key: cord-0881086-8c5iji3y authors: Barati, Majid; Bashirian, Saeed; Jenabi, Ensiyeh; Khazaei, Salman; Karimi-Shahanjarini, Akram; Zareian, Sepideh; Rezapur-Shahkolai, Forouzan; Moeini, Babak title: Factors Associated with Preventive Behaviours of COVID-19 among Hospital Staff in Iran in 2020: An Application of the Protection Motivation Theory date: 2020-04-28 journal: J Hosp Infect DOI: 10.1016/j.jhin.2020.04.035 sha: 27f903993a5d8596a9448d238e1a5bf27d365259 doc_id: 881086 cord_uid: 8c5iji3y Abstract This study was conducted for predicting preventive behaviours of healthcare workers (HCW) towards Covid-19 based on the Protection Motivation Theory (PMT). This cross-sectional and analytical study was conducted on 761 HCW in Hamadan, Iran, using multi-stage random sampling. The preventive behaviours against COVID-19 among HCW were assessed at a relatively desirable level. Based on the PMT, threat and coping appraisal were predictors of protection motivation to conduct COVID-19 preventive behaviours (P<0.001). The intention was also predictive of COVID-19 preventive behaviours (P<0.001). Consideration of personnel's self-efficacy and their knowledge regarding the effectiveness of protective behaviours in designing staff training programs are recommended. A novel coronavirus (now designated SARS CoV 2) was first reported in Wuhan, Hubei 19 province, China, in December 2019 [1] . The COVID-19 pandemic has since reached an Experts also believe that one of the reasons for the failure of educational programs is the lack of 32 attention to analytical studies and their inability to consider psycho-social models as an intellectual 33 framework in educational planning. Among the theories that have been used in various studies to 34 predict protective behaviours is the Protective Motivation Theory (PMT) [5] . Considering the importance of identifying the determinants of the preventive behaviours of 1 COVID-19 in HCW in the design and implementation of preventive programs, this study was 2 conducted for predicting the preventive behaviour of HCW towards COVID-19 based on the PMT. The present cross-sectional and analytical study was conducted in five teaching hospitals of the 5 Hamadan City, the capital of Hamadan Province, affiliated to Hamadan University of Medical 6 Sciences in March 2020. The study population was 25% of hospital staff, selected through multi-7 stage sampling (sequence of Stratified-simple random sampling) to participate in the study. All (strongly agree). The construct perceived susceptibility was assessed by two items, i.e., "It is 17 unlikely that I will be infected with the coronavirus." The perceived severity was assessed by three 18 items, i.e., "Coronavirus disease can lead to death." The perceived self-efficacy was assessed by 19 five items, i.e., "I can use the mask constantly in my work environment." The response efficacy was 20 assessed by five items, i.e., "Disinfecting surfaces and equipment prevent coronavirus." The 21 response cost was evaluated by two items, i.e., "I feel that protecting yourself against coronavirus 22 is time-consuming." And finally, the protection motivation (behavioural intention) was assessed by 23 one item, i.e., "I intend to observe the recommended precautions until the end of the coronavirus 24 epidemic". According to the theoretical assumptions, the threat appraisal score is the sum of the 25 perceived susceptibility and severity scores. Also, the coping appraisal score is the sum of the self-26 efficacy and response efficacy scores minus the response cost score. COVID-19 preventive behaviours were measured by five items rated by a 3-point Likert scale 28 ("always," "sometimes," and "never," scored '2,' '1,' and '0,' respectively). The validity of the 29 questionnaire was confirmed using the viewpoints of 10 health education experts. The reliability of 30 the questionnaire was investigated by calculating internal consistency. Correlation between BMT components was assessed by Pearson's correlation coefficient. The mean 32 of threat and efficacy score were compared according to demographic characteristics using t.test 33 and ANOVA. A univariate linear regression analysis was performed to screen potentially significant determinants of intention and behaviour. All statistical analyses were conducted in 1 STATA version 14 with a significant level of less than 5%. Table I ). The response cost (57.8%) and intention (84.25%) had the lowest and 11 highest percentage of the mean from the maximum obtainable score among structures of the model. Protective behaviours of HCW against COVID-19 showed that wearing a glove for all procedures 13 (43.3 %) and using a face mask at any time (51.8%) were the least frequent preventive behaviours. 