Table 4 Barriers and facilitators of adherence to COVID-19 protective measures in six Sudanese communities

i. Socioeconomic context

Youth seemingly more resilient/rebellious in the face of social pressures

Negative impact on business revenues and household income

Supportive community measures and normalisation of new/adapted behaviors

Poverty and the high cost of essential supplies

Shortages in necessities such as fuel and bread (long queues)

The stigma associated with COVID-19

Bullying and harassment of compliers

Denialism, rumors and misinformation about COVID-19 and the vaccine

ii. Cultural context

Cultural tendency to protect the vulnerable and the elderly

Preventive measures are seen as not compatible with Sudanese customs and habits

Cultural tendency to bypass or manipulate government restrictions

iv. Religious beliefs

Recommendations to comply from well-regarded religious experts/institutions

Conflicts with scripture or religious practices (e.g. physical distancing between worshippers during prayer in mosques is seen as unacceptable)

v. Visibility of the pandemic and pandemic response

Enforcement of restrictions/protective measures in public areas and transportation means and penalties for non-compliers

Regular bulletins and information about COVD-19 in media

The waning intensity of awareness-raising activities

Consistent and sustained risk communication activities (observed local languages and dialects and context-specific)

Mistrust in government information

Visibility of pandemic locally (confirmed cases and deaths)

vi. Feasibility

Provision of economic and in-kind support

Discomfort associated with mask-wearing

Fatigue due to the long duration of the pandemic

vii. Perceived importance of behaviours and measures

Belief in the effectiveness of prevention measures

Inconvenience caused by compliance with protective measures in communal areas, e.g., long waiting times

COVID-19 preventive behaviors and measures are also protective against other diseases

viii. Perceived health system accessibility/capacity

Concerns because of difficulty in accessing health services

Recognizing the need to protect the weak health system from being overwhelmed with COVID-19 cases