This study has successfully represented preparedness and risk behavior perception of ophthalmologists to the novel COVID-19 pandemic in one of the largest tertiary eye hospitals in the middle east using the health belief model. After extensive literature review using search engines; PubMed, google scholar, research gate, and Cochrane, this is the first reported study that has constructed a focused, mapped analysis that described ophthalmologists’ perception behavior to the current COVID-19 pandemic.
This model mainly emphasizes on the attitudes and beliefs of individuals to explain and predict their health behavior. It primarily focuses on two main aspects of health behavior threat perception and behavioral evaluation. Threat perception consists of the disease's perceived susceptibility and the perceived severity of the consequences of the disease, and it plays an essential role in health-related behavior. The behavioral evaluation consists of perceived benefits of a recommended health behavior, and possible barriers that individuals may encounter to engage in this health behavior. It also incorporates two critical elements into its assessments about what it takes to get an individual to be more engaged in such behaviors. These two elements are cues to action and self-efficacy13,14,21,22,25,26.
We learned from previous outbreaks such as; influenzas in 2003 and Ebola in 201315,17,19, that the effectiveness of the control of communicable diseases epidemics is primarily determined by the perception of risk of the infection, health-related behavior of the population and health care providers and their willingness to comply to recommended preventive methods. Therefore, to promote sufficient precautionary behavior among the population and health care providers, public health authorities need to know how individuals perceive risks and its severity, how they perceive the effectiveness and acknowledge precautionary methods such as hygiene, quarantines, wearing masks, maintaining social distance and following patients' care protocols by physicians(13-16,18-26) .
Likewise, O Zawart’s thesis compromised large scale comparative studies into perceived threat and risk perception of emerging infectious diseases, including SARS and Avian influenza. He concluded that most studies on SARS and avian influenza found an association between higher risk perception and engaging in precautionary actions. Thus, suggesting that in stimulating precautionary actions in the control of outbreaks, specific attention should be paid to stimulate a high enough perceived threat to ensure that people will engage in these precautionary actions and enhance their efficacy beliefs and their trust in doing so17–19. Similarly, this current study mapped ophthalmologists' behavior utilizing HBM, and it showed that; perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and cues to action all had a significant relation with action. In particular, perceived susceptibility has the highest correlation and is accordingly the most closely related to action. These correlations interpret that the higher ophthalmologists perceive their susceptibility for COVID-19, the more they carry out protective behavior.
Furthermore, multiple regression analyses revealed that perceived susceptibility was the best predictor of action and therefore had the most significant effect on action.
Also, we have to consider that threat perception is not the only determinant of protective behavior. Individuals have to believe that the benefit of a recommended health behavior is efficient and have the confidence of self-competence to apply successful behavior, which is described by the theory of response efficacy and self-efficacy, respectively. Our findings have confirmed this concept as the perceived benefit was the second most crucial component of the model, influencing action 12–15,17–19,21–23.
Possibly, such findings are rationalized by the fact that ophthalmologists are conscious that they are at high risk of contracting COVID-19 and have substantial exposure among other healthcare workers due to their proximal working distance to patients along with extended critical clinical examination duration their practice and surgery. Consequently, affected their health risk behavior. One advantage of this study is that it took place at the beginning of the pandemic where the knowledge gap about the virus still existed, making it an accurate representation of ophthalmologists’ alertness in a time where evidence about a novel virus pandemic was still limited.
Nevertheless, whether these findings represent all ophthalmologists' perception worldwide of this pandemic as a response to global health care efforts or a reflection of local public health efforts that varies between institutes and countries, these positive results, still supports previous mentioned socio-psychological study's outcomes. Emphasizing the importance of measuring these factors and address them adequately to achieve successful compliance and control of infectious disease pandemics11,12,23,13–15,17–19,21,22.
Finally, our study limitation was related to the fact that most reviewed articles with HBM based questionnaires lacked an existing validated questionnaire for perceived threat and risk perception of infectious diseases. Therefore, the questionnaire was specifically developed for the project reported in this paper [supplementary table1]. It was based upon an earlier questionnaire used in previously discussed studies, then revised by two epidemiologists within our research department, and HBM component reliability was assessed by Cronbach’s alpha [table2].
In conclusion, Pandemics such as COVID-19 are more likely to happen more often in the future. Studies have found that an individual's desire to implement a change in health behavior is not enough to adhere to preventive measures and overcome barriers. Therefore, explicit attention to factors influencing motivation, such as threat perception to adopt appropriate health-related behavior to limit the spread of communicable disease, is necessary. To assess such behavior, Health belief model was used to give insight on risk perception and adhere to risk-reducing behavior. This study demonstrated that this model is useful and concluded how several components were significantly correlated to actions. Most significantly, perceived susceptibility was the most important predictor of action. The second most important determinant of action was the perceived benefit.