Published: 2021-05-25

Adherence to COVID-19 appropriate behaviour among small scale workers in unorganized sector in Rajasthan by applying health belief model and generalized social beliefs

Ashok Kumar, Praveena ., Pradeep K. Tiwari, Rashmi R. Barik


Background: People’s adherence to COVID-19 appropriate behavior (CAB) is important to prevent and manage coronavirus disease-19. The study aimed to determine the prevalence and associated factors of adherence to CAB in small-scale workers in the unorganized sector by applying health belief model (HBM) and generalized social beliefs.

Methods: This community-based, cross-sectional study was done in Central Rajasthan from January 2021 to March 2021. A pre-tested, structured, interviewer-administered tool was used to collect data from 384 participants. Data were collected on five constructs of HBM and two social axioms.

Results: The mean (SD) age of participants was 36.89 (10.84) years. About 58% of participants were male. Adherence to all CAB measures was 15%, it was not found to be associated with age, gender, education level, residence and occupation. The most common practiced CAB measure was face cover (57.8%) followed by handwashing (43.75%). Adherence was found associated with all five HBM constructs and two social axioms.

Conclusions: The adherence to CAB was low among small-scale workers in the unorganized sector. It is pivotal to consider the community’s perceived susceptibility, severity, benefit, barrier, cue to action, cynicism and reward for application to improve the adherence towards CAB.


COVID-19 appropriate behaviour, Health belief model, Social axioms, COVID-19, Adherence

Full Text:



Ministry of Health and Family Welfare. Fact sheet: COVID-19 India, 2020. Available at: Accessed on 12 April 2021.

WHO. Fact sheet: Countary and Technical Guidance, 2020 [cited 2021 Apr 30]. Available at: Accessed on 12 April 2021.

ICMR COVID Study Group, COVID Epidemiology and Data Management Team, COVID Laboratory Team, VRDLN Team. Laboratory surveillance for SARS-CoV-2 in India: Performance of testing descriptive epidemiology of detected COVID-19, January 22-April 30, 2020. Indian J Med Res. 2020;151(5):424-37.

Chatterjee S, Sarkar A, Karmakar M, Chatterjee S, Paul R. SEIRD model to study the asymptomatic growth during COVID-19 pandemic in India. Indian J Phys Proc Indian Assoc Cultiv Sci. 2020;94:1-13.

Kumar N, Hameed SKS, Babu GR, Venkataswamy MM, Dinesh P, Kumar BGP, et al. Descriptive epidemiology of SARS-CoV-2 infection in Karnataka state, South India: Transmission dynamics of symptomatic vs. asymptomatic infections. Clinic Med. 2021;32:100717.

Ministry of Health and Family Welfare, Government of India. Fact sheet: An Illustrative Guide on COVID Appropriate Behaviours, 2020. Available at: pdf/Illustrativeguidelineupdate.pdf. Accessed on 12 April 2021.

Ministry of Health and Family Welfare, Government of India. Fact sheet: 30th SOP on preventive measures in markets to contain spread of COVID-19, 2020. Available at: Accessed on 11 April 2021.

Mehanna A, Elhadi YAM, Lucero-Prisno DE. Factors influencing intention to adhere to precautionary behavior in times of COVID- 19 pandemic in Sudan: an application of the health belief model. medRxiv. 2020.

Shahnazi H, Ahmadi-Livani M, Pahlavanzadeh B, Rajabi A, Hamrah MS, Charkazi A. Assessing preventive health behaviors from COVID-19: a cross sectional study with health belief model in Golestan Province, Northern of Iran. Infect Dis Poverty. 2020;9(1):157.

Tong KK, Chen JH, Yu EW, Wu AMS. Adherence to COVID-19 precautionary measures: applying the health belief model and generalised social beliefs to a probability community sample. Appl Psychol Heal Well Being. 2020;12(4):1205-23.

Bante A, Mersha A, Tesfaye A, Tsegaye B, Shibiru S, Ayele G, et al. Adherence with COVID-19 preventive measures and associated factors among residents of Dirashe district, Southern Ethiopia. Patient Prefer Adherence. 2021;15:237-49.

Yehualashet SS, Asefa KK, Mekonnen AG, Gemeda BN, Shiferaw WS, Aynalem YA, et al. Predictors of adherence to COVID-19 prevention measure among communities in North Shoa Zone, Ethiopia based on health belief model: A cross-sectional study. PLoS One. 2021;16:0246006.

Apanga PA, Kumbeni MT. Adherence to COVID‐19 preventive measures and associated factors among pregnant women in Ghana. Trop Med Int Heal. 2021.

Banerjee R, Banerjee B. Public perspective and adherence to government directives in the face of COVID-19 situation in India. MAMC J Med Sci. 2020;6(2):90-6.

Rosenstock IM. Historical Origins of the Health Belief Model. Health Educ Behav. 1974;2(4):328-35.

Bond MH, Leung K, Au A, Tong K, Chemonges‐Nielson Z. Combining social axioms with values in predicting social behaviours. Eur J Pers. 2004;18:177-91.

Kurman J. What I do and what I think they would do: social axioms and behaviour. Eur J Pers. 2011;25:410-23.

Harper CA, Satchell LP, Fido D, Latzman RD. Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic. Int J Ment Health Addict. 2020;18:1-14

Jones SL, Jones PK, Katz J. Health belief model intervention to increase compliance with emergency department patients. Med Care. 1988;26(12):1172-84.

Kelly RB, Zyzanski SJ, Alemagno SA. Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy. Soc Sci Med. 1991;32(3):311-20.

Weinstein ND. Reducing unrealistic optimism about illness susceptibility. Heal Psychol. 1983;2(1):11-20.

Weinstein ND, Klein WM. Resistance of personal risk perceptions to debiasing interventions. Heal Psychol. 1995;14(2):132-40.

McCaul KD, Wold KS. The effects of mailed reminders and tailored messages on mammography screening. J Community Health. 2002;27(3):181-90.

Liem AD, Hidayat SS, Soemarno S. Do general beliefs predict specific behavioral intentions in indonesia? the role of social axioms within the theory of planned behavior. New York: Springer; 2009: 217-38.

Zhou F, Leung K, Bond MH. Social axioms and achievement across cultures: The influence of reward for application and fate control. Learn Individ Differ. 2009;19(3):366-71.