Perceived Social Norms as Determinants of Adherence to Public Health Measures Related to COVID-19 in Bali, Indonesia

Autonomous and policy-induced behavior change during the COVID-19 pandemic: Towards understanding and modeling the interplay of behavioral adaptation

Changes in human behaviors, such as reductions of physical contacts and the adoption of preventive measures, impact the transmission of infectious diseases considerably. Behavioral adaptations may be the result of individuals aiming to protect themselves or mere responses to public containment measures, or a combination of both. What drives autonomous and policy-induced adaptation, how they are related and change over time is insufficiently understood. Here, we develop a framework for more precise analysis of behavioral adaptation, focusing on confluence, interactions and time variance of autonomous and policy-induced adaptation. We carry out an empirical analysis of Germany during the fall of 2020 and beyond. Subsequently, we discuss how behavioral adaptation processes can be better represented in behavioral-epidemiological models. We find that our framework is useful to understand the interplay of autonomous and policy-induced adaptation as a "moving target". Our empirical analysis suggests that mobility patterns in Germany changed significantly due to both autonomous and policy-induced adaption, with potentially weaker effects over time due to decreasing risk signals, diminishing risk perceptions and an erosion of trust in the government. We find that while a number of simulation and prediction models have made great efforts to represent behavioral adaptation, the interplay of autonomous and policy-induced adaption needs to be better understood to construct convincing counterfactual scenarios for policy analysis. The insights presented here are of interest to modelers and policy makers aiming to understand and account for behaviors during a pandemic response more accurately.

Barriers to access to antiretroviral therapy by people living with HIV in an indonesian remote district during the COVID-19 pandemic: a qualitative study

BACKGROUND

Coronavirus disease (COVID-19) pandemic has a significant influence on the access to healthcare services. This study aimed to understand the views and experiences of people living with HIV (PLHIV) about barriers to their access to antiretroviral therapy (ART) service in Belu district, Indonesia, during the COVID-19 pandemic.

METHODS

This qualitative inquiry employed in-depth interviews to collect data from 21 participants who were recruited using a snowball sampling technique. Data analysis was guided by a thematic framework analysis.

RESULTS

The findings showed that fear of contracting COVID-19 was a barrier that impeded participants' access to ART service. Such fear was influenced by their awareness of their vulnerability to the infection, the possibility of unavoidable physical contact in public transport during a travelling to HIV clinic and the widespread COVID-19 infection in healthcare facilities. Lockdowns, COVID-19 restrictions and lack of information about the provision of ART service during the pandemic were also barriers that impeded their access to the service. Other barriers included the mandatory regulation for travellers to provide their COVID-19 vaccine certificate, financial difficulty, and long-distance travel to the HIV clinic.

CONCLUSIONS

The findings indicate the need for dissemination of information about the provision of ART service during the pandemic and the benefits of COVID-19 vaccination for the health of PLHIV. The findings also indicate the need for new strategies to bring ART service closer to PLHIV during the pandemic such as a community-based delivery system. Future large-scale studies exploring views and experiences of PLHIV about barriers to their access to ART service during the COVID-19 pandemic and new intervention strategies are recommended.

Knowledge, attitudes, and practices related to COVID-19 in Indonesia: A post delta variant wave cross-sectional study

Introduction

Public information and regulations related to the coronavirus disease 2019 (COVID-19) have been widely published and continuously changed. The Indonesian government has responded to the emerging evidence by regularly updating its unprecedented and preventive measures against the transmission of COVID-19 to the public. It is important to understand how the public responded to these updates. This study aimed to investigate the knowledge, attitudes, and practices of Indonesians toward COVID-19 after the emergence of the delta variant wave.

Methods

A cross-sectional study was conducted among the adult population of non-healthcare workers in Indonesia through an online questionnaire using the SurveyMonkey platform. A total of 1,859 respondents completed this survey from September to October 2021. The knowledge, attitudes, and practices data were analyzed descriptively to find their frequency and percentage. A multivariate analysis was conducted to confirm the factors affecting the respondents' knowledge, attitudes, and practices with a p-value of <0.05 set as significant.

Results

Being female, having a higher education level, and having a higher frequency of access to COVID-19 news showed significant impacts on knowledge, attitudes, and practices (p<0.001). Older age stratification influenced the knowledge level (p<0.05) but had no significant effect on people's attitudes and practices toward COVID-19. Respondents' perceived probability of being exposed to COVID-19 (p < 0.05) and their COVID-19 infection frequency (p < 0.001) significantly influenced their knowledge. Household income and respondents' knowledge significantly affected their attitudes toward COVID-19. Furthermore, only their attitudes had a significant impact on the respondents' practices. Perceived severity, perceived susceptibility, and vaccination status did not significantly influence their knowledge, attitudes, and practices (p > 0.05).

Conclusion

After more than a year of the COVID-19 pandemic, Indonesians maintain their high level of knowledge, attitudes, and practices. COVID-19 disinformation must be combatted by strengthening authorized media, empowering communities, and improving governance among institutions during and post-pandemic.

