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 Table of Contents  
Year : 2022  |  Volume : 5  |  Issue : 4  |  Page : 154-161

Public trust, preparedness, and the influencing factors regarding COVID-19 pandemic situation in Iran: A population-based cross-sectional study

1 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
2 Fundamental of Nursing Department, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
5 PhD Student of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Date of Submission19-Aug-2022
Date of Decision25-Oct-2022
Date of Acceptance30-Oct-2022
Date of Web Publication22-Nov-2022

Correspondence Address:
Mohammad Saatchi
University of Social Welfare and Rehabilitation Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/shb.shb_155_22

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Introduction: Preparedness a social behavior with public trust the prerequisite for proper social functioning can reduce disaster sufferings. The aim of this study was to determine the public trust, preparedness, and the influencing factors regarding the COVID-19 pandemic situation in Iran. Methods: This online cross-sectional study conducted on Tehran residents (≥18 years) during the fifth epidemic wave. The tool designed to assess the intention to prepare, public trust, and the subscales. T-test used to compare the means and linear regression to determine the factors influencing on the outcomes. Results: About 26.5% of 407 participants (mean age standard deviation: 40.8 (12.8) years) showed low trust. The mean levels of total trust (P = 0.011), general trust (P = 0.048), and trust to managing authorities (P = 0.018) were significantly lower in men. Adjusted to confounding variables, total trust was lower in men (ß = −3.8, P = 0.01) and less educated (ß = −6.48, P = 0.02) but higher in high-income (ß = 5.7, P = 0.02) people. Only 20% of people were highly prepared. Intention to prepare was higher in families having the elderly (ß = 5.72.8, P = 0.048). Conclusion: Low trust in the managing authorities and their provided information tend to less considering health and preparedness measures in society.

Keywords: COVID-19, intention to prepare, perceived preparedness, public trust, social trust

How to cite this article:
Khankeh H, Pourebrahimi M, Karibozorg MF, Hosseinabadi-Farahani M, Ranjbar M, Ghods MJ, Saatchi M. Public trust, preparedness, and the influencing factors regarding COVID-19 pandemic situation in Iran: A population-based cross-sectional study. Asian J Soc Health Behav 2022;5:154-61

How to cite this URL:
Khankeh H, Pourebrahimi M, Karibozorg MF, Hosseinabadi-Farahani M, Ranjbar M, Ghods MJ, Saatchi M. Public trust, preparedness, and the influencing factors regarding COVID-19 pandemic situation in Iran: A population-based cross-sectional study. Asian J Soc Health Behav [serial online] 2022 [cited 2023 Sep 23];5:154-61. Available from: http://www.healthandbehavior.com/text.asp?2022/5/4/154/361710

  Introduction Top

The coronavirus outbreak as a significant health problem in Iran and the rest of the world has created many social challenges and consequences.[1] At the pandemic onset, many governments denied or underestimated the severity of the disease that caused its further spread. Over time and getting familiar with the disease dimensions, governments and managing authorities have developed more adequate control policies. People also tried to prevent the virus spread by complying with health recommendations.[2] These events have disclosed the social behavior patterns in the general population and the essential role of responsible organizations to maintain people's social and mental health. Therefore, it is noteworthy to see how trust in authorities works in the context of corona pandemic which differs in many aspects from other natural disasters. Previous studies showed that different types of disasters may affect perceived trust in societies to their members and the government which had different impacts on individual disaster preparedness[3] and many preventive and curative matters.[4]

Undoubtedly, people's dealing and fighting with the coronavirus on one hand and their attitude toward the decision of the authorities to adopt the correct strategies on the other hand, shows the status of the government's performance and consequently the mechanism of public trust.[5],[6] COVID-19 pandemic was a complex and multifaceted event. Besides medical knowledge and health policies, coronavirus has had far-reaching social consequences. Managing such an event requires knowing about its various aspects, proper inter-sectoral communication and coordination, trust, calmness, and consecutive training and education.[7]

Gencer believed that preparedness at all individual, social, and organizational levels can reduce the effects and damages caused by disasters.[8] In preparing people for emergencies and disasters, they should collectively strive for better management and adaptation. The team effort and sharing the experiences pave the way for promoting public trust as well.[9] Thus, trust is one of the significant aspects of individual and social relations among people and communities. It is the prerequisite for proper social functioning, realistic understanding of risk, and effectively communicating to manage the risk. Trust plays a prominent role in creating social order, alliance, and maintenance by facilitating social interactions between individuals and communities.[10],[11],[12],[13],[14],[15]

