“It looks OK... but I can’t wear it” – Application of the Expanded Parallel Process Model to Nigerian self-protection attitudes during the Covid19 pandemic

Background From 2020 onwards, the Covid19 pandemic posed a severe global health threat and caused widespread social disruption. Behavioral restrictions were imposed and expected for entire populations in many countries. The Extended Parallel Process Model (EPPM) can describe the interactions of rational cognitive considerations and emotional reactions that influence behavioral decisions. Methods Here we apply the EPPM to the context of facial protection choices in a middle-income country setting. Global shortages of personal protection equipment during the pandemic encouraged use of locally-made facial protection in resource-scarce settings, including clear, 3D-printed, face visors or shields to prevent respiratory droplet exposure. We draw on open-text responses collected in a survey of prospective face shield users in Lagos, Nigeria, in March 2021. An intersectional approach was deployed to explore and evaluate these comments in the local context, perspectives and priorities of potential face shield users. Results Within the context of the Covid19 pandemic, we have been able to adapt and expand the EEPM with various conceptual elements which will be useful in preparedness efforts towards future emerging airborne infections capable of causing pandemics. We describe how individuals traded off expected costs (monetary, diminished appearance, lack of practicality, discomfort, inconvenience) with perceived protection. Some of these trade-offs were grounded in local circumstances (such as high ambient temperature, cultural expectations and dust levels). Conclusion The compromises that were made in facial protection choices in our Nigeria sample are likely to be generalisable to many settings in sub-Saharan Africa and other tropical countries home to about a third of the global population. Product manufacturers should consider factors that will enhance user satisfaction, compliance, wellbeing and health.