Challenges in Preventive Practices and Risk Communication Towards COVID-19: A Cross-sectional Study in Bangladesh

doi:10.21203/rs.3.rs-799161/v1

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Research Article

Challenges in Preventive Practices and Risk Communication Towards COVID-19: A Cross-sectional Study in Bangladesh

https://doi.org/10.21203/rs.3.rs-799161/v1

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published 01 Sep, 2021

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BACKGROUND

Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults.

METHODS

A cross-sectional survey was conducted between December 2020 and January 2021 involving 1,382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges.

RESULTS

Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate hand washing and sanitation facilities (17.6%), and negative influences of family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01,1.7), rural residents (OR = 1.5, 95% CI = 1.2,2), respondents with a low level of education: No schooling vs ≥ higher secondary (OR = 3.5, 95% CI = 2.3,5.2), Primary vs ≥ higher secondary (OR = 2.5, 95%CI = 1.7,3.8), respondents engaged in agricultural (OR = 1.7, 95%CI = 1.2,2.4), laboring (OR = 3.2, 95% CI = 2,5), and domestic (OR = 1.6, 95% CI = 1.07,2.5) works, and people with disabilities (OR = 1.7, 95% CI = 1.1,2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents’ education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents.

CONCLUSION

A substantial percentage of Bangladeshi adults have difficulty practicing COVID-19 protective behaviors and have poor comprehension of risk communications, that is particularly prevalent in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.

Epidemiology

COVID-19

Bangladesh

Protective Behavior

Risk Communication

Pandemic

Following detection of the first case of COVID-19 in Bangladesh on 8 March 2021, the country now has about 0.8 million cases with 12 thousand deaths [1]. Bangladesh experienced a surge in infections from June to August 2020, marking the first wave of the virus. Several containment measures were applied to control the situation including a countrywide lockdown and restrictions on travel and social activities. Risk communication strategies were also developed and deployed in the country as part of the National Pandemic Preparedness and Response Plan (NPPRP) [2]. Consequently, information on COVID-19 was widely disseminated, and advocacy for practicing WHO recommended preventive behaviors was presented via electronic, print, and social media.

Despite these ongoing efforts, a second wave of COVID-19 started in Bangladesh during the second week of March 2021 [3]. Expert opinion suggests that inadequate practice of preventive measures such as wearing masks, hand washing, and social distancing contributed to the emergence of this second wave [4]. Concerns have been raised about the difficulty of implementing recommended preventive behaviors such as "maintaining social distance" and "avoiding social gatherings" in a densely populated country like Bangladesh. [5]. In addition, although the prevalence of mask use has improved over the year, a substantial number of people are still wearing them inappropriately [6, 7]. A considerable number of people also had inadequate access to protective equipment such as masks, gloves, hand sanitizer etc. [8, 9]. Furthermore, different socioeconomic groups in Bangladesh have different levels of understanding of generalized information on COVID-19 precautions. Some people are having difficulty understanding terms such as "social distance" and "quarantine," which do not have a proper translation in the native language [9, 10]. Moreover, the weakness in risk communication campaigns became apparent when about 200 online rumors related to COVID-19 spread across the country [11].

As COVID-19 transmission is influenced by preventive behavior practices, and such practices are influenced by risk communications, then it is likely that these factors have played a role in the resurgence of the infection. Although some anecdotal reports highlighted the barriers to practicing preventive measures and understanding risk communications, any empirical evidence of this is still unavailable. The purpose of this study therefore, is to investigate the challenges in practicing preventive behavior and risk communications for COVID-19 in a low-resource country setting in order to help prevent any future waves of this virus and similar diseases.

Design, Sample size, and Sampling Technique

A cross-sectional survey was conducted from December 2020 to January 2021 with data collected from Bangladeshi adults aged 18 years and above. A multi-stage cluster randomized sampling technique was used to recruit a total of 1,382 participants from both urban and rural regions.