Wu studied public trust and the success rate of policies that control the coronavirus crisis. They reported that the higher the public trust in society was, the more likely the policies such as social distancing and preventing the virus transmission to others were successful.[16] However, it seems that social distancing policy in countries with high public trust was implemented well with the people co-operation to control and prevent the spread of COVID-19. Therefore, social trust/capital plays an important role in community participation and preparedness when a disaster happens. Overall and based on the scientific evidence published about the disease, the successful countries in dealing with the COVID-19 crisis affected by two significant factors. The first was the ruling power of each country's political system. The second was the social capital and the trust of society members to each other and to the government.[2]

The loss of social trust/capital is one of the most significant perils trailed by this pandemic that exacerbates the dangers of distrust and psychosocial turmoil some of which have already been observed before.[2],[4],[5] Although it is difficult to determine the disaster's separate impacts on the levels of social trust and the created conflicts,[1] it is crucial to assess the influencing factors on the trust and the challenges that societies face when they are not prepared in the wake of disasters, including the COVID-19 pandemic. Some studies have found demographic features as one of the major predisposition characteristics that primarily affect individual preparedness behaviors. From those, age, gender, education, location, and race/ethnicity have been highlighted the most[3] which have been considered in the present study.

Considering the social tragedies and crises after the coronavirus pandemic, besides the physical and psychological aspects, COVID-19 has had several social consequences in Iran which is a known disaster-prone country for its special circumstances that has been under heavy international sanctions even in the terms of medical resources and therapeutic supplements. Thus, this study intends to assess the Iranian public trust and preparedness for this epidemic and try to recognize the factors influencing them.

  Methods Top

Study design

This was an online cross-sectional study conducted on an Iranian population living in Tehran, during the fourth and fifth heavy waves of the COVID-19 epidemic in 2021. The inclusion criteria were living in Tehran city, being 18 years or older and willing to participate. The study questionnaire was prepared in Google forms and sent to the participants through social media such as WhatsApp, Telegram, and Facebook.

Variables and measures

The primary outcomes of this study determined (a) the public trust including two subscales: (1) General trust that the community members have to each other and (2) The trust people have in the organizations involved in epidemic management, (b) the intention to prepare, and (c) the perceived preparedness for corona disease in the participants.

The study measurement tools were originated from an inventory developed by Paton based on the socio-cognitive model to evaluate the factors influencing on preparedness[17] reporting authentic validity and reliability in the previous studies about different natural disasters both in English and Persian versions.[18],[19],[20],[21],[22] This inventory was designed in different scales that have successfully been translated to the Persian language and culturally adapted in Iran.[22]

The Public Trust Scale used to assess public trust in this study has 19 items in two subscales: general trust and special trust to authorities. The items are scored on a 5-point Likert scale as “strongly agree” =5, “I agree” =4, “I have no comment” =3, “disagree” =2, and “strongly disagree” =1. The total score for this tool ranges between 19 and 95. A score of 19 indicates the minimum and 95 represents the maximum trust level in the study population. After calculating quartiles, the participants' trust status was classified into three groups: Low (first quartile), moderate (second and third quartiles), and high (fourth quartile).

The Persian version of the intention to prepare scale refers to the intention to engage in behaviors that can reduce the severity of the consequences of emergencies and disasters. The items of the intention to prepare are scored as “I have done before” =4, “I will do” =3, “maybe I do” =2, and “I will not do” =1. The final score ranges between 20 and 80. A score of 80 shows the highest and 20 is the lowest intention to prepare against the epidemic in the study population.

The perceived preparedness was assessed using 5-Likert scoring questionnaire.[23] The concept refers to the target group's perceived level of preparedness for emergencies and disasters (here the COVID-19 epidemic). The Persian version used in this study was validated and confirmed by the experts for the content. According to Cronbach α co-efficient, the internal consistency was 0.95.

Ethical consideration

The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (code: IR.USWR.REC.1399.065). Informed consent was obtained from all the participants.

Statistical analysis

The categorical variables were reported through the tables of frequency and percent. The quantitative variables are shown in the form of means and standard deviations (SDs). The t-test was used to compare the mean outcome scores between men and women after the normality of the data confirmed by the Shapiro–Wilk test. We used the linear regression test to determine the relationship between the independent variables and each outcome of interest after controlling the confounding variables. The outcomes of interest in regression models were as follows: general trust, trust to authorities, total trust (sum of scores of general trust and trust to authorities), preparedness, perceived preparedness, and total preparedness (sum of scores of preparedness and perceived preparedness). Independent variables were age, sex, income, education, job, level of development, number of child or preschools in family, and number of elderly people in family. For reporting adjusted coefficient, all variables were included in the model. For all comparisons, a significance level of 0.05 was considered, and all analyses were performed in STATA software (version 14, STATA Corp, College Station, Texas, USA).

