Our reflexive thematic analysis revealed six overarching themes representing risk perception and protective behavior (Table 3). The results presented here define and interpret themes in the context of critical realism.
Risk perception is a subjective psychological construct depending upon psycho-social factors varying across individuals and groups. Even though the cognitive evaluation involved in risk perception depends on information sources, exposure to the risk, and people’s intention to believe and follow the information, the emotional response engage our risk perception with our fears (Leiserowitz 2006; Sjoberg 2002; van der Linden 2017). Risk perception also depends on the trust in the authority providing information about the risk, familiarity with the situation, awareness about the risk, and perceived uncertainty. In the context of the COVID-19 breakout, the critical situation around the globe requires studying the risk perception of the people regarding this infectious disease. People’s perceptions of risk associated with the fear of contagious coronavirus may inform us about their protective measures and coping strategies (Van Bavel et al. 2020). For example, one of the participants in our study talked about her initial information about the COVID-19 breakout and its symptoms that she later reflected in her protective behavior.
This is a pandemic. I understand how painful this is. First, I would say, if this pandemic had only affected the developing countries like ours; I might have interpreted it as the lack of healthcare facilities. However, this is worldwide and even superpowers are powerless to stop it. It means it is difficult to control and we cannot ignore this. We are being told by the media that we should reduce our social interactions, and we should almost completely disconnect ourselves from the outside world. We have no idea. We do not know who is safe or not. We must stay at home. We can disconnect ourselves from the outer world. Second, they are informing us about the symptoms such as sore throat, flu, breathing difficulties, and fever. People above fifty years of age, children below five years of age, and people with low immunity are vulnerable.
The participant shared the information she obtained from the media about the symptoms of the disease and the vulnerable population. Developing countries generally lack resources to meet the healthcare needs compounded by over-population, under-developed public health infrastructure, and poor or limited capacity to handle medical emergencies. Informed by the media, the participant views the global pandemic as “uncontrolled” which developing countries were not able to manage despite their resources and infrastructure. The way she inferred the “uncontrollability” of the disease in the context of global effects of the pandemic, she reflected her belief in the information provided to her through various sources that shaped her risk perception and corresponding precautionary measures. Ease of access to media and the magnitude of timely information provided by the popular media have an impact on general risk perception at both the personal and societal levels. Personal risk perceptions may be influenced by cultural and traditional sources which may limit behavioral change caused by media-based general risk perception (Oh et al. 2015; Vai et al. 2020). However, the participants in this study (who are new to the current situation) are looking for information to help them to protect themselves. The media campaigns supported by government and internationally recognized healthcare institutes and agencies have an authoritative influence directing a cognitive dimension of the risk associated with COVID-19 breakout.
Participants expressed their concerns about the contagious disease, human vulnerability, and government response in the context of the COVID-19 breakout and prevailing lockdown situation. At the same time, participants situate other people as “irresponsible” while discussing about their own protective behavior.
Fear of Contagion and Human Vulnerability
The participants’ understanding of coronavirus was influenced by their consumption of the “popular” newsfeed via electronic and social media. They shared their awareness of the highly contagious properties of the coronavirus and expressed concerns about its easy and rapid transmission through the air and physical contact.
The virus is extremely contagious. It spreads quickly by shaking hands with the infected person or touching objects. If it is in the air, it can enter into your body through the nose. Now I have learned (from the media) that this virus could live in your wallet or mobile phone. That is, in addition to sanitizing hands, we must sanitize keys, wallet, cell phones, etc. (p14)
With the growth of the disease outbreak, people became interested in the disease and learned about its infectious effects in the media.
Now we know that the coronavirus is spreading and that hospitals are running short of treatment facilities, we are eager to understand this phenomenon. Whatever we have learned from the media and medical professionals about its highly contagious properties is now a public knowledge. It has the potential to contaminate the air we breathe; this is alarming. (p7)
Despite the fact that the participants in this study had no direct experience or direct observation of COVID-19 cases, they appear to accept the “truth” as documented in the news media and country status reports. Therefore, as findings reflect, information and information sources are structured to learn the fear of contagion and the associated human vulnerability. Based on the news related to the uncertainty of the disease and the non-availability of any cure or treatment, participants perceived coronavirus as a real threat to human health. It was also discovered that at first some participants did not consider the disease to be anything more than the flu caused by a cold or allergic reaction (such as dust, pollution). However, later with the gradual increase in the cases (as disclosed by the government) and with a rise in sensitization of the issue by the media, the risk perception associated with high transmissibility and incurability of COVID-19 also increased. For example, one of the participants talked about his earlier misconception about the disease.
