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Journal of Public Health
https://doi.org/10.1007/s10389-024-02210-5
ORIGINAL ARTICLE
The effects ofhigher‑order human values andconspiracy beliefs
onCOVID‑19‑related behavior inGermany
StefanPoier1 · MichałSuchanek2
Received: 25 November 2023 / Accepted: 4 February 2024
© The Author(s) 2024
Abstract
Aim This article simultaneously examines the influence of Schwartz’ higher-order human values (self-transcendence, open-
ness to change, self-enhancement, and conservation) and conspiracy beliefs on four COVID-19-related dependent variables.
Subject and methods Using path analysis with large-scale panel data from Germany (N = 4382), we tested if the correla-
tional effects of higher-order values as independent variables on the perceived threat of the infection event, evaluation of
government measures, number of self-initiated measures, and trust toward individuals and institutions involved as dependent
variables could be mediated by conspiracy beliefs.
Results We found evidence of a significant influence of all four higher-order values on the strength of conspiracy beliefs.
In addition, we detected effects of higher-order values and conspiracy beliefs on all four COVID-19-related measures. Self-
transcendence with consistently positive and openness to change with consistently negative total, direct, and indirect effects
provided the most evident results. The respondents’ country of origin and residence in East or West Germany affected all
four COVID-19-related variables.
Conclusion This article has shown that belief in conspiracy narratives reveals associations of higher-order values with all
four COVID-19-related measures that would not have been apparent without this mediator. In doing so, it contributes to
the understanding of how pandemic mitigation measures are implemented differently. The results of this study can improve
the ability to develop and enforce policies to increase the acceptance of scientifically accepted efforts in better governance.
Keywords Covid-19· Human values· Conspiracy beliefs· Behavior
Introduction
In the spring of 2020, the novel coronavirus (SARS-
CoV-2) spread worldwide. In the early days of the
coronavirus disease (COVID-19) crisis, before there was
supply of vaccines, the world’s nations heavily relied on
citizen participation. Much depended on how consistently
citizens followed government measures, such as contact
restrictions, wearing masks, or disinfecting their hands.
Trust in government institutions and the public health
system was, and still is, an important factor in COVID-19
conditional decisions such as vaccination (Viskupič etal.
2022). However, the behavior of citizens—especially in
times of crisis, when the threat is significant, but information
is scarce—could be influenced, among other things, by their
value system, based on which they perceive and evaluate the
situation (Schwartz and Bilsky 1987). It is possible that, e.g.,
people who have learned that the good of the general public
and environment is higher than their own may be more
willing to comply with unpleasant constraints (Motta and
Goren 2021). Nevertheless, in the case of complex events
on a global scale with a confusing information situation,
not all information can be evaluated in the same manner:
conspiracy narratives arose as soon as the first news of an
unknown virus became known (Douglas 2021; Gómez-
Ochoa and Franco 2020).
With this manuscript, we pursue two aims. First, we
want to assess the influence of Schwartz’ higher-order
human values (self-transcendence, openness to change,
self-enhancement, and conservation) and conspiracy beliefs
on four COVID-19-related dependent variables: perceived
* Stefan Poier
stefan.poier@fernuni-hagen.de
1 Faculty ofEconomics, Fernuniversität inHagen,
Universitätsstraße 47, 58097Hagen, Germany
2 Faculty ofEconomics, University ofGdansk, Armii Krajowej
119/121, 81-824Sopot, Poland
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Journal of Public Health
threat of the infection event, evaluation of government
measures, number of self-initiated measures, and trust
toward individuals and institutions involved. Second, we
examine whether conspiracy beliefs mediate between values
and the four COVID-19-related measures. Therefore, in
general, this study links the findings of previous studies
on COVID-19 and conspiracy beliefs, as the extensive
evaluation of the contribution of human values to conspiracy
beliefs is still under-represented in the extant literature. In
particular, this study narrows the gap in research regarding
how basic human values affect vital decision-making of
national significance through the formation and evaluation
of conspiracy beliefs.
In the following section, we derive the hypotheses for the
study by examining the current state of research and identi-
fying the necessary theoretical underpinnings. The next part
describes the sample used, the construction of variables and
the analysis design. In the subsequent section the results will
be presented. Afterward, the results will be discussed and
placed in the context of the current state of research.
Theoretical background
Since the pandemic outbreak, many studies have emerged
about COVID-19, including many that provide results on
the drivers and consequences of the infectious event (for
a systematic review, see van Mulukom etal. 1982. While
researchers have often focused on the association between
the effects of the COVID-19 pandemic on the personalities
of individuals (e.g., Bojanowska etal. 2021; Bonetto
etal. 2021) and how they deal with it (Enea etal. 2023;
Huang etal. 2022), there are now also numerous studies
related to conspiracy beliefs and the coronavirus (Georgiou
etal. 2020; Hughes and Machan 2021; Kuhn etal. 2021).
Values are formed through socialization and education in
a social and personal context and are considered relatively
stable at the onset of adulthood (Bilsky etal. 2011). They
are the underlying dispositions for beliefs, attention and
behavior (Rokeach 1969) since they are considered guiding
principles in life that refer to desirable goals (Parks and Guay
2009; Schwartz 2012a). In this regard, values according
to the value-attitude-behavior hierarchy are considered
determinants of attitudes and thus of behavior (Homer and
Kahle 1988). We therefore assume that values also affect the
evaluation and implementation of containment measures,
the assessment of institutions and individuals involved,
and the perception of risk. For the same reasons, values
should also affect the formation of conspiracy beliefs. On
the one hand, values are considered underlying dispositions
for beliefs (Rokeach 1969); on the other hand, there is
evidence from research on conspiracy beliefs that points to
basic human values as motivational drivers: Douglas etal.
