Structural equation modeling for explaining preventive health practices of rural adults in the new normal context of COVID-19 pandemic

The effects of the coronavirus disease 2019 (COVID-19) are not only limited to health, they also impinge on the social life and economy of communities around the globe. Challenges faced by developing countries such as Bangladesh were multi-factorial and its rural population was highly vulnerable in this situation due to their cultural and sociodemographic context. Preventive behavioral changes were considered the best way to fight against the virus in absence of specific treatment and vaccines. This study has tried to explain preventive health practices during the COVID-19 pandemic, and aimed to explore the causal relationships of its major determinants through structural equation modeling (SEM) based on reasoned action approach (RAA). This cross-sectional study was conducted in 2020 among 810 rural Bangladeshi respondents aged 18-55 years. Around half of the respondents showed poor knowledge, motivation and practice regarding COVID-19 and its prevention. Along with socio-demographic factors, information, attitude, motivation, and intention of the people were found to be associated with the adoption of preventive health practices. The causal model of the COVID-19 prevention behaviors was assessed and justified through SEM. The model fits well with the empirical data (GFI=0.94, CFI=0.97, NFI=0.97, RMSEA=0.05, SRMR=0.04). Intention significantly influenced COVID-19 prevention behavior directly, showing the highest effect (β=0.89, p<0.001). Attitude (β=0.83, p<0.001) and motivation (β=0.15, p<0.001) also showed significant direct effects on intention. All the predictors together explained 79.6% of the variance for COVID-19 preventive behaviors. Adequate knowledge, a positive attitude, proper motivation, and positive intention can encourage rural adults to adopt healthy behaviors against COVID-19. The theoretical model of the study effectively explained COVID-19 preventive behaviors rationally and provided a roadmap for policy-makers to formulate strategies to combat COVID-19 and any future similar pandemic. © 2023, Mahidol University - ASEAN Institute for Health Development. All rights reserved.

COVID-19 Vaccine Attitudes and Barriers among Unvaccinated Residents in Rural Northern/Central Illinois.

Background: Rural communities have lower COVID-19 vaccine uptake and poorer health outcomes compared to non-rural communities, including in rural, northern/central Illinois. Understanding community perceptions about vaccination is critical for developing targeted responses to improve vaccine uptake in rural communities and meet global vaccination targets. Purpose: This study examines COVID-19 vaccine attitudes and barriers as well as the impact of COVID-19 on specific health behaviors of residents in rural northern/central Illinois to inform efforts to increase vaccine uptake. Methods: In collaboration with community partners and local health departments, we conducted a 54-item, English-language, online questionnaire from Feb 11 to March 22, 2021; the questionnaire included the COVID behavioral questionnaire scale (CoBQ), as well as questions on intention to vaccinate, vaccination attitudes, and barriers to vaccine access. Descriptive and bivariate analyses assessed participant differences based on intention to vaccinate. Results: Most unvaccinated survey respondents (n = 121) were White (89.3%) and female (78.5%), with an average age of 52.3±14.1 years. Lack of intention to vaccinate was negatively associated with trust in the science behind vaccine development (P = .040), belief in the safety of the vaccine (P = .005) and belief that the vaccine was needed (P=.050). CoBQ scores of respondents who intended to get vaccinated differed significantly from those who did not (P<.001), showing a greater negative impact of COVID-19 on engaging in health behaviors for vaccine-hesitant participants. Conclusion: Study findings show mistrust of science and lack of confidence in vaccine safety are barriers to vaccination in rural northern Illinois residents. Similar results have been reported in low- and middle-income countries.

Does worriedness among the rural adults promote COVID-19 related awareness in Bangladesh?

People living in urban areas are usually more aware of their health issues due to the availability and accessibility of health care facilities. Several studies have illustrated anxiousness, attitudes, and perceptions among urban people during COVID-19. This research attempted to assess how worriedness among rural adults may promote COVID-19 related awareness in Bangladesh. A cross-sectional online survey of 311 respondents aged 18 or greater was conducted through Facebook focusing only on the people living in rural areas. The survey included a consent form and requested demographic as well as pandemic related information in a three-section questionnaire from the respondents. We used the chi-square test statistic for bivariate analysis and the binary logistic regression model along with some tools to validate the model to analyze the impact of worriedness on awareness. The bivariate result showed a significant association among regular hand washing ( p = . 007 ) , knowledge about the proper amount of time for washing one's hands effectively ( p = . 004 ) , rules of social distancing ( p = . 00 ) , and education level ( p = . 046 ) with our outcome variable worriedness. From our binary logistic regression model fitting, it emerged that the females ( p = .032, OR = .729) who regularly wash their hands (0R = .393, p = .023), know the rules of social distancing for "yes" (0R = 14.525, p < .01), and "no" groups (0R = 5.518, p < .01), and age groups (18-27, 28 to 37, 38 to 47) were more worried. Results from our modeling justify an accuracy of 73.08%, a sensitivity of 93.71%, and a specificity of 29.33% with Cohen's kappa statistic = .2716, suggesting a fair model fitting. This study shows that the current COVID-19 situation created awareness among females and adults aged between 18 to 47 years in rural Bangladesh.