Determining the predictors of preventive behaviors adopted by pregnant women against COVID-19 based on the Health Belief Model constructs: a cross sectional study | BMC Women’s Health

This study aimed to investigate the predictive factors associated with the adoption of self-care behaviors for preventing COVID-19 disease in pregnant women using the HBM. The pregnant women had a good knowledge about COVID-19 but their self-care behaviors were not favorable. It was also shown that among the constructs of the HBM, knowledge, self-efficacy, and perceived barriers were the most important predictors of adopting self-care behaviors with a variance of 24% change among the pregnant women.

Similarly, Khazaei Poor [24] reported that the constructs of the health belief model could explain 26% of self-care behaviors effective in the prevention of COVID-19.

The results of this study showed that the average score of adopting self-care behaviors in preventing COVID-19 was about 17.27, showing that self-care behaviors taken by the pregnant women to prevent COVID-19 disease were not desirable due to the high prevalence of the disease in Iran. However, some studies [25,26,27] estimated preventive function of different study groups as desirable. Given the specific physiological conditions of pregnant women, they need to pay attention to the plans and strategies adopted to care for COVID-19 disease. Considering the possible beneficial effects of adopting self-care behaviors in health-promoting and reducing the risk of the COVID-19 epidemic, it is necessary to adopt an appropriate strategy to remove possible obstacles to managing this global epidemic.

We found statistically significant correlations between self-care behaviors with knowledge and constructs of HBM except for perceived benefits. However, this correlation was reversed for perceived severity and perceived barriers, indicating that those with high scores in these constructs are less likely to engage in self-care behaviors to prevent COVID-19. This finding is consistent with the results of previous studies [3, 28].

In this study, knowledge of pregnant women about the COVID-19 and its transmission ways was high, and it was the first determinant factor in adopting self-care behaviors. During the pandemic period, people received a lot of information about the disease nature and its effects on the health and lives in various ways, such as mass media, virtual networks, and messages published by the Ministry of Health. With increasing awareness, people are more likely to do optimal self-care behaviors to prevent COVID-19 disease [24].

Perceived self-efficacy had a positive and direct effect on preventive behaviors against COVID-19. The more people feel motivated, capable, and hoping to succeed in fighting the coronavirus, they show more willingness to do individual health behaviors [29]. In the present study, self-efficacy was conceptualized to the extent to which a person feels that they can use self-care and preventive strategies to combat the coronavirus.

Perceived barriers construct as the third construct of the HBM was able to account for the adoption of self-care behavior. In the present study, limited access to essential personal protective equipment was one of the barriers to women’s self-care behaviors. In a previous study perceived barriers was the most important construct of the HBM in predicting the behavior [30]. It should be noted that the low perceived barriers are a privilege because the individuals believe that they face fewer obstacles and fewer problems in adopting self-care and preventive behaviors. In line with the findings of this study, several studies reported the Iranian health care facilities have faced equipment and supplies management challenges in managing COVID-19 pandemic [31, 32].

Besides, the objective and psychological costs of the recommended activities are low, or they are preferable due to the benefits of the behavior. Therefore, it can be suggested that by performing a series of interventions and adopting effective policies to reduce barriers as much as possible, the possibility of adopting self-care behaviors for preventing COVID-19 increases.

Perceived severity as the fourth construct of the HBM could predict the adoption of self-care behaviors in confronting COVID-19. Perceived severity is ultimately related to the perceived threat and refers to the extent to which individuals perceive the danger and seriousness of the spread of coronavirus. This finding is consistent with the results of previous studies by Bates et al. [33], and Khazaee-Pool et al. [24]

Although the present study showed a positive and significant correlation between perceived susceptibility, perceived benefits, and cues to action in the adoption of self-care, these constructs in the model extracted from regression analysis were not confirmed as predictive constructs. In fact, if people are aware of the benefits of taking preventative behaviors, they are better prepared to take activities and they are more likely accept the mentioned behaviors. In other words, if a person believes that home quarantine and the use of personal protective equipment can reduce the risk of developing the disease or transmitting it to others, or have social benefits such as reducing treatment costs or potential costs to the health system of the country, they will be more likely to do self-care behaviors [34, 35].

In tong et al. study cues-to-action was found to be positively associated with adherence to COVID-19 precautionary measures [36]. This finding is consistent with our results. Cues to action can act as stimulus received by people from the COVID-19 outbreak. This stimulus can be in the form of a clip, news of the death of people due to COVID-19, the effects and consequences of this disease on people’s lives posted on mass media and social networks, or the advice and warnings of the staff of health centers [35, 37]. Most of the women in this study reported that the most important sources of information about COVID-19 were health workers and warnings from the Ministry of Health through the mass media. Given the importance of mass media, especially in the period of growth of new technologies and virtual networks and given the importance of non-aggregation to reduce the transfer of COVID-19, the high potentials of social media can be used for educational, awareness-raising, and behavior change purposes.

Of course, it should be noted that pregnant women’s engagement in self-care can be affected by some non-behavioral environmental factors such as the availability of facilities and preventive devices, high cost of protective equipment and disinfectants, and strategies adopted nationwide, etc. By informing the community and officials and adopting useful policies and effective interventions, it is possible to increase the adoption of self-care and preventive behaviors against COVID-19.

This study has a strong point considering that it has been demonstrated that determinants associated with self-care behaviors during COVID-19 pandemic among pregnant women. It can be used to develop future interventions that target these psychological factors related to preventive behaviors during pregnancy. The use of online surveys was considered for sampling so there is a chance of bias in selection.

Based on this, it is suggested that future interventional studies be conducted on self-care behaviors related to coronavirus. It is suggested that other studies in the field of self-care be performed with other behavioral models.