A Study On Preventive Behaviors Of Infectious Dieases Among Rural Residents In Three Provinces Of China During The COVID-19 Pandemic

Background: Since the end of 2019,the COVID-19 has caused a global pandemic,ringing the alarm bell for the prevention and control of infectious diseases.Prevention and control of emerging and re-emerging infectious diseases such as COVID-19 requires scientific and effective preventive behaviors of the general population,therefore it is important to study the preventive behaviors of infectious disease among Chinese rural residents during the COVID-19 pandemic.Objective: To conduct field surveys on preventive behaviors of infectious disease among rural residents in three provinces of China during the COVID-19 pandemic and to analyze the influencing factors,so as to provide scientific basis to inform the making and implementing of preventive measures.Methods: We conducted a cross-sectional questionnaire survey using a multistage stratified random sampling method from July to December 2021 in six counties representing the eastern,central,and western regions of China respectively.These counties were Changle County in Weifang City and Shan County in Heze City,Shandong Province;Zhongyang County and Lan County in Lvliang City,Shanxi Province;and Zhenyuan County in Pu’er City and Yao’an County in Chuxiong Prefecture,Yunnan Province.A total of 3864 rural residents aged ≥15 were selected and surveyed in these counties covering their basic demographic information and preventive behaviors of infectious diseases such as mask-wearing and hand-washing.Data entry was performed using Epi Data 3.1 software,and data analysis was conducted using SPSS 25.0 software.The χ2 test was used to compare differences of rates,and multivariate binary logistic regression was used to analyze the influencing factors of preventive behavors of infectious diseases of rural residents.Differences were considered statistically significant at P<0.05.Results: A total of 3816 valid questionnaires were finally obtained in this survey with an effective rate of 98.76%.Around ninety-four percent(93.45%)of the respondents reported mask-wearing during the COVID-19 pandemic,but only 44.43%of them were able to replace their masks timely.Multivariate binary logistic regression analysis showed that,the female compared with the male(OR=0.370,95%CI=0.271-0.504),aged 15-34(OR=2.619,95%CI=1.413-4.854),35-59(OR=1.408,95%CI=1.020-1.943)compared with 60-93,ethnic minority group compared with Han nationality group(OR=0.496,95%CI=0.249-0.988),occupation as farmers(workers)(OR=1.719,95%CI=1.217-2.429)compared with the unemployed,rural residents in Shandong Province(OR=1.743,95%CI=1.171-2.593)compared with the ones in Yunnan Province were more likely to wear masks(all P<0.05).Furthermore,being female compared with the male(OR=0.813,95%CI=0.697-0.949),aged 15-34(OR=2.155,95%CI=1.669-2.784),35-59(OR=1.644,95%CI=1.372-1.971)compared with 60-93,those with educational level of bachelor and above compared with those who are illiterate or have little literacy(OR=0.405,95%CI=0.208-0.791),primary school(OR=0.486,95%CI=0.251-0.942),occupation as business and service workers(OR=1.473,95%CI=1.131-1.919)compared with the unemployed,rural residents in Shandong Province(OR=3.969,95%CI=3.300-4.774)and Shanxi Province(OR=1.309,95%CI=1.092-1.569)compared with the ones in Yunnan Province replaced their masks more timely(all P<0.05).Among all survey respondents,69.79% reported washing their hands with soap,but only 38.02% met the critiria of proper hand-washing defined by the World Health Organization.Multivariate binary logistic regression analysis showed that,aged 15-34(OR=1.297,95%CI=1.027-1.640),35-59(OR=1.381,95%CI=1.169-1.631)compared with 60-93,the married(OR=2.834,95%CI=1.143-7.032)compared with the divorced,occupation as employees of governmental departments and retirees(OR=2.291,95%CI=1.630-3.220),business and service workers(OR=1.742,95%CI=1.372-2.212),farmers(workers)(OR=1.260,95%CI=1.063-1.495),students(OR=2.529,95%CI=1.395-4.586)compared with the unemployed were more likely to wash their hands properly(all P<0.05).Among all the survey respondents,33.81% reported maintaining a social distance of 1 meter or more.Multivariate binary logistic regression analysis showed that,those with educational level of bachelor and above compared with those who are illiterate or have little literacy(OR=0.413,95%CI=0.225-0.758),occupation as employees