**1. Introduction**

Since human beings have a long tradition of coexistence with pandemics, which may profoundly impact them, adopting preventive measures is crucial for humankind's survival. Global pandemics are rising every day because the proper diagnosis of the right people at the right time is missing [1]. The involvement of vaccine producers, health authorities, and governments is essential for monitoring and preventing such pandemics [2].

The Coronavirus Disease 2019 (COVID-19) began in Wuhan (a Chinese city) in late December 2019. In the face of people's domestic and international mobility, the epidemic

**Citation:** Ahmad, M.; Akhtar, N.; Jabeen, G.; Irfan, M.; Khalid Anser, M.; Wu, H.; I¸sık, C. Intention-Based Critical Factors Affecting Willingness to Adopt Novel Coronavirus Prevention in Pakistan: Implications for Future Pandemics. *Int. J. Environ. Res. Public Health* **2021**, *18*, 6167. https://doi.org/10.3390/ijerph18116167

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 27 April 2021 Accepted: 4 June 2021 Published: 7 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/).

eventually turned into a worldwide pandemic. The Chinese government took strict steps to effectively curtail the epidemic outbreak [3]. As of 29 May 2021, an estimated over 169 million cases tested positive, while about 3.5 million patients lost their lives worldwide due to COVID-19 infection. The epicenter of the COVID-19 shifted from Wuhan through Iran and Italy to the United States. The U.S., with more than 33 Million confirmed cases, is the pandemic's current epicenter, followed by India with more than 27 million cases. Besides, Brazil, France, and Turkey are also among the hotspots of COVID-19 patients, with more than 16, 5.5, and 5.2 million confirmed cases, respectively [4]. Its outbreak started in Pakistan in the middle of March 2020 and reached a peak number of confirmed cases by mid-June 2020. Afterward, the number of cases reduced substantially; however, a resurgence of patients started in the last quarter of October 2020 due to the lack of prevention measures at an individual scale. As of 29 May 2021, around 913,784 cases were reported, whereas the total death toll reached 20,607. In the meantime, an estimated 835 thousand individuals have recovered, which is indeed an optimistic side of the gloomy picture.

To curtail the COVID-19 outbreak, several countries such as Italy, Spain, India, Russia, and China implemented nationwide lockdowns. However, the Pakistani government's COVID-19 containment strategy was not based on complete lockdown across the nation. Instead, smart and targeted lockdowns were imposed on locations with agglomerated patients [4]. In light of this, the individuals' willingness to adopt pandemic prevention (WAPP) becomes vital. Consequently, during a pandemic like COVID-19, the individuals' WAPP is explicitly defined by their intention-based critical factors (ICFs). The ICFs include the driving and inhibitory factors shaping the individuals' intention to accept or reject pandemic prevention. Since the individuals' intention performs a critical role in actual behavior [5], the analysis of ICFs would be imperative to understand the COVID-19 prevention measures.

The COVID-19 pandemic has become a hotly debated issue among global scholars; nevertheless, studies on ICFs affecting individuals' WAPP are scarce. In particular, no research has been identified examining the ICFs involving driving forces and inhibitors of individuals' WAPP in a hybrid theoretical framework. The previous studies were fundamentally based on the following debates: The first debate comprised the epidemiological characteristics of the epidemic, including "acquired immunodeficiency syndrome" (AIDS), dengue fever, malarial infection, and coronavirus infection [6,7]. The second debate considered the prevention and control of pandemics such as SARS-CoV 2002, MERS-CoV 2012, and COVID-19, belonging to the coronavirus family [8–10]. Simultaneously, some studies addressed epidemic prevention and control from the government's perspective [11,12]. The third debate focused on the links of COVID-19 with the sustainable supply chain [13,14] and environmental features such as humidity and temperature [15,16].

The fourth debate was based on the psychological factors interacting with COVID-19 related attributes, including the intention of being vaccinated, individuals' resilience, individual susceptibility to conspiracies, prosocial behavior, socio-political predictors, dark personality traits, and psychological entitlement, among others. In this regard, Karata¸s and Tagay [17] examined and revealed that no experience of trauma, satisfaction of life, and hope were positively linked with adults' resilience during the COVID-19 outbreak. Karlsson et al. [18] studied and disclosed a positive linkage between the perceived risk of COVID-19 and the intention of being vaccinated in the Finnish context. Hughes and Machan [19] assessed and concluded that Machiavellianism and psychopathy positively influenced COVID-19 related conspiracy beliefs. Jin et al. [20] empirically evaluated and found that the age factor positively impacted individuals' prosocial COVID-19 response, meaning that older individuals had a relatively higher perceived cost of being infected by the virus. In a different study, Wagerman et al. [21] investigated and revealed that anxious attachment positively determined the COVID-19 distress factor. Hardin et al. [22] analyzed and discovered that Machiavellianism and Narcissism introduced negative impacts in response to COVID-19 in the U.S. context.

