Why Do We Not Follow Lifesaving Rules? Factors Affecting Nonadherence to COVID-19 Prevention Guidelines in Indonesia: Healthcare Professionals’ Perspectives

Abstract

This study aimed to understand Indonesian healthcare professionals’ (HCPs) perceptions and experiences regarding barriers to both HCP and community adherence to COVID-19 prevention guidelines in their social life. This methodologically qualitative study employed in-depth interviewing as its method for primary data collection. Twenty-three HCP participants were recruited using the snowball sampling technique. Data analysis was guided by the Five Steps of Qualitative Data Analysis introduced through Ritchie and Spencer’s Framework Analysis. The Theory of Planned Behaviour was used to guide study conceptualisation, data analysis and discussions of the findings. Results demonstrated that HCP adherence to COVID-19 prevention guidelines was influenced by subjective norms, such as social influence and disapproval towards preventive behaviours, and perceived behavioural control or external factors. Findings also demonstrated that HCPs perceived that community nonadherence to preventive guidelines was influenced by their behavioural intentions and attitudes, such as disbelief in COVID-19-related information provided by the government, distrust in HCPs, and belief in traditional ritual practices to ward off misfortune. Subjective norms, including negative social pressure and concerns of social rejection, and perceived behavioural control reflected in lack of personal protective equipment and poverty, were also barriers to community adherence. The findings indicate that policymakers in remote, multicultural locales in Indonesia such as East Nusa Tenggara (Nusa Tenggara Timur or NTT) must take into consideration that familial and traditional (social) ties and bonds override individual agency where personal action is strongly guided by long-held social norms. Thus, while agency-focused preventive policies which encourage individual actions (hand washing, mask wearing) are essential, in NTT they must be augmented by social change, advocating with trusted traditional (adat) and religious leaders to revise norms in the context of a highly transmissible pandemic virus. Future large-scale studies are recommended to explore the influence of socio-cultural barriers to HCP and community adherence to preventive guidelines, which can better inform health policy and practice.

The impact of working in COVID-19 hospital on indonesian nurses’ mental health and wellbeing: a qualitative study

“…As reported in previous studies [ 33 , 34 ], the current findings also indicate that poor economic conditions have a significant influence on the efforts of community members and HCPs to comply with preventive protocols and prevent further community transmission of COVID-19. Being at high risk for COVID-19 infection was also reported to exacerbate nurses’ fear of early death.…”

“…The study suggests that family member’s and friend’s skepticism about the ‘real’ diagnosis of patients with COVID-19 or death status due to COVID-19, in addition to suspicion that doctors or nurses tended to “make up” the reason or “blame” COVID-19 as the cause of death to make people adhere to the prevention protocols, were also implicated in causing mental health challenges for nurses. Such skepticism can likely influence people’s attitudes and behaviors towards COVID-19 prevention protocols (distrust) proposed by the government, health authorities and healthcare professionals [ 33 , 41 ]. This skepticism seems to be supported by the misinformation about COVID-19, distrust and public trust in conspiracy theories, which may affect people attitudes and behaviors to follow COVID-19 protocol and access to healthcare services during the pandemic and adherence to COVID-19 protocols as reported in previous studies [ 33 , 42 ].…”

The impact of working in COVID-19 hospital on mental health and wellbeing: A qualitative study with nurses in a hospital in East Nusa Tenggara, Indonesia

“…Room limitation led participants to feel not being well quarantined at home, a condition allowing them to easily have contact or share stuff with other family members, leading nurses to feel more worried, anxious and stressed due to close exposure to infection. As reported previous studies [54][55][56], the current ndings also indicate that poor economic conditions have a signi cant in uence on the efforts of community members and HCPs to comply with preventive protocols and prevent further community transmission of COVID-19. Being at high risk for COVID-19 infection was also reported to exacerbate nurses' fear of early death.…”

Understanding Actions Taken by Female Family Caregivers and Challenges They Faced in Caring for Older People During Covid-19 Pandemic in Belu District, Indonesia: A Qualitative Study

“…This knowledge was reflected in a range of actions undertaken to limit interactions of older adults with extended family members, neighbors and other community members to prevent their exposure to COVID-19, which are congruent with COVID-19 preventive protocols [29, 30] and previous findings reported elsewhere [31, 32]. The actions of the female caregivers seem to also reflect the social behavior theory suggesting that infection may determine behaviors of individuals or communities and alter or reduce social connectivity to prevent transmission [33-35]. Our findings also show the perceived importance of COVID-19-related health and social media literacy for older adults, which led to carer provision of the necessary information about COVID-19 and the control of social media and smart-phones use among older people.…”