Beyond COVID-19: Behavioral Drivers of Pandemic Prevention in Ghana's Informal Urban Settlements

The COVID-19 pandemic highlighted significant disparities in the uptake of precautionary health behaviors, particularly in informal settlements in sub-Saharan Africa (SSA), where access to essential infrastructure and socio-economic opportunities are limited. This study applied the information-motivation-behavioral (IMB) skills model of pandemic risk and prevention to explore the pathways through which COVID-19 information, personal and social motivation, and behavioral skills influenced the uptake of prevention behaviors in three informal settlements in Ghana. A survey of 496 participants was conducted and analyzed using structural equation modeling (SEM). Findings reveal a significant knowledge gap, with only 30.6% of participants answering all COVID-19 information questions accurately. Both personal (β = 0.209, p = 0.005) and social motivation (β = 0.178, p = 0.018) exhibited a direct significant relationship with preventive behaviors. While no direct effect was found between information and prevention behavior, behavioral skills fully mediated this relationship. Though focused on COVID-19, the findings have broader implications for strengthening pandemic/epidemic preparedness in informal settlements. Policy interventions should prioritize tailored health risk communication, motivation enhancement, and practical skills-building to empower vulnerable populations not just for current needs but to effectively respond to future health crises.