Discussion

This study evaluated Jordanians’ protective measures during the COVID-19 pandemic to protect themselves from infection. We found that the most used self-care behavior was getting enough sleep. Several studies reported that insufficient or irregular sleep could impair the immune system and increase a person’s vulnerability to viral infections, such as COVID-19. ^{Reference Souza5} Hence, adequate sleep is essential to enhance immunity and fight COVID-19 infection.

Conversely, the least adopted behavior among Jordanians was regular exercise, which is congruent with a previous study that reported a predominantly sedentary lifestyle during the pandemic. ^{Reference Moore, Bouchoucha and Buchwald4} The lack of physical activity is a serious concern, especially during times of sickness, as it has been reported that regular exercise enhances immunity and decreases the severity of infectious attacks. ^{Reference Wackerhage, Everett and Krüger6} Several reasons could explain this behavior. First, most Jordanians are not adopting healthy lifestyle behaviors, including regular physical activity. Second, it could be due to the confinement measures imposed by the government during the pandemic combined with the limited resources at Jordanian homes, such as sport and fitness equipment. Furthermore, it seems that physical inactivity during COVID-19 is a world-wide issue that is postulated to negatively impact the general population’s health conditions, which inspired recommendations for indoor activity and simple home exercises. ^{Reference Fauzi, Suherman and Safari7}

Wearing masks and performing hand hygiene were predominant behaviors among Jordanians, which was an expected finding considering the proactive measures initiated by the WHO and the Jordanian government. The WHO initiated public awareness and released several recommendations of protective measures during the pandemic, including the importance of personal protective equipment such as face masks and hand hygiene. ⁸ On the national level, the Jordanian government released several Defense Laws that governed the country during the pandemic, particularly Defense Law No. 11, which mandated citizens to wear masks in public to minimize the spread of the virus and the mortality rates during the COVID-19 pandemic and penalized those who did not.

With regard to wearing gloves in public during the COVID-19, public health officials stated that it is not a proven prevention measure. For instance, the Centers for Disease Control and Prevention (CDC) stated that wearing gloves is unnecessary in most situations, except during cleaning or caring for someone infected with COVID-19. ⁹ Likewise, the WHO stated that wearing gloves in public does not offer any additional protection or replace the need for hand hygiene. Despite these declarations, there is a variation in public practice world-wide. In the current study, most did not perceive wearing the gloves as a protective strategy, and few were compliant with it. This behavior might be encouraged by the awareness messages on social media concluding that wearing gloves might give a false sense of safety and increase the risk of contracting the infection if the person touched his/her face after touching dirty surfaces.

Regarding avoidance behaviors, Jordanians avoided traveling to infected areas, but they did not stop going to work or school. This should be interpreted carefully considering 2 main issues. The first 1 is the travel restrictions imposed by the government during the pandemic. The second issue is the economic status among Jordanians, which affects their baseline traveling behaviors and mandates them to attend work to grant getting a payment. According to the latest report from the Department of Statistics, the per share of total household income per capita is 2500 JOD/Year, which equals 290 Dollars/month. Furthermore, Jordanians’ average expenditure on recreation activities, including traveling, is only 0.025% of the average annual expenditure.

We found that older people have better self-care and infection avoidance behaviors, which contradicts previously published studies where younger people had better compliance with the protective behaviors against respiratory-transmitted diseases. ^{Reference Shook, Sevi and Lee10} It should be noted that older people are considered vulnerable to developing severe complications if they contract the infection, making them more willing to adapt the avoidance and preventive behaviors.

Furthermore, women, married, and educated people were found to follow protective behaviors more frequently than others. Female’s compliance can be related to their perceived susceptibility and having higher risk judgment than men. In terms of education level, more-educated people are more likely to update their knowledge, have higher perceived efficacy of the preventive and avoidant behaviors, and have higher compliance. Last, greater concern about COVID-19 was associated with more frequent engagement in protective behaviors, supporting results from a previous study. ^{Reference Shook, Sevi and Lee10} It can be postulated that those people perceive the COVID-19 as a threat to themselves and their loved ones; therefore, they act proactively to protect them.

Our findings provide several practical implications. First, this study presented baseline data about the public’s adoption of protective behaviors; these behaviors may vary throughout the pandemic wave and could be traced to our findings. Second, our results may inform policy-makers to foster the identified protective behaviors and encourage them to overcome negative perceptions and adopt the deserted behaviors. Third, we identified various demographic characteristics that affect the individual’s infection avoidance behaviors during pandemics; targeted advice and education to these individuals through health promotion campaigns may enhance healthy behaviors necessary to combat the spread of COVID-19 and other infectious diseases.