Background: Health awareness videos are integral in disseminating knowledge about
respiratory infectious diseases (RIDs), elevating health-risk perceptions, and enhancing
attitudes towards precautionary measures, as per the Health Belief Model (HBM) and
Cognitive Dissonance Theory (CDT).

Aim: The aim of this study is to produce and evaluate an evidence-based health awareness
video on precautionary measures against RID among public transportation drivers in
Lebanon.

Methods: This project will be conducted over three stages and executed over two fiscal
years (start date March 2026).

Stage one: Drafting the script of the video is inspired by seven published / unpublished
evidence-based studies on public transportation drivers in Lebanon and fourteen studies
from international literature. This ensures the video content is evidence-based,
culturally oriented, socially acceptable and tailored towards the target viewers.

Stage two: Using a Delphi technique, the script will be revised by a panel of eight
experts in public health, infection control, psychology, filmmaking, and public
transportation using two validated assessment tools, the Patient Education Materials
Assessment Tool (PEMAT) and DISCERN. A purposive sampling method will be followed. Once
consensus is reached, the video will be produced.

Stage three: Non-blinded, randomized, two-arm controlled trial will be conducted by a
group of senior nursing students (minimal risk study). Public transportation drivers are
eligible to enroll if they operate within the Lebanese public transportation system,
regardless of their gender. A proportionate sample of drivers will be invited to enroll
from various Lebanese regions. Simple randomization technique will be performed. The
experimental group (n=80) will watch the health-awareness video, whereas the control
group (n=80) will watch a neutral video on traffic signs. Participants' knowledge about
RID, health-risk perceptions, attitude towards vaccination, and cognitive dissonance will
be evaluated. The trial study will be conducted in community settings where public
transportation drivers are naturally present (transportation stations, parking lots). A
written informed consent will be sought. Data will be electronically recorded. Data will
remain anonymous during data entry/analyses. An incentive will be provided.

Data analysis: Data will be analyzed using SPSS; IBM (version 30). Knowledge statements
will be scored and converted to percentage mean score. Risk perceptions, attitude and
dissonance will be scored and converted to mean scores. Between group analyses of mean
differences will be tested using student t-test and one way analysis of variance (ANOVA)
with post hoc analysis (for normally distributed data) and Kruskall Wallis test with post
hoc analysis (for skewed data). Forward stepwise linear regression analyses will be
executed. Statistical significance will be at P<0.05 (two sided). Interim analysis will
be performed at n=40.

Expected outcomes: Public transportation drivers and users might be unknowingly exposed
to RID, so promoting their safety is a priority. When public transportation drivers are
exposed to a video on RID, they will gain knowledge about it and demonstrate a positive
attitude towards precautionary measures. This video contributes to higher service
satisfaction and subsequently higher utilization of the transportation system. Utilizing
the public transportation systems reduces street congestions, controls pollution, saves
money for users and generates profits for stakeholders. Promoting a safe public
transportation system reflects positively on public health, aligns with the CDC mission
to control the global spread of diseases and lessens disease burden. Last but not least,
health awareness videos are cost effective and they can reach a wider audience.

Ethical considerations: This study will not pose any risk or harm to participants. The
video will not contain any material that might offend, insult, degrade, or discriminate
against study participants in any way possible. Medical jargon and complex terms will be
avoided. The video will be concluded with contact information in case participants
decided to consult with experts in the future. Data collectors will be trained on how to
remedy their concerns through cognitive behavioral therapy techniques to resolve negative
thoughts, guide them on sources of knowledge and places to obtain facemasks, hand
sanitizers and vaccines. Last but not least, participants will not be asked for any ID.
The decision to participate or not will have no impact on drivers.