We initially assumed that this was just another bad case of flu that turned into a sore throat and could be treated with standard home care and medications. According to reports, its symptoms were similar to contagious allergic reactions, such as sneezing and running nose. When more cases were reported, and we learned that severely ill patients had been admitted to ICUs (intensive care units), we realized this was not a typical flu.
According to the findings, participants used their perceptions of “responsible” behavior to situate the “irresponsible” behavior of others. As a result, participants appeared to use their risk perception as a standard to judge the “irresponsible” behavior of others, which also triggers their sense of risk and fear.
Situating “Others” Irresponsible Behavior
As previously stated, participants viewed other people’s behavior as “irresponsible” because they do not see them understanding the risk of disease exposure and being aware of its highly contagious effects. They viewed other people’s actions through the lens of risk perception. Other people’s “irresponsible” behavior was also perceived as a challenge. People who do not take precautionary measures (such as keeping a safe distance and wearing masks) make it difficult to control or limit the pandemic; for example, participants expressed concern about the careless response of those around them.
On the one hand, the government is attempting to educate people about the gravity of the situation and advising them on all possible precautions; on the other hand, most people are ignoring these precautions. They are completely unaware of the dangerous situation. As a result, they lack a sense of responsibility in this dire situation. They are irresponsible in their behavior and cause problems for many others.
They emphasized the importance of altering their daily routines in terms of physical distance and the use of masks.
People, for example, are not willing to change their routines, which means they continue to spend their social lives in the same way. They go to markets on a regular basis. They are leaving the house unnecessarily. Wearing a mask is not common, but it should be. Physical distance is not yet accepted as a precautionary measure, and people do not avoid shaking hands and getting too close in the streets and markets. Overall, they are unconcerned about the situation and are treating it casually or as usual. (p12)
The participants identified people’s behavior as “irresponsible” and “pathetic” in the realization of the grave situation caused by their carelessness.
The public behavior is pathetic, and they are not ready to take it seriously. They do not have any idea about its severity. A few days ago, in an online video, a medical doctor was appealing to the public to stay at home. Our people are not serious about it. Some educated people are conscious of it and taking measures. However, several educated people make a crowd at grocery shops. This is pathetic. (p13)
Another reason participants mentioned the irresponsible behavior was the poor understanding of the symptoms of the disease as people mistook it as the common flu or cough. Hence, people who are used to follow folk remedies do not follow government instructions, such as repeated handwashing, use of masks, sanitizers.
We should not use any home remedies. We must take precautions such as washing our hands and maintaining our cleanliness. People do not take the disease seriously and take things for granted. They are unaware that this disease is not the same as the flu and cough that they used to treat without taking precautions. (p16)
Other reported concerns about irresponsible behavior included denial of the situation, intentional negligence, a lack of awareness, being non-serious, and being uncooperative. Participants expressed their concerns about the rapid spread of COVID-19 while discussing their protective behavior and contrasting it with that of others who were “irresponsible.” The way all participants perceive other people’s “irresponsible behavior” in comparison to their own sense of responsibility (which they gradually learn) also demonstrates that the participants who agreed to participate in this study are those who believe COVID-19 is a reality.
