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Assessing Preventive Health Behaviors from COVID-19: a Cross Sectional Study with Health Belief Model in Golestan Province, Nort

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Assessing Preventive Health Behaviors from COVID-19: a Cross Sectional Study with Health Belief Model in Golestan Province, Nort Shahnazi et al. Infect Dis Poverty (2020) 9:157 https://doi.org/10.1186/s40249-020-00776-2 SHORT REPORT Open Access Assessing preventive health behaviors from COVID-19: a cross sectional study with health belief model in Golestan Province, Northern of Iran Hossein Shahnazi1, Maryam Ahmadi‑Livani2, Bagher Pahlavanzadeh3, Abdolhalim Rajabi4, Mohammad Shoaib Hamrah5 and Abdurrahman Charkazi4,6* Abstract Background: Coronavirus disease 2019 (COVID‑19) is a new viral disease that has caused a pandemic in the world. Due to the lack of vaccines and defnitive treatment, preventive behaviors are the only way to overcome the disease. Therefore, the present study aimed to determine the preventive behaviors from the disease based on constructs of the health belief model. Methods: In the present cross‑sectional study during March 11–16, 2020, 750 individuals in Golestan Province of Iran were included in the study using the convenience sampling and they completed the questionnaires through cyberspace. Factor scores were calculated using the confrmatory factor analysis. The efects of diferent factors were separately investigated using the univariate analyses, including students sample t‑test, ANOVA, and simple linear regression. Finally, the efective factors were examined by the multiple regression analysis at a signifcant level of 0.05 and through Mplus 7 and SPSS 16. Results: The participants’ mean age was 33.9 9.45 years; and 57.1% of them had associate and bachelor’s degrees. Multiple regression indicated that the mean score± of preventive behavior from COVID‑19 was higher in females than males, and greater in urban dwellers than rural dwellers. Furthermore, one unit increase in the standard deviation of factor scores of self‑efcacy and perceived benefts increased the scores of preventive behavior from COVID‑19 by 0.22 and 0.17 units respectively. On the contrary, one unit increase in the standard deviation of factor score of per‑ ceived barriers and fatalistic beliefs decreased the scores of the preventive behavior from COVID‑19 by 0.36 and 0.19 units respectively. Conclusions: Results of the present study indicated that female gender, perceived barriers, perceived self‑efcacy, fatalistic beliefs, perceived interests, and living in city had the greatest preventive behaviors from COVID‑19 respec‑ tively. Preventive interventions were necessary among males and villagers. Keywords: COVID‑19, Health belief model, Fatalism, Preventive behavior, Iran Background On January 30, 2020, Te World Health Organization’s Emergency Committee considered it as a global health *Correspondence: [email protected] 4 Faculty of Health, Environmental Health Research Center, Golestan emergency due to its signifcant growth, and declared it University of Medical Sciences, Gorgan, Iran to be a pandemic in March 2020 [1]. Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Shahnazi et al. Infect Dis Poverty (2020) 9:157 Page 2 of 9 SARS-CoV-2 has a genetic similarity of 96% to corona susceptibility), the seriousness of risk (perceived sever- virus originated from bats [2]. Early symptoms of SARS- ity), existence of a way to reduce the incidence or sever- CoV-2 are related to coronavirus disease 2019 (COVID- ity of disease (perceived benefts), and higher costs versus 19) that occurs with pneumonia symptoms. Recent the benefts of action (perceived barriers), and thus they reports indicate gastrointestinal symptoms and asympto- participate in screening and prevention activities based matic infections, especially in children [3]. Its incubation on the evaluation of these factors [12, 13]. During the period is with mean of 5 days and median of 3 days and outbreak of COVID-19 pandemic, large epidemiologi- a range of 0–24 days [2, 4]. Clinical manifestations of the cal study found that high frequency of wearing masks disease usually occur within less than a week. Te symp- regardless of the presence or absence of symptoms was toms include fever, cough, nasal infammation, fatigue, signifcantly associated with lower anxiety and depres- and other signs of upper respiratory tract infection [4]. sion levels [14]. Better hygiene practices and avoidance A feature of the SARS-CoV-2 is its high virulence. of sharing utensils during meals were signifcantly associ- Results of the recent study on 425 patients indicated ated with lower psychological