Health Protocol Practices and Personal Preventive Measures among Fully Vaccinated Individuals with Comorbidities in the National Capital Region, Philippines during the COVID-19 Pandemic: A Mixed-Method Study.

Background and objective: The Philippine Inter-Agency Task Force for the Management of Emerging Infectious Diseases implemented health protocol guidelines to reduce the risk of COVID-19 transmission. Individuals with comorbidities were advised to take precautionary measures due to their increased vulnerability. This study aimed to assess the relationship between knowledge, acceptance, and adherence to health protocols among fully vaccinated individuals with comorbidities in the National Capital Region, Philippines.

Methods: The study employed an explanatory-sequential mixed-method design. The quantitative phase involved an online survey with 384 respondents. The survey included questions on socio-demographic profile, COVID-19 knowledge, acceptability of health protocols, and adherence to preventive practices. Chi-square Test of Independence and Pearson's Correlation Test were used to analyze the data. Semi-structured interviews were conducted with 11 participants, providing rich insights into their personal experiences. The interview transcripts were analyzed using Colaizzi's descriptive method with the aid of qualitative analysis software (MAXQDA), ensuring a rigorous approach to thematic analysis. The integration of the two phases was achieved by connecting quantitative results with qualitative insights, creating a comprehensive understanding of the phenomena under study.

Results: Findings showed that the relationship of socio-demographic characteristics and level of knowledge (Gender p<0.05; Employment status p<0.05), and level of acceptability to minimum health protocols and personal preventive practices varies depending on the respective health protocol practice. The level of knowledge about COVID-19 was positively correlated with knowledge of minimum health protocols (p<0.01). Similarly, knowledge and acceptability were dependent on adherence to most health protocols. The qualitative analysis identified seven themes: Unmasking a collective mystery, Knowledge is part of weaponry, Safeguards for security, Tethered by a boundary, Individual cloaks of safety, The thread in the tapestry, and Towards the end of one story that described the participants' experiences, leading to the formulation of a Swiss Cheese Model of Health Protocol Practices.

Conclusion: The study suggests that multiple factors contribute to non-adherence to health protocols. Recognizing these holes and weaknesses in the COVID-19 pandemic response stresses the need for national leaders to place urgency on properly implementing preventive measures and providing health education to the masses during public health situations. Collaboration from all sectors is crucial in addressing public health crises. This study can be a valuable resource for future researchers, local government units, and policymakers in prioritizing public health care and pandemic preparedness.