  Results Top

The data of 407 residents of Tehran City were analyzed. The mean (SD) age of participants was 40.8 (12.8) years ranging from 18 to 76 years, and 51% were female. [Table 1] presents the basic data of the participants as a whole and separately for male and female participants. About 59% of the participants were married and 45% had an average monthly income of 450–800 $ regarded as the middle-income level. About 10.5% of the participants were educated less than high school diploma and 33.3% were self-employed. [Table 2] presents the average general trust, trust in authorities of epidemic management, total trust, preparedness, perceived preparedness, and total preparedness. Furthermore, [Figure 1] presents the score distribution of outcomes of interest.
Figure 1: Score distribution of general trust (a) special trust to authorities (b) total trust (c) preparedness (d) perceived preparedness (e) and total preparedness (f) in participant

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Table 1: Baseline characteristics of participants based on the gender participants

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Table 2: Trust and preparedness in male and female participants

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The mean of general trust (P = 0.048), trust in managers (P = 0.018), and total trust (P = 0.011) evaluated in men were significantly lower than those in women. About 26.5% of participants had low total trust. Furthermore, 25% and 29.5% of the participants had low trust in perceived preparedness and intention to prepare, respectively. [Table 3] presents the relationship between each participants' basic data with total trust, general trust, special trust to authorities, and [Table 4] presents perceived preparedness, preparedness, and total preparedness using linear regression.
Table 3: Association of special trust to authorities, general trust, and total trust with independent variables in 407 participants using multivariable linear regression

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Table 4: Association perceived preparedness, preparedness, and total preparedness with independent variables in 407 participants using multivariable linear regression

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Men's trust was 3.8 times less than women's trust (P = 0.01) when age, income, education, social development of the residential areas, numbers of the elderly and children in the family, and occupation were controlled. Our findings showed that the trust of individuals educated less than high school diploma was −6.8 times on average less than educated people (P = 0.02). The average trust of those who had higher monthly income was 5.7 times higher than those with low income (P = 0.02). Furthermore, the older the participants were, the more intention to prepare they had (P = 0.047).

  Discussion Top

This study aimed to investigate the level of public trust and preparedness for the COVID-19 pandemic and the influencing factors in Iranian people. The study was conducted in Tehran, the capital city with the maximum cultural diversity in the population. The results showed that about a quarter of people had high public trust and less than one-third of the participants declared to be prepared.

The trust in participants who had high school diploma or less was lower than that educated people. People with high monthly incomes also had higher trust than the lower-income groups. Considering the moderating role of gender in social trust reported in previous studies,[24] the present results indicated a gender-based difference in trust variables as well. Women's general trust, trust in pandemic management, and total public trust were significantly higher than men's. However, there was no significant difference between the two genders in intention to prepare or perceived and general preparedness.

In general unlike our findings, public trust was significantly related to employment and having special needs,[25] being married, having religious observance,[26] higher income[26],[27] and being older;[27] whereas being married[26] and female, having higher annual income,[25],[26],[27] aged over 35 years,[25],[28] better urban development of the residence,[28] and higher education[25] were significantly correlated to the higher levels of disaster preparedness. These findings highlight the importance of contextual mediators as compared to the individual characteristics on forming the social trust and preparedness related to the different disastrous situation in a community. The results also suggest when the target is to install or change social behavior, the outcome of interest will not be achieved if only considering the individual characteristics. Understanding the complex realities that people heed when referring to a widespread disaster such as COVID-19 requires more in-depth studies in different contexts.

Each type of trust uniquely affects people's perceptions and how they react to the COVID-19 pandemic.[29] According to this goal, our studied outcomes included general trust, the level of trust to the in-charge organizations for epidemic management and control, the intention of individuals to prepare for corona disease, and the degree of perceived preparedness for COVID-19 disease in participants.

Studies have shown that people who tend to trust people around them unconditionally perceive their possible risks less than people who have low public trust.[29] These results showed that more than 70% of participants rated to have low or moderate public trust as a whole.

