@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2020;7(3):221-227

Background
…[1-4]. Chinese media reported the first death from the novel COVID-2019 on 11 January 2020. The disease is currently prevalent in most countries of the world as well as it has spread rapidly in Iran [5].
Previous Studies
…[6-12]. Healthcare workers have direct contact with coronavirus-infected patients and healthy individuals, so ensuring the safety of employees is necessary not only to protect them against the virus but also to prevent the spread of the virus in society [13]. …[14]. Evidence reveals that accurate identification of determinants and protective measures requires the use of patterns and theories of behavior change [15]. According to studies, fear-motivating theories are the most popular theories to examine barriers of proper health behaviors, and the description of the behaviors [16, 17]. The theoretical framework of the Extended Parallel Process Model (EPPM), as one of the fear-motivating theories, is based on the fact that people choose one of the two ways against risk factor and threat, according to their self-efficacy abilities and risk analysis; A) Risk control: It is when the perceived level of efficiency of the person is higher than the perceived threat, such a situation allows the person to take precautionary action against the risk factor and B) fear control: It is when the level of perceived threat is more than the perceived efficiency, which causes to adopt a passive mechanism by a person faced with danger and neglected the preventive behaviors [16, 17].
Aim(s)
The aim of this study was to determine the prevention behaviors status of Covid-19 infection and related beliefs among healthcare workers in Hamedan province using the Extended Parallel Process Model (EPPM].
Research type
This is a cross-sectional descriptive study.
Research society, place and time
This study was carried out on healthcare workers of Hamaden University of Medical Sciences in April 2020.
Sampling method and number
950 people were selected among all employees working in the health department of Hamedan University of Medical Sciences, including medical staff, healthcare workers, administrative, and service staff (about 30% of staff) by multi-stage sampling (simple random sampling). Inclusion criteria included technical staff working in the Comprehensive Urban and Rural Health Center of Hamedan and willingness to participate in the research and exclusion criteria included unwillingness of the subject to complete the questionnaire and incomplete questionnaires.
Used devices&materials
The data collection instrument was a researcher-made questionnaire by the self-report method in two parts including demographic characteristics of participants (6 questions) and constructs of the Developed Parallel Process Model. The Extended Parallel Process Model questionnaire was designed using a sample of similar studies questionnaire [11]. In this section, perceived sensitivity with 2 questions, comprehension intensity with 3 questions, perceived self-efficacy with 5 questions, and perceived response efficiency with 5 questions were measured by a Five-point scale of Likert from strongly disagree (score 1) to strongly agree (score 5). Protective behaviors against Covid-19 were also assessed using 5 questions with three options including yes always (score 2), yes sometimes (score 1), and never (score zero). In this study, the threat assessment score was estimated from the sum of perceived sensitivity and severity scores, and the coping assessment score was estimated from the sum of perceived self-efficacy and response scores. Then, in order to Standardization of the data, the total scores of threat assessment and response were divided by the number of questions in each section. Finally, the coping assessment score was subtracted from the threat assessment score. If the obtained diagnostic value was a positive number (more than zero), it indicates the role of the person in the process of risk control, and if the number was negative (less than zero), it indicates the involvement of the person in the fear control process [18]. In order to evaluate the content validity, the questionnaire was distributed among 10 health education and health promotion specialists and it was finally approved by the experts through estimating the values of content validity ratio (CVR) and content validity index (CVI) for questions. The reliability of the questionnaire was assessed using the internal consistency method between 30 healthcare workers in Hamedan city. The internal correlation coefficient (Cronbach's alpha) of the questions for perceived sensitivity, intensity, self-efficacy, response efficiency, and, protective behaviors were 0.80, 0.85, 0.88, 0.782, and 0.85, respectively. Data were analyzed using Stata 14 software through descriptive statistics and the Pearson correlation test.
Findings by Text
