According to Khosravi (2020), primary emotional concerns and public confidence are crucial factors that mitigate perceived threats and decrease perceived barriers associated with a pandemic, thereby enhancing public acceptance of protective measures¹³. Therefore, specialists can develop and use behavior models to decrease perceived barriers as an effective response to a pandemic, and in the face of new threats.

The present study found that half of the study participants had a high level of perceived barriers to the prevention of COVID-19. These study participants had a moderate level of total perceived threats regarding COVID-19. The study findings also demonstrate that the most common source of threat was emotional concern toward their families. These findings are in agreement with those reported earlier by at least four other studies. In a study on the effect of HBM-based education on nursing student’s health beliefs and knowledge about COVID-19, Elgzar et al. (2020) reported that the mean scores for perceived barrier in the intervention and control groups were 11.37±2.03 and 11.21±2.22, respectively, on a 15-point scale before intervention. Therefore, the participants were considered to have moderate perceived barriers to COVID-19, which were significantly decreased after the intervention. The study emphasized the importance of knowledge in decreasing perceived barriers among the students. It is worth mentioning that the Elgzar et al. (2020) study was conducted in Najran University, the same setting as that of the present study.¹⁴ This could be one of the possible justifications for the consistency in the results of the two studies. In a cross-sectional study conducted to evaluate COVID-19-associated risk perception among Iranian medical students, Taghrir et al. (2020) reported moderate risk perception scores among the study participants.¹⁵ Geana (2020) conducted a cross-sectional study on the risk perception related to COVID-19 among Kansans during the pandemic. In that study, the majority of Kansans had moderate total risk of contracting COVID-19. It was further revealed that people’s risk perception associated with any infection was dependent on the severity of the outbreak in their communities.¹⁶ In a research on the application of HBM for the identification of COVID-19 risk perception, Costa (2020) reported a moderate level of total perceived susceptibility, and moderate-to-high levels of perceived barrier scores among the study participants. The efficiency of HBM in assessing COVID-19 determinants was further emphasized.¹⁷ In contrast, Bashirian et al. (2020) applied the protection motivation theory to investigate factors associated with COVID-19 preventive behaviors among Iranian hospital staff and found a high threat among the participants, with paramedical staff having the highest threat score.¹⁸ The differences between the results of the present study and those of the Bashirian et al. (2020) study may be attributed to differences in the study settings. The study by Bashirian et al. (2020) was conducted at a hospital wherein the infection risk was expected to be very high. Thus, the threat was also high. In contrast, the present study was conducted in a university setting where the participants had no direct contact with COVID-19 patients. The present study results indicated a significant relationship between students’ perceived barriers and perceived threats to their family income. Low-income students had higher perceptions of barriers and threats toward COVID-19. These findings seem logical because low-income students could not afford to buy protective equipment, unlike high-income students. Consequently, they may find themselves at a higher risk of contracting COVID-19. In addition, they may feel insecure among their families because they cannot stay at home during health quarantine because they are low-income earners.

The results of this study indicate significant relationships among the total perceived threats, barriers, and age. An in-depth analysis of the relationship between perceived threats and age revealed that older students had higher perceived threats and perceived barriers than their younger counterparts. This may be attributed to the fact that older students, who more mature, can effectively evaluate the severity of the COVID-19 situation. De Zwart et al. (2009)¹⁹ obtained a similar result in a study on perceived threats, risk, and efficacy with regard to SARS. They reported a significant relationship between perceived threats and age: perceived threat levels increased as age increased.

The findings of Yildirim et al. (2020)²⁰ and de Zwart et al. (2009)¹⁹ show variance with the results obtained in the present study. They found that females had higher perceived threats and fear of COVID-19 than males. The difference between the findings of the current study and those of previous studies may be attributed to differences in the culture and age of the study populations. The study by Yildirim et al. was conducted among Turkish adults with a mean age of 30.33 years, while the current research was carried out among Saudi university student participants with a mean age of 20.27 years.

Another significant relationship was found between college type and perceived barriers and perceived threats. Surprisingly, non-health science college students had higher levels of perceived threats and perceived barriers than health sciences college students. The hospital training provided to students in health science colleges such as medicine, nursing, dentistry, and applied medical sciences may place them at risk for COVID-19. Usually, these college students receive more training on preventive and protective measures against infectious diseases than other college students. In addition, they attended infection control courses before starting the hospital training. Thus, they may have more self-confidence in COVID-19 control because of their medical background. Lack of knowledge about infection control and self-protection may be a major barrier for non-health science college students. There are no published studies on the relationship between perceived threats and college type.

A significant association was observed between perceived barriers and residence location, wherein 69.7% of the rural residents had high levels of perceived barriers. This result may be attributed to the lack of health facilities in rural areas, when compared to urban and suburban areas. Furthermore, rural dwellers may lack health orientation programs about preventive and protective practices for COVID-19. An association was found between sex and perceived barriers, with male students having higher levels of perceived barriers than female students. In Saudi culture, males have more freedom of movement than females. They can visit different recreational places with their peers. Consequently, they may find it more difficult to maintain social distancing than female students who usually spend most of their time at home.

To the best of our knowledge, this is the first study on the relationship between perceived barriers, perceived threats, and participants’ demographic variables during the COVID-19 pandemic. The findings of the present study provide valuable information for decision-makers about factors that may affect a population’s perceived barriers and perceived threats during the COVID-19 pandemic.