Assessing Citizens' Knowledge, Attitudes, and Practices Regarding Health Socialization During the Covid-19 Pandemic The Case Study of Citizens of Tehran and Karaj

A B S T R A C T
Health socialization and the practical adherence of citizens to the norms and values of the collective health system is one of the most important types of socialization, which is more important and necessary to pay attention to, especially in times of collective challenges and crises, such as the recent conditions that have emerged in the world due to the spread of the Coronavirus. Finds. For this reason, the current research, with a practical goal, positivist paradigm and a quantitative approach, seeks to measure the health behaviour and socialization of citizens during the Corona epidemic and identify the factors affecting it. In this regard, the literature and the theoretical framework of the research have been compiled using library studies and based on the integration of the KAP model with the theories of Keyes, Bourdieu and Schwarzer. Data collection has also been done through a survey method (using a questionnaire). While confirming the validity and reliability of the tool, the sample size was determined cross-sectionally and online with the help of Cochran's formula and the sampling process in the statistical population (residents of Tehran and Karaj cities). Finally, the sufficiency of the number of high-quality samples (667 samples) was confirmed using KMO statistics and the data analysis was done in a statistical manner (including descriptive and inferential analyses with the help of chi-square and Spearman coefficients and multivariable linear regression model in the SPSSv26 software environment) and the inference mechanism was realized. Is. Descriptive findings show a higher than average level of adherence of citizens (average 3.86) to complying with health and care recommendations considered in public spaces, and according to inferential findings, the level of health socialization of citizens directly depends on the state of awareness (the level of risk perception and its consequences) and Their attitude (perceived self-efficacy level and level of acceptance, cohesion, solidarity and social participation) is affected
Extended Abstract
Introduction
Health socialization and practical adherence of citizens to the norms and values of the collective health system is one of the essential types of socialization, especially in times of collective challenges and crises - such as the current situation in the world caused by the Covid-19 outbreak of Dealing with this global crisis is not enough only in the form of preventive policies by governments and related international organizations and requires sociability and a sense of responsibility of all members of society in the field of health-oriented behaviors. In fact, the degree of adaptation of citizens' lifestyles and individual and collective behaviors in urban spaces to the pandemic conditions and its challenges and limitations, in other words, the sociability of citizens from the perspective of public health, is the most important factor for countries' success in overcoming.
 
Methodology
As applied quantitative research, this study evaluates citizens' behavior, health, and social socialization during the corona epidemic and identifies its factors based on the Knowledge, Attitude, and Practice (KAP) Model. In this regard, first, theoretical literature based on library and documentary studies has been compiled. Then, the theoretical framework of research based on the KAP model and inspired by the theories of Schwarzer (The health action approach), Keys (Theory of Social Well-being), and Bourdieu (Theory of Practice) has been developed. Data were collected by survey method (using a researcher-made questionnaire containing 48 items). Then, the validity of the data collection tool was confirmed logically (formal and content) and using the opinions of 4 professors and experts. The questionnaires' reliability (internal coherence) was performed by conducting a pilot phase (including a sample of 29 people) and approved by Cronbach's alpha. The sample size is determined using Cochran's formula (384 samples for each city), and the sampling process in the statistical population (residents of Tehran and Karaj) are cross-sectional, online, and in the form of a snowball (based on the distribution and sharing of links and descriptions. The questionnaire was conducted in virtual social networks. Finally, while removing inappropriate samples, the adequacy of the number of sound samples (667 ones) has been confirmed using KMO statistics and the Bartlett test. Then, the data were analyzed statistically (including descriptive and inferential analyzes using Chi-square, Spearman coefficients, and multivariate linear regression model in SPSSv26 software environment), and the inferential mechanism was performed.
 
Result and discussion
According to descriptive findings, 72.3% of the participants were women, 42.6% were young people aged 25 to 34, 51% were married, 58% were residents of Karaj, 45.3% were people with a bachelor's degree, 54.4% were relatively religious people, 33.4% were people working in the private sector, 70.4% were people with an income of 6 million Tomans or less, 42.7% were physically healthy people, and 58.3% mentally healthy people. The average level of citizens' health socialization and commitment to the observance of Covid recommendations in public spaces is also above the average (3.86). On the other hand, descriptive findings show the relationship between most individual characteristics and citizens' state of consciousness and attitude during the COVID-19 pandemic. In this regard, the most effective individual variables can be considered age, income level, religious affiliation, and gender. And the most significant indicators in the field of attitude and knowledge of citizens can be considered as their level of participation and social prosperity, as well as the level of risk perception and the level of their media literacy. In addition, a significant relationship has been found between the indicators of knowledge and attitude of citizens. This means that by raising citizens' health literacy level, their perceived self-efficacy, prosperity, participation, and social cohesion can increase. The more citizens become aware of this disease and the stronger their perception of danger and its consequences, the greater their sense of participation, solidarity, and social cohesion. Still, it negatively affects their perceived level of efficiency during this period. On the other hand, according to the findings based on the multivariate linear regression model, the state of knowledge (risk perception and its consequences) and attitude (perceived level of self-efficacy and acceptance, cohesion, solidarity, and social participation) directly affects the degree of health socialization of citizens.
 
Conclusion
According to the research findings that there is a direct relationship between the indicators of knowledge and attitude of citizens with their health performance and socialization during the COVID-19 pandemic; it can be concluded that on the one hand, increasing the level of knowledge of citizens about the signs, symptoms, as well as the risks of COVID-19 can be significantly effective in improving their performance and behavior in the field of adherence to health norms in this period. On the other hand, strengthening the sense of self-efficacy and effectiveness and promoting a sense of belonging and responsibility towards the city/country and their fellow citizens/compatriots can effectively increase their level of sociability, especially health. The remarkable point is that all these things will be possible due to the quantitative, qualitative, and continuous increase of mass and media education by reputable and national institutions.
 
Funding
There is no funding support.
 
Authors’ Contribution
All of the authors approved thecontent of the manuscript and agreed on all aspects of the work.
 
Conflict of Interest
Authors declared no conflict of interest.
 
Acknowledgments
We are grateful to all the scientific consultants of this paper.