Bangladesh has eight major administrative units called divisions: Dhaka, Chattogram, Mymensingh, Rajshahi, Khulna, Barishal, Sylhet, and Rangpur. One district was selected from each division, giving a total of eight districts: Dhaka, Coxs’ Bazaar, Patuakhali, Khulna, Sirajganj, Habiganj, Sherpur, and Rangpur. Two wards (elective units of a city corporation) were randomly selected from each district headquarter or city corporation that represent urban regions. Alongside these, two villages were randomly chosen from each district to represent respondents from rural regions and a further 60 households were randomly selected from each ward and 45 households selected from each village. The prevalence of the COVID-19 virus is higher in urban areas and so more households were targeted from these areas than from rural areas. One eligible respondent from each household were randomly approached for consent to take part in the study. Eligibility comprised Bangladeshi nationals ≥ 18 years of age and had been living in the household for at least one year. Following this procedure, a total of 1,680 adults were approached and of this total, 278 (urban = 159, rural = 119) did not consent to participate and 20 respondents provided incomplete responses. Excluding the incomplete responses, data from a total of 1,382 respondents were included in the analysis. Figure-1 presents the sampling technique and the procedure for including respondents.

[Figure 1: Sampling Technique and Steps to Include Respondents in Analysis in the Cross-sectional Study on Challenges in Preventive Practices and Risk Communication for COVID-19.]

Data Collection and Ethical Considerations

A total of 10 Data Collectors (DCs) were recruited and trained to gather data from households. The first group of households were chosen from the approximate geographical centre of a ward or village and then the DCs visited households in an anticlockwise direction. Informed written consent was taken from each respondent, and data collected using a pretested semi-structured questionnaire. The DCs maintained all necessary COVID-19 safety precautions (e.g., personal protective equipment - gloves, mask, hand sanitizer - and social distancing) while conducting face-to-face interviews. Ethical approval for this study was obtained from the institutional ethical review committee of the Centre for Injury Prevention and Research Bangladesh (CIPRB) [Ref: ERC/CIPRB/08052020]. The study adhered to all ethical principles including the guidelines of the Directorate General of Health Services Bangladesh (DGHS) for conducting research during the pandemic.

Variables and Statistical Analysis

Age, sex, education, occupation, residence location, and disability were included as sociodemographic variables and these were then categorized as age groups (18–30, 31–45, 46–60, 60 + years), sex (male, female), education (no formal education, 1–5 years of schooling = primary, 6–10 years of schooling = secondary, > 10 years of schooling = higher secondary and above), occupation (domestic work, service, business, agriculture, laboring work), residence location (urban, rural), and disability (present, absent). Respondents were asked about their source for receiving COVID-19 information and their level of understanding of it by use of a five point Likert scale: ‘understands all of it/ understands most of it/ understands some of it/ understands little/ didn’t understand at all’, and whether they wanted more information on some aspects of COVID-19 (transmission, symptom, precaution, test, treatment, vaccine). Respondents were also asked if they faced any difficulties in practicing the WHO recommended preventive behaviors during the last month, to which they could respond ‘Yes/NO’. Information on the cause of difficulties in practicing preventive measures was also gathered.

The five-point Likert scale responses on levels of understanding of COVID-19 information were converted to a binary outcome variable with categories - ‘Good understanding’ and ‘Inadequate understanding’. For the new variable, responses of ‘understands all of it’ and ‘understands most of it’ were grouped under ‘Good understanding’, and the remaining three responses were grouped together to present ‘Inadequate understanding’. Multiple logistic regression analysis was then used to help identify the sociodemographic predictors of ‘Inadequate understanding’ of COVID-19 information, where age, sex, education, occupation, and residence location were used as independent variables. Similarly, multiple logistic regression analysis helped to determine the risk groups that faced challenges in preventive practices. In this analysis, education, occupation, residence location, and disability were used as independent variables, and ‘whether they faced any difficulty in preventive practice (Yes/NO)’ was used as an outcome variable. All the assumptions for regression analysis were met and statistical significance was considered at p value < 0.05.

Sociodemographic Characteristics of the Respondents

A total of 1,382 Bangladeshi adults aged 18 years and above participated in the study. The sociodemographic characteristics of the respondents are presented in Table-1.

Table-1: Socio-demographic characteristics of the Bangladeshi Adults that Participated in the Cross-sectional Study on Challenges in Preventive Practices and Risk Communication for COVID-19. (N = 1382)

Characteristics of Respondents	Measurement of variables	Number (N)	Percentage (%) Total
Age	Age 18 to 30 years	449	32.5
	Age 31 to 45 years	571	41.3
	Age 46 to 60 years	255	18.5
	Age 60 + years	107	7.7
Gender	Male	712	51.5
Gender	Female	670	48.5
Disability	Yes	151	10.9
Disability	No	1231	89.1
Residential Location	Urban	792	57.4
Residential Location	Rural	590	42.6
Education	No Literacy	238	17.2
	Primary	348	25.2
	Secondary	325	23.5
	Higher Secondary and above	471	34.1
Occupation	Business	380	27.5
	Service	223	16.1
	Domestic work	222	16.1
	Agriculture	149	10.8
	Laborious work (rickshaw puller, day labourers etc.)	408	29.5

