Exploring the Causes of Inadequate Adherence to and Lack of Prevention against COVID-19: A Qualitative Study

Abstract

Background: The present study aimed at exploring the causes of inadequate adherence to and lack of prevention against coronavirus disease 2019 (COVID-19) which was conducted in two socioeconomically deprived cities in Iran to identify barriers and challenges to COVID-19 prevention in order to inform the improvement of public health strategies and enhance community awareness in these underserved areas. Methods: This qualitative study was carried out in Gilan-e Gharb City, Kermanshah Province, Iran, and Khorramabad City, Lorestan Province, Iran, over a 13-month period from November 2021 to November 2022. Data were collected through 11 in-depth, semi-structured individual interviews and analyzed using conventional content analysis. Findings: Participants comprised 7 women and 4 men, with a mean age of 45.54 ± 15.78 years. Findings were organized around four primary preventive behaviors: 1) non-use of face masks, 2) non-use of disinfectants, 3) face-toface social interactions, and 4) vaccine refusal or hesitancy. These were classified into three main themes encompassing 12 sub-themes: 1) social factors (economic constraints, policy-making deficiencies, normative challenges, cultural barriers, and environmental factors), 2) individual factors (personality-related factors, physical/comorbid conditions, and perceptual/cognitive factors), and 3) educational challenges (ineffective media, absence of preventive learning, insufficient awareness, and illiteracy). Conclusion: Overcoming these barriers appears achievable through short-, medium-, and long-term planning, intersectoral and inter-ministerial coordination, and efforts to build public trust. Further research using diverse methodologies and settings is recommended to eliminate these obstacles and develop evidence-based, targeted interventions for the effective control of current and future pandemics. COVID-19 serves as a stark reminding that humanity remains vulnerable to emerging, unknown, and lethal viral diseases, highlighting the critical importance of primary prevention. © 2026, Isfahan University of Medical Sciences(IUMS). All rights reserved.