Introduction

Coronavirus disease (COVID-19) is a global public health emergency and highly infectious new pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. It is an emerging infection that spread rapidly around the world [2] and it is now recognized as a health challenge worldwide [3]. The emergence of new types of coronavirus, which occurs after the high mutation of this virus, causes an increase in the ability to escape from the immune system and the high power of its contagion and spread [4]. Although many aspects of this disease are still unknown, its direct person-to-person transmission is confirmed [5] and asymptomatic individuals as a potential source of infection are identified [6]. COVID-19 still infects many people around the world and has spread widely in Iran. Symptoms of COVID-19 infection are mild and treatable in 80 percent of patients, but it may be severe and even fatal in others [7].

Promoting prevention measures is the most important strategy to control any epidemics of infectious and communicable diseases [8]. In this accordance, community education about self-care and taking responsibility about own and others’ health are the prerequisites for the successful implementation of a program [9]. By the way, using disease prevention and management techniques, improving lifestyle, teaching health tips, and providing self-care guidelines can help prevent future outbreaks of diseases [10]. A key strategy to combat COVID-19 transmission is self-care promotion [11] which can decrease the risk of its transmission [7, 10] and individuals should pursue self-care strategies as long as there is the risk of transmission [10].

Self-care as a theory focuses on the practice of activities that individuals initiate and perform on their behalf to maintain life, health, and well-being. Dorothea Orem (self-care requisites and self-care behaviors) and Jean Watson (self-compassion within the human caring theory) were among the pioneers of self-care theory [12, 13]. World Health Organization (WHO) defines self-care as “the ability of individuals, families, and communities to promote their health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health worker" [14]. Self-care is a practice in which everyone uses their knowledge, skills, and abilities as a resource to improve their health status independently. The key concepts of self-care are maintenance, self-care monitoring, and self-care management. In addition, self-care guidelines can be used as practical ways to slow the progression of diseases and improve quality of life [15]. Self-care is considered a significant and valuable strategy as it emphasizes the active role of individuals in maintaining their health and well-being. Today, self-care is considered a key component of health promotion to improve the health, and well-being of individuals and as a strategy to reduce the high cost of medical services [16, 17].

Self-care existed before formal health systems and plays an important role in health outcomes. For many people in some cultural and social backgrounds, self-care is an established behavior. Self-care is an important component of an individual’s health even if there is access to a health care system. In addition, interventions that were previously only available through healthcare providers, are now being accessed in the self-care setting [18]. Individuals can solve their health problems through self-care and by raising awareness and modifying their lifestyle [19] Self-care is important in all aspects of health and it is particularly essential for populations who are negatively affected by sex, political, cultural, and power dynamics such as women [18]. Self-care assessment is a prerequisite for self-care promotion interventions [20].

In the recent coronavirus epidemic crisis, promoting self-care is a key strategy to prevent COVID-19 prevention and also to enhance physical and mental health [18], and it is now widely recommended to practice self-care to reduce stress and the risk of COVID-19 infection and the complications [21, 22]. Given the importance of self-care for COVID-19 prevention for the control and management of the COVID-19 epidemic crisis [10], it is important to evaluate the self-care behavior of individuals. For instance, self-care during the COVID-19 pandemic was assessed in Mixico-City and showed 66 to 80% complied with self-care recommendations [11], Many studies in Iran and other countries are concentrated on reproductive health self-care [23–27]. However, to our knowledge there were no study assessed women’s self-care for Coronavirus (COVID-19) prevention and its related factors.

Gender differences in health behavior during the epidemic have not yet been fully elucidated. [28]. However, there seem to be different responses to health and self-care measures by country, age, and gender [29]. The results of studies show that women in these conditions are more at risk of mental consequences such as stress, anxiety, and depression [29, 30]. Besides, women are generally more involved in self-care activities and adopt healthier daily routines than men [9, 29].

Especially married women are usually the center of the family and take responsibility for maintaining the family members’ health comfort, and tranquility. This can be attributed to the women’s biological characteristics and the social expectations about women’s gender roles as wives or mothers. The consequence of such an experience is that they use their maximum capacity to care for and protect the family during the COVID-19 epidemic despite the stressful effects of the crisis [9]. Women are more likely than men to be cautious about the risks of the coronavirus pandemic and to provide more protection, including hand washing, using face masks, and sanitizing surfaces [31]. Therefore, considering gender differences in self-care studies can lead to more accurate results. Therefore, the present study aimed to assess women’s self-care for Coronavirus (COVID-19) prevention and the related factors in Tehran.

