Cha Jiho, Noh Jin-Won, Robinson Courtland, Kwon Young Dae, Kim Jinseok
Moonsoul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea.
Front Public Health. 2023 May 5;11:1151452. doi: 10.3389/fpubh.2023.1151452. eCollection 2023.
Despite the epidemiological importance of social vulnerabilities in compliance with preventive measures, little is known about the disproportional nature of preventive behaviors in crisis-affected populations. We examined adherence to COVID-19 preventive behaviors, focusing on social distancing measures in the conflict-affected regions in eastern Ukraine.
From a multisectoral needs assessment conducted in 2020 using a household interview of a stratified simple random sample, we included 1,617 rural and urban households located in the government-controlled area. We performed multivariable binary logistic regression analysis with latent class analysis (LCA) to identify unmeasured patterns of classification of preventive measures using data from a cross-sectional survey.
The conflict-affected populations showed difficulty in complying with COVID-19 preventive measures due to losses of housing, partners, and access to food resources due to conflicts. Among the various preventive measures, wearing a face mask (88.1%) and washing hands more regularly (71.4%) were the most frequently reported. Compliance with social distancing was significantly lower in those who experienced the direct impacts of conflicts indicated by damaged accommodation or being widowed. Three different groups who showed distinctive patterns of employing COVID-19 preventive measures were identified the LCA model, which were "highly complying group", "moderately complying group", and "face masks only group". The group membership was associated with a respondent's poverty status.
The findings show the difficulty in compliance with COVID-19 preventive measures among conflict-affected populations indicating secondary impacts of the conflicts on preventive health behaviors. To mitigate the health impacts of conflicts, immediate attention is needed to address barriers to COVID-19 preventive measures among conflict-affected populations in Ukraine. This study suggests the need for public health strategies to improve preventive health behaviors in conflict-affected populations under pandemics or large-scale outbreaks.
尽管社会脆弱性在遵守预防措施方面具有流行病学重要性，但对于受危机影响人群中预防行为的不均衡性质知之甚少。我们研究了对新冠病毒预防行为的遵守情况，重点关注乌克兰东部受冲突影响地区的社交距离措施。
从2020年进行的多部门需求评估中，我们通过对分层简单随机样本进行家庭访谈，纳入了位于政府控制区的1617个城乡家庭。我们使用横断面调查数据，进行了带有潜在类别分析（LCA）的多变量二元逻辑回归分析，以识别预防措施分类中未测量的模式。
受冲突影响的人群由于冲突导致住房、伴侣丧失以及获取食物资源困难，在遵守新冠病毒预防措施方面存在困难。在各种预防措施中，最常报告的是佩戴口罩（88.1%）和更频繁洗手（71.4%）。住宿受损或丧偶表明经历了冲突直接影响的人群中，遵守社交距离的情况明显较低。通过潜在类别分析模型确定了三组采取不同新冠病毒预防措施模式的人群，即“高度遵守组”、“中度遵守组”和“仅戴口罩组”。组成员身份与受访者的贫困状况相关。
研究结果表明受冲突影响人群在遵守新冠病毒预防措施方面存在困难，这表明冲突对预防健康行为产生了次生影响。为减轻冲突对健康的影响，需要立即关注解决乌克兰受冲突影响人群中新冠病毒预防措施的障碍。本研究表明需要公共卫生策略来改善大流行或大规模疫情下受冲突影响人群的预防健康行为。