Predictors for adherent behavior in the COVID-19 pandemic: A cross-sectional telephone survey

Background

During the COVID-19 pandemic, protective measures have been prescribed to prevent or slow down the spread of the SARS-CoV-2 virus and protect the population. Individuals follow these measures to varying degrees. We aimed to identify factors influencing the extent to which protective measures are adhered to.

Methods

A cross-sectional survey (telephone interviews) was undertaken between April and June 2021 to identify factors influencing the degree to which individuals adhere to protective measures. A representative sample of 1,003 people (age >16 years) in two Austrian states (Carinthia, Vorarlberg) was interviewed. The questionnaire was based on the Health Belief Model, but also included potential response-modifying factors. Predictors for adherent behavior were identified using multiple regression analysis. All predictors were standardized so that regression coefficients (β) could be compared.

Results

Overall median adherence was 0.75 (IQR: 0.5-1.0). Based on a regression model, the following variables were identified as significant in raising adherence: higher age (β = 0.43, 95%CI: 0.33-0.54), social standards of acceptable behavior (β = 0.33, 95%CI: 0.27-0.40), subjective/individual assessment of an increased personal health risk (β = 0.12, 95%CI: 0.05-0.18), self-efficacy (β = 0.06, 95%CI: 0.02-0.10), female gender (β = 0.05, 95%CI: 0.01-0.08), and low corona fatigue (behavioral fatigue: β = -0.11, 95%CI: -0.18 to -0.03). The model showed that such aspects as personal trust in institutions, perceived difficulties in adopting health-promoting measures, and individual assessments of the risk of infection, had no significant influence.

Conclusions

This study reveals that several factors significantly influence adherence to measures aimed at controlling the COVID-19 pandemic. To enhance adherence, the government, media, and other relevant stakeholders should take the findings into consideration when formulating policy. By developing social standards and promoting self-efficacy, individuals can influence the behavior of others and contribute toward coping with the pandemic.

Adherence to COVID-19 preventive measures and associated factors in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Reluctance to the COVID-19 preventive measures have been repeatedly reported in Ethiopia although compliance with these actions is the key step to minimize the pandemic's burden. Hence, this systematic review and meta-analysis aims to address the gap in the literature by determining the pooled magnitude of adherence to COVID-19 preventive measures and identifying its associated factors in Ethiopia.

MATERIALS AND METHODS

The electronic databases used to search articles were PubMed/MEDLINE, CINAHL, Web of Science, ScienceDirect, Research4Life and other sources of grey literature including Google Scholar and World Health Organization (WHO) database portals for low- and middle-income countries. Full English-language articles published between 2019 and 2022 were eligible for the review and meta-analysis. Relevant data extracted and descriptive summaries of the studies presented in tabular form. The methodological quality of articles assessed using the Joanna Briggs Institute (JBI) quality assessment tool. The pooled magnitude of adherence determined by applying a random-effects model at a 95% CI.

RESULTS

Of 1029 records identified, 15 articles were included in the systematic review and 11 were selected for meta-analysis. The pooled estimate of adherence to COVID-19 preventive measures in Ethiopia was 41.15% (95% CI:32.16-50.14%). Furthermore, perceived COVID-19 disease severity (AOR:1.77, 95% CI: (1.40-2.25)), attitude (AOR:1.85, 95% CI: (1.36-2.53)) and knowledge (AOR:2.51, 95% CI: (1.67-3.78)) to COVID-19 preventive measures showed significant association with adherence to COVID-19 preventive measures.

CONCLUSION

The magnitude of adherence to COVID-19 preventive measures in Ethiopia appeared to be low. Therefore, the government of Ethiopia and other stakeholders should mobilize resources to improve the adherence level of the community to the COVID-19 preventive measures and decrease public fatigue.

Determinants of observing health protocols related to preventing COVID-19 in adult women: A qualitative study in Iran

Background

The best way to prevent COVID-19 is to observe health protocols. Therefore, identifying the reasons of following these protocols in order to plan and make intervention seems necessary. Therefore, the purpose of this study was to identify the determinants of observing health protocols related to prevention of COVID-19 among the Iranian adult women with a qualitative approach.

Method

In this qualitative study, the conventional content analysis approach was used. saturation was obtained after face-to-face semi-structured interviews with 38 women from Kermanshah who were selected through purposeful sampling and snowball sampling. Guba and Lincoln criteria were used for the strength of the research and Graneheim and Lundman method was used for its analysis.

Results

After analyzing the interviews, 5 categories, 12 subcategories and 110 initial codes were obtained. Categories and sub-categories were: 1- Individual factors (personality traits, health literacy about COVID-19); 2- Perceived risk having underlying disease in oneself and family, history of getting COVID-19 and death in close relatives; 3- Fear of the destructive consequences of the disease (concern about the economic consequences of getting the disease, concern about the treatment process); 4- Social and cultural factors (social monitoring, religious insight, ability to properly manage social interactions, impressionability from important others); 5- Environmental factors (supportive living environment, access to health and anti-infective materials).

