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Yao et al. BMC Psychology (2024) 12:634
https://doi.org/10.1186/s40359-024-02156-z
Introduction
On March 12, 2020, the World Health Organization o-
cially declared the coronavirus (COVID-19) outbreak a
global pandemic. As one of the countries most aected
in the initial stages of the outbreak, China was at the
forefront of experiencing this unprecedented challenge.
e pandemic severely disrupted social operations in
China, leading to extensive losses in human resources,
materials, economy, and environment, beyond the capac-
ity of both China and global resources to respond eec-
tively [1]. e relentless spread of COVID-19 worldwide
directly resulted in many deaths and widespread disease
transmission. Public fear of contagion, along with the
risk of death faced by individuals and their loved ones,
highlighted the uncertainty and uncontrollability of
BMC Psychology
*Correspondence:
Yingji Li
liyingji199@163.com
1College of Preschool Education, Shandong Yingcai University,
Jinan 250104, China
2Graduate School, Stamford International University, Bangkok
10250, Thailand
3School of Economics and Management, Zhengzhou Technology and
Business University, Zhengzhou 451400, China
4School of Economics and Management, Shanghai Technical Institute of
Economics and Information, Shanghai 201411, China
5School of Humanities and Management, Yunnan University of Chinese
Medicine, Kunming 650500, China
Abstract
As the COVID-19 epidemic ends in China, it is worth exploring the growth after experiencing the trauma of the
epidemic. China has been managing the epidemic for a relatively long time compared to other countries. Many
scholars have researched trauma and post-traumatic growth in groups such as doctors and patients. However, little
attention has been paid to the post-traumatic growth of ordinary people who experienced the epidemic in the
Chinese context and the related inuencing factors. Based on the educational system as the research context, this
study proposes the eects of proactive personality and social support on PTG in the post-epidemic era through
the mediation of meaningfulness of life. To empirically examine the inuences of PTG in the post-epidemic era,
an online survey of 1210 university students was conducted for data analysis. The analysis results suggest that
proactive personality and social support positively inuence meaning in life. Proactive personality, social support
and meaning in life positively inuence post-traumatic growth. Proactive personality and social support social
support and proactive personality indirectly inuence post-traumatic growth through the mediation of the
meaning in life. This research empirically investigated the role of personality, social support, meaning in life, and
post-traumatic growth among university students.
Keywords Proactive personality, Meaning in life, Social support, Post-traumatic growth
Proactive personality, social support and post-
traumatic growth caused by COVID-19:
mediating eect meaning in life in China
YunaYao1,2, PingWang2,3, KunZhao1,2, QiangLi4 and YingjiLi5*
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Page 2 of 16
Yao et al. BMC Psychology (2024) 12:634
life, as well as the universal threat of mortality and ill-
ness, posing a profound challenge to survival [2] .Con-
sequently, the COVID-19 pandemic has been dened as
a traumatic event [3], exhibiting the typical characteris-
tics of collective traumatic experiences, such as wars and
natural disasters: unpredictability, extremity, persistence,
the unknown nature of danger, and a direct threat to
life [4]. In response to the immense public health crisis,
China implemented strict control measures; neverthe-
less, the pandemic still imposed signicant physical and
psychological pressures on the population [5, 6]. e
uncertainty surrounding the location, scope, and dura-
tion of the COVID-19 outbreak further heightened risks
of imbalance and loss of control [7]. Additionally, stud-
ies indicate that, both in China and globally, individuals
have been more susceptible to negative emotions such as
fear, stress, anxiety, and depression during the pandemic,
partly due to isolation measures and reduced social
interactions [8]. Evidently, the global mental health cri-
sis triggered by the COVID-19 pandemic has persisted
throughout the pandemic period and is expected to con-
tinue impacting mental well-being in the post-pandemic
era [9].
e impact of the COVID-19 pandemic in China has
been particularly profound, especially for university
students. As one of the countries initially most aected
by the pandemic, China implemented stringent con-
trol measures, including an isolation policy lasting up
to three years. is unprecedented situation has signi-
cantly disrupted the academic and daily lives of univer-
sity students. e abrupt shift to remote learning, social
isolation, and uncertainties about the future have all
posed potential traumatic experiences. However, humans
inherently possess a tendency for psychological growth
[10], which provides a foundation for studying post-trau-
matic growth (PTG). In this context, exploring how Chi-
nese university students navigate the challenges posed
by the pandemic and potentially achieve PTG becomes
especially important.
Post-traumatic growth (PTG) is a complex psycho-
logical phenomenon and is not an inevitable outcome of
traumatic experiences. PTG arises from deep cognitive
and emotional struggles with traumatic events, a pro-
cess that imbues these experiences with meaning and
can elevate individuals to a higher level of psychological
development than before [11]. e extent of PTG is inu-
enced by multiple factors, with individual characteristics
and environmental features playing critical roles [12].
Individual traits are particularly impactful on PTG; those
unable to cope eectively with trauma may experience
persistent negative emotions, psychological distress, and
adverse physiological responses [13]. In contrast, indi-
viduals exhibiting traits such as positive emotions and
openness are more likely to achieve PTG [14]. Optimists,
in particular, tend to focus their attention and resources
eectively, allowing them to disengage from issues that
are beyond their control or resolution [15]. In an uncer-
tain and challenging context like COVID-19, individual
proactivity becomes a crucial factor [16]. is proactive
orientation not only reects one’s approach to daily chal-
lenges but also demonstrates a tendency to positively
inuence one’s environment. is observation directs
attention to an important personality trait—Proactive
Personality (PPS). e concept of proactive personality
emerges from understanding why some individuals are
more inclined than others to actively shape their envi-
ronments [17]. Individuals with a high level of proactive
personality are more likely to identify opportunities, take
action, persevere, and seek change [18]. ese traits are
particularly valuable in uncertain contexts, where they
may play a key role in trauma coping and growth facilita-
tion [19].
Building on this understanding, the present study
draws on proactive personality theory and related behav-
ioral theories to explore how proactive traits may assist
individuals in coping with the uncertainties brought
about by the pandemic, and how these traits might facili-
tate the occurrence of PTG [20–22].
Post-traumatic growth (PTG) is inuenced not only by
individual characteristics but also by environmental fac-
tors, among which social support (SS) is a key predictor.
In times of crisis, an individual’s perceptions, responses,
and the support they receive from others can all contrib-
ute to PTG. e perspectives oered by family, friends,
and signicant others, when validated and integrated
by the individual, help to build a more comprehensive
understanding [19, 20]. us, social support from others
is crucial for the development of PTG [23].