(2017) identify existential, social, and epistemic motives
as drivers of conspiracy beliefs. Epistemic motives include
the desire to understand and be able to explain the world
(Douglas etal. 2017) and drive individuals to recognize
patterns even in random events (Gligorić etal. 2021; Zhao
etal. 2014). This motivation overlaps with the higher-order
value of openness to change, especially with the value
self-direction (Schwartz 2012a). Existential motives are
reflected in the desire for security and control and express
that people aim to feel safe in their environment (Douglas
etal. 2017; Gligorić etal. 2021). This motivation is embodied
in the values of conformity, tradition, and security, which
constitute the higher-order value of conservation (Schwartz
2012a). Finally, social motives can also contribute to the
endorsement of conspiracy beliefs. A positive self-image
of the individual or in-group can be achieved by giving
credence to conspiracy beliefs (Cichocka etal. 2016). This
is expressed through the need for uniqueness, i.e., the desire
to be different, independent, and non-conformist (Lantian
etal. 2017; Imhoff and Lamberty 2017). Social motives
are placed on the side of values with a personal focus in
Schwartz’s value continuum and are reflected by both self-
enhancement values (self-direction) and openness to change
values (power, achievement) (Schwartz 2012a). Accordingly,
there is not only a theoretically based causal relationship
between human values and COVID-19-related attitudes and
behavior but also between values and conspiracy beliefs. The
influence of COVID-19 conspiracy beliefs on the assessment
and implementation of containment measures, the assessment
of perceived threats, and trust in the institutions and people
involved have been extensively researched (for an overview,
see, e.g., van Mulukom etal. (1982)). The studies found,
e.g., negative associations between conspiracy beliefs and
attitudes toward vaccines (Pivetti etal. 2021), between
conspiracy beliefs and adherence to government guidelines
(Freeman etal. 2022) or social distancing behavior (Marinthe
etal. 2020), while there were, e.g., positive relations to
“non-normative actions and behaviors which go against
governmental regulations” (Marinthe etal. 2020).
The above-mentioned theoretical foundations of the rela-
tions suggest that values not only have an influence on con-
spiracy beliefs and COVID-19-related attitudes and behavior
but that conspiracy beliefs affect COVID-19-related measures
and that there is a mediating role of conspiracy beliefs between
values and the COVID-19-related evaluation and implementa-
tion of containment measures, the assessment of institutions
and individuals involved, and the perception of risk. Either
way, the relationship of human values, corona conspiracy
beliefs, and pandemic-related attitudes and behaviors, such as
perceived threat of infection, belief in the effectiveness of the
measures, trust in institutions, and avoidance behavior, remains
little explored (van Mulukom etal. 1982). In the following, we
explain the constructs used and present the relevant literature.
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Journal of Public Health
Basic human values andhigher‑order values
In current psychological research, the term values can be
defined as “… conceptions of the desirable that guide the
way social actors (e.g., organizational leaders, policy-mak-
ers, individual persons) select actions, evaluate people and
events, and explain their actions and evaluations” (Schwartz
1999). Schwartz’s theory of basic human values (Schwartz
and Bilsky 1987, 1990) belongs to the most popular and
most researched models to date (Knafo etal. 2011; Sagiv
and Roccas 2021). Values can be captured at the level of the
individual but are also communicated and shared within a
common cultural or social group. In this context, the indi-
vidual’s own experiences, education, and socialization con-
tribute to the long-term development of value expressions
(Bilsky etal. 2011). The revised version of the value con-
tinuum (Fig.1) comprised 19 values, aggregated into four
higher-order values: self-transcendence, openness to change,
self-enhancement, and conservation (Schwartz etal. 2012b;
Schwartz 2017; Cieciuch etal. 2014).
People with a high degree of self-transcendence are inter-
ested in the well-being of others and care about community
and nature. Individuals who exhibit a high degree of open-
ness to change appreciate having new experiences. They
prefer independent thinking and self-realization to a con-
formist life. Individuals scoring high on self-enhancement
strive for personal success. Prestige and social status are
important to them, just as is the need to dominate others.
People with high conservation values have a need for secu-
rity. They prefer adherence to traditional customs and reject
inappropriate behavior. The four higher-order values form
the extreme manifestations of a two-dimensional field of
self-enhancement vs. self-transcendence values (personal-
vs. other-related focus) on the one dimension and openness
vs. conservation values (preservation vs. change of the status
quo) on the other. (Schwartz 2012a; Witte etal. 2020).
Regarding the literature on values related to COVID-
19, Wolf etal. (2020) suspected that human values “play
a widespread role in shaping responses to the COVID-19
pandemic” and suggested from the existing theory self-
transcendence to be positively influencing compliance with
the COVID behavioral prescriptions. Either way, little is
known to date about the role of Schwartz’ human values as
predictors of COVID-19 related behaviors. Bonetto etal.
(2021) examined the role of values as dependent variables
during the pandemic in France. Although values are consid-
ered to be relatively stable, they found significant but weak
changes in conservation, self-enhancement, and openness
to change. In addition to these small changes, which the
authors attributed to the influence of the perceived threat
of the pandemic, they reported consistent positive effects
of self-transcendence and conservation on compliance with
Fig. 1 Modified version of
the motivational continuum of
values. Note: In the innermost
circle, the circumplex structure
of the 19 revised human values
is shown. Surrounding this, the
four higher-order values along
the two dimensions of openness
vs. conservation and self-tran-
scendence vs. self-enhancement
are shown. Moving outward, the
next circle divides the values
into social and personal focus.
The outermost circle distin-
guishes between the dimensions
anxiety–avoidance and anxiety–
freedom. Source: Poier etal.
(2022), based on Schwartz etal.
(2012b)
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Journal of Public Health
movement restrictions and social distancing and a small
negative effect of self-enhancement on social distancing
during the pandemic. This statement was confirmed in a
study from Italy. Here, Pivetti etal. (2023) could prove an
indirect effect of universalim values and a direct effect of
benevolence values, both values included in self-transcend-
ence, on the probability of vaccination against COVID-19.
These results could be supported by Moosa etal. (2022)
from the Maldives and Torres etal. (2023) in Brazil who
found that conservation and self-transcendence positively
determined vaccine behavior. Motta and Goren (2021) inves-
tigated the relationship between basic human values and
prosocial health behavior such as wearing masks in public,
social distancing, and avoidance of the formation of larger
groups in the US. They reported that self-transcendent peo-
ple were more likely to engage in prosocial health behaviors.
Therefore, we expect similar results for the present study and
hypothesize the following:
H_01: Self-transcendence has a positive relationship with
the evaluation of government measures and the number
of measures taken.
Although Wolf etal. (2020) also estimated the influence
of conservation on containment measures to be positive,
there is evidence for a strong relation between politically
conservative orientation and conservation values (Ponizovs-
kiy etal. 2020; Schwartz etal. 2010; Caprara etal. 2008).
However, since conservative individuals are found to be
more susceptible to conspiracy beliefs and therefore would
be less likely to follow recommendations (Latkin etal. 2021;
Calvillo etal. 2020), these contradictory indications make
conservation values appear ambiguous.
