Motivators.
2“We, death, healthSocialClosed
CORONAVIRUS, EVENTS, DISEASE, SHOP
A number of personal and social factors emerged as motivators for good adherence to prevention methods (Motivators for adherence to COVID-19 prevention behaviors among remote communities by qualitative theme and respondent typePersonalFear deadliness of disease: feel at risk in their area, fear of deathSocialLocal gatherings inspected: health center staff routinely observe public places and community meetings to ensure prevention measures are followed; specifically, schools and churchesAdherence enforced at clinic: to receive health servicesPersonalFear deadliness of disease: there is no cure; feel at riskSocialLocal gatherings inspected: health center staff and volunteers ensure guidelines are being followedAdherence enforced in certain settings: in schools, at clinics, at church, in meetingsPersonalFear deadliness of disease: fear contracting the disease; feel at risk; hear about growing case numbers in Zambia from the radio/tvProtect themselves: prevent themselves from contracting the disease; do not want to get sick; maintain their healthSocialClosed doors: began adhering to guidelines when schools, churches, and businesses began closing; realized seriousness of diseaseAdherence enforced in certain settings: in schools, at clinics, at churchIllustrative quotes
“The environmental health technician usually goes to inspect the churches to make sure that people have put the required equipment in place, like hand washing facilities, that people are masking up, that people are also spacing up.” – Health center staff, female, Kalomo district, round 1“[Community members] have come to believe now that COVID-19 is real and they have come to understand it.” – Health center staff, female, Pemba district, round 2“Here at the health facility, when you come without a mask, they would send you to go back and buy a mask. [Only then] they will come and give you the drugs, that is when you’ll be attended to.” – Community-based volunteer, female, Nyimba district, round 1“At the under-five clinic, we see that there is water, in schools we see that there is water and children wash their hands and are wearing masks. Even at church they worship from outside, they do not worship from inside.” – Community-based volunteer, female, Kalomo district, round 2 e. “We follow these guidelines to protect our own lives. When we follow those [guidelines], we cannot get sick. So we protect ourselves from the coronavirus.” – Community member, female, Nyimba district, round 1“They follow because even in schools’ pupils stopped learning the way they used to learn, they just learn for an hour, and they knock off while wearing a mask.” – Community member, female, Choma district, round 2“We have heard about death, thousands and thousands of people have died and in the past days when news is being read, they mention the number of people who have died because we saw that churches were closed, okay most of the things were closed. We just used to say at home and worship from there.” – Community member, female, Choma district, round 2Community members described the closing of schools, churches, and businesses as influencing community adherence to the COVID-19 prevention measures. Additionally, health center staff and CBVs described the inspection and monitoring of local gatherings, particularly early in the pandemic, to ensure adherence to prevention methods in high-risk settings. These inspections are frequently conducted by EHTs and occurred at church services, schools, or other public spaces and events. The EHTs checked the availability of handwashing stations with soap and water, that attendees were wearing masks and social distancing, and that the number of attendees adhered to restrictions.All respondent groups described higher adherence rates in some settings where guideline adherence was “required” or more strictly enforced. Schools, clinics, and churches were repeatedly discussed among all respondent groups. School children were required to wear face masks, and classes were split in size to reduce indoor crowding. At clinics, patients were required to wash their hands, wear masks, and socially distance to receive services. Health center staff described turning away individuals not adhering to these behaviors or sending them to a local shop to procure a face mask when necessary. Church leaders also enforced guideline adherence more than other settings, such as bars and businesses, and ensured handwashing stations were available.