This study aimed to investigate the predictive factors associated with the adoption of self-care behaviors for preventing COVID-19 disease in pregnant women using the HBM. The results of this study confirmed a statistical model consisting of four variables including awareness, self-efficacy, perceived barriers, and perceived severity, which were able to account for about 24% of self-care behaviors associated with COVID-19 disease. Of course, these four variables varied in terms of their power to explain the adoption of self-care behaviors. Similarly, Khazaei Poor (13) reported that the constructs of the health belief model could explain 26% of self-care behaviors effective in the prevention of COVID-19.
The results of this study showed that the average score of adopting self-care behaviors in preventing COVID-19 was about 64, showing that self-care behaviors taken by the pregnant women to prevent COVID-19 disease were not desirable due to the high prevalence of the disease in Iran.
However, some studies (19–21) estimated preventive function of different study groups as desirable. Given the specific physiological conditions of pregnant women, they need to pay attention to the plans and strategies adopted to care for COVID-19 disease. Considering the possible beneficial effects of adopting self-care behaviors in health-promoting and reducing the risk of the COVID-19 epidemic, it is necessary to adopt an appropriate strategy to remove possible obstacles to managing this global epidemic.
To increase the effectiveness of interventions to promote the adoption of self-care behaviors against COVID-19 in pregnant women, it is necessary to identify the determinants of preventive and self-care behaviors in this population. Accordingly, the present study showed awareness, self-efficacy, perceived sensitivity, perceived severity, and the Cues to Action were positively correlated with the adoption of self-care behaviors. However, this correlation was reversed between perceived barriers and self-care behaviors, indicating that those with high perceived barriers are less likely to engage in self-care behaviors to prevent COVID-19. This finding is consistent with the results of previous studies (3, 22). There was no correlation between individual factors such as age, employment, and education of pregnant women with self-care behaviors.
In the present study, knowledge about the nature of coronavirus and self-care in confronting COVID-19 disease was the strongest and most effective variable, which could predict the relationship between self-care in pregnant women alone and with a variance of about 12%. It seems that due to the high prevalence of COVID-19 disease and also due to the widespread information by the mass media, radio and television channels, the Ministry of Health and the distribution of warning banners throughout the areas affected by the disease and public awareness, people are more likely to do optimal self-care behaviors to prevent COVID-19 disease (13).
The self-efficacy as the second construct of the HBM could explain the adoption of self-care behaviors in confronting COVID-19. Perceived self-efficacy had a positive and direct effect on preventive behaviors against COVID-19. The more people feel motivated, capable, and hoping to succeed in fighting the coronavirus, they show more willingness to do individual health behaviors (23). In the present study, self-efficacy was conceptualized to the extent to which a person feels that they can use self-care and preventive strategies to combat the coronavirus.
Perceived barriers construct as the third construct of the HBM was able to account for the adoption of self-care behavior. Perceived barriers represent the most important construct of the HBM with the high predictive power of behavior (24). It should be noted that the low perceived barriers are a privilege because the individuals believe that they face fewer obstacles and fewer problems in adopting self-care and preventive behaviors. Besides, the objective and psychological costs of the recommended activities are low or they are preferable due to the benefits of the behavior. Therefore, it can be suggested that by performing a series of interventions and adopting effective policies to reduce barriers as much as possible, the possibility of adopting self-care behaviors for preventing COVID-19 increases.
Perceived severity as the fourth construct of the HBM could predict the adoption of self-care behaviors in confronting COVID-19. Perceived severity is ultimately related to the perceived threat and refers to the extent to which individuals perceive the danger and seriousness of the spread of coronavirus. This finding is consistent with the results of previous studies by Bates et al. (25), Khazaee-Pool et al. (13), and Didarloo et(15).
Although the present study showed a positive and significant correlation between perceived sensitivity, perceived benefits, and Cues to Action in the adoption of self-care, these constructs in the model extracted from regression analysis were not confirmed as predictive constructs. In fact, if people are aware of the benefits of taking preventative behavior, they are better prepared to take activities and they more likely accept the mentioned behaviors. In other words, if a person believes that home quarantine and the use of personal protective equipment can reduce the risk of developing the disease or transmitting it to others, or have social benefits such as reducing treatment costs or potential costs to the health system of the country, they will be more likely to do self-care behaviors (26, 27).
Cues to Action can act as a stimulus received by people from the COVID-19 outbreak. This stimulus can be in the form of a clip, news of the death of people due to COVID-19, the effects and consequences of this disease on people’s lives posted on mass media and social networks, or the advice and warnings of the staff of health centers (27, 28). The majority of the women in this study reported that the most important sources of information about COVID-19 were health workers and warnings from the Ministry of Health through the mass media.
Given the importance of mass media, especially in the period of growth of new technologies and virtual networks, and given the importance of non-aggregation to reduce the transfer of COVID-19, the high potentials of social media can be used for educational, awareness-raising, and behavior change purposes.
Of course, it should be noted that pregnant women’s engagement in self-care can be affected by some non-behavioral environmental factors such as the availability of facilities and preventive devices, high cost of protective equipment and disinfectants, and strategies adopted nationwide, etc. By informing the community and officials and adopting useful policies and effective interventions, it is possible to increase the adoption of self-care and preventive behaviors against COVID-19. One of the limitations of this study was the use of a self-report questionnaire. Thus, by stating the objectives of the study and assuring the pregnant women that their information is confidential, an attempt was made to reduce this limitation.