Factors associated with COVID-19 preventive behaviors among patients with hypertension and type 2 diabetes in southern Iran: a structural equation modeling study.

BACKGROUND

During the transitional phase of the COVID-19 pandemic-when vaccines were available but coverage remained low-individuals with chronic diseases such as hypertension and type 2 diabetes faced elevated risks, yet their adherence to nonpharmaceutical preventive behaviors was uneven, and the psychological determinants of this variability remained unclear. This study examined the HBM constructs as correlates of COVID-19 preventive behaviors among this high-risk population in southern Iran.

METHODS

A cross-sectional survey was conducted among 338 patients (mean age = 43.83 ± 9.79 years) in Kavar, Iran, using a validated HBM-based questionnaire (CVR > 0.6, CVI > 0.79, Cronbach's α = 0.65-0.92). Structural equation modeling (SEM) was performed using AMOS 24.

RESULTS

SEM demonstrated good fit (χ2/df = 1.46, CFI = 0.995, RMSEA = 0.037). Perceived barriers exerted the strongest negative association with preventive behaviors (β = -0.311, p < 0.001). Perceived severity (β = 0.206) and cues to action (β = 0.203) were significant positive factors. Perceived benefits (β = 0.150) had a modest positive association, while perceived susceptibility and self-efficacy were nonsignificant.

CONCLUSION

Among the studied diabetic and hypertensive patients, practical and psychological barriers- not lack of knowledge or risk awareness-were the primary determinants of behavior. The non-significance of perceived susceptibility and self-efficacy may suggest that due to the prolonged nature of the COVID-19 pandemic, behavior was more heavily influenced by persistent structural barriers than by individual beliefs or confidence. Public health interventions should therefore prioritize reducing access-related, financial, and sociocultural barriers (e.g., mask affordability, misinformation) rather than solely promoting risk perception. These findings may offer actionable insights for epidemic preparedness strategies in similar regional low-resource settings, though validation across diverse contexts remains important.