Health beliefs and their relation to household, necessary, and unnecessary contacts across COVID-19 epidemic waves in Taiwan

The COVID-19 pandemic prompted widespread preventive measures and altered individual contact behaviors. However, limited research has examined how health beliefs shape these behavioral changes. This study investigates the association between health beliefs and close contact patterns during two COVID-19 waves in Taiwan, using a longitudinal survey conducted between July 2020 and June 2021 (the 2021 summer wave, n = 728) and a cross-sectional survey conducted between September and November 2022 (the 2022 autumn wave, n = 2,793). Participants reported close contacts from the previous day, categorized as household, non-household necessary, and non-household unnecessary contacts. Generalized estimating equations and zero-inflated Poisson models were applied to assess associations. The results revealed that perceived benefit from COVID-19 preventive measures and perceived severity of infection remained high since the onset of the 2021 summer wave in Taiwan. The number of non-household contacts declined during peak periods and was associated with health beliefs in distinct ways. High perceived barriers to COVID-19 preventive measures and high perceived susceptibility to infection were linked to a greater number of non-household contacts, whereas high perceived benefit from preventive measures correlated with fewer non-household contacts. Additionally, our longitudinal analysis demonstrated that health beliefs are not static but evolve over time in response to changing epidemic conditions and public awareness. These findings underscore the dynamic role of health risk perception in shaping contact behavior and highlight the value of distinguishing contact types to guide public health policies and modeling of disease transmission.