Knowledge, Attitudes, and Practices Towards COVID-19 Among Ecuadorians During the Outbreak: An Online Cross-Sectional Survey

Knowledge and preventive practices regarding COVID-19 disease among Ukrainian refugees in Poland

Russia's invasion of Ukraine contributed one of the largest migration movements in the 21st century. Refugees may become a source of severe acute respiratory syndrome coronavirus 2 infections for the residents of host countries. The study aim was to assess knowledge and preventive practices regarding coronavirus disease 2019 (COVID-19) among Ukrainian refugees in Poland. The cross-sectional study was conducted between March and April 2022 among Ukrainian refugees registering consecutively in Zielona Góra, Poland. Knowledge and preventive practices were assessed by giving 1 point for each correct answer by anonymous, self-administered questionnaire. The response rate was 96%, 190 participated (mean age 37.8 ± 15.5 years; 57.9% females); 61.6% self-reported their socio-economic status (SES) as high, 38.9% reported high level of education. The mean COVID-19 knowledge score was 3.06 ± 1.95; 19.5% scored >50%. The knowledge level was higher among migrants with high SES (P = .003). The mean preventive practices score was 2.56 ± 1.38; 54.0% scored ≥ 60%. 40.5% declared social distancing, 62.6% followed coughing etiquette, 69.0% home isolate themselves during COVID-19. 57.9% always used masks in public space, however 74.2% wore masks with uncovered nose. Refugees with higher education, high SES and knowledge level had significantly greater preventive practices scores (P = .002; P = .02; P = .03, respectively). The knowledge and preventive practices level was insufficient. Educational campaigns oriented to raising knowledge and prevention behavior skills should be implemented, especially targeting high-risk groups to avoid spread of COVID-19.

Knowledge, attitudes, and practices toward COVID-19 and its prevention among medical and dental students in an educational institution in Telangana

BACKGROUND

Coronavirus disease 2019 (COVID-19) emerged as a global pandemic, threatening millions of lives worldwide. Everyone was overwhelmed by the plethora of information from different sources, creating confusion, misconceptions, and panic in the community.

AIMS

This study aimed to estimate the knowledge, attitudes, and practices (KAP) among medical and dental students toward COVID-19 and to identify factors influencing them.

MATERIALS AND METHODS

A cross-sectional study was conducted among undergraduate students enrolled in MBBS and BDS courses, and KAP scores were calculated using a self-administered questionnaire. The statistical analysis was done by unpaired t test and one-way analysis of variance.

RESULTS

MBBS students had higher KAP scores when compared with BDS students. Knowledge gaps were discovered in the areas of COVID-19 transmission through blood, World Health Organization (WHO)-designated variants of concern, disinfectant usage, and mandatory vaccination. A majority (91.33%) of the students had a positive attitude toward COVID-19. Better knowledge and practice scores were significantly associated with vaccinated students and those who trusted government website resources.

CONCLUSION

Curriculum modifications and creative teaching strategies can fill the lacunae in the KAP scores. Medical and dental students, as torchbearers of the healthcare fraternity, can play a critical role in raising awareness during public health emergencies.

Conocimientos sobre COVID-19 en población general adulta tras dos años de pandemia

OBJETIVO

identificar el nivel de conocimientos sobre la COVID-19 que tiene la población adulta residente en Gijón (España) después de dos años de pandemia.

MÉTODOS

se realizó un estudio descriptivo transversal entre marzo del 2021 y marzo del 2022. Los datos se obtuvieron mediante un cuestionario telefónico sobre una muestra estratificada de tres zonas básicas de salud de Gijón, España (Calzada, Zarracina y Parque-Somió). El tamaño muestral se compuso de 305 personas. Se empleó el análisis ji-cuadrado para estudiar la relación entre variables categóricas y ANOVA para comparar las medias de la puntuación total por zona básica. Se realizaron regresiones logísticas para calcular las odds ratio entre la variable dependiente (poseer conocimientos avanzados) y las independientes (variables sociodemográficas). Se construyó un modelo predictivo entre la existencia o no de conocimiento avanzado y las variables independientes mediante regresión logística.

