**1. Introduction**

The SARS-CoV-2 virus, which is the cause of the 2019 coronavirus disease (COVID-19) was first reported in late December 2019 in Wuhan in the Hubei province of China [1–3]. COVID-19 quickly spread globally and was declared a global pandemic by the World Health Organization (WHO) [4]. This viral disease outbreak overwhelmed global healthcare systems and adversely impacted the routine care for many chronic and ambulatory care-sensitive conditions such as cancer, diabetes, and asthma. It particularly affected resource-poor countries [2,5–9]. The intensity of the dreadful effects of coronavirus was faced by both developed and developing countries. However, in countries with weak healthcare system infrastructures, the effects appeared to be intensified [10,11]. In Pakistan, the first two positive cases of COVID-19 were reported on 26 February 2020. According to documentation, both patients had a history of recent travel to Iran [12]. As of 30 March 2021,

**Citation:** Shah, G.H.; Faraz, A.A.; Khan, H.; Waterfield, K.C. Perceived Benefits Matter the Most in COVID-19 Preventive Behaviors: Empirical Evidence from Okara District, Pakistan. *Int. J. Environ. Res. Public Health* **2021**, *18*, 6772. https:// doi.org/10.3390/ijerph18136772

Academic Editors: Paolo Roma, Merylin Monaro, Cristina Mazza and Paul B. Tchounwou

Received: 22 May 2021 Accepted: 23 June 2021 Published: 24 June 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

a total number of 663,200 cases have been reported in Pakistan, a country with a population of 220.9 million people in 2020 [13], with 14,356 deaths attributable to COVID-19, which many believe is a serious under-estimation due to the severe social stigma associated with this disease [14–16].

To curb the spread of COVID-19 in Pakistan, protective measures such as social distancing, frequent hand-washing, and the use of face coverings in public were put into place and are still considered essential, given that vaccine distribution and acceptance has been challenging in subgroups with a distrust of science and western medicine [17]. To complicate the matter, global health inequities in affordability and the timing of COVID-19 vaccine sales to low-income countries (in comparison with high-income countries) still leaves preventive measures such as social distancing and face coverings as the only means to control the spread of SARS-CoV-2 [18]. A lack of trust in scientific facts, in favor of heresay and conspiracy theories, can be challenging to science-based interventions concerning COVID-19 [19]. A distrust in science may lead to an inability to learn or believe even the simplest facts about COVID-19.

In their efforts to overcome and control the spread of SARS-CoV-2, several timely measures were taken by the Pakistan government. These included the first National Coordination Committee (NCC) for COVID-19, which was established to assist with disease surveillance and data-driven decision-making. On 1 May 2020, Pakistan decided to completely close its western border with Afghanistan and Iran (reopened in August 2020). Additionally, all public gatherings and large meetings (≥250 persons or >50% of location capacity) were banned with immediate effect, and all public and private educational institutions (schools, colleges, universities), wedding halls, and cinemas were closed across the country (re-openings began in January 2021) [20,21]. A countrywide face-covering mandate took effect in Pakistan on 31 May 2020. This mandate, along with social distancing, is still in place [22]. Unfortunately, closures of businesses and a rise in unemployment has caused a negative economic impact on the Pakistani economy [23].

In Pakistan and around the globe, pandemic fatigue coupled with low health literacy has created a public health crisis that necessitates the need for broader compliance with local and global guidelines for stopping the spread of SARS-CoV-2 [19]. For public health practitioners to overcome this disease, it is necessary to understand what motivates a person's compliance with preventive measures [24,25]. To generate the practice-relevant evidence, the present study aimed to analyze the correlates of prevention behaviors concerning COVID-19 by using the Health Belief Model (HBM). HBM is one of the models widely used to convey beliefs that can be effective in shaping health protection and health promotion behaviors, including those concerning COVID-19 [26–28]. According to HBM, behavioral beliefs and modifying factors can be effective in shaping behavior, especially when someone is susceptible to the disease (perceived susceptibility), they aware of the threat of the disease to their health (perceived severity), and they also know the benefits of protective measures (perceived benefits) rather than their barriers (perceived barriers) [24]. By using this model, we aimed to determine which domains of the Health Belief Model are associated with COVID-19 prevention behaviors in Pakistan.
