Too much to mask: determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon

Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics and pandemic fatigue have meant that disease control policies need to be updated. Identifying variables associated with adherence to non-pharmaceutical preventive practices, particularly for vulnerable groups, can therefore help inform and refine interventions in the face of pandemic fatigue and changing disease dynamics. Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper explores the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask and avoiding social gatherings) among this high-risk subgroup in a vulnerable population. Among respondents who report adhering to these measures, the paper also identifies the determinants of sustained adherence over a period of 6 months. The findings suggest that older refugees and those less educated are less likely to wear a mask, and refugees living in informal tented settlements are more likely to relent on preventive practices within 6 months. Individuals with chronic diseases who initially report avoiding social gatherings are also likelier to desist than those without chronic illness. The lower continued adherence to mask wearing among residents of informal tented settlements points to factors beyond pandemic fatigue and that should be taken into consideration in devising measures for disease control: the potential for community-based norms to determine individual-level behavior. Recognizing the pivotal effect of community-based norms in settings such as informal tented settlements is essential in adapting current policy and designing future interventions.