As previously stated, the structure of the top-down flow of information influences the construction of meanings of the risk associated with COVID-19, and participants’ risk perception in this context constructs the meaning of “irresponsibility.” Similarly, we identified three themes related to protective behavior reflected in the underlying structure of lockdown, awareness campaigns, and government and private media sensitization of the situation. Our research uncovered three types of protective behaviors. The physical level measures (personal hygiene); the social level measures (physical distancing as directed by the government and healthcare professionals); and the third level measures (religious coping, which is a cognitive reappraisal of the stressful event, human limitations, and corresponding religious beliefs). Participants reported their coping strategies used during the lockdown under the umbrella of “responsible behavior.” Participants discussed their precautionary measures to demonstrate their responsible behavior in the face of the ongoing pandemic. That is how they use their self-reported responsible behavior as a standard to judge “other people’s irresponsible behavior.” For example, one of the participants said:
People who are aware of the severity of the pandemic are taking reasonable precautions to protect themselves and their families. They are following information from various media sources and will continue to do so. (p13)
It was clear that participants understood “sensible behavior” as following instructions to seek protection.
I’m following the instructions given to me by the media. My family and I have been quarantined at home. I’m not going outside unless absolutely necessary. When I go grocery shopping, I put all of the bags in a corner of the room for 24 hours. In the case of perishable goods, I thoroughly wash them. I don’t let my kids touch anything until I’ve properly disposed of it. I wash my hands and put on new clothes. To boost my children’s immunity, I give them vitamin supplements and fruits. (p1)
Aside from religious coping, which we will discuss later, the findings revealed personal hygiene and physical distancing as protective strategies that participants use in accordance with healthcare professionals’ and government media campaigns’ instructions.
We are sanitizing everything that has physical contact with the person coming from outside. We are, for example, sanitizing doorknobs, switches, chairs, and tables. Whoever goes out has a separate set of clothes and shoes that he or she must change after returning home. We are especially concerned about children, and they are frequently asked to wash their hands in this situation. Children, you know, carelessly touch everything. On the other hand, we avoid ready-made foods and limit ourselves to dining out and takeaway food. In this case, home cooking is the best option. All we can do is try to protect ourselves. We recognize that this is not perfect, but given the circumstances, we can do our best. (p17)
Participants reported personal hygiene as an early and important protective measure against COVID-19. Whatever they learned from healthcare campaigns in the context of COVID-19, they practiced it in several different ways, such as disinfecting the body, clothes, vegetables, and fruits with water and chemicals. The primary objective is to use personal hygiene as a scientific shield against coronavirus.
I am very careful now. For example, I went to a bakery, and I did not touch the door handle. I pushed the door open with my elbow. My son was also with me. After coming home, we washed our hands with soap. Then I managed the stuff we bought. Washing hands with soap is compulsory nowadays. I do not let my kids to touch anything without washing hands with soap, especially after coming home. (p16)
One participant talked about how she is trying to manage hygiene behavior at home while instructing children and her husband.
Whenever my husband comes home, I ask him to take a shower to disinfect him. I wash his clothes with disinfectant chemicals and detergent, and dry them in the sunlight. Children need more specific instructions. I pay attention to their activities at home and outside. They are strictly advised to follow the instructions. (p13)
Participants described their hygiene practices as learned routine actions related to their COVID-19 knowledge and concerns. It was clear that they attempted to modify their behavior in accordance with the instructions they received through the media. The emphasis on personal hygiene appeared to play a critical role in reducing their anxiety. We discovered increased use of antiseptic and disinfectant chemicals, frequent handwashing, and deliberate efforts to adapt hygiene behavior.
WHO recommends physical distance as a preventive measure. Physical distancing entails keeping at least six feet away from other people in public places (such as markets, hospitals, public transport). Participants limited their social interaction in order to maintain physical distance. They avoided social and religious gatherings, as well as unnecessary outings.
We are physically cut off from everyone. We use social media to communicate with our friends and family. We’re avoiding social gatherings. At home, we’ve also stopped having our maid come in and clean the house. We are avoiding unnecessary trips to markets and stores. My husband buys groceries for the entire week, making sure to have as little physical contact with people as possible. If someone pays us a visit, we make every effort to avoid handshakes. In any case, there are some things we simply cannot avoid out of respect, such as shaking hands with the elderly. (p2)
Participants attempt to maintain physical distance; however, in their cultural context, this is interpreted as social distance. As previously stated, refusing to shake hands with elderly people may be perceived as disrespectful. Similarly, people offering Salat (the five-times-a-day prayer ritual practiced by Muslims) at mosques should pray in rows (as required to offer the ritual prayer). In this situation, it is difficult to avoid close contact. Male Muslims are strongly encouraged to pray at the mosque, while female Muslims are not required to do so. One of the male participants used the COVID-19 precautions to justify praying at home and avoiding physical contact with other people in the mosque.
