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Hsien-Cheng Lin,1 Chia-Chen Chen2 1Business College, Taizhou University, Taizhou, Zhejiang Province, People’s Republic of China; 2Department of Anesthesiology, China Medical University Hsinchu Hospital, Zhubei, Taiwan, Republic of ChinaCorrespondence: Hsien-Cheng LinBusiness College, Taizhou University, No. 1139, Shifu Avenue, Taizhou, Zhejiang Province, People’s Republic of ChinaEmail linxianzheng0711@tzc.edu.cnChia-Chen ChenDepartment of Anesthesiology, China Medical University Hsinchu Hospital, No. 199, Sec.1, Xinglong Road, Zhubei, Hsinchu Country, 302, Taiwan, Republic of ChinaEmail d7635@mail.cmuhch.org.twObjective: The COVID-19 outbreak has become a serious public health problem worldwide. The purpose of this study was to use an extended parallel process model (EPPM) to understand factors in COVID-19 prevention behaviors.Methods: This cross-sectional and analytical study was conducted on 1012 participants in Taiwan. A structured questionnaire and an online survey were used to collect data.Results: The EPPM revealed that the severity of the COVID-19 threat perceived by respondents directly affected the arousal of fear in the respondents (β=0.268, t=9.007, p< 0.001), but perceived efficacy did not (β=− 0.019, t=− 0.619, p> 0.05); additionally, fear arousal was significantly associated with COVID-19 prevention behaviors (β=0.119, t=4.603, p< 0.001). Regarding personal characteristics, self-esteem moderated the relationship between perceived threat and fear arousal. However, the moderating effect of self-esteem was stronger in people with low self-esteem compared to those with high self-esteem (β=0.606, − 0.472; t=26.303, − 17.694; p< 0.001, p< 0.001; respectively). The results of this study also indicated that two demographic characteristics (age and gender) affect COVID-19 prevention behaviors.Conclusion: When developing healthcare policies and community interventions for improving COVID-19 prevention behaviors during an outbreak, healthcare administrators should carefully consider the main constructs of the EPPM, particularly personal characteristics (ie, self-esteem) and demographic characteristics (ie, age and gender).Keywords: COVID-19, extended parallel process model, perceived threat, perceived efficacy, prevention behavior