Abstract
BACKGROUND: Sierra Leone's health system has faced significant challenges, including the long-term impacts of the 2014 Ebola outbreak, prolonged conflicts before that, and economic factors contributing to the fragility of healthcare systems in many low-income settings. This qualitative study explores COVID-19 prevention practices among healthcare workers in the context of their past experiences with disease outbreaks. AIM: This study aims to understand COVID-19 prevention practices among healthcare workers in Sierra Leone and how their past experiences with disease outbreaks influence these practices. SETTING: The study was conducted in three districts of Sierra Leone - Freetown, Makeni and Kenema - focusing on healthcare workers in a low-income setting with ongoing public health challenges. METHODS: In-depth interviews were conducted with 24 healthcare workers, and the data were analysed for themes using the Health Belief Model and Theory of Planned Behaviour. RESULTS: Healthcare workers demonstrated positive attitudes and strict adherence to infection prevention measures, influenced by their Ebola outbreak experience. Barriers included limited personal protective equipment and social disapproval. CONCLUSION: Interventions should focus on improving access to infection prevention tools and combating disapproval through community engagement. These findings are crucial for enhancing infectious disease prevention among healthcare workers in low-income settings. CONTRIBUTION: This study provides insights into how past outbreak experiences influence disease prevention practices among healthcare workers in Sierra Leone, highlighting the need to address adherence barriers. These findings contribute to a broader understanding of infectious disease prevention in low-income settings and enhance global efforts in preparing for future public health emergencies.