Fear and COVID-19 Protective Behaviors among High School Students in Hamadan, Iran; Application of an Extended Parallel Process Model

Throughout the ongoing COVID-19 pandemic, the role of students in transmitting the infection has received special attention aiming at protecting the younger generation against COVID-19 and other known respiratory diseases. This research aimed to specify factors related to Covid-19 preventing behaviors in high school students. Instrument & Methods: This cross-sectional study was conducted on 2852 students aged 13 to 18 in Hamadan in 2020. Participants were selected using the multistage cluster sampling method. The data were collected with a researcher-made EPPM questionnaire. Data were analyzed statistically by Stata 14.2 software using the Chi-square and Fisher's exact tests. Findings: The vast majority of students (67.02%) were in the danger control response phase. The response efficacy (77.3%) and perceived efficacy (75.3%) had the highest percentage of the mean from the maximum obtainable score among constructs of the model. There was a significant difference between categories of the EPPM model with doing healthy behaviors. Moreover, the proportion of doing health behaviors was significantly higher in students in the danger control phase. Conclusion: The predominance of the perceived threat of COVID-19 on the perceived efficacy affects preventive health behaviors. Therefore, a theory-based behavioral modification program can be developed based on gender among high school students. Higher grade students and poor socioeconomic status require intense educational interventions to modify their hygienic behaviors.