Oksanen et al. stated that public trust in institutions acts as a protective factor and countries with lower levels of trust before this pandemic (including Italy) experienced higher mortality rates in the crisis.[30] These results are in line with the results of other studies about the role of trust in other crises, including the Ebola outbreak. In this way, people with higher public trust are more likely to follow the health instructions of health care providers.[31],[32]

In general, people need to trust the government, experts, and organizations to receive new information and correctly interpret their knowledge.[29] According to the present study, only 22.7% of people showed high and acceptable levels of trust to authorized organizations which somehow explains the high infection and mortality rates in the peaks of the coronavirus epidemic. In a study regarding the COVID-19 situation in 177 countries (2022),[33] the higher public trust level to the government was significantly correlated with lower infected cases, higher vaccine coverage and less fatalities. These results were consistent with what Han et al. reported about the significant association of higher trust to the government with lower decline in health behaviors and maintain prosocial behaviors adoption over time.[34] A survey by Prati et al. in Italy has also shown that people who trusted the Ministry of Health and media are more likely to implement the behaviors recommended by these organizations to control the H1N1 flu pandemic than people who did not trust these organizations.[35] However, some studies have reported that in some cases, high trust in governments and pandemic management have been associated with reduced perceived risk and ineffective compliance with government measures to manage the risk.[36] Giving all responsibilities related to disaster risk management to the authorities and the people's high trust in them can result in losing the sense of belonging to society and participation of individuals. Then, people do not even seek the necessary information to prepare for disasters and underestimate their perceived preparedness.[28]

Income inequality is associated with many adverse consequences in societies.[37] In addition, the COVID-19 epidemic was related to numerous stressors, which are more severe in low-income people or those deprived of adequate government support.[38] It seems that the effect of income inequality on social trust depends on two factors: the distribution of resources and people's perception of inequality.[37] These study findings showed that the general trust of people with higher monthly income was better than people with low income in the month which was consistent with the other studies findings.[26],[27] The Iranian government's inadequate protection program and financial support during the quarantine periods in the COVID-19 pandemic made it impossible for the low-income groups to consider the quarantine regulations, and they continued their work activities in the community.[38] This outcome made it difficult to effectively control the disease because of the violation of social distance and minimal presence in the community.[39] Many studies report that income inequality reduces community trust in governments and other members of society. In addition, people with lower incomes cannot follow the health guidelines in some cases due to their inability to provide disinfectants and masks. This inability plays a significant role in not breaking the chain of infection transmission and increases the coronavirus spread by low-income groups[38] and violates their levels of preparation and resilience.

Despite examining the effect of many variables on social trust, we cannot definitely decide on the social trust effects on controlling the prevalence of COVID-19.[40] The reason for this uncertainty relates to three issues: first, there is little empirical evidence supporting a significant association between social trust and epidemics; second, previous studies have focused solely on local governments related to this phenomenon; and third, the COVID-19 pandemic is, in many ways, different from other crises that humans have faced throughout the history. One aspect of the difference is the intensification of this crisis after increasing social interactions.[41] However, the social capital theory argues that social trust is formed through the cohesive relationships between individuals through their direct and intimate interactions.[42],[43] Nevertheless, considering scientific results and using reliable evidence, it is necessary to pay attention to political, social, cultural, and economic issues through providing adequate financial and psychological support from society to the vulnerable groups, gaining the trust of all community members, and improving their preparedness to manage the subsequent waves or the new variants of COVID.

It is essential to consider the limitations of the research when interpreting the results. First, the study design was cross-sectional, so it was hard to draw conclusions based on causality. Furthermore, data collection was conducted online because of the heavy wave of the coronavirus epidemic in Iran that made it impossible to ask the questions face to face. As a result of this limitation, not everyone can participate in the study due to the unavailability of the Internet, smartphones, or active application of social media. Because of the complexity and cultural sensitivity of this phenomenon, we suggest designing future studies with a qualitative paradigm in this area.

  Conclusion Top

This study examined the trust of the Iranian community and preparing for the COVID-19 epidemic. The results will lead to develop the initial framework for health system planning and increase the knowledge of healthcare providers to respond to the long-term effects of COVID-19 and similar events.

This study indicated that most study participants had low-to-moderate preparedness and low public trust. Because promoting social trust and preparedness plays an important role in controlling epidemics effectively, the managers in charge should consider supportive measures for the whole society. It is essential to pay attention to social support, especially for low-income groups and to promote community participation by improving social trust and public preparedness in managing the risk of emergencies and disasters.


This study is approved as the research design code IR.USWR.REC.1399.065 by the Ethical Committee for Medical Research at the University of Social Welfare and Rehabilitation Sciences. The study was supported by Alexander von Humboldt-Stiftung, Iranian Academy of Medical Science, and University of Social Welfare and Rehabilitation sciences.

Financial support and sponsorship

The study was financially supported by Alexander von Humboldt-Stiftung, Iranian Academy of Medical Science, and University of Social Welfare and Rehabilitation sciences.

Conflicts of interest

There are no conflicts of interest.

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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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