A chain mediation analysis of the effects of psychological inflexibility, perception of threat, and behavioral adherence among refugees during crisis: The case of the COVID-19 pandemic

Without known medications or vaccines for COVID-19, governments worldwide adopted the World Health Organization's (WHO) preventive guidelines, which primarily focused on regulating physical and social interactions. Although the control measures effectively slowed the spread of the virus, their uptake in refugee settlements was hindered by the challenging living conditions within these settlements. This study examines the correlation of psychological factors, including psychological inflexibility, avoidance coping, perceived threat, and psychological trauma symptoms, with the uptake of COVID-19 preventive behavioral measures. It was hypothesized that avoidance coping, psychological trauma symptoms, and perceived threat mediate the association between psychological inflexibility and non-adherence. These assumptions were tested using data from 387 refugees from two large refugee settlements in Uganda. The results showed support for the hypothesized serial double mediation model. Overall, the results suggest that decreasing psychological inflexibility and consequently fostering adaptive coping could be essential for diminishing psychological trauma symptoms and stimulating accurate perception of risks and threats posed by crises and disasters, thus reducing non-adherence to preventive measures.