Perceived barriers to the implementation of social distancing in the COVID‐19 pandemic in Iran during 2020–2021: A cross‐sectional study

Abstract Background and Aims This research has been on the effective role of social distancing in preventing the spread of COVID‐19 and the obstacles to its implementation. The results of this research can highlight the major barriers to distancing and suggest appropriate solutions to remove them. Methods We conducted this cross‐sectional study during 2020–2021 among 277 faculty members, students of medical universities and ordinary people of Khuzestan province in southwestern Iran. We included them in this study by sampling at convenience. The data collection tool was a researcher‐constructed questionnaire that we distributed among the statistical sample through social networks (WhatsApp and Telegram). Results Mean ± SD = economic barriers 4.49 (0.65), cultural barriers 4.48 (0.70), social barriers 4.40 (0.61), political barriers 4.28 (0.64), educational barriers in universities and schools 4.27 (0.53) and Educational barriers at societal level 3.82 (1.08) were the self‐reported obstacles (perceived) to social distancing during the Covid‐19 pandemic. Comparison of occupational groups with faculty members showed that only scores of academic barriers have a significant difference between occupational groups (p < 0.001). Conclusion The role of economic barriers, cultural barriers and social barriers in social distancing was very prominent. One of our remarkable results was that there is adequate training for people on the proper implementation of the principles of social distance in the prevention of the Covid‐19 pandemic. The responsibility of all members of society to observe social distancing as a moral and even legal duty can be the first step to protect the health of citizens against COVID‐19. We can, therefore, use some planned interventions. This must be within the framework of economic, cultural, social and political structures of society.


| INTRODUCTION
The coronavirus was reported in mid-December 2019 in Wuhan, central China, and on March 11, 2020, the World Health Organization declared the outbreak a pandemic. [1][2][3][4][5][6][7][8] Since then, the Covid-19 virus has infected millions of people worldwide and killed millions. 1 The emergence of the Covid-19 pandemic and its outcomes have led to fear, concern and anxiety among people around the world. 8 Studies have shown that nonpharmacological measures (physical distance, face mask and eye protection to prevent transmission of the virus) can be very effective in reducing the spread of coronavirus.
Observing a distance of at least 1 meter clearly reduces the risk of infection, and the greater the distancing between people (2 m for example), the more will be its effectiveness. 1 Studies have shown that although social distancing is supposedly one of the most effective nonpharmacological measures to reduce the transmission of Covid-19 pandemic, doing so may face many challenges. Unfortunately, these difficulties are likely to reduce adherence to social distancing measures and thereby reduce their effectiveness 2,3 In addition, economic considerations as well as concerns about the development of mental disorders due to social distancing have prevented its observance. 9 Covid-19 has created some changes in people's lifestyles. The most common of these are avoiding social gatherings, obsessive washing of hands and storing essential food and supplies. 9 The National Headquarters for Management and Control of Corona in Iran, as in other parts of the world, has launched a social distancing plan to manage the spread of this virus. Social distancing means creating a physical distance between individuals and preventing social gatherings to maintain individual and public health. As recommended, the use of this strategy should not lead to the destruction of social interactions and it means only physical distance.
Perhaps it is better to use the word physical distancing instead of social distancing in order for people to communicate with each other.
Extensive researches around the world have shown that the application of social distancing and home quarantine is the most important working procedure to prevent the spread of the Covid-19 pandemic. Considering the specific cultural, social, economic, political structure of Iranian society, recognizing major barriers to social distancing is critical to improving the prevention of the spread of this deadly virus. Our research investigates the self-reported barriers to the social distancing requirements in response to the Covid-19 pandemic in Khuzestan province in southwestern Iran. The results of this research can highlight the major barriers to distancing and suggest appropriate solutions to remove them.