As the Table-1 shows, most of those that responded were in the younger and middle aged groups (between 18 to 45 years of age) with older adults (60 + years) making up around 7% of the total. The proportion of male and female respondents was nearly equal, with a male: female ratio of 1.06:1. Approximately 17% of respondents had no institutional education, while one-third (34.1%) had a higher level of education (Higher secondary and above). Urban residents comprised 57.4% of the total respondents. Those working in agricultural and other laboring pursuits made up around 40% of all study participants with 27.5% engaged in business activities, and both service holders and domestic workers accounted for 16.1 % of the total. Around 11% of respondents reported having some form of physical disability.

Challenges in Practicing COVID-19 Preventive Behavior Among Bangladeshi Adults

Nearly 71% of respondents indicated that they faced difficulties in practicing the recommended COVID-19 preventive behaviors. Figure-2 presents the nature of these challenges.

[Figure 2: Challenges in Preventive Practices for COVID-19 Faced by the Respondents.]

Unavailability of protective equipment for COVID-19 tops the challenges list for respondents in adopting preventive practices. Almost 45% reported having insufficient protective equipment such as masks, gloves, soap, and hand sanitizers. More than one-third (36.8%) also stated that their efforts were hampered by crowded or congested living conditions and in the workplace and 17.6% cited inadequate handwashing and sanitation facilities as barriers to practicing preventive measures. Nearly 22% of respondents said that inadequate knowledge of instructions regarding protective measures such as proper use of masks, hand washing techniques, and social distancing, had been challenging. In addition, negligence in the use of protective measures by other family members, friends, and local residents discouraged approximately 17% of respondents from engaging in preventive practices themselves.

Factors Associated with Challenges in COVID-19 Preventive Practices

A multiple logistic regression analysis was used to explore the relationship between the sociodemographic characteristics of respondents and their likelihood of experiencing difficulties in pursuing preventive practices for COVID-19. Figure-3 presents the sociodemographic determinants of challenges in COVID-19 preventive practices.

[Figure 3: Predictive Factors for Experiencing Challenges in COVID-19 Preventive Practices among Bangladeshi Adults.]

Gender, residence, education, occupation, and disability were found to be significantly associated with the likelihood of experiencing difficulties in COVID-19 preventive practices among Bangladeshi adults. Males were 1.3 times more likely than females to face difficulties and those respondents in rural areas had 1.5 times higher odds of experiencing challenges than did respondents in urban areas. Respondents that did not have any schooling and those with primary education were respectively 3.5 and 2.5 times more likely to have difficulties practicing preventive behaviors compared to respondents with an education level of higher secondary or above. Additionally, domestic workers, agricultural workers, and day laborers were respectively 1.6, 1.7, and 3.2 times more likely to face problems compared to those working in business. Challenges in COVID-19 preventive practices were 1.7 times higher among persons with disabilities.

Challenges in Risk Communications for COVID-19 among Bangladeshi Adults

Almost all (98.8%) of respondents said they had been exposed to various forms of COVID-19 awareness campaigns including information via electronic, print, and social media, community distribution of leaflets, miking, and information from health workers or community leaders. Respondents shared their need for more information on certain areas related to COVID-19 as Figure-4 shows.

[Figure 4: Proportion of Respondents with Inadequate Information according to COVID-19 Domains.]

Most respondents (62.3%) said they had inadequate information on treatments for COVID-19 including information on dedicated healthcare facilities and treatment from home procedures. About 60% had inadequate information on the vaccine including the registration procedure, its safety, and effectiveness and more than half (56.9%) reported having inadequate information on diagnostic tests. Around one-third (33%) of respondents wanted more information about protective measures as well as instructions on their proper use and just over 26% wanted more information about symptoms and the transmission modality of COVID-19.