impact, depression, anxi- that the number of patients doubled per week in the cur- ety and stress at outbreak and 4 weeks after the outbreak rent pandemic; and each patient infected 2.2 individuals [15]. on average [5]. Analysis of recent results from the early Given the pandemic and spread of SARS-CoV-2, the stages of the outbreak also indicated that the rate ranged observance of preventive health standards and behaviors from 2.2 to 3.58 individuals [6]. in society is essential to better control the disease. Tere- In Iran, the frst case was reported in Qom on February fore, the present study was conducted to determine the 19, 2020, and then it spread to other regions of Iran. Until preventive health behaviors from COVID-19 based on April 10, 2020, 66 220 individuals had the disease and the health belief model among people in Golestan Prov- 4110 died in Iran [7]. Te disease has been reported in ince in March 2019. 197 countries so far; and 1 521 252 cases of coronavirus were reported worldwide until April 10, 2020 according Methods to Johns Hopkins University. 92 798 of the patients died Procedure from the disease. Iran ranks sixth after China, Italy, the Te present cross-sectional study was conducted in a United States, Spain and Germany [8]. population of over 18 years of age in Golestan Province No vaccine or defnitive treatment has been found for in northern Iran from March 11 to 16, 2019. Te par- the disease so far, and the treatments are symptomatic ticipants were selected using the convenience sampling and supportive. Washing hands regularly with soap and and they completed the electronic questionnaire. Gener- water, covering mouth and nose when coughing and alities of the research were approved in Research Coun- sneezing, and not touching the nose, mouth and eyes, cil of Golestan University of Medical Sciences and the wearing face masks, social distancing and good ventila- National Ethics Committee in Biomedical Research with tion are the only ways to prevent the spread of COVID- a code of IR.GOUMS.REC.1398.384. Te questionnaire 19 [9]. Each person is the most important factor in was forwarded via the virtual networks in Telegram and promoting health; and the right or wrong behaviors are WhatsApp groups and channels, and the individuals were infuenced by the individuals’ beliefs, values, tendencies, asked to optionally complete it and forward it to their and habits [5]. Sociologists, psychologists, and anthro- friends and acquaintances. Te approximate time to com- pologists have proposed a range of diferent theories plete the questionnaire was about ten minutes, and it frst and models to explain the factors infuencing the health started with an explanation of the research objectives. behavior, one of which is the health belief model (HBM). Tis model is introduced by Rosenstock et al. and is a Measures general conceptual framework and theoretical guideline Te research tool included a questionnaire consisting of for health behaviors in the public health research, and it fve sections, including demographic questions, health consists of constructs, namely the perceived susceptibil- belief model construct questions, fatalism questions, ity, perceived severity, perceived benefts, perceived bar- clinical symptom recognition questions, and questions riers, cues to action, and preventive health behaviors [10, on the preventive behaviors from COVID-19. 11]. Te general acceptance and popularity of the health belief model is due to its high predictive power [11]. Te 1 Demographic questions: Te section provided ques- model is designed to explain the reasons why people do tions about age, gender, education, place of residence not participate in the prevention program and is based (city or village) and city of residence. on the hypothesis that the individuals’ preventive behav- 2 Questions about health belief model constructs, ior is afected by their beliefs in being at risk (perceived including six sections (questions about perceived sus- Shahnazi et al. Infect Dis Poverty (2020) 9:157 Page 3 of 9 ceptibility (three questions), perceived severity (three was calculated and stored for each variable. In the analy- questions), perceived benefts (three questions), per- ses, the goodness of ft indices, including the Root Mean ceived barriers (eight questions), sense of self-efcacy Square Error of Approximation (RMSEA), Comparative (one question), and cues to action (two questions). ft index (CFI), Tucker Lewis index (TLI), and Standard- 3 Te fatalism section included two questions. All con- ized Root Mean Square Residual (SRMR) were used to struct questions of the health belief model and fatal- judge the suitability of model.
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