This study aimed to explain an Iranian population’s risk perception and adherence to preventive health recommendations regarding the COVID-19 infection. Based on the structural constructs of the health belief model, the perceived sensitivity, severity and benefits had desirable levels in the studied population. Despite this, some people refused to have proper health behaviors required to prevent and control the disease. Moreover, this study showed that the "attitude towards the disease" and "the intention to stay at home" were the most important predictors of health behaviors in the community.
Our findings showed that women had better behavior and attitude than men regarding the prevention of COVID-19. This was despite the fact that men generally experience a more severe form of the disease and have a higher risk of mortality (22). In this study, attitude, and perceived benefits were better in women than in men. In contrast, the findings of Abdul-Hafez et al. showed that men and women had the same levels of knowledge and attitude regarding the COVID-19 disease (23). Likewise, another study on the H1N1 pandemic revealed a better preventive function in women compared with men (24). These discrepancies between genders can be related to the personality differences of men and women as females are generally much more sensitive and influential than males in perceiving their surroundings. Therefore, it is necessary to use appropriate sensitization methods to help men to better understand the benefits of adhering to the COVID-19 preventive measures.
In this study, the knowledge and behavior about the disease were different in various age groups. People over the age of 50 years had better perceptions and behaviors facing the disease. One of the reasons of this can be a misunderstanding that has spread on social media as only older people are at risk of this disease (25). Contrary to the findings of this study, other reports have shown that younger people possess better knowledge and attitudes towards the disease and its preventive measures (23). This may be related to social, cultural, political, and economic differences among different communities. According to the findings of Abdul Hafez et al., older age, lower literacy and income, as well as living in rural areas were associated with inferior knowledge about the disease (23).
In this study, housewives had good perception and behaviors. On the other hand, farmers and drivers had low knowledge and bad behaviors towards the disease. This observation of ours was similar to that of another study noting better knowledge and attitude about the disease and its preventive measures in people living in city compared with those living in rural areas or people with an income less than 5000 pounds per month (23). It seems that access to social media, having free time to search into information resources, educational level, and social culture can be determining factors regarding the knowledge and behavior about the COVID-19 infection. Usually, people living in rural areas have limited access to scientific facilities, poor studying habits, as well as lower income and shorter free time than residents of urban regions have. So, it is required to improve awareness and attitude about the disease by implementing appropriate programs, especially across low-income communities.
Our study's findings showed that sensitization toward the disease was well established in our participants who had seen themselves at the risk of the infection. In fact, there was a fear of the disease among the population. The perceived sensitivity was higher in middle-aged people (30 to 40 years) than others. This may reflect a sense of curiosity, activism, and better access to social media and the Internet in this age group. Becoming alert to the threats and consequences of the disease can augment the rate of adherence to preventive health behaviors. Furthermore, we noticed that the perceived severity was higher in individuals over 50 years than those in other age groups. This may be explained by the fact that the elderly and people with underlying diseases can experience a more severe form of the disease, which ultimately leads to a higher mortality rate in these groups. Actually, our participants were fully aware of this fact, which was in parallel to the findings of another study indicating the perceived severity as an important predictor of adherence to health behaviors(26). Yet another study showed that perceived severity was positively associated with negative emotions and higher utilization of mobile phones leading to more appropriate health behaviors to confine the COVID-19 infection (27).
Our findings showed that the perceived sensitivity was higher in single people. On the other side, the perceived severity and benefits were higher in married individuals. This can be attributed to the more free time and better access to data resources of single people and to the fact that married individuals are more attached to their martial life. On the same premise, married individual can have a higher perception towards environmental threats. We also found that the perceived benefits were greater in the elderly than young individuals. As explanation, one can say that a higher perceived severity and the fear of the disease complications would lead the elderly to better understood the advantages of preventive behaviors (i.e. regular hand-washing, applying facemasks, and keeping social distancing).
The findings of the present study indicated homogeneous perceived sensitivity and severity comparing women and men; nevertheless, perceived benefits were better in women than in men. This was in parallel with another study suggesting that parameters such as moving to a new neighborhood, having good knowledge and awareness about the disease, and the fear of the disease can encourage observing health behaviors (28).
In this study, the majority of the participants noted that they obtained the required information about the disease and preventive measures through social media. Still, some of them had low adherence to health behaviors. In line with the findings of this study, it has been reported that most people acquire their knowledge about the disease through social media and the Internet (23). In the another study, despite the good knowledge of general population about the transmission patterns and common symptoms of COVID-19 disease, they misunderstood preventive actions because of confusing information circulating on social media (29). As people may perpetrate incorrect behaviors such as unauthorized consumption of antibiotics (25), it is important to improve people's knowledge and awareness about the disease and preventive actions through formal and valid websites and mass media, as well as educations by knowledgeable and trusted individuals such as doctors, nurses and other health staff.
The results of our study showed that most the participants abided by the disease prevention behaviors. People’s beliefs about the effectiveness of treatments can be among factors influencing the rate of behavioral compliance (30). Therefore, providing accurate and reliable information along with necessary personal protective equipment (PPEs) can increase the rate of public adherence to health behaviors amid this pandemic (31). Although a large portion of our participants followed health behaviors, but there were also people who, despite good perceived sensitivity and severity and high awareness, ignored these behavioral protocols. One of the most important reasons for this phenomenon may be people getting used to the situation through the time. Other influencing factors include economic problems and either a shortage in or high-price of PPEs (32).
In this study, it was shown that two variables; attitude towards the disease and tendency to stay at home, predicted more than 50% of the variance of COVID-19 preventive social health behaviors. This was in line with the findings of two studies in China showing the efficiency of lock-down to significantly reduce the incidence and mortality of COVID-19 infection (33, 34). According to the guidelines of the WHO, one important way to control and manage the disease is to keep social distancing and avoid attending group meetings (35). The public staying at home requires a national, social and personal determination. In order to encourage people to stay at home, the infrastructure must first be provided, and schools and universities should be closed and continue education through on-line courses. The recent activity itself requires appropriate infrastructure and the preparation of teachers and students. Furthermore, organizations and agencies that provide essential services should continue to operate with minimal staff. The livelihood needs of the public should be provided, and broadcasting agencies should display entertainment programs. On the other hand, some people who may not have a regular income (i.e. day workers) must be supported by governments and non-governmental organization (NGO). In this way, it is necessary to pave the road for the public to keep social distancing and adhere to required health behaviors.