Community Behavioral and Perceived Responses in the COVID-19 Outbreak in Afghanistan: A Cross-Sectional Study

Mousavi, Sayed Hamid; Delshad, Mohammad Hossein; Acuti Martellucci, Cecilia; Bhandari, Divya; Ozaki, Akihiko; Pourhaji, Fatemeh; Pourhaji, Fahimeh; Reza Hosseini, Sayed Mohammad; Roien, Rohullah; Ramozi, Abass Ali; Wafaee, Marzia; Qaderi, Shohra; Delsoz, Mohammad; Sigdel, Shailendra; Kotera, Yasuhiro; Sawano, Toyoaki; Dhama, Kuldeep; Rodríguez-Morales, Alfonso J.; Wang, Jiwei; Tanimoto, Tetsuya; Yousefi, Ali Ahmad; Sah, Ranjit

OBJECTIVE: Community responses are important for the management of early-phase outbreaks of coronavirus disease 2019 (COVID-19). Perceived susceptibility and severity are considered key elements that motivate people to adopt nonpharmaceutical interventions. This study aimed to (i) explore perceived susceptibility and severity of the COVID-19 pandemic, (ii) examine the practice of nonpharmaceutical interventions, and (iii) assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions among people living in Afghanistan. METHODS: A cross-sectional design was used, using online surveys disseminated from April to May 2020. Convenience sampling was used to recruit the participants of this study. The previously developed scales were used to assess the participants’ demographic information, perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and perceived severity of COVID-19. Multivariate analyses were conducted to assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions. RESULTS: The Internet was the main source for obtaining COVID-19 information among participants in this study. While 45.8% of the participants believed it was “very unlikely” for them to get infected with COVID-19, 76.7% perceived COVID-19 as a severe disease. Similarly, 37.5% believed the chance of being cured if infected with COVID-19 is “unlikely/very unlikely.” The majority of participants (95.6%) perceived their health to be in “good” and “very good” status. Overall, 74.2% mentioned that they stopped visiting public places, 49.7% started using gloves, and 70.4% started wearing a mask. Participants who believed they have a low probability of survival if infected with COVID-19 were more likely to wear masks and practice hand washing. CONCLUSIONS: It appears that communities’ psychological and behavioral responses were affected by the early phase of the COVID-19 pandemic in Afghanistan, especially among young Internet users. The findings gained from a timely behavioral assessment of the community might be useful to develop interventions and risk communication strategies in epidemics within and beyond COVID-19.