Compliance of Elderly with Preventive Behaviors Regarding COVID-19 at Rural Areas in El Gharbia Governorate

Background: COVID-19 is a novel and highly contagious disease that has worse and serious side effects among all age groups, but elderly are the most affected. COVID-19 increases the risk of elderly for hospitalization and dying, as the elderly has multiple chronic condition and low immunity. Thus, compliance with preventive behaviors is very essential to save elderly life. Aim of the study : to determine compliance of elderly with preventive behaviors regarding COVID-19 at rural areas in El Gharbia Governorate. Subjects and method: Study design: A descriptive cross sectional research design was utilized in this study. Setting: This study was conducted at rural villages in El Gharbia Governorate at Bolkina, Shndalat and Elgaafaria rural villages through home visits. Study subjects : A convenience sample of 400 elderly was utilized in this study. Tools: One tool was used to collect the necessary data. It consisted of three parts as follows: Part (1): Socio-demographic characteristics of rural elderly people and health history. Part (2): Knowledge of rural elderly about COVID 19. Part (3): Reported practices of rural elderly regarding preventive behaviors of COVID 19. Results: It was found that, nearly one third (30%) of the studied elderly had poor knowledge regarding COVID 19. Also, most of them (70%) had unsatisfactory practice score. There was significant positive correlation between total knowledge score and total practice score of the studied elderly . Conclusion and recommendations: Based on our study findings, we can conclude that, compliance of most rural elderly regarding preventive behaviors of COVID 19 is unsatisfactory and need improvement. So, we can recommend that: health education programs about preventive behaviors of COVID-19 should be conducted for elderly in rural areas.

Elderly people are more getting affected by the virus than adults and children. are more likely to lead to serious consequences in older people due to the risk of morbidity and mortality from complications. About 90% of all in-deaths occur in elderly population (4)(5)(6) .
Corona viruses can cause clinical diseases in humans extending from the common cold to more severe respiratory diseases that are characterized by high fever, severe inflammation, cough, and internal organs dysfunction that can even lead to death.  (2,7,8) .  (12)(13)(14)(15) .
Wearing a mask during getting out of home or presence of gatherings is an essential preventive measure. Also, disinfecting surfaces frequently with alcohol or chlorine 5% as well as avoiding large gatherings including specific cultural and faith practices such as mass prayer gatherings and large weddings, keeping distance at least 3 feets (1 meter from others) (9,16) .
Elderly are the most exposed to destructive In addition to that compliance of healthful life style (nutrition, exercise and adequacy of sleeping period) The scoring system for practices -A three point Likert Scale was used as follows: rarely or not done was scored (0), sometimes done was scored (1) and always done correctly was scored (2).
-These scores were summed up and the total score equal (38) points then converted into a percent score. The higher score indicates a greater level of rural elderly people compliance.
The scoring systems for practices were as follow: -Unsatisfactory practice < 60 % of the total score.
-Satisfactory practice ≥ 60 % of the total score.

Method
1-An official permission to conduct the study was obtained from the dean of the faculty of nursing directed to Mayors of the villages to facilitate data gathering.

2-Ethical and legal considerations:
-An informed consent was obtained from all studied elderly people after providing appropriate explanation about the purpose of the study.
-Each studied elderly subject was informed that she/he can withdraw from the study at any time she/he wants.
-The study was safe and did not cause any pain or risks for the studied elderly people.
-Privacy and confidentiality were put into consideration regarding the collected data.

3-Developing the tools:
The tool of the study was developed by the researcher based on literature review.

4-
The study tool was tested for its reliability by using Chronabach's alpha test, it was computed and it was found to be = (0.735) for all the study parts.

5-The pilot study:
A pilot study was carried out by the researcher on 10% of the sample for testing the tool/s for its clarity, applicability and to identify obstacles that may be encountered with the researcher during data collection.
Accordingly, the necessary modification was done. This sample wasn't included in the study.

6-The actual study:
-The data were collected over a period of 3 months starting from first of June to the end of August 2020. Home visit was used to reach the study subject.
-The researchers introduced themselves to each elderly people and explained the purpose and importance of the study.
-At the beginning of the interview confidentiality of the elderly information were considered. This helped to gain the elderly people cooperation.
-The structured interview was done individually to each elderly in their homes.
-The average time spent for collecting data from each elderly was approximately 20-25 minutes.

7-Statistical analysis of the data:
The statistical data were organized,      knowledge score, total practice score and socio-demographic data of elderly people.
It was found that, there was significant positive correlation between total knowledge score, job before retirement, level of education and total practice score of the studied elderly. In addition to that level of education was positively correlated with job before retirement.

Socio-demographic characteristics of the studied elderly
The studied elderly people (n=400) N % Age in years 60 < 70 70 < 80 More than 80years

Reported practices regarding preventive measures for COVID 19 of the studied elderly
The studied elderly people (n=400)   were women and more than one quarter of them were married (19) .  (20) .

Rarely
Regarding vaccination with influenza or pneumococcal vaccine, the majority of the studied elderly were not vaccinated revealed that the majority of the studied elderly people received seasonal influenza vaccine (21) . Also Yeon-Hwan et al.
(2018) reported that 83% of the studied elderly people were taken influenza vaccine (19) . (2020) who reported that about 65.5% of the studied people were washing their hands frequently with soap and water for at least 20 seconds (22) .
In addition, our results revealed that more than two thirds of the studied elderly people were discarding tissue papers in basket after coughing and sneezing (table   5). This is in the same line of Akalu et al.
(2020) who reported that about 73.1% of the studied people were cover mouth and nose with tissue paper then discard it in trash (22) .
In relation to, total practice score of the  (22) .
Regarding correlation between total knowledge score, total practice score and socio-demographic data of elderly people, it was found that, there was significant positive correlation between total knowledge score, job before retirement, level of education and total practice score of the studied elderly (  (22) .