Effect of perceived risk of covid 19 on protective behavioral changes among adult population in pakistan: A web-based cross-sectional study

The COVID-19 pandemic is still a global public health issue. Little is known about the treatment, therefore prevention plays a vital role to guard the high risk group. Thus understanding the effect of perceived risk on protective behaviors among our population is essential. The study aims to assess the effect of perceived risk of COVID 19 on protective behavioral changes among adult population in Pakistan. A web based survey was administered to Pakistani adults. Convenience sampling was adopted to assess the knowledge, protective methods and perceived risk towards COVID-19 among the population. Descriptive Analysis along with stepwise multivariable linear regression analysis was performed. There were total of 185 respondents with valid responses. Risk perception mean score was 12.11 (SD=3.97) and the highest mean score was for risk of getting infection and risk of transmitting illness to loved ones that is 3.38 (±1.28) and 3.24 (±1.40) respectively. Avoiding people who are sick had the highest mean score of 4.25 (±1.02) among all protective practices. The linear regression analysis suggests that increase in one unit of risk perception is associated with increase in 0.39 units in overall protective behavior towards covid-19 after adjusting with other independent variables. Similarly, with an increase in 1 unit of knowledge is found to be associated with an increase of 0.045 units of in overall protective behavior (regression coeffi cient: 0.38, 95% 0.008-0.77) after adjusting with risk perception, gender and educational status. In the end, the study found that the risk perception along with gender, educational background and knowledge has signifi cant impact on preventive behavior towards Covid-19. Research Article Effect of perceived risk of covid 19 on protective behavioral changes among adult population in pakistan: A webbased cross-sectional study Rahil Barkat1*, Anum Rahim1, Ahsun Jiwani1, Sherwali Khan1 and Saleema Ali2 1Indus Hospital Research Center, the Indus Hospital, Karachi, 72400, Pakistan 2Data Management, Medicins Sans Frontieres, Karachi, 72400, Pakistan Received: 17 March, 2021 Accepted: 31 March, 2021 Published: 01 April, 2021 *Corresponding author: Rahil Barkat, Indus Hospital Research Center, the Indus Hospital, Karachi, 72400, 103 Seven Star Garden, Garden West Karachi, Pakistan, E-mail:


Introduction
The novel coronavirus disease that emerged at the end of 2019 began threatening the health and lives of millions of people after a few weeks. Highly contagious with the possibility of causing severe respiratory disease, it has quickly impacted governments and public health systems [1]. The world has responded by declaring it a public health emergency of national and international concern, as well as by adopting extraordinary measures to prevent its transmission and limit the outbreak.
The rapid increase in the COVID-19 cases has not only elevated the risk of death, but has also created unwanted psychological burden [2]. Millions of lives have been signifi cantly altered, and a global, multi-level, and demanding stress-copingadjustment process is ongoing [3].

Study design
A cross-sectional study was conducted on adult population of Pakistan aged 18 -60 years. The study population was conveniently enrolled into the study.

Survey collection tool
A self-administered survey questionnaire was designed using Redcap and link of survey questionnaire was sent to study population through Facebook and WhatsApp. The survey questionnaire was developed based on previous studies related to risk perception and behavioral changes [7]. Questionnaire was divided into four parts. First part included information related to socio demographic details of study participants including their age, gender, educational status, profession, ethnicity and comorbidity.
Second part of questionnaire assessed knowledge of the study participants about COVID-19 including its mode of transmission, incubation period and standard preventive measures. One point was given for correct answer and no point was given on wrong answer. Total knowledge score was calculated by adding the score of all correct answers. The questionnaire was pre-tested on 12 adult individuals to test the face validity of the questionnaire. Where the question was not comprehendible by the participant, it was modifi ed.

Data collection procedure
The survey was administered through social media. All the individuals in the target population was invited to be a part of this study. The URL link of this survey was developed using Redcap. Social media platform including Facebook and WhatsApp were used to share link of this survey with the study population.

Data analysis
Data was analyzed using the statistical software STATA

Ethical considerations
The ethical approval of the study was taken from Institutional Review Committee of Interactive Research Development. An electronic informed consent was taken from participants at the beginning of the survey while inviting the participants to join the study. The information of the participants was kept confi dential and anonymous.

