*Article* **Perceived Benefits Matter the Most in COVID-19 Preventive Behaviors: Empirical Evidence from Okara District, Pakistan**

**Gulzar H. Shah 1,\*, Ansar Ali Faraz 2, Hina Khan <sup>2</sup> and Kristie C. Waterfield <sup>1</sup>**


**Abstract:** The 2019 coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus has affected the social determinants of health, worsening health inequities and deteriorating healthcare capacities around the globe. The objective of this study is to investigate the COVID-19 prevention behaviors within the framework of the Health Belief Model in the city of Depalpur in the Okara District of Pakistan in May 2020. Using an observational, cross-sectional, and quantitative study design, a faceto-face field survey was conducted during the epidemic of COVID-19 in district Okara, Pakistan. A sample of 500 adults was selected from the city of Depalpur the in Okara district of Pakistan, using a two-stage sampling design with cluster sampling in stage one and systematic random sampling at stage two. A COVID-19 prevention behavior scale was computed based on twelve dichotomous items. Descriptive statistics, analysis of variance (ANOVA), and negative binomial regression analyses were performed. The most common prevention behavior among study participants was avoiding going for walks in the parks (81.0%), followed by not leaving home during the lockdown (72.6%), and washing hands every day with soap and water for 20 s after going out of their home (64.0%). Fewer people exhibited prevention behaviors such as social distancing (e.g., staying at least six feet away from other people) which in the EU was recommended to be a minimum of 1.5–2 m (44.4%) and following all of the basic protective measures (e.g., hand washing, use of a face covering in public, social distancing) in order to protect against COVID-19 (33.0%). The results from the negative binomial regression analysis showed that after controlling for the other HBM constructs and sociodemographic factors, only the perceived benefits of preventative actions showed significant association with the prevention behavior scale (IRR, 1.16; CI, 1.061–1.276; *p* < 0.001). The study findings show that public health interventions attempting to control the spread of COVID-19 in Pakistan may want to affect a change in people's perceived benefits of preventative actions through mass awareness-raising campaigns.

**Keywords:** COVID-19 preventative behaviors; perceived susceptibility; cues to action; health belief model; health education; Okara, Pakistan