Conclusion

Increasing the adherence of adult women to health instructions related to COVID-19 requires interventions at different levels of individual, environmental and social, and without accurate knowledge of the customs and culture of a society effective interventions cannot be established.

Health Beliefs and Socioeconomic Determinants of COVID-19 Booster Vaccine Acceptance: An Indonesian Cross-Sectional Study

INTRODUCTION

The threat of new SARS-CoV-2 variants indicates the need to implement COVID-19 vaccine booster programs. The aim of this study was to identify the level of booster acceptance and its determinants.

METHODS

A cross-sectional online survey was conducted in Jakarta and Bali, Indonesia. Booster acceptance was divided into three categories: non-acceptor, planned acceptor, and actual acceptor. The primary independent variables were health beliefs, media influence, and trust in authoritative sources. Other covariates included demographics, socioeconomic status, and COVID-19 history. A primary analysis was conducted through multinomial logistic regression. The effects of the hypothetical situations on booster acceptance were tested using the Wilcoxon signed-rank test.

RESULTS

The final analysis included 2674 respondents with a booster acceptance rate of 56.3% (41.2% planned acceptors, 15.1% actual acceptors). Health beliefs, social media influence, and trust in authoritative information sources were identified as determinants for planned and actual booster acceptance. Socioeconomic status indicators were also identified as determinants for actual booster acceptance. Booster acceptance was increased in hypothetical scenarios involving booster requirements for work, travel, and accessing public places.

CONCLUSIONS

Booster acceptance was found to be lower than the predicted primary vaccine acceptance prior to its launch. The acceleration of booster coverage requires strategies that leverage health beliefs and focus on people with a lower socioeconomic status.

The Effect of Reading Leaflets During the Observation Period After Vaccination on Knowledge of COVID-19 and Vaccines Among Chinese Small Town Residents: A Randomized Controlled Trial

Background

Public health education is essential for epidemic prevention and control in the post-COVID-19 era. This randomized controlled trial (RCT) aims to evaluate the effect of reading leaflets during the observation period after vaccination on knowledge of COVID-19 disease and vaccines in Chinese small town residents and to provide suggestions for public health education.

Methods

Residents were recruited during the observation period after getting vaccinated against COVID-19 in Xidian and were randomly divided into an education group and a control group. The education group was asked to complete the questionnaire after reading a leaflet, whereas the control group directly completed the questionnaire. The questionnaire comprised two sections on COVID-19 knowledge and vaccine knowledge, and the scores were used to assess the resident's knowledge.

Results

A total of 142 participants in the education group and 154 participants in the control group were enrolled. The rates of correct knowledge in the education group and the control group were 90.7 and 83.1%, respectively. The scores of the two sections and the aggregate knowledge score of the education group were significantly higher than those of the control group (P < 0.001). The rates of correct responses to questions on clinical manifestations and transmission routes of COVID-19 and indications and contraindications of vaccines significantly increased after reading the leaflets (P < 0.05). Knowledge of different groups of genders, ages, marital statuses, education levels and occupations all improved (P < 0.05), and the 18–29-year-old and never-married group revealed a higher growth rate of correct responses.

Conclusion

Chinese small town residents have a median level of knowledge regarding COVID-19 disease and vaccines. Reading leaflets during the observation period after vaccination effectively improved their knowledge. This low-cost and efficient health education approach can be widely applied.

Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic

The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

Health Action Process Approach (HAPA) as a Framework to Understand Compliance Issues With Health Protocols Among People Undergoing Isolation at Emergency Hospital for COVID-19 Wisma Atlet Kemayoran and RSCM Kiara Ultimate Jakarta Indonesia

INTRODUCTION

This study aims to identify the psychosocial determinants and examine the mediation mechanisms of the compliance with COVID-19 health protocols among people undergoing isolation in health facilities that specifically treat COVID-19 cases in Jakarta, Indonesia.

METHODS

This is a cross-sectional study which used socio-cognitive approach, known as the Health Action Process Approach (HAPA), to understand the complexity of issues related to compliance with health protocols. A total of 1,584 subjects participated in this study, including 865 men and 719 women over the age of 18 years old during the data collection period (October 19-26, 2020). The data were collected using questionnaire that was developed by a team of experts from the Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, and survivors. The data that has been collected were then analyzed using Structural Equation Modeling, a multivariate data analysis technique.

RESULTS

The final research model in this study fulfills the criteria for a good model fit. This study found that individuals who have strong self-efficacy regarding their ability to implement behaviors and overcome obstacles will have stronger intent to comply in the future. The study also found that stronger intent will lead to stronger planning, and planning was found mediating intention and compliance with health protocols.

CONCLUSION

This research model is comprehensive and useful in understanding compliance with health protocols among people undergoing isolation in health facilities for COVID-19 (Wisma Atlet and RSCM Kiara Ultimate). Having intent (related to the risk perception, outcome expectancies, and self-efficacy) and having a plan can positively influence the behavior of people undergoing isolation, resulting in better compliance to health protocols. The understanding gained from this study can be used to improve strategies related to compliance with health protocols against COVID-19 in the communities.