Relationship between the government implemented protective measures for coronavirus disease 2019 (COVID-19) during the pandemic and the understanding of religious evidence in Muslim community: A cross-sectional study from Saudi Arabia : Journal of Family and Community Medicine

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Original Article

Relationship between the government implemented protective measures for coronavirus disease 2019 (COVID-19) during the pandemic and the understanding of religious evidence in Muslim community: A cross-sectional study from Saudi Arabia

Wali, Alzubair A.

Author Information
Journal of Family and Community Medicine 30(1):p 23-29, Jan–Mar 2023. | DOI: 10.4103/jfcm.jfcm_125_22
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Abstract

Introduction

Coronavirus disease 2019 (COVID-19) was caused by a new form of coronavirus (SARS-CoV-2) that first appeared in China at the end of 2019 and quickly spread to all countries worldwide.[1] By the beginning of 2022, China had reported 133,404 confirmed cases and 5699 deaths.[2] The outbreak of a novel coronavirus disease in December 2019 was one of the most devastating public health emergencies since the founding of the People’s Republic of China in 1949.[3] The virus spread internationally within 1 month of its being first identified, transmitted through close human-to-human contact.[4] On January 30, 2020, the World Health Organization (WHO) declared COIVD-19 a public health emergency of international concern, and 6 weeks later, the outbreak was characterized as a pandemic.[5] The pandemic has spread all over the Middle East and renewed religious controversies due to the government’s decision to tighten its reins on religious practices in its efforts to fight the pandemic.[6]

The incidence of COVID-19 increased in the 1st 2 weeks in Saudi Arabia, from zero cases on March 1, 2020, to more than 15 cases/day by March 16, 2020, to a total of 133 cases.[7]

Unfortunately, the unavailability of an effective antiviral drug aggravated the situation. The implementation of effective preventive measures was one of the important options to counteract COVID-19.[8]

Immediate quarantine of the involved regions, production and supply of a large number of protective facemasks, and the prevention of its stockpiling or smuggling were the main actions suggested to deal with the present or any future COVID-19 outbreaks.[9]

The government stated on many occasions that the nonadherence of citizens to COVID-19 preventive measures has resulted in an escalation of cases once lockdowns were lifted.[10] To prove this, we included the question, “Why are many people in Saudi society unwilling to adhere to the preventive measures against COVID-19?.”

At the beginning of the pandemic, the implementation of effective preventive measures was the only way to counteract COVID-19.[8] Masks appeared to be effective when used with and without hand hygiene, but combining hand hygiene with the wearing of masks offered more protection.[11]

The WHO advised the maintenance of a distance of at least 1 m (3 feet) between persons.[12] Keeping a safe distance between people during prayer in mosques was expected, but appeared to be against Prophet Muhammad’s advice to “stand in straight rows and do not differ among yourselves (432 Sahih Muslim)”.[13]

Some people do not follow the precautionary measures because they think it affects their trust in Allah. This Ayat from verses of the Holy Quran states that Allah said, “Nothing shall ever happen to us except what Allah has ordained for us.” Surah Al-Taubah (51)[14] In countries like Saudi Arabia, some people view the restrictions as violations of religious practice.

The present study explores the reasons why people do not follow preventive measures against COVID-19 and ignore the recommendations by the authorities. The study also explores how those reasons relate to peoples’ understanding of Islam.

Materials and Methods

A cross-sectional community-based study was conducted from August 11, 2020, to May 18, 2021, in Saudi Arabia. Data were collected from 922 participants. All Muslims were eligible to answer the questionnaire for this study, which was written in both Arabic and English using the Survey Monkey program and Google Sheets. It was distributed randomly through social media and as a paper questionnaire. Ethical approval was obtained from the Institutional Review Board vide Letter No. 1441-2111270 dated 10/08/2020, and informed written consent was taken from all participants.

The questionnaire consisted of 17 questions, divided into four categories.

The first category comprised three general questions on age, gender, and experience or practice in the medical field. It was believed that the responses provided by people who had a medical background could affect our statistical analysis, so their responses were analyzed separately. The second category had five questions designed to measure people’s compliance with governmental protective measures. The third comprised two religious pieces of evidence that were likely to be misunderstood. The fourth group had six religious pieces of evidence in support of the protective measures. A final question was asked to determine whether people’s views/commitment to the protective measures had changed after completing the questionnaire.

Three professors were requested to check the questionnaire for validation. A pilot test study was conducted, after which a few adjustments were made to clarify the questionnaire and shorten the time for its completion.

Statistical analysis compared people’s compliance with protective measures with their understanding of religious evidence. Analyses were carried out using the SPSS version 21.0 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Frequencies and proportions of responses were calculated. Chi-square test was used to determine the association between the understanding and commitment and attitude; P≤ 0.05 was considered statistically significant.

Results

The study included 922 participants with ages ranging from 17 to 68 years and the mean age of 43.9 (±12.69) years. The majority (29.6%) were aged between 35 and 44 years, and 54.4% were females, and only 11.5% worked in medical field [Table 1].

T1
Table 1:
Sociodemographic characteristics of the study participants (n=922)

About 71% of the participants were committed to wearing face masks and 69.6% to washing their hands. Regarding the mosque precautions, 49.9% were committed to using a prayer mat, 53.7% adhered to keeping a safe distance both at work and in the mosque, and half of the participants were always committed to adhering to the measures. When the people that did not attend the mosque or were unemployed were excluded, the percentage increased to 80.4% and 76.9%, respectively. However, only 34.3% of the participants always maintained a social distance while visiting relatives and about 25.2% often kept a social distance [Table 2].