Conspiracy beliefs
During the past few decades, studies concerning conspiracy
beliefs focused mainly on attitudes to politics or authori-
ties (Swami and Furnham 2012; Imhoff and Bruder 2014),
self-esteem (Cichocka etal. 2016), social dominance orien-
tation (Swami 2012), or the need for uniqueness (Lantian
etal. 2017). However, although there are some studies on
personality traits in relation to conspiracy beliefs (Goreis
and Voracek 2019; Swami etal. 2016), the research base is
limited regarding interaction with basic human values and
higher-order values.
Douglas etal. (2019) identify a conspiracy as a “secret
plot by two or more powerful actors,” stressing that, “while
a conspiracy refers to a true causal chain of events, a con-
spiracy theory refers to an allegation of conspiracy that
may or may not be true.” Swami etal. (2014b) add to this
definition, “… a subset of false beliefs in which the ulti-
mate cause of an event is believed to be due to a plot by
multiple actors working together with a clear goal in mind,
often unlawfully and in secret” (Swami etal. 2014a). Con-
sequently, conspiracy beliefs offer alternative explanations
for established knowledge and thus lead to less than opti-
mal or less expected outcomes according to the currently
prevailing scientific view—including a negative impact on
health decisions (Jolley and Douglas 2014; Oliver and Wood
2014b). This can include unreasonable epidemic behavior.
As explained at the beginning of “Theoretical background”
section, studies on the relationship between conspiracy
beliefs and COVID-19-related measures found, e.g., nega-
tive associations between conspiracy beliefs and attitudes
toward vaccines (Pivetti etal. 2021), between conspiracy
beliefs and adherence to government guidelines (Freeman
etal. 2022) or social distancing behavior (Marinthe etal.
2020), while there were, e.g., positive relations to non-nor-
mative behavior which counteract governmental regulations
(Marinthe etal. 2020; Jolley etal. 2019). Pavela Banai etal.
(2022) and Karić and Međedović (2021) could detect direct
negative effects of COVID-19 conspiracy beliefs on adher-
ence to preventive measures and a direct negative effect on
trust in government officials. Latkin etal. (2021) found that
COVID-19 skepticism not only stems from conservative
political attitudes but also leads to downplaying the dangers
of COVID-19. Taken together, we make the hypothesis:
H_02: Conspiracy belief has a negative association with
the four COVID-19-related outcomes (perceived threat of
infection with the coronavirus, behavioral changes meas-
ured by the number of measures taken, beliefs in the effec-
tiveness of public policy measures to mitigate the spread
of the pandemic, and trust in politics and institutions).
Existential, social, and epistemic motives are considered
drivers of conspiracy beliefs (Douglas etal. 2017). They relate
to the need for security and control, the desire to maintain a
positive image of oneself and one’s social group, and an under-
standing of one’s environment, respectively. Epistemic motives
are based on a desire to understand the big picture in the world,
trying to construct explanations where information is scarce
and to find patterns where events are merely random (Douglas
etal. 2017). Conspiracy beliefs serve here to make sense and
thus take on a role similar to religion and spirituality (van Prooi-
jen 2020). In a similar manner, Saroglou (2014) postulated a
positive correlation between conservation values and religiosity.
According to the assumption that existential motives
foster conspiracy beliefs, people turn to conspiracy beliefs
when they feel anxious (Grzesiak-Feldman 2013), powerless
(Abalakina-Paap etal. 1999), or feel a lack of sociopolitical
control (Bruder etal. 2013). Accordingly, values from the
self-protection hemisphere (conservation, self-enhancement)
should support the belief in conspiracy narratives. In contrast,
values from the growth hemisphere (openness to change,
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Journal of Public Health
self-transcendence) should counteract it. The need for secu-
rity and control is reflected here in the corresponding values
“security” and “control,” which are assigned to the higher-
order value of conservation (Schwartz 2012a). Farrell etal.
(2019) found that individuals with high levels of security,
conformity, and tradition had greater difficulty assigning the
correct truth value to a story and recognizing the difference
between subjective and objective statements. They suggest
that, in this specific case, values could outweigh the truth.
The social component refers to the individual’s relationship
to his or her social environment. People often turn to con-
spiracy beliefs when they see their positive external image
challenged (Cichocka etal. 2016). This applies to people
who tend to be on the losing side, who come from ethnically
disadvantaged groups, and/or who feel victimized (Bilewicz
etal. 2013) but also to narcissistically inclined people who
are looking for confirmation of their exaggerated self-image
(Cichocka etal. 2016). This leads to the hypotheses:
H_03: Conservation has a positive correlation with
conspiracy beliefs.
H_04: Self-enhancement has a positive association with
conspiracy beliefs.
H_05: Self-transcendence has a negative association
with conspiracy beliefs.
Sociodemographic control variables
A systematic review by van Mulukom etal. (1982) found
consistent positive associations between low education,
income, and nonwhite ethnicity (in the US and UK) with
stronger conspiracy beliefs. Age and sex inconsistently
affected conspiracy beliefs across studies. In two repre-
sentative surveys conducted by the Konrad Adenauer Foun-
dation, twice the proportion of conspiracy believers with
an immigrant background in Germany compared to people
without an immigrant background was found (Roose 2020).
In addition, more people, at 9%, in East Germany (the ter-
ritory of the former German Democratic Republic) stated
that corona was a means of oppression, than those in West
Germany (the territory of the Federal Republic of Germany
until 1990), at 5% (Roose 2020). Hence, we decided to
include birth country outside of Germany and residence in
East Germany as covariates in the estimation.
Materials andmethods
For the present analysis, data from an ongoing longitu-
dinal survey of individuals living in private households
were used, provided by the Leibnitz Institute for the Social
Sciences (GESIS) (Bosnjak etal. 2018; GESIS 2021).
Supplementary material, such as SPSS syntax and outputs
or Mplus code, can be obtained at the following address:
https:// osf. io/ kq78y/.
The GESIS panel is a probability-based mixed-mode
access panel fielded every second month since 2013. Data
collection was carried out by Kantar TNS, a German market
and social research institute, following the standards of the
International Code on Market, Opinion and Social Research
and Data Analytics (International Chamber of Commerce
and ESOMAR 2016). The participants provided their written
informed consent for initial participation as well as subse-
quent panel participation. Ethical standards of the GESIS
panel are explained in detail in the Rules for Safeguarding
Good Scientific Practice (Wolf and Koch 2018).
When this study was conducted, the complete data set
also included the results of the “GESIS Panel Special Survey
on the Coronavirus SARS-CoV-2 Outbreak in Germany,”
which was conducted among the online panel participants
between March and September 2020 (GESIS Panel Team
2020). This additional survey contained questions about
feelings, beliefs, and behaviors regarding COVID-19.
