The findings showed that the levels of social responsibility, pandemic awareness, and COVID-19 preventive behavior were high among Korean nursing students and that these factors were positively correlated with each other. Moreover, social responsibility and pandemic awareness were identified as factors influencing COVID-19 preventive behaviors.
The mean COVID-19 preventive behavior of Korean nursing students was 4.38 out of 5 points. Compared to previous studies that used similar measurement tools to measure the level of practicing MERS preventive behavior among nursing and medically inclined college students, the level of COVID-19 preventive behavior in the present study was higher than the level of MERS preventive behavior in previous studies. Such results may be due to COVID-19 being declared a global pandemic, whereas MERS was not declared a global public health emergency. According to the theory of planned behavior, subjective norm affects behavior. Strict strategies for social distancing were implemented by many countries; in particular, South Korea implemented even stricter measures based on its experience from the MERS outbreak. As a result, these factors may have acted as subjective norm.
However, even compared to previous studies on preventive behavior during the 2009 H1N1 pandemic, which was officially declared a pandemic, the results of the present study showed a higher level of preventive behavior. COVID-19 preventive behavior was practiced at a higher level when COVID-19 had a greater effect on daily life and among those who live in the Daegu/Gyeong-buk area. The measurement of the effect of COVID-19 on daily life was intuitive since it was measured by a single item on a 5-point Likert scale, while the Daegu/Gyeong-buk area was the region with the highest number of confirmed cases in South Korea. Such results could be interpreted in the same context as previous studies that reported that perceived concerns, anxiety, and perceived efficacy can improve preventive behavior[26, 27].
The findings of the present study demonstrated the effect of people’s perception of a situation on their preventive behavior. Existing studies on the relationship between disaster awareness and response have reported inconsistent results, such as having an influence, or being related without being an influencing factor[28, 29]. It is believed that the findings on this study are because a pandemic is a form of disaster, but it should not be overlooked that the pandemic has been perceived differently from other forms of disasters[14, 30]. Considered together with the additional analysis results from the present study, which showed statistically significantly higher pandemic awareness among students with pandemic education experience (F = 6.808, p < .01), customized education for specific disasters should be added to educational strategies suggested for disaster preparedness.
Meanwhile, social responsibility was identified as the factor with the biggest influence on COVID-19 preventive behavior in the outcome model of the present study. The mean score for social responsibility among Korean nursing students was 3.84 out of 5 points, which was higher than the score reported in previous studies on nursing students and college students in other majors. This difference could be attributed to the fact that previous studies were conducted under peacetime, whereas the present study was conducted under a disaster situation. In a qualitative synthesis study, professional values such as “responsibility to care” were discussed as a competency for infectious disease nursing. But Studies have reported that under a disaster situation, especially a pandemic, health disparity worsens according to economic level and race[33, 34]. Under such circumstances, society is demanding more social responsibility and appropriate behavior from healthcare professionals, along with a reorganization of the healthcare delivery system[36–39].
The findings in the present study showed that social responsibility had a statistically significant influence on COVID-19 preventive behavior, and thus, inclusion of social responsibility could be a practical strategy for strengthening disaster response competencies. Given the positive relationship between social responsibility and the volunteer experiences of nursing students in the current study, service-learning programs with various vulnerable populations are recommended for nursing students. Community service learning was found to be an effective pedagogical tool for health professional students to enhance their sense of social responsibility. Accordingly, providing opportunities to understand health disparity during a disaster through regular participation in volunteer programs and planning simulation programs that allow indirect experience and immersion in disaster situations could help improve social responsibility, which could ultimately be a practical educational strategy for disaster response.
On the present study, since the measured concept were limited to the individual level, there were limitations in investigating the correlations with environmental factor such as having dependents, job security, and vaccine availability, which have been reported to be factors influencing non-participation in pandemic response. Furthermore, because the study population was limited to Korean nursing students and South Korea differs from other countries with respect to pandemic experience or government response, it is necessary to consider the historical and social context when conducting and interpreting the results of studies on nursing students in other countries.