Methods

Sample size

The minimum sample size was calculated using the formula of descriptive studies and considering the 50% probability of women’s self-care the Type I error of 0.05 and the absolute error of 0.5, the minimum sample size of 385 samples was calculated.

Results

Four hundred three women aged 31.58 ± 9.41 (Mean ± SD) years, with the range 18 to 80 years participated in the study. The majority of the participants (97.3%) were urban residents and the rest were rural residents. The demographic characteristics of the participants are shown in Table 1.

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Table 1. Socio-demographic characteristics of the women (n = 403).

https://doi.org/10.1371/journal.pone.0294983.t001

Results showed a self-care score of 71.84±17.81 Percent. The items with the highest and lowest scores were “the use of masks in public vehicles” and “not touching the face (eyes, nose, and mouth) under any circumstances”, respectively (Fig 1).

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Fig 1. Mean (±SD) of women’s self-care scores for Coronaviruses prevention behaviors (WSCPB).

https://doi.org/10.1371/journal.pone.0294983.g001

Table 2 shows the relationship between women’s self-care in Coronavirus prevention with the participants’ socio-demographic characteristics. The results demonstrated no relationship between self-care and the socio-demographic characteristics of women.

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Table 2. The relationship between women’s self-care for Coronavirus prevention with socio-demographic characteristics of women.

https://doi.org/10.1371/journal.pone.0294983.t002

Table 3 shows the frequencies and mean scores of women’s self-care for Coronavirus prevention of women with or without a medical condition. The results also demonstrated no significant difference between women’s self-care on Corona prevention with (72.74 ±15.86) or without medical conditions (71.35±18.81) (t-test; p = 0.454).

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Table 3. The frequencies and mean scores of women’s self-care on Coronavirus prevention of women with or without a medical condition.

https://doi.org/10.1371/journal.pone.0294983.t003

However, the results revealed a significant negative correlation between the women’s self-care on Corona prevention with their mental status including the level of stress, anxiety, concerns, and fear, respectively. Analysis of variance also confirmed the results (Table 4).

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Table 4. The correlations between women’s self-care Coronavirus prevention and their mental status.

https://doi.org/10.1371/journal.pone.0294983.t004

The results also demonstrated no significant difference between SCVP of women who were affected with COVID-19 or not affected, and performed or not performed vaccination (Table 5).

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Table 5. The comparison of self-care for Coronavirus prevention of women who were affected by COVID-19 or were not affected and performed or not performed vaccination.

https://doi.org/10.1371/journal.pone.0294983.t005

Linear multiple regression test showed that the model is predicting 4.1% of the SCVP Besides, two factors including women’s age (p = 0.033) and their number of children (p = 0.042) predict SCVP (Table 6). So, for increasing each year to women’s age, SCVP increases by 0.463 units, and with increasing each child, SCVP decreases by 3.608 units.

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Table 6. Linear regression of possible predictive factors related to self-care for coronavirus prevention in women participating in the study.

https://doi.org/10.1371/journal.pone.0294983.t006

Discussion

This study assessed the related factors with women’s self-care on Coronavirus prevention in Tehran and found that women had the highest score for the behavior of "using a mask in public transportation" and the lowest self-care score for the item of “not touching the eyes, nose and mouth”. There were also significant negative correlations between women’s self-care on Corona prevention and their mental status including the levels of anxiety, fear, stress, and anxiety. Also, women’s age and number of children predict the level of their self-care in Covid-19 prevention.

The results showed that women in Tehran meet most of the criteria recommended by the valid sources for self-care on COVID-19 prevention. It seems community education about self-care on COVID-19 prevention through digital resources and social media plays a significant role in promoting self-care behaviors. Besides, sharing health information from reliable scientific sources is one of the most effective strategies for promoting self-care in COVID-19 prevention and mental health enhancement of people during the COVID-19 pandemic crisis [36].

The results indicated the highest score for the behavior of “using a mask in public vehicles" and then "refusing to use shared utensils with sick people." Given that these are the basic principles for preventing respiratory infectious diseases, it seems that community education about Coronavirus prevention and self-care led to raising awareness [37] among women.

The lowest scores were related to the participants’ behaviors about "not touching their face including their eyes, nose and mouth” and then “disinfection of all surfaces of the home with alcohol spray". It seems self-care education is necessary for all items; however, more emphasis is essential on community health education through the media about “not touching eyes, nose and mouth”, “disinfecting high-touching surfaces and tools”, and “not leaving home for unnecessary reasons during COVID-19 epidemic”.