A path analysis with mediation test was conducted to
examine the total, direct, and indirect effects of higher-
order human values on COVID-19-related trust in institu-
tions, the perceived threat of infection, evaluation of the
effectiveness of containment measures, and the number of
self-administered measures (Fig.2).
We used Mplus 8.7 with full information maximum
likelihood estimation (Muthén etal. 2016; Muthén and
Muthén 1998–2020). To account for non-normal distri-
butions, robust confidence intervals were estimated using
10,000 bootstrapping samples. Due to a saturated model,
R2 values are reported as measures of model fit. Determin-
ing the statistical power of a mediation analysis is often
challenging. Fritz and Mackinnon (2007) therefore provide
precalculated scores that can be used to estimate statistical
power from sample size. Under the most conservative con-
ditions (complete mediation and small effect sizes (0.14)
of both α- and β-paths), an empirical power of 0.80 can
be obtained with 462 to 667 participants, which is well
below the sample size of 4382 participants. Ordinal pre-
dictor variables (e.g., net monthly household income, level
of education, origin) were transformed into binary-coded
dummy variables and included as control variables, with
the reference variables excluded.
Sample description
The whole dataset comprised 11,797 individuals. Questions
about the participants’ corona conspiracy beliefs were asked
of 4518 individuals around September 2020. Human val-
ues from the previous year (i.e., just before the pandemic
outbreak) were included in the study, which limited the
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Journal of Public Health
sample size to 4382. Individuals were aged 21 to 86, with
a mean age of 55.51 (SD = 14.41, 50.5% female). In total,
4022 individuals (91.8%) were born in Germany, 213 in
Europe (4.9%), and 57 (1.3%) outside of Europe; of these,
3259 (74.5%) reported living in West Germany, while 1114
(25.5%) reported living in the territory of the former German
Democratic Republic (GDR). Higher-order values showed
mean scores of 4.85 (SD = 0.68) for openness to change,
3.19 (SD = 0.84) for self-enhancement, 4.24 (SD = 0.91) for
conservation, and 4.74 (SD = 0.68) for self-transcendence
(see the full table with descriptive statistics in the supple-
mentary material).
Construction ofvariables
Not all questions were included in every wave of the survey;
for example, questions about human values were asked
every year in and around September; COVID-19 items were
asked only since March 2020, but every two months in each
wave; three questions on corona conspiracy beliefs have
occurred only once so far in September 2020. Following
the Hyman–Tate conceptual timing criterion (Tate 2015),
we took the measurements before the pandemic for the
higher-order human values, while the items for COVID-19
conspiracies were queried during the pandemic.
To avoid confronting the survey participants with the
57-item measurement scale, the basic human values were
measured with a 17-item, 6-point Likert scale where 1
denoted, “not like me at all,” and 6 meant, “very much like
me.” The items each consisted of one statement about a per-
son, describing what the person values (“it is important to
her/him …”). The Schwartz Values Short Scale-4 was devel-
oped by the GESIS panel, and the items were chosen to match
the four poles of the scale best. The reliability estimates were
satisfactory (ω = 0.62 to 70) for the four higher-order values
(GESIS 2021). For each of the four higher-order values, scale
scores were computed by taking the mean of the basic human
values belonging to this higher-order value (see Table1).
According to the Coding & Analysis Instructions
(Schwartz 2016), we used the uncentered values to compute
the scale scores. The reliability was estimated with McDon-
ald’s omega and ranged between ω = 0.640 for Conservation
and ω = 0.784 for Openness to change with ω = 0.707 for Self-
enhancement and ω = 0.693 for Self-transcendence. However,
although these values are not excellent, they are common
for psychometric short-scales. According to Rammstedt and
Beierlein (2014), Cronbach’s alpha coefficients tend to under-
estimate the reliability of short-scale measures.
The GESIS panel provided four multi-item scales for the
COVID-19-related outcomes (perceived threat of infection
with the coronavirus, behavioral changes measured by the
Fig. 2 Structural model of
mediation analysis. Note: The
figure presents the structural
model of the mediation analysis
of effects of higher-order values
on COVID-19-related outcomes
mediated through conspiracy
beliefs. OC = Openness to
change, SE = Self-enhancement,
CO = Conservation, ST = Self-
transcendence
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Journal of Public Health
number of measures taken, beliefs in the effectiveness of pub-
lic policy measures to mitigate the spread of the pandemic,
and trust in politics and institutions) as well as a three-item
scale for the intensity of coronavirus conspiracy beliefs.
Conspiracy beliefs about COVID-19 comprised three
items (“I think the coronavirus is a biological weapon, which
has been developed in secret governmental laboratories,”
“…the coronavirus is used in order to restrict civil rights
and to start an ongoing surveillance of citizens,” “…the dan-
ger and numbers regarding the coronavirus are purposely
exaggerated”), each measured with a Likert scale from 1
(strongly disagree) to 10 (strongly agree). All three have
in common that someone else (secret governmental scien-
tists, politicians, health institutions) is up to something that
does not correspond to the mainstream information. The
index was based on the mean of the three items (M = 2.47,
SD = 1.46, ω = 0.85).
The perceived threat of infection was measured with five
items, which asked about the estimated likelihood that the
respondents will: (a) infect themselves; (b) someone close
to them will become infected; that (c) the respondent will
need to be hospitalized; or will (d) need to comply with
quarantine measures in the next two months; and (e) that
the participant will infect others. Responses were measured
using a Likert scale, from 1 (not at all likely) to 7 (absolutely
likely). We used the mean of the item scores to form the
index (M = 3.31, SD = 1.01, ω = 0.87).
The evaluation of the effectiveness of the measures was
built on seven questions about pandemic containment meas-
ures taken by the government. These included, for exam-
ple, the closure of daycare centers, schools or restaurants,
or curfews. The items were answered on a five-point Likert
scale ranging from 1 (not effective at all) to 5 (very effec-
tive). Again, the mean value was used to form the scale score
(M = 2.97, SD = 0.79, ω = 0.87).
The scale used to measure trust in politics and institutions
included assessments of trust in nine political and health
actors and institutions, which became important during the
pandemic, such as, e.g., the city administrators, the federal
government, the World Health Organization (WHO), or sci-
entists. The scale value was again calculated from the mean
of all nine items (M = 3.74, SD = 0.77, ω = 0.92).
