The determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon

Lebanon battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated.Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper explores adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask and avoiding social gatherings). The findings suggest that no individual-level characteristics were robustly associated with mask wearing. For avoiding social gatherings, education was inversely associated with adherence to this preventive measure. Avoiding social gatherings was also significantly lower for residents of informal tented settlements. For both preventive practices, of those who initially adhered, those in informal tented settlements were also significantly less likely to maintain adherence.The material, physical, administrative and socio-economic constraints of life in an informal tented settlement suggest that avoiding social gatherings is hardly feasible. Yet despite the challenging conditions, the indication to wear a mask is initially complied with, suggesting that tailoring policies to the limits and constrains of context can lead to successful outcomes even in very adverse settings.