The present study was conducted in 2021 to compare the HBM, and TPB to predict intention and CPBs in Urmia. The results showed that the mean score of intention, and CPBs was at a favorable level. Singh (2020) found that 93.2% of Indian subjects adopted CPBs (mask use: 97.6%, frequent hand washing: 97.3%, avoiding handshakes and kissing: 97.8% and staying at home: 95%) [22]. Dires et al (2020) found that a majority intended to wash hands (85.5%), wear a mask (81.9%), and social distance (74.6%) to prevent COVID-19 [23]. An Iranian study by Zarei et al. (2021) found that, in accordance with the findings of the current study, 72.2%, 64.2%, and 97.7% of participants intended to observe social distance, wear personal protection equipment, and practice hand hygiene, respectively [24]. COVID-19 in Iran, specifically Urmia, is causing high intention and CPBs due to its prevalence. If the population’s COVID-19 knowledge is appropriate, the level of CPBs adoption will be more favorable. Since the CPBs adoption has beneficial effects to promote the health and reducing the COVID-19 risk, it is necessary to eliminate CPBs barriers and manage this global pandemic with an appropriate strategy. The study found that TPB was a stronger predictor than HBM for intention and CPBs among adults over 18 in Urmia. Before opting to complete a task, TPB participants evaluate its effectiveness and usefulness. If they determine that it is reasonable, they proceed. The impression of a health hazard in HBM, on the other hand, results in behavior modification. Therefore, informing adults over 18 about the CPBs benefits increases the compliance more than describing complications of not using them. No similar study examining HBM and TPB's predictive power on social distancing, mask use, and hand hygiene intention and behavior was found to confirm this study's findings. HBM and TPB were evaluated separately for predicting intention and CPBs in most studies. For example, Iawaya et al., (2020) reported that TPB explained 85% social distancing intention variance [25]. Issrani et al., (2021) indicated that TPB explained 71.9% of the variance in quarantine behavior [18]. Tsai et al., (2021) reported that HBM predicted 58% of CPBs intention variance [26]. Mirzaei et al., (2021) indicated this model predicted 29.2% of CPBs variance [19]. According to the findings of these studies, TPB was more effective than HBM at predicting intention and CPBs, consistent with current study findings. The fact that the SN component is present in TPB is most likely what caused this outcome. SN construct in TPB leads to more attention on social factors affecting intention and behavior than HBM, including family, friends, colleagues, and healthcare workers. Since no study was performed in the field of comparing the predictive power of HBM and TPB for intention and CPBs, the present study is a type of innovation. Therefore, it is suggested to conduct more studies in this field to obtain more accurate results.
Considering high power of TPB to predict the intention and CPBs in the present study, the predictors of CPBs were evaluated based on TPB. The results showed that BI, PBC, ATD, and SN were significant predictors of CPBs, and PBC, ATD, and SN were significant predictors of the intention to adopt CPBs.
The findings of the current study also showed that CPBs adoption increases along with mean BI scores in terms of preventing COVID-19. The prevalence of CPBs will rise when people show a greater interest in following health advice or have plans and intentions to do so. Several studies conducted in the field of CPBs were consistent with the results of the present study. For instance, Das et al. (2021) found that BI predicted social distancing adoption in Bangladeshi individuals [27]. Wollast et al., (2021) indicated that BI was a predictor of adoption of hand-washing behavior among Belgian and French people [28]. Zahed et al., (2021) stated that BI predicted masking behavior adoption in southern U.S. students [29]. Health workers can improve CPBs with targeted educational interventions based on BI-related factors. It can be said that the intention is pre-action stage. At this stage, preparation for healthy behaviors is provided. The intention does not necessarily translate into the action, though, as external or internal circumstances can change a person's decision to engage in healthy behavior over time. More consideration should be given to ATD, SN, and PBC in order to translate people's intentions into proper action.
PBC, one of the TPB structures, predicted CPBs and intention. By increasing motivation, ability and hope of success to fight against COVID-19 disease, the intention to adopt CPBs increases and more CPBs are adopted and vice versa. If people find the implementation of CPBs easier and more feasible, they will adopt CPBs more. Das et al. (2021) and Kim et al, (2022) reported that the PBC construct was the strongest predictor of social distancing intention and behavior and mask use among women, respectively [27, 30]. Studies' results were consistent with the present study. Shubayr et al. (2020) found PBC insignificant in predicting intention and CPBs [31], which was inconsistent with this study’s results. The paradox may be due to the PBC concept, which includes many various factors, but may not have been considered in the study and relies on behavior facilitators or barriers. Neglecting these factors may explain the varying results.
In the field of ATD, Results showed that belief in CPBs led to increased compliance. By boosting awareness of CPBs, people are more mentally prepared and accepting of these activities. In CPB studies, ATD is an effective predictor of behavior, fully mediating the intention-behavior link. According to Kim et al. (2022), ATD was the best predictor of men's mask usage intentions for COVID-19 prevention [30]. As found by Duan et al. (2022), ATD significantly predicts social distancing, mask use, and hand hygiene behavior and intention [32]. It is suggested that strategies related to improving the ATD construct including group discussion and role-playing, should be included in all interventions designed and implemented to improve the level of intention and CPBs. Therefore, to increase CPBs adoption, highlight their positive outcomes through group discussions and role-playing.
SN, as another construct of TPB, predicted intention and CPBs. If a person perceives approval from loved ones, healthcare staff, and influencers, he/she is more likely to perform CPBs. Sun et al., (2021), Iwaya et al., (2020), and Trifiletti et al., (2021), reported that SN construct was the strongest predictor of mask use intention, social distancing intention, and frequent hand washing in preventing the COVID-19, respectively [25, 33, 34]. SN was not a predictor of social distancing intention, according to Thacker et al. (2022) [35], which was inconsistent with the findings of the current investigation. The inconsistency may be due to a disconnect between perception and reality, and population factors.
This study's strengths included comparing the HBM and TPB's predictive power for CPBs (social distancing, masks, hand hygiene), designing a construct-based questionnaire for CPBs, and assessing its validity/reliability. One of the limitations of the present study was the nature of self-reporting and online completion of the questionnaire, which affected the reliability of the data. By using the necessary measures to increase maximum anonymity and gain the trust of research units, we tried to increase the accuracy of self-report findings.