| MATERIALS AND METHODS
This cross-sectional research (2021) investigates the self-reported obstacles to the social distancing in the Covid-19 pandemic in Khuzestan province in southwestern Iran. The population of this research consisted of faculty members, students of medical universities and ordinary people of Khuzestan province. In this research, Sampling was done with convenience sampling, recruiting 277 people. The faculty members of medical sciences universities were considered as the reference group. However, from the opinions of 33 students and 104 employees in universities of medical sciences, as well as 47 other people who either did not have a job or were not working in government offices, they were identified as experts and their opinions were used. Data collection tool is researcherconstructed (in Persian) and a multidimensional questionnaire (38 questions) including demographic characteristics and major barriers to social distancing in pandemic Covid-19. These barriers assess the major barriers to social distancing of Pandemic Covid-19. We used re-testing to determine the reliability of the instrument. We distributed 20 questionnaires with a time interval of 2 weeks among faculty members, students and ordinary people and examined the reliability of the questions. With the help of Pearson correlation test, we obtained a significant relationship by 86%. The reliability of the structure was confirmed by Cronbach's alpha at 92% agreement. This questionnaire was structurally evaluated by exploratory factor analysis and after going through validity steps with CVI and CVR indices equal to 89% and 87%, respectively. We distributed this questionnaire through statistical networks among the statistical sample. The designed electronic questionnaire was sent through specialized and general WhatsApp and Telegram groups that could be accessed directly or indirectly. To comply with ethical considerations and before sending the questionnaires, we explained the objectives of the study and the sensitivity of receiving accurate answers to the statistical sample. After obtaining their consent, we assured them that researchers consider the received information as confidential.
Inclusion criteria were being a faculty member, student or ordinary citizen of Khuzestan province who were willing to participate in the study. Exclusion criterion was cancellation of participation in the study. We performed Data analysis through SPSS (SPSS 24, Inc.) at a significance level of 0.05. We used mean and standard deviation to  Table 1 shows the personal characteristics of the participants, from which we can see that 277 people participated in this research. Of which 93 were faculty members, 33 were students, and 104 were employees in universities of medical sciences. Also, 47 of them were either unemployed or not working in government offices and were identified as experts and their opinions were used in this research.

| RESULTS
Also, 43.8% of the participants were women and 56.2% were men. A total of 24.1% were single and 75.9% were married. In terms of age, 0.7% of them were under 20 years old, 17.8% between 21 and 30, 34.5% between 31 and 40, 35.3% between 41 and 50, 10.2% between 51 and 60 and 1.5% over 60 years old.
According to Table 2   Dunnett's test showed that the scores of the academic barriers of the faculty members were significantly lower than the scores of government employees, students, and nongovernmental jobs ( Table 4).
The results of the multiple linear regression model, taking into account the adjusted coefficient of the variables on the educational barriers score of the samples, showed that gender, age and marital status had no effect on their score. However, considering the educational category below the diploma as the Reference group of education variable, it was seen that the average academic score of people with bachelor's and postgraduate education is 0.535 on average (standard error = 0.233, significance = 0.022) and 638 0/0 (standard error = 0.273, significance = 0.020) is more than people with less than diploma education. Also, faculty members had a significantly lower average score of educational factors barriers than students, Nongovernment job and government's employee. The results are presented in Table 5.
Pearson correlation test showed that there is a significant and direct relationship between the inhibiting factors. The results are presented in Table 6.

| DISCUSSION
Respondents gave high scores on all dimensions of the questionnaire.
The main obstacles to social distancing in the Covid-19 Pandemic in Iran were economic barriers, cultural, social, political barriers, academic obstacles in the universities and schools, and educational obstacles at societal level. Therefore, we can claim that this research was able to examine the major obstacles. In their research in Brazil, Thomé et al. 6 divided the barriers to social distancing into three political, socioeconomic, and scientific dimensions, the results of which are consistent with our research. Coroiu et al. 10

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

TRANSPARENCY STATEMENT
The lead author Abdolreza Gilavand affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.