Taking Chinese university students as an example,
during the COVID-19 pandemic, students who experi-
enced support from family and peers were not only able
to mitigate the trauma caused by the pandemic but also
demonstrated improved academic performance in the
home-learning environment [24]. However, the pan-
demic also brought feelings of isolation and restriction
for many, even aecting access to medical services [25].
In this unique context, further exploration of the role of
social support in PTG becomes particularly important.
e global impact of the pandemic has highlighted
the reality that certain aspects of life are entirely beyond
individual control. Consequently, many have shifted
their focus to areas they can manage, such as adapting
to remote learning and working from home [26]. is
adaptive behavior is closely tied to the construction of
life meaning. Life meaning is dened as individuals’
interpretation of life, encompassing a sense of purpose
and goals to pursue [27]. is sense of meaning is vital
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Page 3 of 16
Yao et al. BMC Psychology (2024) 12:634
for maintaining positive psychological functioning, espe-
cially when facing obstacles and trauma [28].
For Chinese university students, the search for and
pursuit of life meaning may involve deeper self-reection
and a deliberate eort to narrow the gap between cur-
rent achievements and future goals. It is within this pro-
cess that PTG can occur. Specically, PTG manifests as
a deeper and more comprehensive understanding of life,
reordering of personal values, the formation of closer and
more meaningful relationships with others, heightened
self-awareness and a sense of personal strength, the dis-
covery and embrace of new opportunities, and growth
both intellectually and spiritually [14].
Previous studies on the PTG of COVID-19 have pri-
marily focused on patients and healthcare workers as
they are directly experienced trauma (respiratory dis-
tress, respiratory failure, tracheotomy) or witnessed and
rescued trauma (e.g., medical care) [29]. In contrast,
there is a lack of argumentation for the general popula-
tion who suer indirect trauma. ey also experience real
or unrealistic fear of human infection, social isolation,
economic hardship, or community-wide risk [29, 30].
e impact of the pandemic on the eld of education
has been profound. e United Nations’ policy brief in
August 2020 noted that over 1.6billion students in 190
countries were aected worldwide [31]. For Chinese uni-
versity students, the three-year pandemic isolation policy
required them to adapt to remote learning [32]. is sud-
den shift not only disrupted their daily lives but may also
have impacted their condence and adaptability in learn-
ing, leading to increased levels of stress and anxiety [33,
34].
Although post-traumatic growth (PTG) is regarded as
a positive strategy for coping with the adverse eects of
COVID-19, its potential benets among Chinese univer-
sity students remain underexplored. Considering this,
the present study focuses on three key variables: proac-
tive personality (PPS), social support (SS), and meaning
in life (ML). e aim is to investigate the direct and indi-
rect eects of the pandemic experience on PTG among
Chinese university students from the dual perspectives of
individual traits and environmental factors.
e unique context faced by Chinese university stu-
dents provides a rich basis for exploration. For instance,
prolonged campus isolation policies may have intensied
students’ feelings of loneliness and stress, yet they may
also have spurred students to seek new ways of social
interaction and avenues for self-growth. e challenges
of remote learning have not only tested students’ adapt-
ability but may have also encouraged the development of
greater self-directed learning skills and digital literacy.
Furthermore, within a collectivist cultural context, how
Chinese university students maintain and reconstruct
their social support networks despite physical isolation is
an important question worthy of examination.
is study will explore the following core questions:
(1) How does proactive personality (PPS) inuence post-
traumatic growth (PTG) among Chinese university
students during the pandemic?
(2) How does social support (SS) aect the post-
traumatic growth process of Chinese university
students in the unique context of the pandemic?
(3) In the Chinese cultural context, how does meaning
in life (ML) moderate the relationship between
proactive personality, social support, and post-
traumatic growth?
Investigating these questions can deepen the understand-
ing of PTG theory within the Chinese cultural context
and provide an empirical foundation for developing tar-
geted mental health interventions. is is crucial for
supporting Chinese university students in coping with
the pandemic’s long-term eects and fostering resilience
for similar challenges they may encounter in the future.
Additionally, the ndings of this study oer important
insights for policymakers and administrators in Chi-
nese higher education. Understanding the factors that
promote student growth amid adversity can assist uni-
versities in designing more eective support systems,
optimizing remote education strategies, and fostering
students’ proactivity and adaptability.
In summary, this study focuses on the unique group of
Chinese university students, examining proactive per-
sonality as a personal trait variable, social support as
an environmental factor, and the role of life meaning in
this process. By systematically analyzing how these fac-
tors interact and collectively inuence the PTG process
among university students, this research aims to uncover
the underlying mechanisms of psychological adaptation
and personal growth among Chinese students during the
pandemic. is study not only provides a new perspec-
tive on psychological resilience in the context of COVID-
19 but also oers empirical evidence for developing
targeted mental health interventions and personal devel-
opment plans, thereby supporting the psychological well-
being and holistic development of university students in
the post-pandemic era.
Below is the remaining text of this study. e next sec-
tion provides a literature review related to the variables,
followed by a detailed account of the study’s design and
methodology, including information on the partici-
pants, instruments used, and data analysis techniques
employed. Additionally, a descriptive analysis of the vari-
ables is included. e subsequent section presents the
key empirical results and path analysis of structural equa-
tion modeling for post-traumatic growth (PTG) after an
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Page 4 of 16
Yao et al. BMC Psychology (2024) 12:634
epidemic among Chinese university students. Finally, the
study concludes with a comprehensive discussion and
conclusion, which highlights the main ndings, limita-
tions, and potential avenues for future research.
Literature review
Proactive personality (PPS)
Proactive personality has been dened as a relatively sta-
ble, contextually unconstrained personality disposition
over time [35, 36]. Meta-analyses have shown that over
50% of the variance in PPS is independent of the Big Five
personality traits [37, 38], indicating its distinctiveness
[22]. PPS is a persistent and relatively stable trait that
characterizes individuals [39]. ose with PPS exhibit a
proclivity towards behaving in a proactive manner which
enables them to adjust to environmental changes. ey
are adept at inuencing and changing their environment,
proactively identifying and creating opportunities, tak-
ing personal responsibility when faced with diculties,
and dealing with dierent solutions to eliminate prob-
lems [40]. In China, the new crown epidemic has brought
tremendous trauma to human beings and uncertainty in
both time and space to the study and life of university stu-
dents. Proactivity is especially important in uncertainty
[41, 42]. Proactive individuals often exhibit motivation to
evaluate potential future environmental conditions and
adopt eective coping strategies to reduce uncertainties,
especially during challenging situations [43, 44]. Research
has shown a signicant positive correlation between PPS
and creative performance [39, 45, 46]. In other words,
individuals with PPS are more likely to adapt to changes
in their environment and generate positive outcomes.