The present study showed that age can be a predictor of women’s self-care in COVID-19 prevention. This result is consistent with the results of similar studies that showed middle-aged women pay more attention to self-care during the COVID-19 epidemic and adopt healthier daily routines [9, 29]. By passing through life, people’s experiences of adaptation and resilience in different situations develop, which may explain healthier and more protective behaviors of middle-aged women compared to younger women [9]. A study found that people who perceived greater risks were more likely to engage in protective behaviors [38]. It seems perceived the risk improves with aging, which causes taking more responsibility for protecting and caring about themselves and their family members.

The findings showed that self-care for the prevention of the coronavirus among women with or without a medical condition is not significantly different. Although some studies found that people with medical conditions such as cancer, cardiovascular or pulmonary diseases have more self-care and seek more prevention methods [39–41] the measures as well as the tools for measurement of self-care for the prevention of the coronavirus are different from the prevention of other medical conditions [23, 42, 43].

The regression analysis in the present study showed the number of children could also be a potential predictor of women’s self-care for Coronavirus prevention. Bahrami and colleagues found a correlation between knowledge about self-care and the number of children [44]. It seems that women with more children find less time and opportunities for self-care measures. Besides, more children may increase parental stress and responsibility as well as financial problems [45]. A study showed more children are associated with lower quality of life, which was attributed to their greater responsibilities in large families. The numerous responsibilities of women in large families can leave them with less time and opportunity to perform self-care measures [46].

The findings of the study showed that women evaluated the effect of the coronavirus pandemic on their mental status on increasing depression, anxiety, fear, stress, and anxiety, respectively. The outbreak of COVID-19 caused many countries to make mobility regulations for citizens to reduce the potential risk of infection. Quarantine and the restrictions have affected people’s lifestyles and caused mental health consequences during and after the COVID-19 outbreaks [47, 48]. According to these studies, the negative impact of the COVID-19 crisis and its mental consequences is very wide. A study conducted by an online survey during the COVID-19 epidemic found symptoms of severe anxiety and severe depression in the general population among 20.8% and 27.5% of the general population, respectively [11]. According to some studies, the most important negative mental consequences of quarantine in the COVID-19 crisis are anxiety and distress [49, 50]. Similarly, other mental problems such as increased feelings of loneliness, stress disorders and post-traumatic stress symptoms, anger, fear, and sleep disorders are reported in the literature [11, 47, 51, 52]. Therefore, promoting self-care measures is an important factor in preventing immediate and late consequences of the COVID-19 pandemic [53].

The results indicated the significant negative correlations between self-care for Coronavirus prevention with women’s evaluation of the impact of COVID-19 on their mental status including depression, anxiety, fear, stress, and worries. Recent evidence demonstrated women are reporting higher scores on perceived stress than men during lockdown which is attributed to women’s roles, mainly the burden of both work and caring roles. An overload of women’s caring roles and an experience of greater stress levels and mental health problems contribute to a greater vulnerability for women and therefore, they are more likely than men to avoid healthy behaviors and self-care [29, 54]. Self-care education is one of the dimensions of psychological empowerment to prevent infectious diseases such as coronavirus prevention [36]. Self-care is considered a significant strategy for keeping an individual’s psychological well-being because it significantly operates as a mediating mechanism in the association between perceived stress and mental health in a quarantine situation [47].

Consistent with our results another study found that self-care decreased with increasing fear of COVID-19 [55]. Mental problems such as anxiety, fear, stress, and worries seem to cause stress that can be an obstacle to self-care and protection.

Finally, the tool, method, and findings of the present study are recommended to be used by the researchers and policymakers to show the need for interventional programs and planning an evidenced-based coronavirus prevention promotion program.

Conclusion

During the coronavirus pandemic, women are practicing more than seventy percent of the self-care measures for coronavirus (COVID-19) prevention in Tehran. Considering that age can be a potential predictor of self-care, it seems appropriate self-care educational interventions for young women are necessary. Also, regarding the results that increasing the number of children can be a potential negative predictor for women’s self-care for COVID-19 prevention, it seems mothers who are busy with many children need more easily to access health facilities, education, and reminders to improve their self-care and family care.

Regarding the negative relationship of self-care with mental status such as increased depression, anxiety, fear, stress and worry during the coronavirus pandemic, education and promotion of self-care measures are suggested. Besides, community education, especially women’s education about copying strategies during the pandemic crisis is emphasized. Self-care promotion can help to improve people’s especially women’s mental health during the COVID-19 pandemic crisis.

Promoting self-care is strongly recommended in public health, not only in the prevention of COVID-19 but also in the prevention of all epidemic respiratory viral infections. Besides self-care promotion is particularly necessary for women who take the main role of family care. The effectiveness of the promotion programs is also essential using a valid tool like the one introduced in this study for improving future programs.

Supporting information