14 7.9% and 3.7% of participants never used gloves or a mask during patient care, respectively. 87% In Table II, . The lower levels of PPE declared in our study may be attributable to low levels of 7 awareness, no habit of mask and glove wearing, perception that they interfere with performing 8 tasks, lack of time, and lack of understanding of the importance of observing health and safety 9 principles. 10 As the most important hypothesis of the PMT, as well as the most important hypothesis of the 11 present study, the results showed that both threat appraisal and coping appraisal predicted 12 behavioural intention. In other words, according to the hypothesis of the PMT that suggests two 13 decisions process to engage or not engage in health-related behaviours, the threat appraisal 14 components have a higher ability to predict the behavioural intention. Huang et al. showed that 15 emotion-focused and problem-focused responses were predicted coping strategies of nurses and 16 nursing students at the time of COVID-19 outbreaks, which is consistent with the results of the 17 present study [10] . 18 This study showed that HCW were not at a desirable level of perceived efficiency; rather, their 19 assessed perceived threat was relatively at a desirable level. As a result, 35.5% of participants were 20 on the fear control path. Considering the assumptions of the PMT, first, the threat is assessed in 21 terms of severity. Next, by increasing the perceived threat, a second evaluation is motivated on the 22 effectiveness of the recommended strategies. In this situation, in addition to evaluating the 23 effectiveness of recommended strategies, the individuals also evaluate their level of effectiveness. When the threat is not considered seriously (low perceived susceptibility and severity), there is a 25 low motivation to focus on the subject, making people superficially evaluate the effectiveness of 26 recommended strategies. In other words, if people do not grasp the threat and do not understand its 27 severity, they will easily ignore the relevant available information. In contrast, similar to the 28 findings of the present study, despite the perceived threat, when people find the recommended 29 strategy ineffective with low self-efficacy, or find themselves unable to act against the 30 recommended strategy and to prevent a serious threat, the fear control process will prevail over the 31 danger control process [5] . Considering the findings of the present study, increasing the perceived 32 efficacy of protective behaviours against COVID-19 by HCW is recommended as an educational 33 priority. One of the limitations of this study is that evaluating behaviour by self-reporting can cause bias and 1 misrepresentation. Furthermore, the reluctance of some members of the research community to 2 participate in the study was another limitation. However, the findings showed that protective 3 behaviours against COVID-19 were at relatively favourable levels among HCW. HCW are 4 expected to be at the highest level of threat and efficiency and experience the process of danger 5 control. Therefore, future training programmes must consider the level of self-efficacy of HCW and 6 increase their knowledge regarding the effectiveness of recommendation strategies to perform 7 protective measures against the COVID-19. 8 Table I Mean, SD, percentage, range of scores and Pearson correlation coefficients among the constructs of PMT (n=761) Clinical features of patients infected with 2019 19 novel coronavirus in Wuhan MERS transmission and risk factors: a systematic review World Health Organization. Coronavirus disease (COVID-19) technical guidance: Surveillance and 25 case definitions /technical-guidance/surveillance-and-case-definitions (available at Protection Motivation Theory Determinants of Health Behavior: Personal and Social) Testing an integrative theory of health 31 behavioural change for predicting seasonal influenza vaccination uptake among healthcare workers Prediction of preventive behaviors of the needlestick 1 injuries during surgery among operating room personnel: Application of the health belief model Patterns of Healthcare Workers: Implications for Infection Prevention and Control A Study of the Swine Flu (H1N1) Epidemic Among 7 Health Care Providers of a Medical College Hospital of Delhi Emotional responses and coping strategies of nurses and nursing college 10 students during COVID-19 outbreak 9 We would like to thank the Hamadan University of Medical Sciences for the support of this study. The authors report no conflict of interest.