Yes, some people believe we should go to the mosque, and the mosque should not be empty during prayer time. People, however, cannot maintain physical distance while praying together. To offer prayer, all participants must stand in a row. In this terrible situation, praying at home should be sufficient. Even the holy cities of Makkah and Madinah in Saudi Arabia are closed. It teaches us that we can pray at home without having to go to religious gatherings at the mosque. (p14)
The participants practiced physical distancing while compromising on several culturally expected social interactions. On the other hand, avoiding unnecessary market or public place visits, as well as limiting receiving services at home (such as maids), was a preventive measure to ensure limited physical contact with people. One participant mentioned three protective measures that she was using and thought they were useful.
We are taking the most stringent precautions. First, wash hands frequently; second, avoid handshakes; and third, stay at home the majority of the time. We are trying to do so in order to avoid the pandemic. We avoid gatherings for meals, parties, and religious reasons. As recommended by the healthcare professionals, yes, it is helpful. At least, we know we are protecting ourselves and others by taking precautions. (p15)
The steps they take to protect themselves against the coronavirus (as advised by media campaigns) provide them with a sense of security, which ultimately helps to reduce anxiety in this critical situation.
It is my belief and I think every Muslim believes in it that this is a natural disaster. Allah is showing us what he can do. He is informing us about our limitations and vulnerability in this world. And in our prophet’s lifetime when a pandemic struck a region, the prophet (peace be upon him) advised people not to leave the infected area and do not enter the infected area. It implies that we should be careful. But it is also true that death is the ultimate destination no matter wherever we are. Hence, we must seek Allah’s forgiveness. We should pray and seek his shelter. This (pandemic) is from him and he will rescue us. (p16)
The majority of the participants discussed their religious coping strategies for seeking divine protection during the COVID-19 pandemic. Participants reported common religious practices such as connecting to their faith, turning to religious teachings to maintain health, ritualized cleaning, and prayers. They discussed connecting with their faith in God and seeking his protection. This faith-based shield, they say, gives them hope that they will be safe during the pandemic. One of the participants used the story of the prophet Jonah, who was swallowed by a whale as an example.
We must pray to Allah. Recite His praises and glory, and beg forgiveness from Him. ‘Ayat Karima’ must be recited (the verse in the Quran that Prophet Jonah recited when he was in the belly of the whale). It was due to the miracle of Ayat Karima that prophet Younus (Jonah) survived in the belly of the whale until it spit him out at the shore. If we ask Allah for forgiveness. I believe that repeatedly reciting Ayat Karima will eventually rescue us from this terrible situation. (p16)
Ayat Karima is a verse in Quran that says, “There is no deity except You; exalted are You. Indeed, I have been of the wrongdoers.” Participants mentioned several verses from the Holy Quran that they believe to work as a protective shield against unseen hazards, threats, and diseases. All these verses are about praising God, submitting to his will, accepting human vulnerability, seeking is forgiveness and shelter.
The findings also revealed that participants get religious reinforcement to practice personal hygiene. For example, doing ablution to offer prayer five times a day is perceived as a purification ritual necessary to offer prayer ritual.
We believe that only Allah can protect us. Our religion directs what we should do. We need to keep ourselves clean. We should perform ablution to cleanse ourselves physically and spiritually. We can’t offer prayer unless we’ve had ablution. Hands, nose, ears, face, arms, and feet should be thoroughly washed five times a day to maintain personal hygiene. Then, praying is a way to connect with God and ask for his blessing. (p11)
Participants expressed faith in God as the ultimate power. During the current pandemic, they expressed feelings of helplessness and submission in order to seek protection. Seeking satisfaction through religious rituals was a faith-based behavior that participants perceived as beneficial in dealing with stressful situations. In some ways, the pandemic has helped religious people reconnect with their faith with renewed vigor. In some cases, it is a declaration of their faith as the most valuable and beneficial resource in their lives. Overall, our findings revealed religious practices to be an effective coping strategy for remaining resilient during this pandemic.