Psychosocial indicators of individual behavior during COVID-19: Delphi approach

The COVID-19 pandemic exposed the inadequacy of healthcare systems in incorporating human behavior indicators into rapid responses. While Arab countries implemented various control measures, the results were inconsistent with the efforts. Studies highlighted weaknesses in considering individual social and psychological factors, leading to one-size-fits-all strategies. Wang and Wang (2020) noted a lack of focus on social pressure and adherence to preventive measures in China, while ignoring the impact of rumors and fear. This study addresses the gap by investigating psychosocial indicators that influence adherence to preventive behaviors among Arab populations, aiming to provide a more effective framework for future pandemic responses. The study's significance lies in its potential to inform policy decisions and improve pandemic preparedness in Arab countries by identifying key psychosocial factors influencing individual adherence to health guidelines.

The study draws upon several behavioral change theories, including the Health Belief Model (HBM), Social Engineering Theory, and the Theory of Planned Behavior (TPB). The HBM emphasizes the role of perceived risk, self-efficacy, and the feasibility of preventive measures. Social Engineering Theory focuses on modifying the environment to influence behavior, while the TPB highlights behavioral, normative, and control beliefs in shaping intentions. The review revealed existing studies focusing on the impact of COVID-19 on individuals and economies, but none combined social and psychological indicators to predict preventive behaviors. Studies from the Arab region showed unsatisfactory coronavirus prevention behaviors despite health guidelines, highlighting the need for this research.

The study employed a two-step approach: a scoping review and a three-round Delphi survey. The scoping review identified psychosocial indicators of COVID-19 preventive behaviors from various databases using keywords like "COVID-19," "preventive behavior," "psychological," "social," "indicators," "health," and "society." This resulted in 24 indicators (12 social and 12 psychological). The Delphi survey involved 19 experts from nine Arab countries who rated the indicators' importance using a 5-point Likert scale. Consensus was reached when the absolute deviation from the median was less than one point. The Delphi process involved three rounds. Round 1 presented the questionnaire; Round 2 provided feedback on the results to refine responses; and Round 3 focused on achieving consensus on the remaining indicators. Non-probability sampling was used targeting experts with over 20 years of experience in human behavior. Qualitative data analysis was done after each round to avoid bias.

The scoping review identified 101 studies on social indicators and 149 on psychological indicators, with only 28 examining both. The Delphi process yielded consensus on nine indicators: five social and four psychological. The five social indicators, ranked by average rating, were Belief System (5), Income Status (4.9), Family Commitment (4), Faith (4), and Kinship System (3.9). The four psychological indicators were Self-Efficacy (5), Perception of Hazard (4.5), Motivation (4.5), and Stigma (4.2). The Belief System and Faith indicators reflected the influence of religious beliefs on adherence to preventive measures. Income Status highlighted the challenges faced by low-income individuals in adhering to guidelines due to financial constraints. Family Commitment showed the strong influence of family ties in behavior, while Kinship System revealed how traditional social structures might impact adherence, particularly for women in rural areas. Self-Efficacy reflected the individual's belief in their ability to follow preventive measures. Perception of Hazard indicated that higher perceived risk led to greater adherence. Motivation highlighted the importance of personal drive and community influence in compliance. Stigma emphasized the impact of social discrimination on behavior.

The findings address the research question by identifying key psychosocial factors influencing COVID-19 preventive behaviors in Arab countries. The strong influence of belief systems and religious faith necessitates culturally sensitive interventions. Economic status needs to be addressed to ensure equitable access to resources and support for low-income individuals. The significant role of family ties calls for interventions targeting families as units. Social stigma needs to be challenged through targeted campaigns that promote inclusivity and empathy. The combination of self-efficacy and belief systems as significant predictors highlights the importance of integrating micro-level individual factors with macro-level social factors in designing effective interventions.

This study identified nine key psychosocial indicators influencing COVID-19 preventive behaviors in Arab communities. These findings are crucial for designing culturally appropriate and effective pandemic interventions. Future research should explore the interplay of these indicators across different demographic groups and settings and investigate the efficacy of targeted interventions.

The study's reliance on expert opinions through the Delphi method limits generalizability to the wider population. The sample of experts may not fully represent the diversity of views across all Arab countries. The study did not consider demographic factors like gender, age, and education level, which might influence preventive behaviors. Future studies should incorporate larger, more diverse samples and explore the influence of these demographic variables.