The average age of subjects was 37.64±8.62 years (ranging from 20-61 years), and most subjects were in the age group of 30-39 years. The education level of most employees was a bachelor's degree, and occupationally, 25.6% of employees were healthcare workers, and 21.7% were healthcare providers. The work experience means of the study population was 13.9±36.45 years. Until the beginning of the study, the training courses related to the Covid-19 were provided to 704 employees (74.1%) (Table 1).Most employees avoided touching others, washing their hands frequently with soap and water, and keeping proper distance from others, respectively, while a smaller percentage of employees wore masks and gloves (Figure 1).The status of perceived sensitivity, perceived intensity, perceived self-efficacy, and perceived response efficiencies was estimated at 76.2%, 79.5%, 81.5%, and 80.2% levels, respectively. Also, there was a positive and significant correlation between perceived self-efficacy structures with perceived response efficiency and between perceived intensity with self-efficacy (p<0.01; Table 2).Among 950 healthcare workers, 437 subjects (46.0%) were in the process of perceiving risk, and 513 subjects (54.0%) were in the process of perceiving fear. Among the beliefs associated with perceived sensitivity in the threat assessment, the belief that "there is a risk of developing the disease at all ages" was more common. Also, among the beliefs related to perceived severity, the belief that "Coronavirus can infect many people in the community in the short term" was the most common (Table 3).In coping assessment, among the beliefs related to perceived self-efficacy, the belief "I can avoid handshake with clients after each contact" was the most common, and the belief "I can use the mask consistently in the workplace" was less common. Also, among the beliefs related to the effectiveness of the perceived response, the belief "disinfecting surfaces and equipment prevents the spread of coronavirus" and the belief "protected contact with the patient helps prevents coronavirus infection" had the most and less frequency, respectively (Table 4).
Main comparison to the similar studies
In this study, the behaviors of avoiding handshake with others, frequent handwashing with soap and water, and observing social distance with others had the highest frequency and were in favorable conditions. The results of a study by Nega et al. Showed that 30.8% of Hong Kong health workers had received the vaccine at the time of the seasonal Influenza prevalence [19]. Prevention of Influenza was reported in 48% of Irish healthcare staff [20]. In other studies, protective behaviors against diseases and injuries in the workplace were reported undesirable among healthcare workers and students, such as nurses and physicians [15, 21, 22]. These findings are not consistent with the results of this study. In the present study, the behaviors of continuous use of masks and gloves in all procedures with the frequency of 57.2% and 59.7%, respectively, had less frequency. …[23-25]. However, contrary to the results of this study, the findings of Rajura et al.'s study showed that 82.6% of physicians and 85% of Indian nurses wore masks in their workplace during the H1N1 Flu epidemic [26]. …[27]. Examining the main assumptions of the Developed Parallel Process Model in the present study showed that more than half of health workers are on the path to fear understanding in coping with Covid-19 disease. In other words, the subjects were not in a favorable situation in terms of coping assessment, while their perceived threat was assessed in a relatively favorable situation. The results of this study are consistent with the findings of most of the studies conducted using the Developed Parallel Process Model and the theory of protection motivation on the topics of behaviors and health risks [28-3].
Suggestions
Investigating the effective factors on the performance of protective behaviors against Covid-19 in other target groups, including public is suggested by the authors.
Limitations
One of the limitations of this study is the evaluation of behavior by self-report method, which can cause bias and misrepresentation of data.
Conclusions
The rate of protective behaviors against Covid-19 is at a relatively good level. More than half of healthcare workers are afraid of Covid-19 infection. In other words, the employees under study are not in a favorable situation in terms of coping assessment, while their perceived threat is in a relatively favorable situation.
Acknowledgments
This study was approved by the Research Council of Hamedan University of Medical Sciences (registration number: 9812209844) and was carried out with the support of the Vice-Chancellor for Research and Technology. The authors also thank all participants in this study.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This study is approved by the Research Council and the Research Ethics Committee (Ethics ID: IR.UMSHA.REC.1398.1093 )of Hamadan University of Medical Sciences.
Funding Sources
The financial resources of this research have been provided personally.

TABLES and CHARTS

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