Social support (SS)
Social support refers to social interactions in which
resources are obtained from others [47, 48]. Social inter-
actions can facilitate individuals in developing relation-
ships that are regarded as aectionate, nurturing, and
accessible [48–50]. SS assists individuals in improving
their capacity to manage real-life problems and safe-
guards them from unfavorable results through the rec-
ognition of overall assistance from people in their social
network [51].
A person’s social networks consist of his or her fam-
ily, friends, neighbors, coworkers, and other signicant
persons. Social support plays a crucial role in promot-
ing physical and mental well-being. In fact, research has
shown that having a strong social support network can
improve health outcomes, increase resilience to stress,
and enhance overall quality of life. Emotional support,
for instance, can help individuals cope with dicult life
events, such as the loss of a loved one or a major ill-
ness. When faced with nancial diculties, instrumen-
tal support can provide the necessary resources to help
individuals overcome their challenges. Informational
support, on the other hand, can assist individuals in
making important decisions, such as seeking medical
treatment or nancial planning. Lastly, evaluative sup-
port can help individuals gain a better understanding of
their strengths and weaknesses, which can lead to per-
sonal growth and development. Overall, social support
is an essential component of human relationships that
can greatly impact an individual’s physical and emotional
health [52].
According to Haber [53], social support (SS) can be
categorized into two distinct types. e rst type is
objective support, which is further divided into material
support and network support. While material support
involves tangible resources that help individuals meet
their goals and basic needs, network support encom-
passes both stable and unstable social relationships that
provide emotional support and guidance. e second
type is subjective support, also known as emotional sup-
port. is involves the perception of being respected and
cherished within one’s social circle, which is deeply inter-
twined with one’s own subjective well-being [53].
Regardless of the classication, SS can be seen as dif-
ferent types based on the individual’s social relationships
that help the individual recover from hardship and adver-
sity. In cases of social isolation at school, classmates,
friends, and peers may act as the most dependable mem-
bers of a university student’s social network and a pri-
mary source of social support.
In addition, research has demonstrated that family sup-
port can assist kids in overcoming adversity, reducing
psychological stress, and preventing mental health issues,
so promoting good psychological development [54].
Of course, SS is also benecial to students’ physical and
mental health from other sources, such as their teach-
ers [55–57]. In conclusion, SS can alleviate emotional
trauma, promote psychological resilience, and prevent
common psychological distress and psychiatric symp-
toms in university students exposed to epidemic stress.
e more the perception of SS, the fewer students are
inuenced by pandemic, which inspires us to believe that
our lives can thrive [58].
Meaning in life (ML)
Meaning in life is the meaning one assigns to the value of
one’s life [17, 52], and a structure that promotes adapta-
tion. It is a force that makes our experiences understand-
able, guides us toward a desired future, and inspires in us
the belief that our lives are important and valuable [53,
54]. e earliest psychologist to systematically study the
ML was Frankl (1963), who argued that the pursuit of
ML is the original driving force for human existence and
a human instinct [19]. On the other hand, Steger’s study
of ML is more widely applied. He divided the ML into
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Page 5 of 16
Yao et al. BMC Psychology (2024) 12:634
two parts: presence meaning and searching for mean-
ing. Presence meaning describes the extent to which an
individual believes he or she is alive, while search for
meaning indicates that the individual is actively seek-
ing ML [17]. Previous literatures argued that individuals
who chronically lack a sense of purpose and ML acquire
psychological disorders, whereas healthy individuals can
explore the ML, gain additional growth experiences in
the process of pursuing meaning, and increase their psy-
chological health. From the aspect of positive psychol-
ogy, the trauma of the pandemic aids university students
in discovering and comprehending the meaning of their
own lives and in realizing their positive life goals and
missions.
Post-traumatic growth (PTG)
PTG (Post-Traumatic Growth) refers to the positive
psychological growth that an individual experiences as
a result of overcoming adversity [59, 60]. It highlights a
person’s potential for transformation in dicult and trau-
matic circumstances [12, 61]. However, scholars studying
PTG believe it is not the traumatic event itself, but rather
the subsequent struggle, reection, and integration that
lead to PTG [59]. Experiencing hardships may poten-
tially elevate one’s comprehension of the signicance of
interpersonal relationships. rough such experiences,
individuals may also enhance their inner strength, reor-
ganize personal priorities, cultivate a greater appreciation
for the details of daily life, and aspire to achieve a more
fullling spiritual existence [61]. Furthermore, research
indicates that the existence of personality dynamics and
trauma characteristics can have a positive impact on
post-traumatic growth and spiritual development. Addi-
tionally, social support and emotional expression are
regarded as eective means of alleviating mental illness
and coping with stress responses [62]. However, uncer-
tainty remains regarding PTG following a disaster or
other very challenging life circumstances. As this concept
is extremely complicated and can dier by environment,
demographics, and personality traits [63].
Relationships between relevant variables
Proactive personality and meaning in life
e Big Five personality traits, the Big Two personality
traits, and PPS have been added to ML-focused research
in recent years. Personality has been demonstrated to
be a predictor of ML [64]. Işık & Üzbe performed a
study on adults aged 18 to 65 and found that the pres-
ence of ML was associated with all personality qualities,
with openness and neuroticism explaining the ML [65].
Empirical evidence indicates a statistically signicant
positive relationship between positive personality traits,
namely extraversion and agreeableness, and the pres-
ence of meaning [66, 67]. Additionally, forgiveness has
been shown to promote ML [68]. More specically, the
sub-dimensions of good personality, including dutiful-
ness and compassion, are signicantly correlated with
the presence of meaning [69, 70]. Considering this, it is
imperative to establish a positive correlation between
positive personality traits and the presence of meaning.
PPS is the disposition to identify possibilities for change
and act on them until the desired change is achieved. PPS
is strongly associated with the inclination to seek mean-
ing in life [35, 65].
During the epidemic, optimism helped older adults
recuperate from the impacts of COVID-19 by support-
ing positive coping strategies and acceptance of adversi-
ties [71]. Similarly, in reaction to the unforeseen situation
caused by the pandemic, many changes in student learn-
ing and lifestyle have occurred. It believed that per-
sons with a high PPS should adjust positively to change
through positive adaptation to accomplish the expected
learning tasks.
erefore, hypothesis H1: University students’ PPS
positively inuences life ML.
