Did Low Risk Perception Mediate the COVID-19 Second Wave in Bangladesh? A Cross-sectional Study on Risk Perception and Preventive Practice

  1. Farah Naz Rahman
  2. AKM Fazlur Rahman
  3. Shah Monir Hossain
  4. Mohammad Abul Faiz
  5. Abu Jamil Faisel
  6. ATM Iqbal Anwar
  7. Moudud Hossain
  8. Tarek Mahmud Hussain
  9. Tania Mahbub
  10. Liaquat Ali

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Abstract

Objective

This study assessed the risk perception and preventive behavioral practice towards COVID-19 just prior to the second wave of corona, as well as the impact of perceived risk on preventive practices.

Design, setting, participants, and outcome measures

A cross-sectional study was conducted between December 2020 and January 2021, involving 1382 respondents aged 18 years and above from all eight divisions in Bangladesh. We used multiple linear regression to identify sociodemographic predictors of risk perception and multiple logistic regression to determine the relationship between risk perception and preventive practice.

Results

Low risk perception regarding COVID-19 was present among one-fifth of the respondents (19.8%). Younger age, being male, low education, single marital status, and rural residence were significantly associated with a low perceived risk of COVID-19. Hand washing and wearing mask were practiced by 80% and 67% of respondents, respectively. A low prevalence was noticed for social distancing (31%), avoiding social gathering (31%), and covering face while coughing/sneezing (18%). Furthermore, respondents with a high risk perception were found to be more likely than those with a low risk perception to practice all recommended COVID-19 preventive behaviors-hand washing (OR=2.4, 95% CI=1.5, 3.7), mask use (OR=3.4, 95% CI=2.3, 5), social distancing (OR=3.7, 95% CI=2.4, 5.6), sanitizer use (OR=2.7, 95% CI=1.8, 4.1), avoiding gathering (OR=2.3, 95% CI=1.6, 3.5), avoid touching face and mouth (OR=2.8, 95% CI=1.5, 5.3), and covering mouth while coughing/sneezing (OR=7, 95% CI=3.6, 13.4).

Conclusion

Considerable number of Bangladeshi adults had low risk perception and low practice of some vital COVID-19 preventive behaviors before the onset of second wave of corona. All preventive practices were also influenced by respondent’s risk perception. This highlights the importance of strengthening and optimizing risk communication strategy even when the number of corona cases are low.

STRENGTHS AND LIMITATIONS OF THIS STUDY

  • The study explored the perceived risk and preventive practices for COVID-19 in Bangladesh right before the recent onset COVID-19 second wave in the South Asian region, and included a larger sample size than previous studies.

  • Unlike most other studies on COVID-19 risk perception that used online surveys, this study administered a face-to-face data collection from both urban and rural settings across all the eight divisions of Bangladesh.

  • This is the first study in Bangladesh that investigated the effect of perceived risk of COVID-19 on the practice of a range of preventive behaviors, and used an analytical approach to quantify risk perception.

  • Respondents’ self-reported information on COVID-19 preventive behavior practice is subject to be influenced by recall and desirability bias.

  • The study was unable to explore the respondents’ frequency and adherence to preventive practices, as well as the influence of psychological factors on preventive behaviors.

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    SciScore for 10.1101/2021.08.08.21257737: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Following informed written consent, the respondent was interviewed using a pretested semi-structured questionnaire.
    IRB: The institutional ethical review committee of Centre for Injury Prevention and Research Bangladesh (CIPRB) provided the ethical approval of this study [Ref: ERC/CIPRB/082020].
    Sex as a biological variableThis resulted in a total target of 1680 households, which was greater than the required sample size at 80% power, 95% CI, 50% prevalence of high risk perception, design effect of 2, with gender stratification (male, female).
    RandomizationSample Size and Sampling Technique: We randomly selected eight districts from each of the eight division: Dhaka, Coxs’ Bazaar, Patuakhali, Khulna, Sirajganj, Habiganj, Sherpur, and Rangpur.
    Blindingnot detected.
    Power AnalysisThis resulted in a total target of 1680 households, which was greater than the required sample size at 80% power, 95% CI, 50% prevalence of high risk perception, design effect of 2, with gender stratification (male, female).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This is supported by several other studies that demonstrated a positive relationship between risk perception and preventive practice.[9,11,16,18] Our findings have few limitations. Due to data inadequacy, we couldn’t look at some important determinants of risk perception reported in other studies, such as presence of chronic condition and knowledge level of COVID-19. We couldn’t include wealth index in sociodemographic determinants as participants were found unwilling to respond to these questions in our piloting. Furthermore, we considered self-reported prevalence of preventive behaviors which is subject to recall and desirability bias. We were also unable to determine the frequency and adherence of these preventive behaviors among the respondents. Moreover, being a cross-sectional study, it couldn’t establish a causal relationship between COVID-19 risk perception and preventive practices. Despite these limitations, the study contributed to address a knowledge gap by exploring the relationship between COVID-19 risk perception and preventive practice in a vulnerable South Asian country context. It also used face-to-face data collection method from both rural and urban settings across all divisions of Bangladesh, and thus offers an improved generalizability compared to previous studies. This is possibly the first study to assess people’s perceived risk and practice just prior to the onset of COVID-19 second wave in South Asian region, and the findings conceptually support ‘Pel...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.08.08.21257737v1 on medRxiv