The present research aimed to predict the adoption of COVID-19 preventive behaviors based on the Protection Motivation Theory among Hormozgan residents, those above 15 years of age. The results revealed that maladaptive behavior rewards, response efficacy, self-efficacy and fear predicted the protective behaviors. Among these constructs, self-efficacy was the strongest predictor. The mean score for COVID-19 preventive behaviors in the target population was above the average. This can be due to the adequate awareness-raising and management of the disease. Among preventive behaviors, avoiding unnecessary travel, avoiding kissing/shaking hands and wearing masks showed to be the most prevalent preventive behaviors.
Moreover, the results showed a statistically significant correlation between age and protective behavior of the disease. The higher the age, the higher the frequency of adopting protective behaviors. This can be due to a higher awareness and perceived threat at the higher age. Older people are more prone to background diseases, which can be a reason for more protection too. Perceived severity is dependent on age, and is higher among the elderly than the youth (27).
The present finding is consistent with some similar research about unsafe driving in Yazd (28), which showed that a higher age is associated with more protective behaviors. Yet, the results reported by Lowe et al. among Australian university students showed that a higher age was followed by fewer protective behaviors against sunlight (22). This is divergent from the present finding and the reason can be the different cultures and protective behaviors binvolved. As the results showed, it is essential to plan for the youth’s awareness-raising and to encourage them to adopt more protective behaviors.
The overall score showed statistically significant differences for preventive measures and education levels. Those holding a Bachelor’s degree or higher adopted more protective behaviors, which can be due to their higher level of knowledge. It is, thus, necessary to plan for making the required interventions to raise the awareness of less educated residents of the province.
The results also showed that women adopted more preventive behaviors than men. Several other studies in other ethnicities also confirmed such differences between male and female in terms of health beliefs and healthy behaviors. These findings show that certain gender-specific plans need to be made to reinforce preventive behaviors for COVID-19.
Pearson’s correlation coefficients showed statistically significant positive correlations between preventive behavior and perceived severity, vulnerability, response efficacy, self-efficacy and protection motivation. Significant negative correlations were found between behavior and perceived reward and costs. These are consistent with a number of studies(21, 29).
The present findings also revealed that COVID-19 preventive behavior was significantly and positively correlated with perceived vulnerability. This finding shows that if people perceive themselves vulnerable to the disease, they adopt more protective behaviors. These findings are consistent with the results reported by Babazadeh et al (30) and Mohammadi et al (31).
The present research also found that protective behaviors and perceived severity were positively and significantly correlated. Thus, if people are made aware of the health consequences of the disease, they adopt more protective behaviors. This is in agreement with Tazval et al (32) yet different from Hadi et al (33).
A statistically significant positive correlation was also observed between perceived vulnerability and severity of the disease. This finding is consistent with a number of studies including Barati et al (34)., Zare et al (21) and Park et al(35). These findings show that for a better perception of the risk of affliction with the disease, a higher level of perceived vulnerability is needed, as such a perception can strongly and positively affect the perceived threat of COVID-19.
A statistically significant positive correlation was found between perceived response efficacy of preventive behaviors and self-efficacy and protection motivation. This shows that an increased perception of the effectiveness of protective behaviors is followed by an increased level of self-efficacy, and vice versa. Moreover, an increased perception of the effectiveness of protective behaviors is associated with a higher motivation for protection, and vice versa. This is consistent with Zare Sakhvidi et al.(21).
The present research also showed that COVID-19 preventive behavior was significantly and positively correlated with protection motivation. This finding diverged from that of Kaviani et al.(36).
Variables subsumed under coping appraisals were the strongest predictors of protective behaviors in the target population. Self-efficacy was the strongest predictor of the behavior. Only next was the response efficacy, similar to several other studies(21, 37) .Those enjoying a higher level of self-efficacy perceive themselves capable of making achievements. Thus, they show a tendency to preventive behaviors of the disease. Both response efficacy and self-efficacy are subsumed under coping appraisal in PMT. Response efficacy deals with the fact that the suggested coping response may be effective in lowering threat. Self-efficacy deals with the perceived capability of making a coping response. Regression coefficients of these two constructs show that a higher level of self-efficacy and response efficacy can help increase motivation for preventing COVID-19. These findings are consistent with previous studies which also adopted PMT as their theoretical framework.
Available coping strategies to participants are more effective in the frequency of adopting protective behaviors. High response efficacy strengthens their intention of self-protection and belief in the effectiveness of the protective behavior(38, 39). The effect size of coping variables or threat depends to some extent on the nature of the health issue. In the light of the related literature, threat appraisal variables showed to be the strongest predictor of cancer preventive behaviors. Yet, for smoking, coping appraisals were the strongest predictor of preventive behaviors(29). The high education level of the participants can be part of the reason for this (40). In the present research, the majority of participants were between 31 and 40 years old. This can be the main reason for the unprecedented effect of perceived severity and vulnerability in PMT and preventive behaviors. Higher self-efficacy can improve preventive behaviors in vulnerable population (41, 42). Health promotion programs with the aim of improving self-efficacy in COVID-19 preventive behaviors might improve behaviors and promote health at a social level.
Maladaptive behavior reward and fear were negatively correlated with preventive behaviors. Thus, it can be concluded that the higher the level of fear and maladaptive behavior reward, the lower the probability of adopting protective behaviors. Therefore, awareness of the rewards of maladaptive behaviors is more important than the perceived cost of healthy behaviors. This finding is consistent with the use of condom in some other research(43). However, in an investigation of cancer preventive behaviors at workplace, perceived costs showed to be more important than perceived reward (21).
In the present research, protective behaviors showed to be at a desirable level, which is consistent with some research by Barati et al about COVID-19 protective behaviors among hospital staff (34). Moreover, in the present research among preventive behaviors, avoiding unnecessary travel was found to be the most prevalent protective behavior, which seems to result from limits set by social distancing. Avoiding kissing/shaking hands and wearing masks ranked second and third among protective behaviors. In another study in Saudi Arabia on MERS, hand-wash showed to be the commonest protective behavior along with wearing masks while coughing/sneezing(44). In a study in China, the most prevalent protective behaviors included avoiding crowds, going out less frequently, wearing a mask while going out, and not entering closed and crowded places(45). Considering the fact that COVID-19 is a new-coming disease and has afflicted all countries all over the world, the information sources are constantly being updated and, thus, adopting protective behaviors at an acceptable level is not far-fetched.
As regular washing of hands is the foremost protective behavior, yet is less adopted by the target population, it seems that more extensive awareness-raising and relevant education is of an incomparable importance.
Behavioral change is a process and it takes time to initiate and develop a new behavior. According to the theory adopted in this research, coping appraisal responses that lead to protection motivation are made after the threat appraisal process. That is because a threat needs to be identified before the appraisal of coping strategies to choose from. Evidently, before things get uncontrollable, attempts should be made to improve public awareness, create mutual trust, promote effective coping responses and contribute to the achievement of plans.