of governmental departments and retirees(OR=2.314,95%CI=1.627-3.290),business and service workers(OR=1.637,95%CI=1.260-2.127),farmers(workers)(OR=1.585,95%CI=1.290-1.947)compared with the unemployed,rural residents in Shandong Province(OR=1.696,95%CI=1.397-2.059)and Shanxi Province(OR=1.338,95%CI=1.102-1.625)compared with the ones in Yunnan Province were more likely to maintain a social distance of 1 meter or more(all P<0.05).Among the 3214 people who reported spit,cough,and sneeze,16.80% reported that they could do it in a hygienic manner.Multivariate binary logistic regression analysis showed that,being female compared with the male(OR=0.576,95%CI=0.465-0.714),aged 15-34(OR=1.618,95%CI=1.131-2.315),35-59(OR=1.312,95%CI=1.006-1.711)compared with 60-93,those with educational level of bachelor and above compared with those who are illiterate or have little literacy(OR=0.235,95%CI=0.113-0.492),primary school(OR=0.397,95%CI=0.194-0.811),rural residents in Shandong Province(OR=4.167,95%CI=3.092-5.616)and Shanxi Province(OR=2.043,95%CI=1.495-2.792)compared with the ones in Yunnan Province were more likely to spit,cough and sneeze in a hygienic manner(all P<0.05).Among all the survey respondents,41.14% reported using different cutting boards and knives for raw and cooked food.Multivariate binary logistic regression analysis showed that,aged 35-59(OR=1.204,95%CI=1.020-1.421)compared with 60-93,ethnic minority group compared with Han nationality group(OR=0.559,95%CI=0.435-0.718),those with educational level of bachelor and above compared with those who are illiterate or have little literacy(OR=0.517,95%CI=0.280-0.953),being employees of governmental departments and retirees(OR=1.582,95%CI=1.118-2.238),business and service workers(OR=1.337,95%CI=1.041-1.717)compared with the unemployed,rural residents in Shandong Province(OR=1.507,95%CI=1.254-1.811)compared with the ones in Yunnan Province,rural residents in Yunnan Province compared with the ones in Shanxi Province(OR=0.699,95%CI=0.581-0.842)were more likely to use different cutting boards and knives when cooking raw and cooked food(all P<0.05).Among all the survey respondents,31.11% reported they do not use own chopsticks to get food from plates for all people at table when dining out.Multivariate binary logistic regression analysis showed that,aged 15-34(OR=2.193,95%CI=1.668-2.883),35-59(OR=2.206,95%CI=1.807-2.695)compared with 60-93,ethnic minority group compared with Han nationality group(OR=0.545,95%CI=0.418-0.712),those with educational level of bachelor and above compared with those who are illiterate or have little literacy(OR=0.124,95%CI=0.061-0.248),primary school(OR=0.158,95%CI=0.079-0.315),middle school(OR=0.269,95%CI=0.137-0.527),senior school(OR=0.394,95%CI=0.202-0.769)occupation as employees of governmental departments and retirees(OR=1.896,95%CI=1.296-2.775),business and service workers(OR=1.582,95%CI=1.200-2.086)compared with the unemployed,rural residents in Shandong Province(OR=2.117,95%CI=1.724-2.600)compared with the ones in Yunnan Province,rural residents in Yunnan Province compared with the ones in Shanxi Province(OR=0.636,95%CI=0.512-0.789)were more unlikely to use own chopsticks to get food from plates at table for all people when dining out(all P<0.05).Among all the survey participants,96.99% reported being able to ventilate their houses/rooms daily.Multivariate binary logistic regression analysis showed that,being female compared with the male(OR=0.639,95%CI=0.423-0.966),rural residents in Shandong Province(OR=2.716,95%CI=1.427-5.166)compared with the ones in Yunnan Province,rural residents in Yunnan Province compared with the ones in Shanxi Province(OR=0.633,95%CI=0.415-0.966)were more likely to practice daily house/room ventilation(all P<0.05).Conclusions: During the COVID-19 pandemic,rural residents in three provinces of China exhibited relatively good preventive behaviors against infectious diseases,such as mask-wearing,hand-washing,and ventilating their houses/rooms.However,some problems remain such as replacing mask not in a timely manner,low rates of proper hand-washing,and unhygienic spitting,coughing,and sneezing.Overall,men,older adults,the less educated,and the unemployed have relatively poor preventive behaviors of infectious diseases.Therefore,effective communication and education measures should be targeted at those groups to improve the preventive behaviors of infectious diseases among rural residents in China.