Attitudes and practices toward COVID‐19 precautionary measures: A comparative study of health professionals and public

Abstract Background Containment of the COVID‐19 pandemic has been impaired by the denial and defiance of preventive recommendations. Aims We aimed to study the attitudes toward COVID‐19 social measures among laypersons and healthcare professionals. Methods We conducted a cross‐sectional study in the United Arab Emirates using a self‐administered online questionnaire. Both healthcare workers and laypersons were actively recruited. In addition to sociodemographic variables, the questionnaire included questions on anxiety, knowledge, and defiance related to COVID‐19. Results A total of 615 individuals with a mean age of 32 years (SD, 12) participated. Females comprised 69% and healthcare workers constituted 60% of the study sample. Among laypersons, over 42% reported having social gatherings at home, and 44% admitted to visiting crowded places. More than half of the respondents felt increased anxiety. Previous COVID‐19 infection did not affect attitudes or anxiety levels. Knowledge about COVID‐19 was higher among those who were more educated (r = .21). Healthcare workers had lower anxiety than laypersons (p = .002). COVID‐19 anxiety was higher among older persons and did not decrease with more knowledge. COVID‐19 defiance was higher among younger male respondents from larger households and did not correlate with knowledge. Multivariate analysis showed more defiant attitudes at younger ages. Conclusions Anxiety‐related to the COVID‐19 pandemic is more common in older individuals, whereas younger persons were more likely to deny and defy prevention recommendations despite having knowledge of viral transmission. Voluntary compliance by young individuals requires an engaging communication strategy to generate more compassionate attitudes.


INTRODUCTION
Pandemics impact mental health which in turn affects social behavior and compliance (Amerio et al., 2021;Khan et al., 2021;Petzold et al., 2020).Social isolation can worsen mental well-being by reducing access to psychiatric care (Ambrosetti et al., 2021).The impact of pandemics can be felt across the society including on women and children (García-Fernández et al., 2021;Nobari et al., 2021).Control of pandemics requires voluntary social cooperation (Leung et al., 2022).
People need to follow social precautions such as wearing face masks and staying at home during outbreaks.Unfortunately, compliance with recommended measures remained low during the recent pandemic (Leung et al., 2022).Attitudes and behaviors toward public health measures varied across and within communities.
Although social preventive measures were implemented in the interest of public health and safety, at an individual level, the timedependent reactions were not always positively accepted and understood (Hassan et al., 2021;Khan et al., 2022;Tsenoli et al., 2021).Some believed that the restrictions were an infringement on civil liberties, others appeared to actively make decisions to engage in behaviors that they considered to be in their personal interests regardless of social implications (Denford et al., 2021).Defiance and denial of pandemic preventive measures remain a concern worldwide.The perceived efficacy of these measures together with the fear of the virus still needs to be better understood (Latkin et al., 2021;Magarini et al., 2021).There is a paucity of research studies on the predictors of denial and defiance of social precautions.
We studied perceptions and attitudes toward social precautionary measures during the pandemic.We aimed to compare laypersons with healthcare workers in terms of their practices.These factors will be important in controlling future pandemics.statement to report this study (Elm et al., 2007).Data was collected between 1 October 2020 and 31 May 2021.The survey was collected using convenience and snowball sampling techniques.Survey responses were collected anonymously.Prior to the study, each of the study participants consented by agreeing to voluntary participation information.Participants were recruited from a major tertiary hospi-tal and a primary healthcare center.The target population included healthcare professionals and public residing in the United Arab Emirates (UAE).Participants who were aged 18 or more, understood the content of the study, and who agreed to participate in the study were allowed to complete the web-based questionnaire.Healthcare professionals included physicians, nurses, pharmacists, dentists, and other allied health professionals.

Study questionnaire design
The questionnaire was developed by the researchers based upon instruments validated previous studies (Alhazmi et al., 2020;Zhang et al., 2020;Zhong et al., 2020).The study utilized a 31-item selfadministered, bilingual (English, Arabic) web-based questionnaire.The survey questionnaire was initially developed in English and then forward translated and subsequently back translated using best practices for translation and cultural adaptation (Wild et al., 2005).The survey was distributed via email and various social media platforms.Data collection was conducted using Google Forms.A pilot study of 10 healthcare professionals and 10 laypeople living in the UAE was conducted to determine the face validity and usability of the study tool.
The questionnaire took around 5-10 min to complete and consisted of multiple choice, true and false, and fill in the blank items.As a result of piloting feedback, the study tool was revised to ensure that it was easily understood and completed.
The three primary outcomes were the scores on knowledge, anx-  ).An alpha level of p < .05 was considered statistically significant, and missing values were less than 1% and were not imputed.

RESULTS
The study had 615 participants with a broad range of age groups and ethnic backgrounds ( Among the participants, 44 (7.2%) reported that they had been infected in the past with SARS-CoV-2.The rate of past infection was higher among healthcare professionals.
Responses from participants revealed evidence of gaps in knowledge, the defiance of social protective measures, and COVID-19related anxiety (Figure 1).Over 40% of the participants reported having social gatherings at home and going to crowded places.Healthcare professionals had greater knowledge and less anxiety related to the pandemic (Figure 2).However, Defiance scores were similar across public and healthcare workers.Comparison of those with a history of SAR-CoV-2 infection with those who never had a positive result showed no differences in knowledge, anxiety, or defiance scores (Figure 3).
Social media influence was present to a small extent.About 17% (104 out of 615 respondents) admitted following COVID-19 advice of nonmedical persons on social media.