Proactive personality and post-traumatic growth
Personality plays a vital role in the development of post-
traumatic growth (PTG), as it is a stable internal char-
acteristic that oers unique psychological resources
with cross-situational stability and wholeness [62, 72].
Research has shown that positive coping mechanisms,
which are promoted by an individual’s personality, can
contribute to higher levels of PTG following traumatic
events such as the Wenchuan earthquake or the COVID-
19 epidemic [73]. Based on the above researches, highly
optimistic people are better able to readjust their life
goals in response to adversity, which can lead to greater
PTG outcomes [74, 75]. Furthermore, an optimistic per-
sonality has been identied as a signicant predictor of
PTG in Greek blockade zones [76]. Attempts have also
been exerted to establish the mechanisms of PTG devel-
opment in individuals with certain personalities or the
factors that inuence such development [77]. It is sug-
gested that PPS, as a stable personality disposition [17],
is associated with many positive outcomes such as career
satisfaction and success, job satisfaction, organizational
commitment, and job performance. Positive psycho-
logical changes experienced after growing up post-trau-
matically and struggling through very challenging life
situations [78]. e positive psychological changes expe-
rienced after trauma and struggling with very challeng-
ing life circumstances [59, 79], is also a positive outcome.
During pandemic, proactive university students face
the crisis, overcome anxiety and panic, and proactively
embrace changes in their learning styles and lifestyles.
Meanwhile, they adjust their physical and emotional state
and psychological expectations.
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Page 6 of 16
Yao et al. BMC Psychology (2024) 12:634
erefore, hypothesis H2: University students’ PPS
positively inuences PTG.
Social support and meaning in life
As an inherent component of human nature, particularly
following trauma exposure [80]. ML may result from the
encouragement and support of others [81]. When indi-
viduals receive care from others, such as family, friends,
and classmates, they are more capable of dealing with sig-
nicant life transitions [52]. SS helps individuals exposed
to a pandemic reassess it positively and facilitates the
psychological resources needed to rediscover the self. It
has been shown that during a pandemic, students often
seek support through family and social networks. Typi-
cally, emotional support from family and friends leads to
more ML when confronted with a crisis [82]. e empiri-
cal results have demonstrated a notable positive correla-
tion between SS and ML, wherein heightened SS levels
correspond to enhanced ML discernibility [83]. Social
contacts provide students the opportunity to share emo-
tional suering and experiences. Despite adversity, it may
assist in triggering a sense of purpose, hope, and accom-
plishment [82–84]. us, higher levels of SS have been
associated with a search for ML [85]. Students’ sense
of meaning is often validated by feedback and guidance
from trustworthy people such as teachers, parents, and
friends. During pandemic, university students experience
psychological uctuations, dissatisfaction with the situa-
tion, and fear of life. erefore, they need to share their
experiences of searching for ML with signicant others,
such as teachers, classmates, parents, and friends, to gain
understanding, emphatic guidance, and feedback. In this
way, students complete their perception of the presence
of meaning and the direction of their search for meaning.
erefore, it is inferred that H3: University students’ SS
positively inuences ML.
Social support and post-traumatic growth
Research has shown that social support (SS) can have a
negative correlation with psychological disorders in trau-
matic environments [86]. at is, high levels of SS can
eectively prevent the onset of symptoms of physical and
mental illnesses such as anxiety, depression, and insom-
nia to some extent. Because individuals with high SS are
more likely obtain emotional and nancial assistance
from others which can lead to a surge of positive emo-
tions and overall mental well-being. Moreover, empirical
data reveals that SS, functioning as a supportive social
environment and an environmental asset, may capacities
individuals to eectively cope with challenges and engage
in cognitive adaptive processes in response to traumatic
experiences [87]. Consequently, SS has a protective eect
on positive trauma adaption.
Studies of veterans and survivors of natural disasters
have shown that low levels of SS following traumatic
events are associated with PTSD symptoms [88]. Mul-
tiple studies have also identied healthcare workers dur-
ing a pandemic where support and communication from
family, friends, and colleagues helped them manage the
adverse mental health consequences of the pandemic
[89]. For example, the SS of nurses reported higher PTG
during Chinese nurse assistance in Wuhan [90]. us, SS
was positively associated with PTG [87, 91]. e subjects
of this study are university students, who are more mal-
leable and better qualied to change their outlook on
life. When the epidemic leads to changes in ordinary life
and study situations, especially when they receive su-
cient support, they will also confront the dilemma and
undergo positive changes.
erefore, hypothesis H4 is proposed: SS of university
students positively aects PTG.
Meaning in life and post-traumatic growth
A worthwhile pursuit would be to comprehend the asso-
ciation between ML and PTG, as documented evidence
reveals their connection to benecial health outcomes.
ML may be a vital resource, a buer against harmful
mental health consequences, and a role in healing after
experiencing a traumatic incident in life. e presence of
meaning is a characteristic variable including the percep-
tion that one’s life has signicance, and it is frequently
the focus of ML research [92]. e presence of mean-
ing is related to psychological well-being and PTG [93].
Presence is the opposite of existential, and the search
for meaning indicates motivation to discover mean-
ing, which the two-factor model shows is supported by
factor analysis [27]. e meaning search usually entails
some psychological distress [94]. However, it also helps
individuals to some extent to reect from their traumatic
experiences. Some studies have indicated that meaning
seeking is positively associated with PTG [95]. Incredibly,
ML may even contribute to coping and growth resulting
from the struggles with traumatic experiences [94, 96].
Traumatic experiences change one’s way of thinking, per-
ception of the world, and understanding of trauma. Valu-
able aspects are found in adversity and then are plausibly
integrated to form a coherent life story. Furthermore,
researchers found that ML and PTG have a positive rela-
tionship, and that meaning making is positively corre-
lated with PTG [97].
An abundance of scholarly literature exists exploring
the correlation between ML and PTG in various patient
populations, for instance, individuals diagnosed with
chronic obstructive pulmonary disease [98], stroke sur-
vivors [99], and individuals with other chronic illnesses
[85]. e results demonstrate that ML is positively related
to PTG. e relationship between individual life meaning
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Page 7 of 16
Yao et al. BMC Psychology (2024) 12:634
and PTG in natural disasters, such as oods or droughts,
has also been studied [61, 93]. Coronavirus pandemics,
like diseases and natural disasters, can also be traumatic
[100].