Determinants of Inadequate Understanding of COVID-19 Information among Bangladeshi Adults

Respondents shared their level of comprehension of the COVID-19 information they have received on a five-point Likert scale (understands all of it/ understands most of it/ understands some of it/ understands little/ didn’t understand at all). The majority of respondents (66.3%) stated that they understood most of the information received, 16% said they understood all of it and 4.1% stated they understood some of it. However, approximately 11% reported having little understanding of the received information, and 2.2% of having no understanding at all. The five Likert scale responses were converted to a binary outcome variable - ‘Good understanding/Inadequate understanding’ (see methodology), and a multiple logistic regression was carried out. Adjusted odds ratios from the multiple logistic regression analysis, predicting the effects of sociodemographic variables on the level of understanding of COVID-19 information among Bangladeshi adults, is presented on Table-2.

Table 2

Determinants of Inadequate Understanding of COVID-19 Information among Bangladeshi Adults
Independent Variables	Outcome Variables		Sig.	OR	95% CI
	Inadequate Understanding	Good Understanding
Age N (%) N (%)
18–30 years 71 (15.8%) 378 (84.2%) - 1 -
31–45 years	104 (18.2%)	467 (81.8%)	0.68	0.92	0.64–1.33
46–60 years	49 (19.2%)	206 (80.8%)	0.58	0.87	0.55–1.40
60 + years	16 (15%)	91 (85%)	0.05	0.52	0.27-1.00
Gender
Female 116 (17.3%) 554 (82.7%) - 1 -
Male	124 (17.4%)	588 (82.6%)	0.51	1.11	0.80–1.56
Residence
Urban 126 (15.9%) 666 (84.1%)
Rural	114 (19.4%)	474 (80.6%)	0.64	1.07	0.78–1.47
Education
Higher Secondary & above 20 (4.2%) 451 (95.8%) - 1 -
Secondary	46 (14.2%)	279 (85.8%)	0.00	4.05**	2.30–7.15
Primary	84 (24.1%)	264 (75.9%)	0.00	6.99**	4.02–12.14
No Schooling	90 (37.8%)	148 (62.2%)	0.00	13.47**	7.52–24.12
Occupation
Business	39 (10.3%)	341 (89.7%)	-	1	-
Service	19 (8.5%)	204 (91.5%)	0.05	1.88	1.00-3.52
Domestic work	35 (15.8%)	187 (84.2%)	0.03	1.79*	1.03–3.10
Agriculture work	35 (23.5%)	114 (76.5%)	0.01	1.97*	1.13–3.43
Laborious work	112 (27.5%)	296 (72.5%)	0.00	2.39**	1.55–3.67

[Adjusted odds ratio (OR) from multiple logistic regression analysis illustrating the likelihood of low to moderate understanding of COVID-19 information across sociodemographic variables. Outcome variables were categorized as ‘Inadequate understanding = 1’ and ‘Good Understanding = 0’. Variables adjusted were age, gender, residence, education, occupation. The first category under each independent variable was considered the variable's reference category. *p < 0.05, **p < 0.01; N = 1382.]

Education and occupation were significantly associated with the level of understanding of COVID-19 information among respondents. Low education was associated with a low level of understanding and inadequate understanding was nearly 13.5 times higher among respondents without any institutional education compared to those with a higher secondary or higher education level. Inadequate understanding of COVID-19 information among respondents with primary and secondary education was respectively 7 times and 4 times higher compared to those with an education level of higher secondary or above. Agricultural workers and day laborers were approximately twice as likely as businesspeople to have an inadequate understanding of COVID-19 information. Domestic workers were also 1.7 times more likely to have inadequate understanding than those who were engaged in business.

This is the first study in Bangladesh to provide empirical evidence on the challenges in preventive practices and risk communications for COVID-19 among Bangladeshi adults around the time of the second wave of the pandemic. The study analyzed data from face-to-face interviews conducted in rural and urban areas across all eight divisions of Bangladesh, allowing for greater generalizability of the findings. Limited availability of protective equipment such as mask, gloves, and hand sanitizer, as well as crowded living situations and workspaces, were the barriers for COVID-19 preventive practices among about 40% of the respondents. Additionally, male respondents, rural residents, respondents with a low level of education, those engaged in agricultural, laboring, and domestic work, and people with disabilities were more likely to have difficulty practicing COVID-19 protective behaviors. Despite the fact that almost all of the respondents had been exposed to some form of COVID-19 awareness campaign, 17.4% had an inadequate understanding of the information they received. Furthermore, a large number of respondents reported a lack of knowledge about COVID-19 diagnostic tests, treatment, and vaccines. The education and occupations of respondents were significant predictors of inadequate understanding of COVID-19 risk communications.

