Research Centre for Public Health Policy, Torrens University Australia, Adelaide 5000, Australia.
Institute of Resource Governance and Social Change, Kupang 85227, Indonesia.
Int J Environ Res Public Health. 2022 Jul 12;19(14):8502. doi: 10.3390/ijerph19148502.
This study aimed to understand Indonesian healthcare professionals' (HCPs) perceptions and experiences regarding barriers to both HCP and community adherence to COVID-19 prevention guidelines in their social life. This methodologically qualitative study employed in-depth interviewing as its method for primary data collection. Twenty-three HCP participants were recruited using the snowball sampling technique. Data analysis was guided by the Five Steps of Qualitative Data Analysis introduced through Ritchie and Spencer's Framework Analysis. The Theory of Planned Behaviour was used to guide study conceptualisation, data analysis and discussions of the findings. Results demonstrated that HCP adherence to COVID-19 prevention guidelines was influenced by subjective norms, such as social influence and disapproval towards preventive behaviours, and perceived behavioural control or external factors. Findings also demonstrated that HCPs perceived that community nonadherence to preventive guidelines was influenced by their behavioural intentions and attitudes, such as disbelief in COVID-19-related information provided by the government, distrust in HCPs, and belief in traditional ritual practices to ward off misfortune. Subjective norms, including negative social pressure and concerns of social rejection, and perceived behavioural control reflected in lack of personal protective equipment and poverty, were also barriers to community adherence. The findings indicate that policymakers in remote, multicultural locales in Indonesia such as East Nusa Tenggara (Nusa Tenggara Timur or NTT) must take into consideration that familial and traditional (social) ties and bonds override individual agency where personal action is strongly guided by long-held social norms. Thus, while agency-focused preventive policies which encourage individual actions (hand washing, mask wearing) are essential, in NTT they must be augmented by social change, advocating with trusted traditional (adat) and religious leaders to revise norms in the context of a highly transmissible pandemic virus. Future large-scale studies are recommended to explore the influence of socio-cultural barriers to HCP and community adherence to preventive guidelines, which can better inform health policy and practice.
本研究旨在了解印度尼西亚医疗保健专业人员（HCP）对其社会生活中 HCP 和社区遵守 COVID-19 预防指南的障碍的看法和经验。本研究采用质化研究方法，通过深入访谈收集主要数据。采用雪球抽样技术招募了 23 名 HCP 参与者。数据分析遵循 Ritchie 和 Spencer 的框架分析提出的五步质化数据分析方法。计划行为理论用于指导研究概念化、数据分析和对研究结果的讨论。研究结果表明，HCP 遵守 COVID-19 预防指南受到主观规范的影响，例如社会影响和对预防行为的不认可，以及感知行为控制或外部因素。研究结果还表明，HCP 认为社区不遵守预防指南受到他们的行为意图和态度的影响，例如不相信政府提供的与 COVID-19 相关的信息、不信任 HCP，以及相信传统的仪式实践可以避免不幸。主观规范，包括负面的社会压力和对社会排斥的担忧，以及感知行为控制，反映在缺乏个人防护设备和贫困，也是社区遵守的障碍。研究结果表明，印度尼西亚偏远、多元文化地区（如东努沙登加拉（Nusa Tenggara Timur 或 NTT））的政策制定者必须考虑到家庭和传统（社会）关系和纽带凌驾于个人机构之上，个人行动受到长期以来的社会规范的强烈指导。因此，虽然以机构为重点的预防政策鼓励个人行动（洗手、戴口罩）是必要的，但在 NTT，必须通过社会变革来增强这些政策，与值得信赖的传统（adat）和宗教领袖合作，在高度传染性的大流行病毒背景下修改规范。建议开展未来的大规模研究，以探索社会文化障碍对 HCP 和社区遵守预防指南的影响，这可以更好地为卫生政策和实践提供信息。
