Socio-cultural challenges in the implementation of COVID-19 public health measures: Results from a qualitative study in Punjab, Pakistan

Background: : Informed public health measures are crucial to curb the COVID-19 pandemic. The socio-cultural context is important to understand the success or failure of implementing public health measures. This study explores the social and behavioral response to COVID-19 and unveils challenges in the implementation of related public health measures in Pakistan. Methods: Within this qualitative study, we conducted 34 telephonic/online in-depth interviews with youths, adults, old-age people, and healthcare professionals in the Punjab province of Pakistan. Framework analysis was used for data analysis. Results: People’s poor understanding about COVID-19 and the need for preventive measures were the major challenge in implementation of public health preventive strategies. Study participants reported that the lockdown strategy increased poverty and unemployment. People’s poor living conditions and living environment compelled them to not follow social distancing and restricting themselves to homes. Additionally, an underdeveloped healthcare system was one of the major challenges for Pakistan. False and misleading information about the disease had significant consequences for the COVID control program. In Pakistan, the culture of denial related to the epidemiology of COVID-19 were important challenges within the implementation of public health preventive measures. Conclusions: It is extremely important that public health experts and social scientists work together to understand the contextual socio-cultural factors which shape behaviors associated with the spread of a pandemic. This knowledge is needed in order to design and implement preventive strategies that could effectively work in the local context.