Results
There were total of 185 respondents, 102 males and 82 females. The mean age of study participants was 31.29 (SD=8.35) years and ranged from 18 to 60 years. Majority of the participants (52.17%) were single. 47.57% attended at least bachelor's degree program and only 12.97% of respondents did not have any formal education. Nearly half of the respondents (48.65%) spoke Urdu as their mother tongue (Table 1).
29.34% claimed to have no contact outside their home.
However, 27% of participants had more than 12 and 23.95% had contact with 5 to 12 people outside their home during last 24 hours. Most of the respondents (24.02%) used social media as the most common source of information to get updates about COVID-19, followed by websites (20.47%) and television (19.60%) ( Table 2).

Risk perception towards Covid-19
Related to risk perception, overall mean score was 12.11

Precautionary health behavioral practice related to Covid-19
Avoiding people who are sneezing or coughing has the highest mean score 4.25 (±1.02) while the lowest mean score was removing mask while talking to other people ( Table 5).

Effect of risk perception on Precautionary health behavioral practice related to Covid-19
Total fi ve outlying values were identifi ed. Hence, only     [12,13]. This may explain the observation that although awareness of the pandemic is relatively strong, some individuals still do not comply with the protocols and precautionary measures defi ned by authorities. One of the signifi cant fi ndings in the current study is that participants perceived 1) risk of death, 2) risk of getting infected, 3) risk of transmitting infection to a loved one and 4) risk of serious illness as highly unlikely. This is evident with their mean score, but it creates an impacts on the overall protective behaviors.
This fi nding is in agreement with a study conducted in Iraq, which reported respondents adopting precautionary measures including handwashing, wearing masks, wearing gloves and adherence with lockdown regulations [14]. Additionally, in a review conducted by Bish & Michie for identifying the essential attitudinal and demographics of different kinds of protective behavior, it was found that educational status is highly associated with increased chance of implementing protective behaviors [15]. Our analysis supports this fi nding as it shows that educational status is also associated with increased protective behavior adaptation. Respondents with more years of schooling were more likely to adopt healthy behaviors.
Results of our study shows that gender can also infl uence in protective behaviors towards COVID-19. These fi ndings are consistent with the previous studies where females were found to be more engaged in protective behaviors compared to males [10]. This shows that women are more likely to practice healthy protective behaviors like wearing masks, washing hands, cleaning items and surfaces and reducing their exposure to affected areas like crowded places. This is somehow related to the perception of women being more vulnerable to illness [16].
This vulnerability of females makes them to be perceived as more susceptible to getting an illness. Therefore, to prevent themselves and their loved ones, they take better care of themselves and their surroundings.
Even though, the current research shows that the participants engage in prominent healthy protective behavior, certain protective behaviors have low mean score, including removing mask while talk to people and not wear gloves. It is evident from literature that change in behavior is quite challenging and also change in behavior can be an unstable and unsteady process that requires time and knowledge for understanding things and its signifi cance.

Research implications
Efforts are required to understand the factors that can Findings of our study showed that knowledge related to COVID-19 had a positive impact on overall protective behavior, which supports the fi ndings of previous studies [10,11]. It is evident that people who are aware of any disease and its impact

Study limitations
One of the major advantages of this study is the ability to get timely responses in the situation where the data collection was diffi cult because of health reasons. Nonetheless, the current study has certain limitations. Firstly, the number of participants is small as compared to the target population.
Secondly, practicality and notion of online surveys in this region is quite low as less numbers of people are aware of this.
The use of online survey in this study may have resulted in the less representation of the uneducated and unprivileged individuals. It means that views of this segment of the society was left out in the study that raised an issue on study coverage.
Therefore, fi ndings of this study are not generalized to the whole study population. However, in the future, it is intended to conduct the similar survey targeting the general public using more comprehensive methods.

Conclusion
The current study showed that risk perception can create impact on precautionary behaviors towards Covid-19 and knowledge signifi cantly predicted precautionary behavior.
Besides this, gender and educational status are also important variables signifi cantly associated with the precautionary behaviors. Females are more likely to show precautionary behaviors as compared to males. We believed that awareness campaigns related to Covid-19 need to focus more on awareness of risks that are associated with infection for making individuals to be engaged in the precautionary behaviors.