After COVID-19, coronavirus patients believed that
the disease experience altered their outlook on life in a
positive direction. It led to development and growth
for the majority of participants. Numerous participants
indicated that they reassessed their perceptions of the
meaning and priorities of their lives. ey realized that
life is fragile and precious and reassessed values and
goals [100]. Dierent people’s experiences bring dierent
insights. University students deal with the reality of infec-
tion, social isolation, and the resulting unrealistic fears
during a new crown pandemic. However, trauma may
reshape individuals’ assumptions regarding their self-
image and their outlook on the world. Individuals tend
to seek for meaning post-trauma such that through the
emergence of new meanings, they could reconstruct their
perceptions of themselves and the world, ultimately lead-
ing to an exposition of meaningfulness [101]. is theory
of meaning-construction is congruent with the psycho-
logical theory of growth [102]. erefore, we infer that:
H5: e ML in university student groups positively
inuences PTG.
Based on the above studies, we construct the basic
model for this study in Fig.1.
Research Design and Framework
is study employed a questionnaire survey method. e
following provides a detailed description of the sample
selection, sample size determination, data collection,
research instruments, and data analysis [103].
Sample size and data collection
e participants of this study were university undergrad-
uates. e questionnaire was distributed online through
the Questionnaire Star platform. e average time to
complete the survey was about 10 min. is study was
determined using the convenience sampling method.
is method allowed for voluntary participation and easy
access to data for the study participants.
ese data were collected between 3rd January 2023–
24th January 2023. e respondents were 1255 under-
graduate students from 4 universities in Shandong,
Henan, and Yunnan, China. After excluding invalid
responses, duplicate IP addresses, and surveys with
excessively short response times, a total of 1,210 valid
questionnaires were obtained. Ideally, the sample size
should be 10 times greater than the number of items in
the PLS sample [104]. e present research project was
47 items with a sample size of 1210, which fully complies
with the requirement.
To ensure the statistical power of latent and observed
variables, we utilized the online statistical tool provided
by Soper (2024). Based on a model statistical power of
0.8, we considered factors such as the number of latent
Fig. 1 Basic research framework. Note 1: FAM = family support; FRI = friend support; SO = signicant others; LMP = Presence of Meaning; LMS = Search for
Meaning; NP = New possibilities; PS = Personal strength; RO = relationship with others; SC = spiritual change; AL = Appreciation of life
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 16
Yao et al. BMC Psychology (2024) 12:634
variables, number of observed variables, anticipated
eect size (d = 0.3), and signicance level (P < 0.001). e
recommended sample size for this study was set at 241.
us, the sample size in this study meets the statistical
requirements for structural equation modeling, ensuring
the robustness and reliability of the results.
ere were 492 males (40.7%) and 718 females (59.3%).
Subjects’ majors included arts (622, 51.4%), science (288,
23.8%), engineering (132, 10.9%), and other (168, 13.9%).
Instruments
e questionnaire of this study was separated into two
parts. e rst part is the questionnaire section, which
consists of PPS Variables, Meaning in Life Scale, Multi-
dimensional Social Support Scale, and Post Traumatic
Growth Inventory (PTGI-SF). e second part is the
demographic survey section, which mainly collects infor-
mation on individual characteristics variables, including
gender, age, income, and parents’ education. e ques-
tionnaire takes a self-report approach to data collection.
A Likert response format was used in this study. e
items are rated on a 7-point Likert scale ranging from 1
to 7.
Proactive personality
PPS was assessed by the PPS-6 [105, 106]. e instru-
ment consists of a 7-point Likert-type scale, ranging from
1 (“strongly disagree”) to 7 (“strongly agree”). Reliability
estimates were reported by Claes et al. (2005), with Cron-
bach’s alpha values of 0.78 (in Finland), 0.79 (in Belgium),
and 0.86 (in Spain). Due to the impact of the epidemic,
this study employed a modied 5-item version of the
PPS-6. e internal consistency of the instrument in this
study was high, with a Cronbach’s alpha value of 0.94.
Social support
e Social Support Scale used in this study is a 12-item
scale with three dimensions measuring perceived sup-
port from family, friends, and signicant others [107,
108]. Because students were sequestered from school
during the epidemic, signicant others in this study were
primarily teachers and classmates. High mean MSPSS
scores indicated higher levels of perceived social network
assistance by participants. e alpha coecient for inter-
nal consistency of the MSPSS was 0.93, and the three
dimensions of family, friends and signicant others were
0.91, 0.89, and 0.91, respectively [109]. is study was
adjusted for the context of the epidemic, with a total of
10 items. e alpha for the three dimensions in this study
was 0.92, 0.91, and 0.95, respectively, and social support
was 0.95.
Meaning in life questionnaire
ML was assessed by meaning in Life Questionnaire
(MLQ). e scale is a two-factor structure consisting of
presence (MLQ-P; current meaning) and search (MLQ-
S; search for meaning) [27]. “e Presence subscale mea-
sures a person’s perception of the degree to which his or
her life has meaning, such as “I understand the meaning
of my life.” e “Search” subscale measures a person’s
motivation to nd ML, such as “I am searching for mean-
ing in my life.” e estimated alpha coecients for inter-
nal consistency were 0.81 and 0.84, respectively [110].
e scale has ten questions. is study was adjusted
for the context of the epidemic, with a total of 8 items.
Importantly, these modications were reviewed and vali-
dated by experts to ensure content validity, conrming
that the adapted version retains the scale’s original eec-
tiveness. e alpha for the two dimensions of meaningful
presence and search was 0.88 and 0.89, respectively, and
the alpha for ML was 0.93.
Post-traumatic growth
PTG aims to quantify an individual’s development fol-
lowing a very stressful or traumatic incident [14, 96]. e
PTG opted for this study because it has been utilized in
prior research to evaluate the association between PTG
and chronic diseases such as cancer [94, 111] and stroke
[112]. e PTG consists of 21 items that measure growth
through 5 factors: relationships with others (7 items),
new possibilities (4 items), personal strength (3 items),
spiritual change (2 items), and appreciation for life (5
items). We made some adjustments in the context of
the epidemic for 13 items. In previous studies, the PTG
scores proved to be reliable. e scale’s personal strength
(α = 0.67), relationship with others (α = 0.85), new possi-
bilities (α = 0.84), spiritual change (α = 0.85), and appreci-
ation of life (α = 0.67) were able to conrm the validity of
the questionnaire [14]. In the present study, the dimen-
sions 0.92, 0.81, 0.93, 0.86, 0, 89, and the overall alpha
coecient of the PTG was 0.95, indicating a high internal
consistency.