Precautionary behavior as the number of measures taken
to prevent an infection was measured with 10 dichotomous
(0 = not mentioned; 1 = mentioned) items, such as “places
avoided,” “quarantined because of/without symptoms,” or
“face mask worn.” The scale score was formed from the sum
of the mentioned measures (M = 5.01, SD = 1.70, ω = 0.66).
Sociodemographic variables such as sex, age, level of
education, and household income were observed variables
and are usually included as covariates to control for effects
not resulting from the predictors.
Educational level and monthly household net income
were categorized and aggregated into variables with three
values each (low, medium, high). According to the Federal
Statistical Office (Statistisches Bundesamt), the current
official figures for Germany from 2018 assume an average
net household income of €1925 and a median household
income of €1733. They describe an income of less than
50% of the median income as very low, and an income of
200% or more of the median income as high (Statistisches
Bundesamt (Destatis) etal. 2021). Consequently, household
income was classified into three groups: low income (< 900
€); middle income (900 to 3200 €); and high income (> 3200
€), according to the income classes provided by the GESIS
panel.
No school-leaving certificate at all, a lower-secondary
school grade (Hauptschule), or a degree from a polytech-
nic secondary school (GDR) were classified as a low-edu-
cational level. A secondary school certificate (Realschule)
and a 10th grade diploma from a polytechnic secondary
school (GDR) counted as a medium level of education, and
an entrance qualification for a university or a university of
applied sciences was classified as a high level of educa-
tion. From both variables, education level and net monthly
income, 0/1 dummy variables were formed. For the respond-
ents’ country of birth, the panel asked whether they were
born in Germany, another European country, or a non-Euro-
pean country. From this, as well as for gender and place of
residence in East or West Germany, binary-coded dummy
variables were formed.
Results
In the path analysis, we used a sequential design, i.e., human
values were measured first, followed by conspiracy beliefs,
and finally outcomes (see Table2 for correlations).
This was to ensure that no interactions were included.
However, since we are dealing with cross-sectional data,
Table 1 Assignment of basic values to higher-order values
Table presents the assignment of basic human values; N = 4382,
McDonald’s omega for uncentered values
Higher-order value McDonald’s ω Basic human values Items
Openness to change .784 Self-direction 3, 14
Stimulation 8, 10, 17
Self-enhancement .707 Achievement 2, 15,
Power 6, 11
Conservation .640 Security 7
Conformity 12
Tradition 4
Self-transcendence .693 Universalism 1, 5, 16
Benevolence 9, 13
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Journal of Public Health
i.e., we are not examining a change in a value, we would like
to emphasize that the term “effect” does not imply a causal
relationship in the sense of “a change in variable X causes
a change in variable y.” It rather expresses the statistical
correlational relationship of the variables (Wu and Zumbo
2008). We report standardized total effects of higher-order
human values on conspiracy beliefs and COVID-related
outcomes and standardized direct and indirect effects
mediated through conspiracy beliefs. Conspiracy beliefs
were the strongest predictors of all four COVID-19-related
outcomes, namely the assessment and implementation of
containment measures, the assessment of perceived threat,
and trust in the institutions and individuals involved while
all four higher-order values showed a significant effect on
conspiracy beliefs with self-transcendence the strongest.
Table3 presents all standardized direct effects of higher-
order values and control variables on conspiracy beliefs and
the four COVID-19-related outcomes. A partial mediation
of the influence of self-transcendence via conspiracy beliefs
on all four COVID-19-related measures could be proven.
Simultaneously, a partial mediation of openness to change
via conspiracy beliefs could be detected for perceived threat
and trust in institutions and individuals involved (Table4).
The inclusion of covariates increased the explained vari-
ance for conspiracy beliefs from R2 = 0.039 to R2 = 0.147,
for perceived threat from R2 = 0.050 to R2 = 0.064 for the
number of measures taken from R2 = 0.099 to R2 = 0.128,
for trust in institutions and persons involved from R2 = 0.319
to R2 = 0.342 and for the evaluation of the measures from
R2 = 0.088 to R2 = 0.115 (see supplementary material).
Exploratory findings
Residence in East Germany had a negative total effect on
all four COVID-19-related outcomes. People born outside
Europe showed a negative total effect on trust in people and
institutions. People born outside Germany showed consist-
ently negative indirect effects on all COVID-19-related out-
comes, as did people who resided in East Germany. The
coefficients for East Germans were approximately twice as
strong in each case (Table5). An independent samples t-test
revealed significant differences between individuals living in
East and West Germany for all COVID-19-related outcomes
as well as for conspiracy beliefs. We used the Welch test
statistic, which is robust to variance heterogeneity, for this
purpose. In addition, the analysis of variance showed signifi-
cant differences for conspiracy beliefs between individuals
born in Germany and individuals born in foreign countries
and regarding trust in politics and institutions between indi-
viduals born in Germany and people born in non-European
countries (Fig.3). Among higher-order human values, a sig-
nificant difference was found only for conservation. Thus,
people residing in East Germany rated conservative values
significantly higher.
Discussion
The positive effect of self-enhancement on conspiracy
beliefs made us accept hypothesis H_04. Conservation was
the only higher-order value that did not have a total effect
on any of the four COVID-19-related outcomes. However,
taking conspiracy belief into account as the mediator vari-
able, positive coefficients of direct effects became signifi-
cant for three of the COVID-19-related outcomes, except for
perceived threat of infection while all indirect effects were
negative, which confirms the assumption of an ambiguous
nature of conservation. Since a positive effect on conspir-
acy beliefs was found, hypothesis H_03 could be accepted.
Individuals who valued self-transcendence rated infection
risks as higher, rated interventions as more effective (indi-
rectly via conspiracy beliefs), had significantly more trust in
authorities and responsible individuals, and took more action
to combat the pandemic, which led us to subsequently accept
hypothesis H_01. The strong negative effect on conspiracy
beliefs also made us accept hypothesis H_05.
The finding that conspiracy beliefs are negatively asso-
ciated with all four COVID-19-related measures is in line
with the pre-COVID results on similar issues as published
by Oliver and Wood (2014a) and Jolley and Douglas (2014),
suggesting that conspiracy beliefs negatively affect health
decisions, confirming hypothesis H_02. The strongest effects
were seen in the lower rating of the usefulness of the meas-
ures and the significantly lower perceived trust in the institu-
tions and persons involved.
