Individual participation in preventive efforts is crucial in containing the spread of infection and reducing mortality attributed to infectious diseases such as the COVID-19 pandemic. However, adherence to preventive behaviour depends mainly on individual perception of the risk and benefits of such behaviour (Baek et al. 2022). This hypothesis is further supported by the health belief model (HBM) (Rosenstock 1974; Rosenstock et al. 1988). The HBM suggests that individuals will likely act when experiencing a personal threat or risk, but only if the benefits of acting outweigh the actual or perceived barriers or threats. This model (as presented in Fig. 1 below) consists of six constructs that cover perceived susceptibility (i.e. a subjective evaluation of contracting the disease), perceived severity (i.e. a subjective evaluation of the severity of the disease), perceived benefits (i.e., positive outcomes of practising recommended interventions), cues to action (i.e. stimuli that trigger the decision-making process to undertake the necessary interventions), perceived barriers (i.e. the degree to which people think taking the advised health action will be challenging or have adverse consequences), and self-efficacy (i.e. the level of confidence an individual has in performing recommended health interventions) (Rosenstock 1974; Rosenstock et al. 1988).

Health belief model (Adapted from (Rosenstock 1974))

The COVID-19 pandemic poses an enormous negative impact on health and the economy worldwide. The practical effects of the pandemic are evident in the shortage in food systems, increased public health problems, and the increased threat of extreme poverty due to economic and social disruption (World Health Organization 2020). To reduce these burdens, various health-promotive behaviours were implemented in Germany; this includes vaccination and wearing face masks in public spaces.

The vaccination process confers immunity to a large proportion of the population. Therefore, since the authorisation of the COVID-19 vaccine, there has been a mandate to increase vaccine acceptance, especially among those most vulnerable to the severe course of COVID-19 infections. Nevertheless, various research has contended that the rapid development of the vaccine is linked with vaccine hesitancy among Germans, primarily due to safety and efficacy concerns (Fiske et al. 2022; Fobiwe et al. 2022). On the other hand, it is argued that the acceptance of the COVID-19 vaccine was influenced mainly by the possible health-related consequences of the COVID-19 virus (Bendau et al. 2021). Vaccine acceptance has been argued to substantially alter the pandemic course by decreasing morbidity and mortality (Haas et al. 2021; Meslé et al. 2021; Watson et al. 2022). However, recent studies suggest that vaccination alone is unlikely to stop the pandemic, thereby arguing the appropriateness of other precautionary measures such as wearing a face mask as effective for containing the virus spread (Gettings et al. 2021; Lyu and Wehby 2020; Sharif et al. 2021).

In the absence of vaccination, precautionary measures such as social distancing and face masking were employed as the primary means to contain COVID-19 outbreaks. These measures were gradually lifted as vaccination coverage increased, given their adverse effects on societal and economic functioning, as well as overall public well-being. Nevertheless, the resurgence of new daily infections indicates a need to reconsider the mandatory use of face masks, in conjunction with vaccination efforts, to effectively manage the ongoing pandemic and prevent potential future outbreaks.

A face mask is a covering worn on the face to shield it from coarse and fine droplets (Kinyili et al. 2022). Wearing a mask is believed to ensure that fewer SARS-CoV-2 particles are emitted into the surroundings by the infected person on the one hand while offering partial protection to the wearer on the other (Bartsch et al. 2022). Recent findings further suggest that a face mask is one of the most effective, fair and socially responsible strategies to mitigate the spread of the pandemic (Bearth and Siegrist 2022; Howard et al. 2021).

Although the multifaceted benefits of face masks are sufficiently known, the frequency and acceptance of wearing masks remain controversial among the general population due to the challenges posed by wearing face masks for long periods. According to recent studies, the most common reported hurdles to face mask adherence were physical and social discomfort, difficulty breathing, glasses fogging, financial reasons, headache, perioral dermatitis, facial itching and rash/irritation (Abid et al. 2022; Fikenzer et al. 2020; Scarano et al. 2020). Furthermore, face masks hindered face recognition and communication, both verbal and non-verbal, affecting emotional signalling, especially between teachers and students in educational facilities (Carbon 2020; Spitzer 2020).

Many people must adhere to focused behaviours to contain the pandemic. Howbeit, a considerable percentage of people in Germany remain unvaccinated against COVID-19 (Robert Koch Institut 2022). Similarly, the inconvenience and other side effects attributed to face mask usage have remained popular in social discourse among German adults (Carbon 2021; Niesert et al. 2021). From this point of view, an exploration of adherence to COVID-19 preventive measures is indispensable.

The HBM presents a behavioural framework that fits the trend in COVID-19 preventive behaviour. This social and psychological theoretical model may help understand the individual decision to adhere to COVID-19 preventive measures. For example, Barakat and Kasemy (2020) identified perceived susceptibility, benefits, barriers and self-efficacy as predictors of preventive behaviours. In another study, Karimy et al. (2021) found that the supposed advantages and disadvantages were significant predictors of COVID-19 preventive behaviours. A considerable number of other studies have also demonstrated that the properties of HBM are a crucial predictive component of preventative measures during the pandemic (Jadil and Ouzir 2021; Shmueli 2021; Zewdie et al. 2022).

In Germany, the influence of HBM properties on COVID-19 preventive behaviour is rarely investigated. Few available studies have focused on individual aspects, for example, risk perception, self-efficacy, and barriers, while others have explored socio-demographic predictors of adherence to protective measures (Lüdecke and Knesebeck 2020; Kojan et al. 2022; Mahdavian et al. 2022). There is, however, a lack of relevant knowledge in the collective about individuals’ health beliefs regarding COVID-19 infection and preventive measures. The current study, therefore, focuses on investigating determinants that stimulate the public’s compliance with vaccine and face mask behaviour using the HBM.