Demotivators.
CBVs
VIRUS, DISEASE, WEDDINGS, WEDDING
All major demotivators to performing prevention behaviors discussed by respondents were at the personal, rather than the social, level (Demotivators for adherence to COVID-19 prevention behaviors among remote communities by qualitative theme and respondent typeDoubt/fatigue about existence of COVID-19: have not seen a case firsthand; have become fatigued of hearing about COVID-19 and prevention measures; do not believe COVID-19 is a threatLack knowledge: do not understand certain aspects including purpose of prevention measures, infectiousness, lethality, the need to perform prevention behaviors in all settingsDoubt/fatigue about existence of COVID-19: have not seen a case firsthand; do not believe COVID-19 is a threat; think the risk is over because COVID-19 has endedLack of knowledge: do not understand why they need to continue adhering to guidelinesDoubt existence of COVID-19/benefit of prevention measures: think COVID-19 is a lie; do not believe it is in Zambia; have never seen it firsthand; feel detached from it because it is a faraway problem; underestimate its severity; doubt due to lack of knowledge, ignorance, or stubbornness; believe COVID-19 is linked to politics and upcoming electionAlcohol: fail to adhere to guidelines when drinkingIllustrative quotes
“I think [community members] don’t understand social distancing because [health center staff] have kept on talking about social distancing but I have observed that whenever there is a wedding, whenever there is a funeral, normally people are actually grouped together without social distancing. So, I think we still have a problem where social distancing is concerned.” – Health center staff, male, Kalomo district, round 1“For those that believe they can’t get COVID-19, it’s because they’ve made up their minds that COVID-19 is not there. [They think] the government and the world have just made it up. It doesn’t exist. They don’t believe that they can have something that doesn’t exist. Then with those that believe that they can get it, we’ve been highlighting on how the disease has been trending. For the others, we show them videos of actual patients. There are some people who only believe when they see something [in person], so when they see those videos, they strongly believe and try to use all the interventions to protect themselves.” – Health center staff, male, Nyimba district, round 2“The biggest barrier for people not to adhere to the guidelines is not believing or not accepting that this pandemic is real.” – Community-based volunteer, female, Nyimba district, round 2“People are just stubborn. Because they have never seen [a case of COVID-19 or] what the disease does.” – Community member, female, Choma district, round 1 e. “It is drunkards who are found in taverns. They are the ones who do not follow the guidelines because they meet anyway, and they sit [together]. If they are normal and not yet drunk, they will be wearing a mask, but when they reach the tavern and start drinking, they put the mask in their pocket.” – Community member, female, Kalomo district, round 2Health center staff and CBVs noted early challenges with adherence when COVID-19 was first detected in Zambia when understanding was low and many individuals lacked knowledge. Lack of knowledge was a stronger theme during round 1 but persisted during round 2. During round 1, health center staff were particularly concerned that many in the community still did not understand some of the most critical aspects of COVID-19, including how the guidelines linked to modes of transmission meant to prevent spread of the virus, how infectious the virus was, and how lethal it could be if widespread transmission occurred.Many community members and a few health center staff and CBVs discussed the role alcohol played in failure to adhere to prevention behaviors. Individuals at drinking establishments were described as sharing glasses, not wearing masks, not social distancing, and not washing hands. They were described as forgetting about prevention behaviors as soon as they began consuming alcohol. A few respondents also described high emotional states, such as excitement or grief (i.e., weddings and funerals), affecting adherence to prevention guidelines.