depressive and anxiety symptoms among Chinese young adults: A latent class analysis. Journal of Affective Disorders352: 267–277.
63.
TanH (2023) The mediating role of anxiety in disease uncertainty and acute stress in acute ischaemic stroke patients in the post-epidemic era. Frontiers in Psychiatry14: 1218390.
64.
ThompsonB (2004) Exploratory and Confirmatory Factor Analysis: Understanding Concepts and Applications. American Psychological Association.
van BeekJAntonidesGHandgraafMJ (2013) Eat now, exercise later: The relation between consideration of immediate and future consequences and healthy behavior. Personality and Individual Differences54(6): 785–791.
67.
van Den BosK (2001) Uncertainty management: The influence of uncertainty salience on reactions to perceived procedural fairness. Journal of Personality and Social Psychology80(6): 931–941.
68.
Van Den BosKEuwemaMCPoortvlietPM, et al. (2007) Uncertainty management and social issues: Uncertainty as an important determinant of reactions to socially deviating people. Journal of Applied Social Psychology37(8): 1726–1756.
69.
WangD (2009) Development and Preliminary Application of a Healthy Lifestyle Questionnaire (HLQ) for College Students. Southern Medical University.
70.
WittinkHOosterhavenJ (2018) Patient education and health literacy. Musculoskeletal Science and Practice38: 120–127.
71.
WrightLJAfariNZautraA (2009) The illness uncertainty concept: A review. Current Pain and Headache Reports13(2): 133–138.
72.
WuSZhangKParks-StammEJ, et al. (2021) Increases in anxiety and depression during COVID-19: A large longitudinal study from China. Frontiers in Psychology12: 706601.
73.
ZhangLLiHChenK (2020) Effective risk communication for public health emergency: Reflection on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. Healthcare8(1): 64.
74.
ZhangY (2017) Uncertainty in illness: Theory review, application, and extension. Oncology Nursing Forum44(6): 645–649.
75.
ZhangYLiuRLiG, et al. (2015) The reliability and validity of a Chinese-version Short Health Anxiety Inventory: An investigation of university students. Neuropsychiatric Disease and Treatment11: 1739–1747.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
