Introduction
Method
Design
Participants
Variable | Dimension | Frequency (%) |
---|---|---|
Gender | Female | 8 (26) |
Male | 23 (74) | |
Age (Year) | 18–38 | 8 (26) |
31–50 | 15 (48) | |
Over 50 | 8 (26) | |
Marital status | Married | 24 (77) |
Single | 7 (23) | |
Job | Salesperson | 10 (32) |
Bank employee | 4 (13) | |
Hairdresser | 8 (26) | |
Municipality employee | 3 (10) | |
Driver | 6 (19) | |
Education | Under high school graduate | 18 (58) |
High school graduate to BA | 3 (10) | |
Higher than BA | 6 (19) |
Data collection
No. | Questions |
---|---|
1 | What do you know about COVID-19? Please explain. |
2 | Please explain the symptoms, ways of transmission, and how dangerous COVID-19 is. |
3 | How do you think COVID-19 can be prevented? |
4 | Did you know that your job is one of the riskiest jobs in this COVID-19 pandemic? If yes, then why are you still working and have not stopped working? |
5 | Why do not you follow health guidelines? |
6 | Do you have enough access to hygienic products or are you reluctant to use them yourself? Please explain. |
7 | Does your employer warn you about observing the health issues? Do they provide you with hygiene items? Explain. |
8 | Do your colleagues observe health issues? Please explain. |
9 | What do you think about the performance of officials and television about the information and warnings they provide for people? Do they encourage you to consider health advice? Please explain. |
10 | What are the most important barriers for you to maintain the health norms? Please explain. |
Data analysis
Trustworthiness
Results
Categories | Subcategories | Codes |
---|---|---|
Individual factors | personality traits | Frustration, carelessness, impatience, laziness, risk-taking |
lack of self-efficacy | I can’t wash my hands after touching anything, I can’t wear gloves while driving, I can’t wear a mask because I feel short of breath, it’s hard for me to stay at home, I can’t work with my phone or do other things easily when I have gloves. | |
little knowledge of the disease and how to observe health issues related to it | The use of one mask during the day, repeated use of a mask and disposable gloves, incorrect use of the mask, insufficient knowledge about how to wash hands properly, and lack of sufficient knowledge of symptoms, transmission ways and ways to prevent COVID-19 | |
misconceptions about health | Most old men take COVID-19 seriously, young people do not consider it as fatal, and people who had a previous illness die more. I am not sick. I am healthy. So nothing happens to me. I’ve heard that COVID-19 is like the common cold, not believing in quarantine | |
Structural factors | difficulty of access to health supplies | The high cost of hygienic products, lack of hygienic products, poor distribution of hygienic products in the city, crowded queue for distribution of hygienic products, poor quality of hygienic products |
lack of supportive environment | Not providing health facilities by the employer, lack of necessary hygienic products in the workplace, crowded work environment, non-observance of health norms by the customer or client, non-observance of health norms by colleagues | |
weak laws and supervision | The lack of compulsion and pressure to observe health norms, the lack of rules to punish offenders, the lack of strict enforcement by officials, and the lack of adequate oversight for observing health norms | |
poor performance of officials and national media | Not dealing with COVID-19 seriously, broadcasting contradictory messages, broadcasting different statistics, joking around about COVID-19 effects and consequences, not showing its serious consequences, and broadcasting TV shows (showing many people together) | |
Economic factors | economic costs of living | Reduction of income, being in debt, being a tenant, not having a job other than high-risk work, spending money on home and family |
lack of government economic support | Inadequacy of government assistance, fear of being fined by banks | |
Sociocultural factors | learning | Learning from officials as a model in media, Learning from neighbors as models, Learning from colleagues as models |
cultural beliefs | Fatalism, being labeled as fastidious and foppish by colleagues in case of observing health guidelines, being labeled as a coward by associates in case of observing health guidelines | |
social customs and rituals | New Year (Norouz) parties, close relationship with each other, to have courtesies with colleagues |
Individual factors
Personality traits
"I don't care at all if I get COVID-19, I don't care anything for a long time." (Participant 12)
"I don't have the patience to wear gloves or stay at home." (Participant 1)
"Sometimes I pay attention to it, sometimes I get lazy, I say take it easy." (Participant 5)
"I don't pay much attention to it, I'm not afraid of taking it, I'm not afraid of death, too." (Participant 8)
The presence of certain personality traits in participants made them reluctant to pursue health issues, which further endangered their health."I am disappointed with this world. Nothing matters to me. It doesn't matter if I die or survive, that's why I’m not hard on myself." (Participant 22)
Lack of self-efficacy
"As soon as I wear a mask, I feel short of breath." (Participant 29)
"It's hard for me to wash my hands several times in an hour." (Participant 16)
"I can't wear gloves when I’m driving." (Participant 8)