Data analysis
During the data collection process, we transferred data
from the Questionnaire Star survey platform and ana-
lyzed the data using SPSS 23. We performed descriptive
statistics between demographics and examined the rela-
tionship between the variables PPS, social support, the
ML, and PTG.
To verify the research’s hypotheses, structural equation
models were employed. In this context, we used PLS-
Smart 4.0 for path analysis. Partial Least Squares Struc-
tural Equation Modeling (PLS-SEM) was selected as the
core data analysis tool. is method combines principal
component analysis with iterative estimation techniques
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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Yao et al. BMC Psychology (2024) 12:634
of multiple regression, providing a robust approach for
causal modeling. Compared to the structural equation
models of LISREL and AMOS, the PLS method requires
less measurement scale, sample size, and residual distri-
bution [113, 114].
is study utilized PLS-SEM analysis in two distinct
stages. Firstly, a comprehensive reliability and validity
analysis was conducted. Secondly, the path coecients
and explanatory power of the structural model were
estimated and veried. PLS-SEM is primarily focused
on constructing theoretical models and exploring causal
links between structural variables [115–117]. Further-
more, this methodology is capable of handling both
model structure and measurement items. In addition,
PLS has less rigorous constraints for the normality and
randomness of variables, making it helpful in analyzing
correlations between variables in data distributions that
are not normal. In addition, it can analyze complex pre-
dictive models [115]. is investigation investigated the
causal links between PPS, SS, ML, and PTG. Except for
PPS, all variables included second-order variables. PLS is,
therefore, more suitable than other SEM analysis meth-
ods for investigating the causal links among the variables,
reducing measurement error, and avoiding covariance in
this investigation.
Results
Outer model and scale validation
Internal consistency, convergent validity, and discrimi-
nant validity of the constructs are evaluated as part of
the external model’s correlation test. To determine the
dependability of the test items, the matching questions
are loaded. e individual reliability threshold for factor
loadings is 0.6 [116].
Composite reliability (CR) indicates the consistency
of the internal variables, the higher the CR value of the
potential variables, the more the potential variables can
be measured, and their measured variables are highly
correlated. erefore, the CR value needs to be higher
than the threshold value of 0.7. e CRs of the potential
variables in this study are all greater than 0.9, indicating
good consistency in the constructs of this study. Consid-
ering convergent validity, a construct has good conver-
gent validity if the AVE of all the constructs is > 0.5 and
the reliability is > 0.7 [116, 118]. Table 1 shows that all
constructs met the recommendations made by Fornell
& Larcker (1981), indicating good convergent validity. In
addition, the square root of the AVE was tested to see if
it was more signicant than the correlation coecient of
the structures to conrm the discriminant validity.
Discriminant validity
e discriminant validity of an item set is how well it can
distinguish one variable from another. Fornell-Larcker
criteria and factor loadings serve as main methods to
measure discriminant validity. According to the Fornell-
Larcker criterion, the diagonal value of each factor in
Table2 should be greater than the correlation coecient
on the corresponding row for each factor’s average vari-
ance extracted AVE square root value, respectively. e
questionnaire data would have good discriminant validity
if this criterion is met. e data in this study met the For-
nell-Larcker criteria, demonstrating discriminant validity
among the constructs.
Inner model and hypotheses testing
is study evaluated the path of coecients and R square
using PLS analysis. e path coecients indicate the
intensity and direction of the association between vari-
ables, demonstrating causality, while the R-squared value
interprets the proportion of the dependent variable, indi-
cating the predictive capacity of the model. erefore, the
bootstrapping method has been used to determine the
protability of each path coecient in this study. Data
were resampled to determine the values. e measured
value is more precise than the frequently employed limit
approximation [119]. Consequently, this method was
Table 1 Reliability and AVE of the outer model
Cronbach’s alpha Composite reliability AVE
AL 0.958 0.958 0.889
FAM 0.953 0.953 0.876
FRI 0.928 0.929 0.822
LMP 0.889 0.890 0.751
LMS 0.921 0.922 0.761
ML 0.942 0.943 0.685
NP 0.953 0.953 0.876
PPS 0.953 0.954 0.811
PS 0.953 0.953 0.877
PTG 0.971 0.975 0.659
RO 0.861 0.881 0.703
SC 0.952 0.953 0.876
SO 0.965 0.965 0.905
SS 0.962 0.963 0.706
Note 1: PPS = Proactive personality; FAM = family support; FRI = friend
support; SO = signicant others; LMP = Presence of Meaning; LMS = Search for
Meaning; NP = New possibilities; PS = Personal strength; RO = re lationship with
others; SC = spiritual change; AL = Appreciation of life; ML = Meaning in life;
PPS = Pro active personali ty; PTG = post-traumatic grow th; SS = Social support
Table 2 Results of discriminant validity by Fornell-Larcker criteria
ML PPS PTG SS
ML 0.828
PPS 0.771 0.901
PTG 0.847 0.877 0.811
SS 0.762 0.826 0.885 0.840
Note 1: PPS = Proactive personality; FAM = family support; FRI = friend support;
SO = signicant others; LMP = Presence of Meaning; LMS = Search for Meaning;
NP = New possibilities; PS = Personal strength; RO = relationship with others;
SC = spiritual change; AL = Appreciation of life; ML = Meaning in life; PTG = post-
traumatic gro wth; SS = Social suppor t
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Page 10 of 16
Yao et al. BMC Psychology (2024) 12:634
utilized to determine the signicance of the association
between variables. H1-H5 were all supported, as shown
in Table3; Fig.2.
According to the causality diagram of the study model
(As is seen in Fig. 2), PPS positively promotes ML and
PTG with estimates of 0.479 and 0.326; social support
positively inuences ML and post-traumatic support with
estimates of 0.387 and 0.382, respectively; and mean-
ing in life positively inuences PTG with an estimate of
0.313. All hypotheses P < 0.001, dierences were statisti-
cally signicant. erefore, all hypotheses are supported.
e causality diagram of the study model shows that
the explanation strength of PPS and SS on ML is 64.4%;
the strength of PPS, SS, and ML on PTG is 88.3%. It
shows that the model explains the degree of potential
variables favorably.
Testing of mediation eects
According to Zhao et al. (2010), the mediation analysis is
known from the Table4, and the PPS→ML→PTG, and
SS→ML→PTG mediated relationships are supported.