F I G U R E 1
Laypersons and health professionals' responses to selected questions (n = 615).

F I G U R E 2
Comparison of healthcare professionals versus laypersons for COVID knowledge, anxiety, and defiance subscales.

Multivariate analysis
On

DISCUSSION
A key finding emerging from this study is the high self-reported defiance of COVID-19 precautionary measures among younger male individuals.Knowledge about the virus did not correlate with lower anxiety related to the pandemic.Remarkably, COVID-19 denial and defiance were equally prevalent among health professionals and laypersons.
In our study, a substantial proportion of participants continued attending social gatherings and visiting crowded places.Alarmingly, many respondents indicated agreement with statements such as the pandemic is overblown, the rules are pointless and too restrictive, and the COVID-19 is not as bad as people say it is.These findings are concerning.COVID-19 skepticism has also been reported in an online questionnaire survey of 683 respondents from the United States (Latkin et al., 2021).The US survey found an association of skepticism with younger age, better health, and politically conservative views.
However, despite public health measures such as social distancing, facemasks, and travel restrictions, the spread of SARS-CoV-2 infection worldwide has continued.This is partly due to unfavorable attitudes and practices toward these precautionary measures.
Furthermore, skepticism correlated with the lower use of preventive measures such as wearing a mask.A survey of 681 individuals in the United Kingdom revealed that 92.8% did not adhere to the social distancing rules; although age, gender, ethnicity, education, and employment status were not predictive (Hills & Eraso, 2021).In comparison, in our study, COVID-19 defiance was associated with lower age but not with educational attainment, health professional status, or knowledge of the disease itself.This implies that public health education needs to target younger individuals in this region.Younger adults need more focused educational efforts to address irrational beliefs and defiant attitudes toward social measures.Building trust in the community requires using a variety of dissemination channels as well as the use of reliable information (Fridman et al., 2020).As in our study results, unverified news sources such as social media can lead to the defiance of preventive recommendations (Ghaddar et al., 2022).
The level of anxiety was high in our study sample.This is consistent with other research studies evaluating the psychological effects of regional lockdowns and social restrictions (Ammar et al., 2020).An earlier study found high levels of emotional exhaustion, irritability, and sleep disturbances (Cheikh Ismail et al., 2020).We found a mildly lower level of anxiety among health professionals compared to laypersons.This is possibly due to a higher level of knowledge of the disease and its prognosis among healthcare workers.
It is concerning to note that younger individuals, both layperson and healthcare professionals, regardless of their educational attainment and prior knowledge of the virus, are more likely to deny and defy protective measures.An online survey of adults living in North America and Europe also showed that men and younger individuals showed lower adherence (Coroiu et al., 2020).In one region, almost 30% of individuals did not believe in the use of facemasks (Meo et al., 2021).An in-depth review of irrational beliefs about COVID-19 has shown that misinformation tends to cluster with particular socio-environmental factors such as lower education, younger age, low levels of trust, avoidance of uncertainty, collective narcissism, and a conspiracy-prone mindset (Magarini et al., 2021).Although legally enforced travel restrictions and mandatory testing are needed to ensure compliance, public health campaigns should highlight compassionate attitudes toward social measures.Voluntary self-isolation by infected persons is critical to control the spread.Yet, young individuals with mild symptoms cannot be coerced to stay at home.Voluntary selfisolation can only occur if they harbor compassionate attitudes toward the safety of others.Social support has been found to be associated with lower risk of depression in a recent cross-sectional survey (Grey et al., 2020).In a study from UAE, divorced mothers were more likely to be hesitant about vaccinations for their children (Alsuwaidi et al., 2020).Hence, contextual factors such as family and community may play a role in this illness (Hashim, 2016).As supportive care remains the mainstay of treatment, patient-centered communication plays a central role in allaying COVID-19 anxiety (Hashim, 2017).
To our knowledge, this is the first study conducted in the UAE evaluating defiance of public health measures Minor grammatical edits made.Our study highlights the need for holistic measures and policies and interaction with the public to modify health behaviors.
There are some limitations inherent in our study design.The study inferences may be limited by the use of an online data collection format; however, the anonymous nature of this medium may foster more candid responses than in-person interviews.Recall bias can affect participants' responses.Another limitation of our study was that the sample was over-representative of university educated individuals, perhaps due to the format of the study.This may affect generalizability of findings.Due to the rapidly evolving nature of the pandemic, a validated questionnaire could not be applied.The cross-sectional study design does not permit making firm inferences due to the lack of follow-up over time.

Table 1
well as dentists, lab technicians, midwives, phlebotomists, physiotherapists, and respiratory therapists.Unemployed status was reported by 5.5% (27) of the respondents, with an additional 0.8% (5) individuals reporting unemployment due to the economic impact of the COVID-19 pandemic.The study sample also included 19 homemakers (3.1%) and 193 students (31.4%).All respondents were living in the UAE, with the majority residing in Abu Dhabi and Dubai.National origin ranged from South Asia (India, Pakistan, and Bangladesh) and Arab countries (UAE, Egypt, Jordan, Syria, Sudan, and Algeria) to Western origin (United States, United Kingdom, and Australia) and East Asia (Philippines and Malaysia) as well as others such as South Africa, Turkey, and Iran.
Comparison of individuals with a history of COVID-19 versus those who never had the infection.Note: None of the differences between the two groups were statistically significant (p > .05;one-way ANOVA).