Hidden Problem of COVID-19: Behavioral Surveillance and Its Preventive Measures Among Rural Adult Population in Tamil Nadu, India

Background COVID-19-appropriate behavior has been recommended by the Government of India to reduce the spread of the disease. However, a lack of awareness, inadequate knowledge, or improper practices regarding personal protective measures have contributed to the ongoing cases in India. Therefore, this study aimed to assess the pattern of behavioral surveillance related to COVID-19 and its preventive measures and also to study the impact of knowledge of COVID-19 on their behavior among the rural population in Tamil Nadu, India. Methods A descriptive cross-sectional study was conducted among the rural adult population in Siruvachur Village, Perambalur district, Tamil Nadu, from June to December 2022. The study included adult participants aged 18 years and older who had no previous history of COVID-19 disease. The participants were selected using a systematic random sampling method. A pre-designed and semi-structured questionnaire was used to assess their awareness of COVID-19, knowledge of symptoms, preventive measures, and actual behavioral practices. The collected data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. The chi-square test and linear regression were employed to assess the association and strength between behavior and knowledge of COVID-19 preventive measures. A p-value of less than 0.05 was considered statistically significant. Results According to the results, 94.7% of the participants reported being aware of COVID-19, with fever being recognized as the most common symptom. Regarding specific preventive measures, 71.5% of participants demonstrated adequate knowledge of handwashing, while only 55.3% had sufficient knowledge of social distancing norms. In terms of mask usage, 62% reported having adequate knowledge of how to use masks to prevent COVID-19 transmission. However, despite having adequate knowledge, the study found that only 11.3% of participants consistently used masks in outdoor settings. This indicates a significant gap between knowledge and actual behavior in mask usage. Furthermore, a significant association was found between knowledge and behavioral practices related to COVID-19 preventive measures, such as mask usage and social distancing. In other words, participants who possessed greater knowledge of these measures were more likely to exhibit corresponding behaviors. On the other hand, the study did not find a significant impact of handwashing knowledge on actual handwashing behavior (p>0.05). Conclusion Despite a relatively high level of knowledge and awareness, there is a significant gap between knowledge and actual behavioral practices, particularly in terms of mask usage and hand hygiene. These findings highlight the need for targeted interventions to bridge the gap between knowledge and behavior in COVID-19 preventive measures, particularly in terms of consistent mask usage and adherence to social distancing norms. Efforts should focus not only on increasing knowledge but also on promoting behavior change through effective education, awareness campaigns, and practical demonstrations of proper preventive measures.