The outbreak of Covid-19 virus is a global crisis and engagement of people in preventive behavior against COVID-19 has a key role to stop chains of transmission and adherence to preventive measures can be affected by psychosocial factors. This study aimed at assessing the relationship between the level of adherence to preventive behaviors and COVID-19 related anxiety in Iranian adults.

 

In this cross-sectional correlational study, 1008 Iranian adults were selected by the convenience sampling method. The online questionnaire of Preventive Behavior against COVID-19 and the Corona Anxiety Scale was sent to research participants. Data were analyzed using descriptive and analytical statistics and SPSS 24 (SPSS Inc., Chicago, IL., USA) at a significance level of 0.05.

 

Results

Discussion

Analysis of the study data showed that the observance of preventive behaviors until mid-May was relatively acceptable and the total mean score was 19.47± 2.35. Coinciding with this study in the United States, a study of public adherence to preventive behaviors in the first week of the COVID-19 epidemic found that most people reported observance of preventive behaviors at an appropriate level [10]. In a study conducted in Iran on 240 medical students, only 5.8% of participants scored low on preventive behaviors, and the researchers cited the level of literacy and greater awareness of this group as one of the reasons for this [22].
Contrary to the results of the present study, a study in Myanmar found that only 22% of the general population's preventive behaviors were acceptable, 45% of participants washed their hands regularly, and 47% always covered their mouth and nose when sneezing or coughing, and only 34% refused to travel. In this study, the reason for the low level of preventive behaviors in Myanmar compared to other countries was the lack of public awareness of coronavirus in this country [23].
According to the results of the present study, behaviors such as observing social distance, masking in public places, not attending parties and gatherings, and not leaving home except for necessary occasions were less observed than other behaviors. In 2006, a study was conducted on the influenza epidemic and the results showed that the level of public perception of the effectiveness of preventive behavior in contracting the disease plays a key role in the observance of preventive behaviors [24]. The effectiveness of behaviors such as masking during the first months of the COVID pandemic was questionable, and health organizations and communities dealt with this contradictory issue; therefore, they can be considered as one of the reasons for weakness in this area.
In addition, qualitative studies in the UK have shown that having adequate, low-cost facilities is very effective in improving preventive behaviors during the pandemic, and during the flu in the UK, the general public due to factors such as lack of masks and disinfectants and lack of space to perform physical distance encountered problems in observing preventive behaviors [25]. Therefore, one of the reasons for the weakness in social distance and masking in public places of the present study can be similar to the study conducted in the UK and factors such as lack of facilities and lack of low-cost equipment for public use in the early stages of the disease.
Analysis of data on COVID-19 anxiety revealed that more than half of the study participants experienced moderate to severe anxiety. In countries such as China, India, Oman and Iran, several studies have examined the psychological state of the general public during the outbreak of COVID -19 and pointed to increased levels of stress, anxiety and distress in this period [14, 16, 26-28]. According to a study conducted in the first month of COVID-19's appearance in Iran, the level of anxiety experienced by the Iranian public was high and moderate, and more than the experienced anxiety of the Chinese people. In this study, factors such as the level of social support were mentioned as effective reasons for anxiety due to the disease [15].
In the present study, there was a significant relationship between the two variables of observance of preventive behaviors and anxiety caused by COVID-19 disease (r = 0.203 and P<0.001). Mean and standard deviation of scores obtained from the scale of preventive behaviors and severity of anxiety caused by COVID-19 were examined separately for demographic variables and the results showed that the mean scores were higher in women aged 50-69 years and retirees and housewives than in other groups.
In line with the present study, a study in the UK noted the positive role of cowardice-induced fear and anxiety in improving preventive behaviors such as hand washing and social distance. The authors of this study considered the existence of an appropriate level of anxiety to improve preventive performance and considered it as an effective and functional fear and anxiety; however, they noted that the experience of fear and anxiety caused by the disease in the long run may have adverse effects on preventive behavior and lead to fatigue and anxiety and psychological crises [29]. In most studies, fatigue due to long-term anxiety is somehow mentioned as an effective factor in not observing preventive behavior [17]. Also, in line with the present study, in several studies conducted during the pandemic in different countries, the results confirmed that the anxiety caused by the disease in women and the elderly was more than other groups [29, 30].
 
 

Conclusion

Being aware of the general state of preventive behavior of the general public and their experienced anxiety about the disease and identifying at-risk individuals, health policy makers can, shift disease control planning to a greater emphasis on less observed behaviors and positively induce disease anxiety and improve preventive behaviors.

 

Acknowledgments

This study was the result of a project approved by the Student Research Committee of Babol University of Medical Sciences under the number IR.MUBABOL.REC.1399.172. We would like to thank all the officials of Babol University of Medical Sciences who have contributed to the approval of this project, as well as all the participants in the research.

 

Conflicts of Interest

The authors declared no connflict of interest.