There are many ways to transmit COVID-19, which can cause people to observe many health issues; this can lead to a decrease in self-efficacy in individuals because people do not see the potential to follow all the health tips."If you want to be completely healthy, life will be very difficult and I can't do that." (Participant 11)
Little knowledge of the disease and how to observe health issues related to it
"I wear one mask every day and every time I want to eat something, I take it off and put it in somewhere. After having water or food, I use it again." (Participant 15)
"Before my customers come in, I tell them to wash their hands. So I get sure I won't take it even if they are sick." (Participant 23)
"When I see someone coughing, I walk away from them and I don't let them get close to me. So nothing threatens me anymore." (Participant 17)
Despite the widespread publicity in the media, many people still do not have a clear understanding of COVID-19 and how to observe hygiene requirements, and this leads to the poor performance of preventive and hygienic principles and, as a result, the spread of the disease."Those who have COVID-19 are sick very badly, so they can't get out for shopping, so I'm not too scared." (Participant 3)
Misconceptions about health
"Most old men take COVID-19 seriously, while young people don't consider as fatal. Hence, I feel relaxed and carefree." (Participant 30)
"People who had a previous illness die more. I'm not sick. I'm healthy. So nothing happens to me." (Participant 22)
"I've heard that COVID-19 is like the common cold, we take it too much seriously." (Participant 19)
The misconceptions about COVID-19 have led many participants to believe that they are protected from the disease, which makes them less likely to observe health advice."If I wash my hands regularly and don't eat anything outside, I won't take COVID-19." (Participant 13)
Structural factors
The difficulty of access to health supplies
"I like to observe, but if I want to be very hygienic, I have to spend all the money I make to buy hygienic products." (Participant 2)
"At first, I was very sensitive and looked for masks and gloves, but no pharmacies had these items so I let it go." (Participant 4)
"In the whole city, only a few places are arranged to distribute hygienic products. If you want to go, you have to wait in line for two hours. With these working conditions, I can't stand in line, although the queue itself is very dangerous because everyone is close to each other and not far enough from each other."(Participant 17)
Therefore, one of the main reasons for not observing the health norms among the participants was the difficulty of access to health supplies. Health officials in Iran have not been able to create a suitable mechanism to provide easy access to hygienic products for all people."Two or three days ago, I took a pack of gloves, and as soon as I wore them, they were torn."(Participant 13)
Lack of supportive environment
"I'm a taxi driver. Taxi drivers’ organization should have given us masks and gloves, but they didn't give us anything." (Participant 6)
"I’m a bank employee. From the beginning, they agreed to give us a hand disinfectant solution, but so far they haven't done anything. Maybe I would have followed health protocols if they had given us the equipment." (Participant 9)
"Our workplace is always crowded. If we observe health norms ourselves, it is useless when others do not observe it. We warn so many times a day, but no one listens. So I let it go." (Participant 9)
Therefore, the lack of a strong supportive environment in the workplace and the lack of health supplies in it as well as the reluctance of the colleagues not observing health norms by were the main reasons behind it."I was very sensitive and observant, but when I saw that none of my colleagues observed health issues, I got disappointed." (Participant 21)
Poor laws and supervision
"We Iranians are accustomed to being forced to do something, otherwise we don’t observe anything. Maybe if they forced us to observe rules, I would do it." (Participant 23)
"Everyone behaves the way they want. They did not make any laws to penalize those who do not observe health issues. They only fined those who had moved from their city to another city." (Participant 31)
"In the media, officials tell us to observe health advice all the time, but they never monitor. If they have more control, everyone will have to observe." (Participant 28)
Therefore, the participants mentioned the lack of strong laws and poor supervision as one of the reasons for not observing health rules."If they had set the law and had supervised it, both I and all my colleagues would have observed." (Participant 7)
The poor performance of officials and national media
"Many officials didn't take COVID-19 seriously at first, and we don't take it seriously when we see they don't take it seriously." (Participant 11)
"We have heard so many strange statistics that we no longer believe in anything. That is why I say that whatever happens is not important." (Participant 12)
"On TV, they telecast different opinions every day, one day they say to wash your hands a lot, another day they say wash a little. One day they say when you go home from work, wash your clothes, another day they say don't wash. One day they say not everyone should wear a mask, another day they say everyone should wear a mask. We are human beings, we got tired."(Participant 25)
"At first I took it very seriously and observed it, but when I saw the officials all joking around about COVID-19, I somehow concluded that this is not such a dangerous disease." (Participant 18)