Moreover, Zitek and Schlund [23] studied the psychological entitlement in the United States and revealed that the individuals were not concerned about transmitting the disease to others. Therefore, they were less likely to follow the COVID-19 prevention guidelines. Ruggieri et al. [24] investigated pre-and post-quarantine behaviors and found a rise in anxiety, stress, and loneliness, along with a decline in life satisfaction. Chan [25] studied and unveiled that fairness and caring showed compliance with all types of individual behaviors; however, sanctity merely predicted the social distancing and wearing a face mask in the United States. Next, Li et al. [26] studied the community sample in China. They discovered that high perceived risk was linked with increased donations to the COVID-19 patients and the health workers. Paredes et al. [27] examined and found that highly resilient people, who were better at overcoming stressful and traumatic situations, demonstrated relatively less impact of COVID-19 threat on prospective pandemic anxiety and stress. Malesza and Kaczmarek [28] analyzed and concluded that the factors, including a greater amount of protection recommendation, COVID-19 information from diverse sources, and a lack of belief that catching COVID-19 was determined by individuals' actions, significantly contributed to pandemic-related anxiety.

Besides, Volk et al. [29] investigated and uncovered that the demographic attributes involving income and children were directly linked to COVID-19 handling response. While age, sex, income, and children had an indirect linkage. Grossman et al. [30] studied and disclosed that COVID-19 related concerns were positively correlated with loneliness and sleeplessness. Ahmad et al. [1] studied the influencing factors of the acceptance of COVID-19 protection in China. Their findings showed that guidelines by the Chinese government boosted the epidemic protection adoption in China. However, their study included a highly educated population comprised of government employees. Therefore, the findings of their research cannot be generalized. As a further note, China's political system is different from that of other democratic nations. Hence, the findings extracted based on their sample cannot be generalized for the other democratic countries. Additionally, no research has been known to introduce the above-stated ICFs to a behavioral framework obtained by integrating the composite of planned behavior (PBST) and reasoned action schools of thought (RAST). Finally, the driving forces and inhibitors of individuals' WAPP were not previously considered. The understanding of such driving forces and inhibitors would help improve the adoption behavior substantially. Therefore, the investigation of such critical factors is timely and urgent.

To fill the aforementioned gaps, this research investigates the ICFs of individuals' WAPP in terms of driving forces and inhibitors. From the empirical side, new critical factors involving the lack of trust in political will and mythical attitude towards pandemic are included. Furthermore, a theoretical framework composite of PBST and RAST is integrated to incorporate additional ICFs that determine the WAPP. Those factors include a lack of trust in political will, mythical attitude towards pandemic, perceived risk, pandemic knowledge, the ease of pandemic prevention adoption, risk-averse behavior, and moral values. The empirical outcomes of this work are distinguished from the mainstream literature. The derived policies are equally useful for both the developing and developed nations in the world health emergency during the COVID-19 pandemic as well as potential future pandemics.

The remainder of the study is arranged as follows: Section 2 explains the extraction of a hybrid theoretical framework. Section 3 is based on data, methods, and analysis. Section 4 details the results of this work. Section 5 explains the conclusion and policy suggestions.

#### **2. Literature Review and Hypotheses Formulation**

#### *2.1. Mythical Attitude towards Pandemic*

Mythical attitude towards pandemic can be defined as the traditional way of thinking about the existence or non-existence of a pandemic and its influence on human beings. Individuals with mythical attitudes might believe that the pandemic will automatically

vanish due to external factors such as high temperature. They might also believe that pandemic prevention is useless for them. In this regard, Latkin et al. [31] studied the linkages of COVID-19 skepticism with protection behavior, social distancing, conspiracy theories, and individuals' political ideas in the U.S. and revealed the highly skeptical individuals less likely to adopt COVID-19 protection. Alper [32] investigated the correlation between COVID-19 conspiracy theories and protection adoption and revealed no link between the two in the Turkish context. Research was conducted to examine the knowledge, preventive measures, and attitude of live poultry market workers regarding the avian influenza in the Chongqing district of central China by taking a sample of 216 workers of this district. The results exhibited that the workers had imperfect knowledge, took insufficient preventive measures, and had weak susceptibility perceptions [33]. In another work, Shi et al. [34] investigated the present level of evidence-based chronic disease prevention (EBCDP) by taking interviews with health practitioners and patients of different health institutes in China and found that it was at an earlier level in the implementation of prevention practices. Further, a survey was conducted in Ukraine consisting of medical, custodial, and prison administrative staff with a sample size of 243 to determine criminal justice system workers' attitudes towards drug addiction and opioid substitution therapy. The results demonstrated that the worker's attitude was negative towards drug addiction [35].

Further, Mao and Yang [36] studied the expansion of infectious diseases among human beings and prevention practices to save themselves by making two networks. This infection network deals with disease transmission and a communication network that deals with preventive measures. Moreover, Przybyla et al. [37] conducted a study to assess the attitude, knowledge, and awareness of pharmacy students regarding human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP). It was done by using descriptive statistics and multivariate logistic regression analysis. The results explored that educational modules' progress helped increase exposure towards the attitude, information, and awareness regarding HIV and PrEP. Similarly, Ibrahim [38] investigated the expansion of HIV in Indonesia and focused on the prevention strategies to minimize it by renewing primary health care, paired with suitable economic and other risk units to health care. Given the survey of above-stated studies, the following hypothesis is formulated:

**Hypothesis 1.** *Mythical attitude towards pandemic is likely to have a negative association with a willingness to adopt pandemic prevention.*