Both paths are complementary mediators. Additionally,
this study conducted statistical analysis on the impact of
control variables, such as age, gender, income, and paren-
tal education level, on post-traumatic growth. e nd-
ings indicate that the inuence of these control variables
on the dependent variable lacks statistical signicance.
Discussion
Discussion of ndings
e present study examined the factors associated with
the college student population to promote PTG in the
post-epidemic era. e direct eects model suggests a
positive relationship between PPS and PTG. Previous
Table 3 Summary of inner model results
β STDEV T statistics P values Result
H1 PPS -> ML 0.479*** 0.063 7.610 0.000 supported
H2 SS -> ML 0.387*** 0.064 6.081 0.000 supported
H3 PPS -> PTG 0.326*** 0.036 9.045 0.000 supported
H4 SS -> PTG 0.382*** 0.038 10.107 0.000 supported
H5 ML -> PTG 0.313*** 0.028 11.31 0.000 supported
Note 1* p-value < 0.05; ** p-value < 0.01; *** p-value < 0.001
Note 1: Number of bo otstrap samples = 5000
Fig. 2 Standardized path coecients and signicance of inner model. Note 1: FAM = family support; FRI = friend support; SO = signicant others;
LMP = Presence of Meaning; LMS = Search for Meaning; NP = New possibilities; PS = Personal strength; RO = relationship with others; SC = spiritual change;
AL = Appreciation of life. Note 2: ***p < 0.001. Abbreviations: CV1, sex; CV2, grade; CV3, family income; CV4, father’s education level; CV5, mother’s educa-
tion level
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Yao et al. BMC Psychology (2024) 12:634
study indicates that proactive people are more inclined
to have positive experiences and outcomes. Researchers
have discovered, for instance, that PPS is connected with
greater life satisfaction [120, 121] and more proactive
behaviors [39, 122]. During an epidemic, students who
exhibit proactive characteristics are better able to face
the dilemma of the epidemic, accept the reality of the
moment, adjust their perceptions, and accept the reality
of the moment, such as learning new skills and achiev-
ing online learning. In addition, students are more able
to value human relationships and feel more enjoyable
in oine classes, which are expressions of psychologi-
cal growth and positive outcome consistent with prior
research.
Indirect eects models suggest that ML partially medi-
ates PPS and PTG in university students. It also demon-
strates that PPS is strongly associated with the tendency
of individuals to search for meaning in their life. Fur-
thermore, the presence of meaning mediates personality
and mental health. Based on the positive correlation, this
study concludes that college students with PPS are more
willing to adopt a positive attitude toward the objective
world, are more likely to integrate their original percep-
tions, are more able to accept the reality of their dilem-
mas, and gain post-traumatic psychological growth.
Consequently, the conclusion of this investigation is
aligned with those of the original research.
Similarly, there exists a positive and direct association
between perceived social support and posttraumatic
growth (PTG) in university students, with the mediating
role of the ML in the indirect eect model. Specically,
the direct eect model yielded results that are aligned
with previous research, arming a positive correlation
between social support in university students and PTG
[122].
ese ndings are congruent with social cognitive the-
ory [123]. Provision of top-quality social support could
enable individuals experiencing distress to eectively
cope with their situation and reconstruct their cognitive
abilities. Sucient social support can assist young people
tackling trauma after an epidemic distress experience in
high school students, which can help reinforce positive
adjustment and help facilitate PTG.
Furthermore, a partial mediating role could be played
by ML between SS and PTG based on indirect eects
models. Many studies suggest that SS may play a positive
role in the promotion of MIL. ese studies suggest
that intimate relationships, such as emotional attach-
ment with family members and friends, generate a
greater sense of belonging, which are both source and
consequence of ML [84, 124]. As a result of such posi-
tive associations, it is possible to conclude that the feel-
ing and reality of being cared for, of being able to receive
help from others, and of being part of a supportive social
network, are important [125]. It would encourage indi-
viduals to understand the traumatic event, which in turn
may require a reassessment of the event in a positively
rewarding and fully meaningful way. Consequently, PTG
may develop from these speculations. When in distress,
university students who receive SS from family, friends,
and others will be more able to face the distress and expe-
rience positive psychological adjustment. is support
can help them nd positive meaning from their traumatic
experiences. us, students with higher levels of per-
ceived social support are more inclined to reect on ML
than those with lower levels, which may encourage PTG.
e ndings also show that ML plays a crucial role in SS
and PTG.
e results indicate that the impact of independent
variables on post-traumatic growth (PTG) is more signif-
icant, while control variables such as age, gender, income,
and parental education level do not signicantly aect
this outcome. In the context of the pandemic, these con-
trol variables may not be critical factors inuencing PTG.
is suggests that the study design eectively controls for
potential confounding factors, allowing the inuence of
the independent variables on the dependent variable to
emerge more clearly.
e focus of this study is to explore how SS, PPS, ML,
and PTG are interconnected in the context of the ongo-
ing pandemic, which has signicantly impacted global
social engagement and has yet to be thoroughly exam-
ined. is research aims to delve into a new area of
study that has not previously been explored, given the
unprecedented nature of this global epidemic. While
research on PTG has largely focused on other forms of
traumatic experiences, such as disease [94, 111], war
[72], and natural disasters [61, 95], there is promising
potential for this research to extend to the unique type
of widespread trauma brought on by COVID-19. e
results of this study emphasize the crucial impact of both
internal factors, including personality traits and a sense
Table 4 Mediation eects testing
Dependent
variable
Mediated
variables
Independent
variable
Direct eect Indirect eect Total eect Mediated
Validation
PPS ML PTG ***0.326(13.148) ***0.134(6.923) ***0.460 (14.544) complemen-
tary mediators
SS ***0.313(12.582) ***0.119(7.521) ***0.432(14.586) complemen-
tary mediators
Note: ML: Mea ning in life; PPS: Proactive p ersonality; PTG: Pos t-traumatic growth; SS: So cial support
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 12 of 16
Yao et al. BMC Psychology (2024) 12:634
of meaningfulness in life, and external factors, such as
social support, in the explanation of PTG. Additionally,
the study uncovers indirect paths that potentially lead to
PTG during the COVID-19 pandemic. To expand on the
current literature regarding PTG in this pandemic, this
research highlights the role of ML in mediating between
PPS and PTG, as well as SS and PTG.
e results emphasize the critical eects of endogenous
factors (e.g., personality characteristics and meaning in
life) and the external environment (e.g., social support)
in interpreting PTG during the COVID-19 pandemic and
reveal indirect pathways which may contribute to PTG.
e results of this study not only add to the literature on
PTG in the COVID-19 pandemic, but also contribute by
exploring the mediating role between PPS and PTG and
the mediating role of ML between perceived social sup-
port and PTG.
