Application of health belief model for the assessment of COVID-19 preventive behavior and its determinants among students: A structural equation modeling analysis

Background: COVID-19 is a new pandemic that poses a threat to people globally. In Ethiopia, where classrooms are limited, students are at higher risk for COVID-19 unless they take consistent preventative actions. However, there is a lack of evidence in the study area regarding student compliance with COVID-19 preventive behavior (CPB) and its predictors. Objective: This study aimed to assess CPB and its predictors among students based on the perspective of the Health Belief Model (HBM). Method and materials: A school-based cross-sectional survey was conducted from November to December 2020 to evaluate the determinants of CPB among high school students using a self-administered structured questionnaire. 370 participants were selected using stratified simple random sampling. Descriptive statistics were used to summarize data, and partial least squares structural equation modeling (PLS-SEM) analyses to evaluate the measurement and structural models proposed by the HBM and to identify associations between HBM variables. A T-value of > 1.96 with 95% CI and a P-value of < 0.05 were used to declare the statistical significance of path coefficients.  Result: A total of 370 students participated with a response rate of 92%. The median (interquartile range) age of the participants (51.9% females) was 18 (2) years. Only 97 (26.2%), 121 (32.7%), and 108 (29.2%) of the students had good practice in keeping physical distance, frequent hand washing, and facemask use respectively. The HBM explained 43% of the variance in CPB. Perceived barrier (β= - 0.15, p < 0.001) and self-efficacy (β= 0.51, p <0.001) were significant predictors of student compliance to CPB. Moreover, the measurement model demonstrated that the instrument had acceptable reliability and validity. Conclusion and recommendations: COVID-19 prevention practice is quite low among students. HBM demonstrated adequate predictive utility in predicting CPBs among students, where perceived barriers and self-efficacy emerged as significant predictors of CPBs. According to the findings of this study, theory-based behavioral change interventions are urgently required for students to improve their prevention practice. Furthermore, these interventions will be effective if they are designed to remove barriers to CPBs and improve students' self-efficacy in taking preventive measures. Data were collected using a structured self-disinterred questionnaire. The self-administered technique was selected over the interviewer-administered method for the following reasons: a) all of the study participants were literate, b) it can reduce social desirability bias, and c) this approach is resource-efficient. Four BSc nurses and two public health professionals were participated in the data collection process as a data collector and supervisor respectively, after they received a one-day training on the purpose of the study, the data collection process, the ethical considerations, and the precautions that should be taken during the data collection process. The data were collected at school from Monday to Friday.