Although respondents’ country of birth did not directly
influence the COVID-19-related outcomes (unlike residence
in East or West Germany), both indirectly affected outcomes
via conspiracy beliefs (Table5). This is an indication that
country of origin could have an influence on COVID-19-re-
lated outcomes that would not have been detected if con-
spiracy beliefs had not been part of the study as a mediator
variable. Looking at the standardized total effects of origin
and place of residence in Germany, it is striking that the
differences between West and East Germans with respect
to conspiracy beliefs are stronger (and significant) than
the differences between those born in Germany and those
born abroad. The higher-order values from the anxiety-free
growth hemisphere (see Fig.1) provided the most evident
effects. In contrast, the effects of higher-order values from
the anxiety-avoidance hemisphere (conservation, self-
enhancement) were not consistent and had positive indirect
effects when negative direct effects were present and vice
versa.
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Journal of Public Health
Table 2 Correlations of variables
Table presents correlations of standardized measures based on 10,000 bias-corrected bootstrap samples. OC, Openness to change, SE, Self-enhancement, CO, Conservation, ST, Self-transcend-
ence; ***p < 0.001, **p < 0.01, *p < 0.05
threat measures eval trust OC SE CO ST Sex Age East Origin E Origin W School m School h Income m Income h
consp –.207*** –.292*** –.278*** –.554*** –.056** .086*** .094*** –.138*** –.021 –.155*** .112*** .105*** .090*** .086*** –.211*** .136*** –.162***
threat 1 .289*** .267*** .203*** –.005 .026 –.042** .046** .059*** –.055** –.082*** .004 –.007 –.031* .083*** –.053** .067***
measures 1 .340*** .350*** .071*** .010 .057*** .133*** .066*** .055** –.171*** .033 –.012 –.040** .060*** –.065*** .081***
eval 1 .358*** .033* .049** .026 .069*** –.067*** –.019 –.089*** .015 –.007 –.072*** .035* –.039* .027
trust 1 .048** –.039* .033* .194*** .068*** .144*** –.047** –.026 –.071** –.033* .068*** –.063*** .070***
OC 1 .182*** .296*** .608*** .047** –.027 .012 –.008 –.036 –.004 .118*** –.042** .053**
SE 1 .188*** .027 –.096*** –.205*** –.021 .041* .080** –.032* .078*** –.118*** .112***
CO 1 .260*** .026 .177*** .064*** .061*** .034 .100*** –.178*** .064*** –.064***
ST 1 .206*** .032* –.006 –.002 –.022 .009 .040** .029 –.028
Sex 1 .000 –.009 .026** –.010 .063*** –.012 .103*** –.099***
Age 1 .059*** –.035*** –.046*** .030** –.197*** .172*** –.171***
East 1 –.116*** –.064*** .177*** –.058*** .119*** –.131***
Origin E 1 –.052*** –.045*** –.026** .044* –.060**
Origin W 1 –.027** .019* .049* –.051**
School m 1 –.590*** .067*** –.056***
School h 1 –.258*** .286***
Income
m
1 –.940***
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Journal of Public Health
Table 3 Standardized coefficients of direct effects
Table presents standardized coefficients (β) for the direct effects of higher-order values on conspiracy beliefs, the perceived threat of infection, evaluation of the effectiveness of the measures,
trust in politics, and institutions and number of measures adopted. CI, 95% confidence interval. p values are based on 10,000 bias-corrected bootstrap samples; number of observations: n = 3715
Conspiracy beliefs Perceived threat Evaluation of measures Trust in institutions Number of measures
β p CI β p CI β p CI β p CI β p CI
Conspiracy beliefs - - - -.206 < .001 -.246; –.169 –.325 < .001 –.363; –.287 –.554 < .001 –.585; –.521 –.276 < .001 –313; –.239
Openness to change .061 .003 .023; .102 –.044 .041 –.085; –.002 –.006 .772 –.047; .034 –.088 < .001 –.121; –.054 –.025 .228 –.066; .016
Self–enhancement .046 .008 .012; .080 .047 .010 .011; .082 .047 .007 .012; .082 .025 .106 –.004; .056 .030 .079 –.004; .063
Conservation .096 < .001 .061; .131 –.009 .619 –.043; .025 .043 .014 .009; .078 .047 .002 .017; .187 .062 .001 .026; .098
Self–transcendence –.197 < .001 –.235; –.159 .058 .007 .015; .099 .034 .105 –.007; .075 .152 < .001 .117; .187 .099 < .001 .059; .140
Sex .007 .650 –.024; .040 .057 .001 .023; .089 –.082 < .001 –.113; –.049 .030 .030 .003; .058 .039 .015 .007; .070
Age –.211 < .001 –.242; –.177 –.066 < .001 –.103; –.031 –.073 < .001 –.107; –.038 .039 .011 .009; .068 .014 .439 –.021; .048
East .124 < .001 .091; .157 –.053 .002 –.085; –.018 –.037 .028 –.069; –.003 .031 .029 .003; .060 –.129 < .001 –.161; –.097
Origin in Europe .057 .001 .024; .092 .009 .616 –.027; .046 .014 .392 –.019; .047 .025 .105 –.005; .056 .017 .288 –.015; .047
Origin outside Europe .054 < .001 .024; .084 .010 .574 –.025; .044 .000 .987 –.033; .032 –.009 .519 –.037; .017 .004 .816 –.033; .041
Medium school education –.079 < .001 –.123; –.037 .006 .789 –.040; .054 –.069 .002 –.112; –.026 –.013 .517 –.053; .025 .018 .415 –.025; .062
High school education –.248 < .001 –.294; –.202 .015 .566 –.036; .065 –.076 .002 –.123; –.028 –.034 .108 –.075; .007 .007 .783 –.041; .055
Medium income –.075 .189 –.188; .036 .069 .152 –.025; .166 –.113 .025 –.213; –.013 –.049 .293 –.139; .045 .025 .631 –.078; .126
High income –.181 .002 –.293; –.069 .078 .110 –.018; .173 –.140 .006 –.239; –.039 –.030 .521 –.123; .063 .058 .273 –.046; .160
R2.147 < .001 – .064 < .001 – .115 < .001 – .342 < .001 – .128 < .001 –
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Table 4 Standardized effects of
higher-order values on COVID-
19-related measures
The table presents standardized total, direct, and indirect effects of higher-order values on the perceived
threat of COVID infection, evaluation of governmental measures, trust in politics and institutions, and the
number of measures adopted through conspiracy beliefs. OC, Openness to change, SE, Self-enhancement,