Practical application
is paper proposes a comprehensive framework to
address the challenges faced by students in times of cri-
sis by strengthening social support systems, fostering
positive meaning-making, and implementing practical
recommendations. e goal is to enhance student resil-
ience and promote holistic development amid prevailing
uncertainties.
A strong social support network is crucial in guid-
ing students through dicult times, both at the familial
and school levels. Eective communication and connec-
tion within families can empower students to face chal-
lenges collectively. Family support in life and academics
fosters the development of positive values in students.
Engaging in joint activities deepens parent-child rela-
tionships, facilitating mutual growth. Universities play a
vital role in maintaining transparent and consistent com-
munication to reduce student anxiety during uncertain
times. Schools should leverage social media platforms
and oer professional counseling and crisis intervention
services, especially during unconventional measures.
Adaptive guidance is essential for helping students tran-
sition smoothly to online learning. Additionally, fostering
online social platforms for interaction strengthens the
supportive social network for students.
e process of building resilience involves guid-
ing students to nd positive meaning in adversity and
encouraging cognitive restructuring. Mental health
education can help students interpret traumatic events
positively, viewing them as growth opportunities and
resilience-building experiences. Encouraging students
to set clear, future-oriented goals provides motivation
and a sense of direction. Teachers play a key role in help-
ing students deepen their self-understanding through
individual tutoring or group discussions, enhancing self-
awareness. Additionally, guiding students to balance their
understanding of external challenges and internal aspira-
tions promotes problem-solving skills and facilitates cog-
nitive integration.
Implementing continuous, practical support mecha-
nisms provides a solid foundation for students’ psy-
chological well-being. Regular online parent-teacher
meetings allow for shared insights on student academic
performance and family circumstances, fostering a sup-
portive learning environment. Designating a specic
month for mental health education, with activities such
as lectures and workshops, raises awareness and rein-
forces mental health as a priority for students. Mental
health apps, online assessment systems, and other digital
tools provide accessible self-assessment channels, ensur-
ing continuous psychological support.
By implementing these three core components
comprehensively, this framework aims to enhance
students’ resilience and mental health, strengthen fam-
ily-school collaboration, and support students’ holistic
development.
Limitation and further research
e rst limitation is the adoption of a cross-sectional
study. Cross-sectional studies have a degree of limita-
tion on the extent to which we can make causal infer-
ences between the variables. Discussion and conclusions
regarding the direction of the relationships between vari-
ables are based solely on theoretical concepts and are not
supported by empirical assessments. e second con-
straint of this study can be attributed to the participant
demographic, which exclusively encompasses university
students. However, it is undeniable that relatively homo-
geneous groups and convenience sampling methods
make the study population lack randomness or represen-
tativeness. Limited sample representativeness may pro-
duce a selection eect sample. e subjects in this study
were neither those who directly experienced symptoms
and traumatic treatment nor witnessed patient suer-
ing, but those who experienced real or unrealistic fears of
infection, fear of social isolation, and fear of risk through-
out school [29]. Also, the study participants were Chinese
students, so generalizing results to similar studies may be
limited due to their cultural inuences.
e study also provides directions for further investi-
gation. First, in the future scholars could design a longi-
tudinal study to sort out potential causal relationships
between variables. Second, besides employing self-
reported assessments, further research should consider
mental health-related data or neuroscientic tools to
elucidate the mechanisms of PTG. ird, the inclusion of
diverse and representative samples in future studies on
PTG, such as individuals from various occupational and
income strata, would contribute to an enriched and all-
encompassing understanding of the PTG status among
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Page 13 of 16
Yao et al. BMC Psychology (2024) 12:634
diverse populations, thereby validating the stability and
consistency of the ndings. Additionally, building upon
convenience sampling, integrating qualitative research
methods will enhance the depth and breadth of the study
by providing a deeper understanding of the characteris-
tics and contexts of the samples.
Furthermore, exploring the cultural dierences in
PTG is essential. is exploration is worth undertak-
ing because individuals’ cognitive strategies and parent-
ing styles are inevitably shaped by their cultures in the
course of their development [126]. e outcomes of this
study provide a conceivable avenue for disentangling the
intricate mechanisms that underlie PTG in collectivist
cultures like those evident during the COVID-19 pan-
demic. Moreover, it is crucial to research PTG in a broad
range of diverse cultural settings, including individualis-
tic cultures.
Conclusions
is study constructs a mechanism for the interaction
of internal and external factors in university students’
tackle the trauma caused by the COVID-19. It indi-
cates that PPS is positively related to ML and PTG. SS
was positively correlated with ML and PTG. e results
consistently suggest that the personality traits and SS of
university students are critical in coping with the trauma
of uncertainty during the pandemic. e positive nature
of PPS and SS from family, friends, school teachers, and
peers outside of the coronavirus disease crisis enabled
university students in isolation to actively cope with
trauma, discover and even create meaning in their lives,
and complete the process of PTG. e longitudinal data
of this study have increased the use of PTG in the organi-
zational literature. It explains from a modeling perspec-
tive how personality traits and social relationships help
people in distress to disengage.
Abbreviations
SS Social Support
PTG Post-Traumatic Growth
PPS Proactive Personality
ML Meaning In Life
COVID-19 Corona Virus Disease 2019
Acknowledgements
The authors would like to thank the respondents for participating in this
research.
Author contributions
YY was involved in the study including conceptualization, methodology,
software, investigation, formal Analysis, writing - original draft and revision
of the manuscript. PW was involved in the study on data curation and
writing- original draft of the manuscript. KZ was involved in the visualization
and investigation of the manuscript. QL was involved in the study resources,
supervision, software, validation of the manuscript. YL is corresponding author
was involved in the study visualization, writing - review & editing. All authors
have read and agreed to the published version of the manuscript.
Funding
This study was funded by the Shandong Provincial Education Department
Fund (M2021158).
Data availability
The datasets used and analyzed during the current study are available from
the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Written informed consent was obtained from all participants prior to lling in
the survey with assurance of condentiality of the data, and the research was
approved by Academic Ethics Committee of the Shandong Ying Cai University
(SDYCU20220056). I conrming that all experiments were performed in
accordance with relevant guidelines and regulations.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Received: 20 September 2024 / Accepted: 5 November 2024
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