The top three preventive practice challenges identified by respondents were lack of protective equipment, crowded living spaces, workspaces, and neighborhoods, and inadequate knowledge on the proper use of protective measures. These findings are reflected in an ongoing study in Bangladesh that has been monitoring mask use among northern Dhaka dwellers and revealed improper mask use among 25% of the citizens, indicating a lack of knowledge on their proper use [12]. This ongoing study also tracked improper social distancing on 14 June 2021 among 53% of the citizens. In addition, a large Randomized Controlled Trial (RCT) in Bangladesh involving 350,000 people considered the unavailability of masks and lack of knowledge on their proper use as barriers to preventive practice, and found that no-cost mask distribution and sharing information on wearing them through electronic and print media increased better practice among community people [13]. The findings of this current study are also consistent with the findings of an exploratory study conducted among garment workers in Bangladesh, that identified community living in close proximity as a barrier to maintaining social distance [14]. This current study also identified inadequate sanitation facilities and negative influences of family/friends as barriers to preventive practices for COVID-19. Other experts have highlighted the lack of sanitation facilities as a potential barrier to COVID-19 preventive practices in Bangladesh [5], and another large RCT identified modeling and endorsement by trusted leaders as a way to increase mask use among community people [13]. Sociodemographic groups that are more likely to face barriers, and be more vulnerable in practicing COVID-19 protective behaviors, were identified in this study as male, rural residents, and those with a low level of education. These findings are in line with several other studies conducted in Bangladesh on COVID-19 prevention practices that identified significantly lower practices among males, rural residents, and those with low education [15–17]. Bangladeshi men tend to be very outgoing and are often the sole wage earners of the family, a situation that forces them to work during the restriction period and exposes them to crowded workplaces and social gatherings during the pandemic. Alongside this, rural residents have a lower level of education and come from a poorer socioeconomic background than urban residents. This limits the ability of rural residents to access or afford COVID-19 protective equipment, as well as their ability to understand instructions on how to use them. Large families living in congested areas are also common in rural areas, making social distancing impossible [18, 19]. This situation also applies to agricultural workers, day laborers, and domestic workers, who are from low socioeconomic groups and have a low level of education and were also found to be more vulnerable to barriers in COVID-19 preventive practices in this current study. People with disabilities were found to be more vulnerable to the challenges of protective behaviors in this study and according to Kibria et al., who reviewed the situation of those with disabilities in Bangladesh during the pandemic, marginalization and the constant need for care from others act as barriers to their safety from COVID-19 [20].

Despite widespread dissemination of COVID-19 information as part of the NPRP, approximately 60% of respondents in this study had insufficient knowledge of COVID-19 diagnostic tests, treatment, and vaccines. Bangladesh has been running very low on COVID-19 diagnostic tests, with only about 5,000 tests per million people for a population of over 160 million [21]. The country has been relying on passive testing by the population rather than actively screening for cases. A lack of knowledge about diagnostic facilities among the general population, therefore, may have contributed to low testing coverage and, as a result, limited the case detection procedure. Furthermore, since the beginning of the pandemic, several reports have highlighted the difficulty that people have in getting COVID-19 treatment in the country [11, 22]. The separation of COVID-19 management from regular hospitals to dedicated centers caused confusion among the general public, indicating a lack of readily available information. Besides that, the national COVID-19 management guidelines recommend that patients with mild symptoms should be treated at home with physician consultation via telemedicine [23]. However, rural residents, people with low socio-economic and educational backgrounds, and those from disadvantaged communities had difficulty adhering to self-quarantine, isolation, and home treatment procedures [18, 19], further pointing to a weakness in the COVID-19 information campaigns. Additionally, inadequate vaccine information among respondents is consistent with the findings of another cross-sectional survey that found vaccine refusal and hesitancy among one-fourth of their participants [24]. About 21% of the respondents in this current study also reported having insufficient information on protective behaviours that potentially contributed to improper use of masks, personal protective equipment (PPE), and faulty hand washing techniques [6, 25, 26]. Nearly one-fifth of respondents were also found to have an inadequate understanding of COVID-19 information that was more common among people with a low level of education and those working in agricultural, laboring, and domestic jobs. Although no studies evaluating the level of understanding of COVID-19 risk communications are available, a few studies have found an association between low education and lower knowledge of COVID-19 among the Bangladeshi population [15, 16]. Furthermore, the vulnerable occupation group, particularly day laborers and agricultural workers, face intersectional disadvantage because of their low socioeconomic and educational backgrounds that makes existing risk communication strategies less comprehensible to them.