Therefore, the officials and the national media, who could have played a significant role in informing the people, with their poor and conflicting performance, not only discouraged the people to maintain health norms, but also discouraged them from doing so."On television, they say don't gather in crowded places, but they put a hundred people in a small place in their programs. Well, when a person sees these, he feels that he doesn't need to be so observant." (Participant 10)
Economic factors
The economic costs of living
"My income has been declining since the outbreak of the coronavirus. I stayed home for a week, but I saw that this was putting a lot of pressure on my family. So I went back to work." (Participant 27)
"I am a tenant. If I can’t pay the rent at the end of the month, my landlord will complain a lot. I don't have any other income, so I have to do vending." (Participant 16)
"I'm paying for a family of six. If I don't go to work, how can I earn and pay for their expenses? I know it's a bad situation and I may get sick and my family's condition may get worse, but I have no choice."(Participant 15)
Thus, the high cost of living and the lack of income in these critical circumstances forced many participants to go to work despite being aware of the dangers that might threaten their health."Anyone who comes out in this condition and puts his life in danger, be sure, it’s because of the financial pressure, otherwise no one will like to get COVID-19." (Participant 4)
Lack of government’s economic support
"The government didn't help me as a vendor, they tell us to stay home all the time, they don't know about my life." (Participant 7)
"Living costs have risen so much that with the little help the government is giving, we can't make a living, so people like me are forced to go to work in these bad conditions." (Participant 21)
The inadequacy of the government’s financial assistance and not considering the conditions of the families have forced many people to continue their work due to financial difficulties."I owe to the bank and I have a monthly installment. If I don't pay my installment, I have to pay a fine. Instead of thinking about me, the government is just telling me to observe health issues. I come to work due to fear of being fined so that I can pay my installments at the end of the month."(Participant 24)
Socio-cultural factors
Learning
"I see a lot of officials on TV who have ten reporters in front of them but they don't use a mask. I say to myself it is not necessary; I have such a job that no more than ten people gather in my shop." (Participant 12)
"Most of my colleagues don't observe health norms. Well, when I see them, I get kind of relieved and I don't observe, too." (Participant 16)
Since many people in Iran do not observe the health tips related to COVID-19, this non-observance of health issues has become a model; So that people learn from each other not to follow the health tips."When I see our neighbors who don't observe health tips, I tell myself that I’m like them, whenever they observe, I do too." (Participant 5)
Cultural beliefs
"Death and life are in the hands of God. If God wills, I will get sick even if I don't get out of my room; but if God doesn't will, if I go to the hospital and shake hands with COVID-19 patients, I won't get sick, so we shouldn't take it too hard." (Participant 8)
"I put on a mask for a few days, but my friends were making fun of me and saying, 'When did you get so fastidious?', so I took it off." (Participant 15)
"One of our colleagues was wearing a mask and gloves and was not talking to anyone. The rest of the colleagues were making fun of him, saying he was coward and afraid of death." (Participant 27)
The belief that the destiny of people’s lives has been predetermined was prevalent among the participants. Also, in Iranian society, those who observe health issues are usually stigmatized as being fastidious and coward by those around them, and this can play a role in not observing health rules."From day one, God has decided how we die, so whatever is supposed to happen will happen, whether I observe or not." (Participant 22)
Social customs and rituals
"I, as a vendor, have been waiting all year for Norouz (Iranian New Year) to earn money for costs of several months. Now I can't stay home and let it go, although my sales have decreased a lot." (Participant 20)
"Everyone expects you to visit them on Norouz (Iranian New Year) vacation. I can't tell my mother that COVID-19 has come and we can't visit you." (Participant 6)
"We Iranians have a lot of courtesy. It happens to me many times that my colleague used my tools, but I couldn't tell him anything." (Participant 28)
There are strong kinship patterns in Iran and it plays a strong role in the communication and behavior of people. Therefore, most people gather at special parties and ceremonies and their presence are mandatory and if someone is absent they will be blamed by relatives. In the New Year, despite having many warnings from health experts, people could not refrain from attending family ceremonies due to the pressures of social customs and this made many problems for observing the health rules. The existence of specific social customs as well as the coincidence of the COVID-19 prevalence with New Year in Iran made it more difficult for Iranians to observe health guidelines."Everyone loves to congratulate each other on the New Year. When my colleague comes to kiss me, how can I tell him that he shouldn’t kiss me, you might get sick? I’m sure he gets upset. “(Participant 30)