T2
Table 2:
Study participants’ adherence and commitment to the preventive measures for coronavirus disease 2019

Commitment percentages were distributed among wearing masks, hand washing, mosque precautions (prayer mat), keeping a distance (at work and mosque), and distancing during visits to relatives as 91.0%, 89.5%, 55.7%, 66.1%, and 59.4%, respectively [Table 2]. We reported more than 90.0% adequate understanding of all questions [Table 3]; 97.9% had an adequate overall understanding [Table 4]. We found that after answering the questionnaire around 62.0% had positive intentions and attitudes toward future commitment [Table 4].

T3
Table 3:
Good understanding of Islamic principles related to disease preventive measures among the study participants
T4
Table 4:
Study participants’ overall good understanding of Islamic principles and attitude toward the future commitment to the protective measures for coronavirus disease 2019

Table 5 shows that an adequate understanding of religious principles was significantly associated with commitment to mask wearing at P < 0.01, hand washing at P < 0.01, keeping an appropriate distance (at work and mosque) at P = 0.26, and keeping a distance during visits to relatives at P = 0.43, but the mosque precautions at P = 0.094. We also found a significant relationship between inadequate understanding of religious evidence and poor commitment to the wearing of masks, hand washing, keeping the appropriate distance (at work and mosque), and keeping a distance during visits to relatives.

T5
Table 5:
The association between the overall good understanding of religious principles and the commitment toward coronavirus disease 2019 precautions by the study participants

We found that an adequate understanding of religious principles was significantly associated with overall commitment; P = 0.001 and inadequate understanding were significantly associated with lack of commitment [Table 5].

We found that adequate understanding of religious principles was significantly associated with a positive attitude toward future commitment and inadequate understanding was significantly associated with a negative attitude (P < 0.001)[Table 6].

T6
Table 6:
Relation between overall good understanding of religious principles and positive attitude toward future commitment

There was no significant relationship between working in the medical field and understanding religious principles (P=0.55), but there was a significant association between working in the medical field and acceptance of preventive measures (P=0.013). There was also a significant association of a positive attitude toward future commitment (P < 0.001) [Table 7].

T7
Table 7:
Relation between overall good understanding of religious principles, commitment to preventive measures and positive attitude toward future commitment, and working in the medical field

Discussion

Respiratory viruses, like SARS-CoV-2, are known to spread by direct contacts, such as touching an infected person or an infected surface.[15,16]

Recommendations to practice good hand hygiene, physical distancing, and isolation of infected patients to prevent transmission are common in organizational guidelines for respiratory viruses.[17]

To prevent the spread of the virus that affects healthcare systems, the authorities have instituted regulations and recommendations that include social distancing, washing of hands, and the wearing of a face mask.

These measures received mixed reactions; some ignored the advice.

Mortality by COVID-19 reached more than 85002 in Saudi Arabia. Even workers in the medical field succumbed to the disease. Despite the regrettable situation, many people were not persuaded to follow governmental protective measures. The Ministry of Health (MOH) in Saudi Arabia broadcast the story of the spread of the disease in one family on social media and on the news.

Muslim households usually consist of relatively large families, and as per religious advice, strong relations are maintained between members. This is why the percentages of commitment to “always” and “often” were relatively low with regard to the maintenance of appropriate distance when visiting relatives [Table 2], compared to keeping the distance at work and in the mosque.

About 62.0% had a positive intention and attitude toward future commitment after answering the questionnaire [Table 4]. This shows that since questionnaires are conveniently distributed by social media or in the waiting areas of primary healthcare centers and hospitals, it could be a novel way of raising awareness in society.

We found that an adequate understanding of religious principles was significantly associated with an overall commitment, and inadequate understanding was significantly associated with a lack of commitment [Table 5]. It is very important, therefore, that in a Muslim society people are taught the proper explanation of evidence to avoid misunderstanding preventive measures for diseases.

Jang et al.,[18] measured the levels of preventive behaviors such as wearing face masks and hand washing. Between the surveys, respondents who reported practicing social distancing increased from 41.9% to 58.2% during the Middle East respiratory syndrome coronavirus (MERS-CoV) to 83.4%–92.3% in COVID-19. In our study, it was 66.1% [if we count always and often Table 2]. The reason is that protective measures were not applied for MERS-CoV and the people were not convinced about the government’s protective measures.

Conclusion

In times of crisis, clarity of the information given in the government’s policies determines social cohesion. The differences in social classes are important factors that influence decisions taken by individuals in times of crisis. A few Muslims have no grasp of disease prevention due to their inability to comprehend religious evidence, but the scholars of religion can resolve this. The scholars who are diligent in their work should have discussions of the religious evidence in society to prevent misinformation by individuals with little learning.

These discussions should be shown through the media by the MOH in support of their preventive measures for any endemic disease. Questionnaires can be distributed through the media and in hospitals to inform people and correct misconceptions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The author would like to thank Dr. Yahya Kharrat for his effort in adjusting the translation of the study questionnaire and also Dr. Kharrat Zulfa, Dr. KarKaz Nasser, and Dr. Al-Dakheel Mohammed for their efforts in validating the study questionnaire.

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Keywords:

Compliance; coronavirus disease 2019; protective measures; understanding of religion

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