Limitations and Directions for Future Research

The study findings have a few limitations. Socio-economic information could not be collected from respondents and meant that the variation in challenges regarding COVID-19 preventive practices and risk communications across socioeconomic groups could not be determined. However, the variation across related social determinants of health, such as education and occupation, was investigated and risk groups were identified whose economic status could provide some insights into economic variability. In addition, the underlying causes of these challenges among different groups could not be investigated due to data limitations. For instance, the data do not adequately represent marginalized groups such as indigenous peoples and urban slum dwellers that meant it was not possible to determine how the challenges were distributed among these communities.

Future exploratory research can look in-depth at the causes of challenges and barriers in COVID-19 preventive practices and risk communications among various socio-demographic groups, as well as how these factors influence transmission of COVID-19 among them. Further research with a more inclusive approach could also explore these challenges among marginalized communities in Bangladesh. Moreover, building on the evidence from this study, future research may investigate the ways of mitigating these challenges and barriers through developing intervention strategies.

This study identified the unavailability of protective equipment and crowded living spaces as major barriers to practicing COVID-19 protective behaviors, and identified those socio-demographic groups that are more likely to face these barriers. This evidence can help policymakers in developing intervention strategies such as the free distribution of masks and other protective equipment, particularly for vulnerable groups. It also emphasizes the need for developing culture- and context-specific alternative strategies for people whose socioeconomic circumstances do not allow them to maintain recommended protective behaviors such as "social distancing" and "frequent handwashing." Persons with disabilities were identified as a vulnerable group for the challenges in COVID-19 preventive practices in this study, highlighting the importance of focusing on the needs of marginalized communities through targeted research and programs. Furthermore, inadequate information regarding the proper use of protective measures was identified as a key challenge in both preventive practices and risk communications for COVID-19. A strengthening of the ‘how to’ component of risk communication campaigns is therefore recommended while advocating for COVID-19 protective behaviors. Additionally, an insufficient flow of information was identified in vital COVID-19 domains such as diagnostic tests, treatment, and vaccines for the virus. This calls for optimization of the national COVID-19 awareness campaign, risk communications, and vaccination campaign strategies. Moreover, the lower comprehension of the COVID-19 awareness campaign among agricultural workers, day laborers, and people with low education levels, highlights the necessity of developing risk communication messages tailored to people's social context and need.

ACKNOWLEDGEMENT

The authors would like to thank the members of the National Public Health Advisory Board for COVID-19 management, Directorate General of Health Services (DGHS), Bangladesh, and CIPRB’s staff who helped in data collection.

FUNDING STATEMENT

Centre for Injury Prevention and Research Bangladesh (CIPRB) funded this study.

COMPETING INTEREST

All authors declare that they do not have any competing interest.

DATA SHARING STATEMENT

De-identified data is publicly available at 10.6084/m9.figshare.14794326.

ETHICS STATEMENT

The Institutional Ethical Review Committee (IRC) of Centre for Injury Prevention and Research Bangladesh (CIPRB) provided the ethical approval of this study [Ref: ERC/CIPRB/08052020].

AUTHORS CONTRIBUTION

KD, AKMFR, MAAB, KH and FNR conceptualized the study. MAAB and KH administered the project and processed data curation. HTAK supervised the data analysis conducted by FNR. FNR prepared the first draft of the manuscript. The manuscript was finalized with the critical inputs of KD, AKMFR, MAAB, KH, HTAK, and FNR. All authors reviewed and approved the final manuscript.

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Challenges in Preventive Practices and Risk Communication Towards COVID-19: A Cross-sectional Study in Bangladesh

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Abstract

BACKGROUND

METHODS

RESULTS

CONCLUSION

Figures

Introduction

Materials And Method

Design, Sample size, and Sampling Technique

Data Collection and Ethical Considerations

Variables and Statistical Analysis

Results

Sociodemographic Characteristics of the Respondents

Challenges in Practicing COVID-19 Preventive Behavior Among Bangladeshi Adults

Factors Associated with Challenges in COVID-19 Preventive Practices

Challenges in Risk Communications for COVID-19 among Bangladeshi Adults

Determinants of Inadequate Understanding of COVID-19 Information among Bangladeshi Adults

Discussion

Limitations and Directions for Future Research

Conclusion

Declarations

References

Status:

Journal Publication

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