Background: With a massive population of internet users, China has witnessed a shift in the behavior of social media users towards the COVID-19 pandemic, transitioning from reticence to frequent sharing of information in response to changing circumstances and policy adjustments of the disease. This study aims to explore how perceived benefits, perceived risks, subjective norms, and self-efficacy influence the intentions of Chinese COVID-19 patients to disclose their medical history on social media, and thus to examine their actual disclosure behaviors. Methods: Based on the Theory of Planned Behavior (TPB) and Privacy Calculus Theory (PCT), a structural equation model was constructed to analyze the influence paths among perceived benefits, perceived risks, subjective norms, self-efficacy, and behavioral intentions to disclose medical history on social media among Chinese COVID-19 patients. A total of 593 valid surveys were collected via a randomized internet-based survey, which constituted a representative sample. Firstly, we used SPSS 26.0 to conduct reliability and validity analyses of the questionnaire, as well as the tests of demographic differences and correlations between variables. Next, Amos 26.0 was employed to construct and test the model fit degree, identify the relationships among latent variables, and conduct path tests. Results: Our findings revealed the following: (1) There were significant gender differences in the self-disclosure behaviors of medical history on social media among Chinese COVID-19 patients. (2) Perceived benefits had a positive effect on self-disclosure behavioral intentions (β = 0.412, p < 0.001); perceived risks had a positive effect on self-disclosure behavioral intentions (β = 0.097, p < 0.05); subjective norms had a positive effect on self-disclosure behavioral intentions (β = 0.218, p < 0.001); self-efficacy had a positive effect on self-disclosure behavioral intentions (β = 0.136, p < 0.001). (3) Self-disclosure behavioral intentions had a positive effect on disclosure behaviors (β = 0.356, p < 0.001). Conclusions: Our study, by integrating TPB and PCT to examine the influencing factors of the self-disclosure behaviors among Chinese COVID-19 patients on social media, found that perceived risks, perceived benefits, subjective norms, and self-efficacy had a positive influence on the self-disclosure intentions of Chinese COVID-19 patients. We also found that self-disclosure intentions, in turn, positively influenced disclosure behaviors. However, we did not observe a direct influence of self-efficacy on disclosure behaviors. Our study provides a sample of the application of TPB in the context of social media self-disclosure behavior among patients. It also introduces a novel perspective and potential approach for individuals to address the feelings of fear and shame related to illness, particularly within the context of collectivist cultural values.

Objectives To develop a Chinese Adults Dietary Index (CADI) based on current Chinese dietary guideline (2016), Chinese dietary reference intakes (2013) and existing scientific evidence and to apply it to assess the overall dietary among Chinese adults. Methods Dietary data were obtained using 24-hour dietary recalls among 932 adults aged 18 to 70 years between 2013 and 2014. Potential confounders were also collected. The Chinese Adults Dietary Index included 17 components, which incorporated foods/food groups (grains, red meat, white meat, nuts, vegetables, fruits, dairy and dairy products, soybeans, drinking water, alcohol, SSBs, dietary variety) nutrients (dietary fiber, fatty acids, calcium, magnesium) and energy balance. The Chinese Adults Dietary Index was designed as a continuous scoring system and the range of possible CADI score was 0 to 170, with a higher score indicating better diet quality. The Pearson or Spearman correlation were used to assess the correlations between the total CADI score and age, body mass index (BMI) and nutrient adequacy ratios to test the association between CADI scores and significant indicators of diet quality. A stepwise multiple regression analysis of the data was performed to explored that if socioeconomic factors were correlated with the CADI scores. Results The means, 25th and 75th percentiles of CADI score was 91.0, 78.5 and 102.6 points, respectively. Scores for red meat, white meat, nuts, dairy and dairy products and soybeans were much lower (<3 points), reflecting excessive consumption of red meat and insufficient consumption of white meat, nuts, dairy and dairy products and soybeans. The CADI score of women was higher than that of men (P < 0.0001). Significant and positive correlations of CADI with the majority of nutrient adequacy ratios (energy, protein, vitamin A, vitamin C, vitamin E, thiamin, riboflavin, niacin, potassium, iron, zinc, phosphorous, copper, selenium) were observed (Pearson or Spearman correlation coefficients ranging from 0.11 to 0.56). which indicated increasing CADI scores reflected higher overall diet quality. Age, educational level and smoking status were correlated with Chinese Adults Dietary Index. Conclusions The findings indicate that the Chinese Adults Dietary Index is capable of recognizing differences in Chinese diet, therefore, it can be used to assess overall diet quality among Chinese adults. Diet quality needs to be improved among Chinese adults. Funding Sources This study was supported by a research grant from the National Natural Science Foundation of China (81,673,158). Supporting Tables, Images and/or Graphs

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