The role of risk perception, risk communication, and demographic factors in COVID-19 preventive behaviors: an online survey in Iran

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Osong Public Health Res Perspect. 2022;13(4):282-289

Publication date (electronic) : 2022 August 31

doi : https://doi.org/10.24171/j.phrp.2021.0345

Mansour Rezaei¹, Nader Rajabi Gilan¹, Ali Almasi¹, Mehdi Khezeli¹, Fatemeh Jamshidi Nazar², Zahra Jorjoran Shushtari³, Yahya Salimi^,1, Farid Najafi⁴, Neda Sarabi⁵, Shahram Saeidi¹, Saeid Saeidi¹

¹Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran

²Kermanshah Office of Education, Kermanshah, Iran

³Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

⁴Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran

⁵Department of Sport Management, Faculty of Sport Science, Razi University, Kermanshah, Iran

Corresponding author: Yahya Salimi Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Laleh alley, Shahid Beheshti Blvd, Kermanshah 67146-49115, Iran E-mail: salimiyahya@yahoo.com

Received 2022 January 15; Revised 2022 May 23; Accepted 2022 August 1.

Abstract

Introduction

The World Health Organization declared a global public health emergency in January 2020 following the rapid and sudden outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. According to statistics, SARS-CoV-2 spread faster in some parts of the world than in others [2]. Iran is still among the leading countries in the Eastern Mediterranean region in terms of the total number of cases and deaths due to coronavirus disease 2019 (COVID-19) [3].

The rapid transmission and unknown aspects of COVID-19, as well as the lack of definitive treatments, have posed serious challenges for disease control [4]. Personal protection measures (e.g., face mask wearing, hand washing, and personal hygiene), travel restrictions, and physical distancing can help reduce the risk of infection and control the spread of disease [5]. People’s willingness to participate in self-care plays an important and decisive role in implementing the preventive guidelines recommended by public health authorities. However, encouraging the public to take preventive measures and receive vaccinations remains a problem for health [6]. Assessing the people's perceptions, beliefs, and behavioral responses during epidemics can provide useful information for effective risk communication and successful changes in health behaviors [7].

The lack of attention to scientific analyses, the inability to explain the role of psychosocial patterns, and the lack of appropriate models and theories are some reasons for the failure of national health programs [8]. The health belief model (HBM) aims to explain preventive behaviors, for which the issue of risk perception has been discussed. According to the HBM, to perform a health behavior, people must first feel their vulnerability to the problem (in this case, COVID-19), and then perceive the physical and mental severity of the danger [9]. Risk perception, which is a mental judgment that people make about the characteristics and severity of a risk, is influenced by psychological factors and environmental and social conditions [10]. Understanding the risk of disease can greatly affect the care process and have a significant impact on changing behaviors and lifestyles [11]. According to the protection motivation theory, the adoption of protective measures in individuals is significantly affected by their level of risk perception. This theory suggests that perceptions of the severity of a health threat and vulnerability to that threat determine the degree of risk perception [12]. Evidence shows a moderate correlation between risk perception and health behaviors [13], and research has found that people who are cautious in dangerous situations make more rational decisions [14]. Studies have also shown that attention to health warnings provided by the media is a factor affecting risk perception in society [15].

Health communication is an essential tool for achieving public health goals, facilitating and supporting behavioral changes, and reducing health inequalities [16]. Risk communication is a key concept in health communication to increase understanding of health threats and support people in making informed decisions to reduce risks [17]. Risk communication involves the effective and accurate exchange of information about health risks during a crisis or emergency condition that promotes risk awareness and health protective behaviors among individuals, communities, and institutions [18]. Risk communication is also effective both for limiting mortality and for minimizing damage to the national economy and public health infrastructure [1].

Previous studies have suggested that the level of attention to health warnings about COVID-19 from state-owned media and social media is an important issue [19−21]. Strengthening health messages during a pandemic can increase the role of health communication and media attention. EffectiveRisk communication means that all related risk messages can be presented and shared openly and in a timely manner with the aim of bridging the knowledge gap between informants and the recipients of messages [22].

In this study, we consideredrisk communication as the level of attention to health warnings about the negative effects of COVID-19 and its role in preventive behaviors [23]. The study by Heydari et al. [24] showed that risk communication has direct and indirect positive effects on preventive behaviors. Since few studies have been conducted in Iran on the relationships of risk perception and risk communication with preventive behaviors, the present study was conducted to investigate COVID-19 preventive behaviors and its related factors in western Iran.

Materials and Methods

Results

The total number of participants in this study was 2,155. Among the respondents 61.4% were women, 32.3% were single, and 76.3% had a university education. More than half of the respondents lived in a family with 4 to 6 people, and more than 39% perceived themselves as being in the middle class of SES. The mean±SD age of the respondents was 37.62±10.03 years. The mean±SD score of SES was 5.53±2.04. More than half (52%) of the respondents stated that they always paid attention to health warnings from the media. About 9% of respondents did not use gloves at all and about 40% always wore a mask. The mean±SD of the risk perception score was 24.16±3.04 (Table 1).

Table 1.

Characteristics of the study participants

The Pearson correlation test showed that risk communication had a significant correlation with COVID-19 preventive behaviors (r=0.320, p<0.01), and the association between risk communication and risk perception was moderate and positive; in other words, with increasing risk perception, risk communication also increased (r=0.445, p<0.01) (Table 2).

Table 2.