CO, Conservation, ST, Self-transcendence. 95% Confidence intervals from 10,000 Bootstrap samples are
reported in brackets; number of observations: n = 3715
Total p Direct p Indirect p
Perceived threat of COVID infection
OC –.057 [–.099, –.014] .010 –.044 [–.085, –.002] .041 –.013 [–.022, –.005] .004
SE .037 [.000, .073] .045 .047 [.011, .082] .010 –.010 [–.017, –.003] .010
CO –.029 [–.063, .006] .108 –.009 [–.043, .025] .619 –.020 [–.029, –.012] < .001
ST .098 [.055, .140] < .001 .058 [.015, .099] .007 .041 [.031, .052] < .001
Evaluation of governmental measures
OC –.026 [–.069, .016] .233 –.006 [–.047, .034] .772 –.020 [–.034, –.007] .003
SE .032 [–.005, .069] .082 .047 [.012, .082] .007 –.015 [–.026, –.004] .008
CO .012 [–.025, .048] .524 .043 [.009, .078] .014 –.031 [–.044, –.019] < .001
ST .098 [.056, .140] < .001 .034 [–.007, .075] .105 .064 [.050, .080] < .001
Trust in politics and institutions
OC –.121 [–.162, –.080] < .001 –.088 [–.121, –.054] < .001 –.034 [–.056, –.013] .003
SE –.001 [–.037, .036] .974 .025 [–.004, .056] .106 –.026 [–.045, –.007] .008
CO –.006 [–.043, .030] .732 .047 [.016, .077] .002 –.053 [–.073, –.034] < .001
ST .261 [.218, .301] < .001 .152 [.117, .187] < .001 .109 [.087, .132] < .001
Number of measures adopted
OC –.042 [–.084, .001] .055 –.025 [–.066, .016] .228 –.017 [–.029, –.006] .004
SE .017 [–.018, .051] .328 .030 [–.004, .063] .079 –.013 [–.023, –.003] .009
CO .035 [–.002, .073] .061 .062 [.026, .098] .001 –.027 [–.038, –.017] < .001
ST .153 [.111, .195] < .001 .099 [.059, .140] < .001 .054 [.042, .068] < .001
Table 5 Indirect effects
of residence and origin on
COVID-19-related outcomes
The table presents standardized total, direct, and indirect effects of respondents’ country of origin in
Europe (OE), respondents’ country of origin outside Europe (OW), and residence in East Germany (east)
on the perceived threat of COVID infection, evaluation of governmental measures, trust in politics and
institutions, and the number of measures adopted, mediated through conspiracy beliefs. 95% confidence
intervals from 10,000 Bootstrap samples are reported in brackets; number of observations: n = 3715
Total p Direct p Indirect p
Perceived threat of COVID infection
OE –.002 [–.039, .035] .899 .009 [–.027, .046] .613 –.012 [–.020, –.005] .002
OW –.001 [–.037, .034] .945 .010 [–.025, .044] .575 –.011 [–.018, –.005] .001
East –.078 [–.112, –.043] < .001 –.053 [–.085, –.018] .002 –.026 [–.035, –.018] < .001
Evaluation of governmental measures
OE –.004 [–.039, .030] .816 .014 [–.019, .047] .392 –.018 [–.031, –.008] .002
OW –.018 [–.049, .012] .242 .000 [–.033, .032] .987 –.018 [–.028, –.008] .001
East –.077 [–.112, –.043] < .001 –.037 [–.069, –.003] .028 –.040 [–.053, –.029] < .001
Trust in politics and institutions
OE –.006 [–.042, .028] .745 .025 [–.005, .055] .105 –.031 [–.051, –.013] .001
OW –.039 [–.073, –.007] .021 –.009 [–.037, .017] .519 –.030 [–.047, –.013] .001
East –.037 [–.071, –.004] .030 .032 [.003, .060] .028 –.068 [–.087, –.050] < .001
Number of measures adopted
OE .001 [–.032, .032] .937 .017 [–.015, .047] .288 –.016 [–.026, –.007] .002
OW –.010 [–.051, .028] .607 .004 [–.033, .041] .816 –.015 [–.024, –.007] .001
East –.164 [–.196, –.131] < .001 –.129 [–.161, –.097] < .001 –.034 [–.045, –.025] < .001
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One of the COVID-19-related dependent variables was
trust in institutions and individuals involved. One assump-
tion of the present study was that the expression of values
and conspiracy beliefs influence how this kind of trust was
perceived. After all, trust was related to those institutions
and individuals involved in making decisions about actions
and communicating them during the pandemic. The per-
ception of trust in institutions and individuals involved thus
temporally lagged behind the beginning of the pandemic.
Even though there is evidence in the literature that con-
spiracy belief is an antecedent of trust in institutions and
individuals involved (Pavela Banai etal. 2022; Karić and
Međedović 2021; Pummerer etal. 2022), there are also stud-
ies that assume the opposite direction of action (Bruder and
Kunert 2022; Eberl etal. 2021). Consequently, even though
the relationship between these two constructs are closely
intertwined, it may not be possible to clarify which is the
antecedent and the consequent clearly. More research is
needed to elucidate this question in an experimental design.
Basically, for the sake of completeness, it should be men-
tioned that in any correlational mediation analysis, no mat-
ter how sound the theoretical derivation, other alternative
models as well as additional variables not yet investigated
are possible (see Wu and Zumbo (2008) and Fiedler etal.
(2018) for a comprehensive view).
Bonetto etal. (2021) and Bojanowska etal. (2021) exam-
ined the change in values due to the impact of the pandemic.
In both studies, the changes were very small, while the sign
of the correlation coefficient, however, remained constant.
However, to avoid a possible interaction effect, the values
variables were measured before the pandemic, and the vari-
ables of conspiracy beliefs and the COVID-related outcomes
were measured later. This sequential procedure is also con-
sistent with the necessary Hyman–Tate criterion for media-
tion analyses, according to which the putative predictor
variables must be temporally antecedent to the putative
outcomes. In addition, while basic human values form dur-
ing adolescence, the specific attitudes toward COVID-19
conspiracy beliefs could only form in young adulthood at
the earliest, since all individuals in the sample are already
at least 21.
There is widespread agreement in the prevailing lit-
erature that perceived threat and loss of control are pos-
sible causes for adopting conspiracy beliefs (Douglas etal.