Correlations among the main variables

Multiple linear regression was used to identify factors associated with COVID-19 preventive behaviors. For this purpose, in the first step (model 1), demographic and contextual variables were entered in the model. The analysis in this section showed that demographic and contextual variables explained 4.89% of the changes in dependent variable (R²=0.0489, adjusted R²=0.0364). Among the variables included in the model, age (β=0.010), sex (β=−0.567), employment as a shopkeeper (β=−0.460), and very high SES (β=0.483) were significant determinants of preventive behaviors (Table 3).

Table 3.

Multiple regression analysis of factors associated with COVID-19 preventive behaviors, Kermanshah, Iran, 2020

In the second step (model 2), in addition to the contextual and demographic variables, Risk perception related to COVID-19 was also included. In this step, the explanatory power of the model was increased to 8.88%, reflecting a change of approximately 4 percentage points (R²=0.0888, adjusted R²=0.0762), which indicates the importance of the risk perception of COVID-19. In model 2, the variables of age (β=0.010), sex (β=−0.553), very high perceived SES (β=0.446), and risk perception (β=0.113) remained in the model (Table 3).

In the third step (model 3), risk communication was entered into the model in addition to the variables of model 2. The new analysis showed that the sum of the variables in model 3 explained 14.23% (R²=0.1423, adjusted R²=0.13) of variance in preventive behaviors toward COVID-19. Sex (β=−0.482), risk perception (β=0.047), andrisk communication (β=0.662) remained in the final model (Table 3).

Discussion

The aim of this study was to investigate the effect of contextual and demographic variables, risk communication, and risk perception on COVID-19 prevention behaviors in western Iran.Risk communication had a direct effect on preventive behaviors that was greater in magnitude than the other variables included in the regression model. This finding is consistent with the study by Heydari et al. [24], who similarly emphasized the role ofrisk communication in COVID-19 preventive behaviors. Studies on the mechanism of the relationship between risk communication and individual performance and adopting appropriate strategies have emphasized the following steps: (a) receiving a warning message (b) understanding the relevant content, (c) accepting and believing the importance of the existing message, (d) confirming the truth of their interpretations with other people, and (e) acting in response to save lives [25].

Risk communication plays an important role in effectively communicating, supporting public needs, and carrying out preventive measures in stressful situations and epidemics [26,27]. Understanding how people interpret risk, and especially how people use risk information to make important decisions about health behaviors, is effective for preventing disease [28]. It is important to identify the factors that are likely to lead to behavior change because ignoring audience perceptions can ultimately promote destructive and high-risk behaviors for health [29]. Risk communication is one of the most important components related to health that can enhance correct perceptions of risk and reduce the risk of harm through preventive behaviors [30].

Another finding of this study was the direct effect of risk perception on COVID-19 preventive behaviors. This finding was consistent with the study of Heydari et al. [24], although the effect of risk perception in their study was greater than that observed herein. It seems that increasing risk perception and engaging in protective behaviors are effective ways to moderate the risk factors of the disease [31]. The results of a prior study showed an association between increasedrisk perception and increased protective measures [12]. According to other studies, increasing risk communication can enhance risk perception and subsequently, increase protective behavior [32,33].

One of the important results of this study was the significance of age and sex variables in all 3 regression models. The results of this study showed that age had a positive and significant effect on COVID-19 preventive behaviors. This finding is inconsistent with the study by Khazaee-Pool et al. [34] in Iran, but Tabibi et al. [35] showed that older participants had adapted more to COVID-19 preventive measures. Other studies have also shown more positive intentions to follow preventive measures in older individuals [36,37]. The elderly are at a significantly higher risk of morbidity and mortality due to COVID-19. Observance of COVID-19 preventive behaviors at older ages seems to be directly related to the degree of their vulnerability and risk perception [38].

Regarding sex, several studies have shown sex differences in preventive behaviors to avoid the spread of disease. For example, women are more likely than men to observe social distance and personal hygiene [39,40], which is consistent with our study. Fard et al. [41] in Iran showed that the sex variable explained 9% of variance in self-care behaviors associated with COVID-19. Firouzbakht et al. [42], in a study in Iran, showed that women generally had better preventive behaviors. In a meta-analysis, Moran and Del Valle [43] showed that women are more likely to avoid crowds and physical contact with others to prevent respiratory diseases. They also showed that women engage in more preventive behaviors than men to adapt to new conditions. These results indicate an inherent difference in how men and women respond to respiratory diseases and epidemics.

Another noteworthy result of this study was the effect of SES on COVID-19 preventive behaviors. In our study, in model 1 and model 2, having a very high subjective SES had a positive and moderate effect on COVID-19 prevention behaviors, but in model 3, the effect of subjective SES was not significant with the entry of risk communication. Some studies [42,44] have emphasized the role of SES in preventive behaviors, which is consistent with the results of models 1 and 2 in this study. Although evidence has shown that SES is among the strongest predictors of individual morbidity and mortality [45,46], in this study, the inclusion of risk communication removed SES from the final model.

Conclusion

This study showed that risk communication, risk perception, female sex, and older age were significant determinants of COVID-19 preventive behaviors. It seems that strengthening appropriate and timely programs and messages through mass media would likely be effective for preventing high-risk behaviors for COVID-19 in Iran. Paying attention to health warnings in the COVID-19 pandemic plays a role beyond all economic, social, and cultural factors and diminishes the effects of those factors. In general, based on the findings of this study, the importance of media and messages should be acknowledged as an important and influential source of preventive behaviors beyond SES.

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