2019; van Prooijen and Acker 2015). The present paper also
builds on this argument. However, this assumption might
be challenged by two studies from recent years. Concern-
ing “lack of control” the authors could not find a signifi-
cant effect on general conspiracy theories, but they write
that “the predicted effect of control was more likely to be
observed when beliefs were measured in terms of spe-
cific conspiracy theories, rather than as general or abstract
claims” (Stojanov and Halberstadt 2020). The present article
investigates specific conspiracy beliefs in the correspond-
ing context (COVID-19). The authors also write, “In fact,
it appears that the correlational evidence for a negative link
between feelings of control and conspiracy beliefs is more
robust than the experimental evidence” (Stojanov and Hal-
berstadt 2020). The present study is purely correlational.
Therefore, the findings of Stojanov and Halberstadt (2020)
are more applicable to experimental designs with general
conspiracy beliefs. Regarding “anxiety, uncertainty aversion,
and threat” the authors indeed found “that people who were,
on average, more anxious, uncertainty averse, and existen-
tially threatened held stronger conspiracy beliefs” (Liekefett
etal. 2023). Only in the opposite direction could no effect
be proven—but this was irrelevant for the present study.
Therefore, both articles ultimately support our derivation
of conspiracy beliefs.
Fig. 3 Mean values of COVID-19-related outcomes by residence and origin
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Journal of Public Health
It is worth noting that we did not distinguish between
different types of conspiracy theories when designing this
study. As per, for example, Nera etal. (2021) despite the
diversity of conspiracy theories, they are sometimes seen
as a single, homogenous phenomena. There is a proposal
to distinguish between believing in upward conspiracy
theories and downward conspiracy ideas using traditional
conspiracy theorizations. The former are hypothesized to be
beliefs that challenge authority, while the latter are hypoth-
esised to be supported by conservative ideology. Based on
that distinction, we believe the findings of this paper to be
applicable to upward conspiracy theories mostly, while the
downward conspiracy theories still require more research in
this respect. This may also be due to the nature of the spe-
cific conspiracy beliefs in question. The three components
that constitute the conspiracy beliefs of the present study
(“I think the coronavirus is a biological weapon, which has
been developed in secret governmental laboratories,” “…
the coronavirus is used in order to restrict civil rights and to
start an ongoing surveillance of citizens,” “…the danger and
numbers regarding the coronavirus are purposely exagger-
ated”) all target authorities and supposed elites.
Obviously, any discussion on various phenomena con-
nected with conspiracy theories ultimately faces the very
challenge of treading carefully on the side of the facts and
not opinions (Brotherton and Son 2021). This leads to the
issue of a metacognitive labeling of various claims. While
this has not been within the scope of the paper, we under-
stand that what exactly is truth at any given time, what is
just another opinion, and what is ultimately made-up stories,
is always known only after the fact. However, we have to
make assumptions regarding what is a conspiracy theory.
Otherwise, one could claim to any evidence, no matter how
good, that it is false, one only has to wait long enough until
the opposite is proven. This is possibly a potential area for
future research.
A limitation of this study is the restricted availability
of data for the relevant period. The standard edition of the
GESIS panel only records whether the participant resides in
East or West Germany (GESIS 2021). A more precise deter-
mination of the place of residence (at least by state) could be
possible in the extended version. To examine this, however,
one had to be on-site at the data center. So, here, the fear of
data privacy violations may distort results, since only east/
west differences can be examined, but the true differences
are possibly to be found in the north/south divide. Further-
more, there is the issue of the low reliability of the short
scale for recording human values. The GESIS panel records
human values with 17 items, while the current version of
the PVQ-57 uses 57 items (Schwartz etal. 2012b). Not only
are more questions asked here, but the GESIS questions are
also slightly modified. However, the scale was developed to
measure the values in the best possible way (GESIS 2021).
Conclusion
Because of their persistence and association with resist-
ance to advisable behavior, not just during the COVID
pandemic, conspiracy beliefs and their associations have
harmed challenges of controlling the coronavirus pan-
demic and pose a risk for similar situations in the future.
To increase acceptance of scientifically accepted efforts
in better governance, it will be necessary for scientists
and policymakers to challenge these conspiracy narra-
tives. The results of this study can improve the ability
to develop and enforce policies. This article has shown
that belief in conspiracy narratives reveals associations
of higher-order values with all four COVID-19-related
measures that would not have been apparent without this
mediator. In doing so, it contributes to the understanding
of how pandemic mitigation measures are implemented
differently. We were able to demonstrate a partial media-
tion of the influence of self-transcendence via conspir-
acy beliefs on all four COVID-19-related measures, the
assessment and implementation of containment meas-
ures, the assessment of perceived threat, and trust in the
institutions and individuals involved. A partial media-
tion of openness to change via conspiracy beliefs could
be detected for perceived threat and trust in institutions
and individuals involved. Our results suggest that human
values, conspiracy beliefs, and the consequences of the
pandemic should be further examined in a long-term
context as well as in experimental studies to reveal and
confirm possible cause–effect relationships. Moreover,
values could contribute to the formation of conspiracy
beliefs and indirectly affect COVID-19-related attitudes
and behaviors through them. This finding enriches the
research on conspiracy beliefs as well as epidemiology.
However, more research is needed to examine the relation-
ship of conspiracy beliefs, values, and human behavior.
This includes comparative studies with other countries
and also the contribution of other psychometric variables.
Author contributions Stefan Poier: conception and design, data collec-
tion, data analysis and interpretation, manuscript drafting and revising,
approval of final version for submission.
Michał Suchanek: conception and design, manuscript drafting and
revising, approval of final version for submission.
Funding Open Access funding enabled and organized by Projekt
DEAL. This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Data availability Due to data protection restrictions, access to the data
can only be provided to registered users of the GESIS panel, available at
Leibniz-Institut für Sozialwissenschaften, Mannheim. Scientific use is free
of charge and can be requested at: https:// www. gesis. org/ gesis- panel/ data
The analysis scripts used for this article can be accessed at: https://
osf. io/ kq78y/.
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Journal of Public Health
Declarations
Ethics approval This article uses panel data and does not contain any
studies with human participants or animals performed directly by any
of the authors. Data collection was carried out by Kantar TNS, a Ger-
man market and social research institute, following the standards of the
International Code on Market, Opinion and Social Research and Data
Analytics (International Chamber of Commerce & ESOMAR, 2016).
Patient consent statement All participants provided their written
informed consent for panel participation. Ethical standards of the
GESIS panel are explained in detail in the Rules for Safeguarding Good
Scientific Practice (Wolf & Koch 2018): https:// www. gesis. org/ filea
dmin/ upload/ insti tut/ leitb ild/ Gute_ Praxis_ GESIS_ engl. pdf
Conflicts of interests The authors have no competing interests to de-
clare.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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