RESULTADOS

se encontraron diferencias en la puntuación media del nivel de conocimientos entre Parque-Somió y Calzada (p = 0.000) y Parque-Somió y Zarracina (p = 0.045), obteniendo mayor puntuación media la de Parque-Somió. Se observó una asociación entre el nivel de conocimientos y las variables medio de información utilizado (p = 0.018), edad (p = 0.036), zona básica de salud (p = 0.000), nivel educativo (p = 0.000) e historia previa de contacto estrecho (p = 0.004).

CONCLUSIONES

el nivel de conocimientos avanzado se presenta sobre todo en las zonas básicas de salud con mayor nivel socioeconómico, población con nivel educativo alto, de 25 a 45 años, que se ha informado por su entorno y con historia previa de seguimiento por ser contacto estrecho.

Knowledge, attitude and perception towards COVID-19 among representative educated sub-Saharan Africans: A cross-sectional study during the exponential phase of the pandemic

Coronavirus disease 2019 (COVID-19) pandemic, caused by the Severe Acute Coronavirus 2 (SARS-CoV-2), is a global health threat with extensive misinformation and conspiracy theories. Therefore, this study investigated the knowledge, attitude and perception of sub-Saharan Africans (SSA) on COVID-19 during the exponential phase of the pandemic. In this cross-sectional survey, self-administered web-based questionnaires were distributed through several online platforms. A total of 1046 respondents from 35 SSA countries completed the survey. The median age was 33 years (18-76 years) and about half (50.5%) of them were males. More than 40% across all socio-demographic categories except the Central African region (21.2%), vocational/secondary education (28.6%), student/unemployed (35.5%), had high COVID-19 knowledge score. Socio-demographic factors and access to information were associated with COVID-19 knowledge. Bivariate analysis revealed that independent variables, including the region of origin, age, gender, education and occupation, were significantly (p < 0.05) associated with COVID-19 knowledge. Multivariate analysis showed that residing in East (odds ratio [OR]: 7.9, 95% confidence interval (CI): 4.7-14, p<0.001), Southern (OR: 3.7, 95% CI: 2.1-6.5, p<0.001) and West (OR: 3.9, 95% CI: 2.9-5.2, p<0.001) Africa was associated with high COVID-19 knowledge level. Apart from East Africa (54.7%), willingness for vaccine acceptance across the other SSA regions was <40%. About 52%, across all socio-demographic categories, were undecided. Knowledge level, region of origin, age, gender, marital status and religion were significantly (p < 0.05) associated with COVID-19 vaccine acceptance. About 67.4% were worried about contracting SARS-CoV-2, while 65.9% indicated they would consult a health professional if exposed. More than one-third of the respondents reported that their governments had taken prompt measures to tackle the pandemic. Despite high COVID-19 knowledge in our study population, most participants were still undecided regarding vaccination, which is critical in eliminating the pandemic. Therefore, extensive, accurate, dynamic and timely education in this aspect is of ultimate priority.

Compliance with measures among actors and lessons learnt in the management of COVID-19 institutional quarantine in Uganda

Introduction

To support COVID-19 containment measures, several countries implemented quarantine protocols. This study determined the level of compliance to COVID-19 quarantine measures, associated factors, and lessons learnt in institutional quarantine management in Uganda.

Methods

This concurrent mixed methods study involved a cross-sectional survey among individuals who were in institutional quarantine and interviews with key informants, who were reached mostly through phone calls. Univariate, bivariate, and multivariable analysis were conducted to analyse quantitative data while qualitative data were analysed thematically with the aid of Atlas ti 7.

Results

Compliance with quarantine measures at the individual level was moderate at 65.4 %. Factors associated with high compliance with measures were: older age (above 40 years) [APR = 1.30 (95 % CI: 1.04-1.63)], spending 14-15 days in quarantine [APR = 1.39 (95 % CI: 1.00-1.92)] and reporting a high Ministry of Health compliance [APR = 1.33 (CI: 1.11-1.58)]. The positive factors included the availability of guidelines, inspection of facilities and training of personnel. The challenges were related to long turnaround time for results and provision of personal protective equipment (PPE).

Conclusion

Efforts to improve training, supervision and inspection of facilities, and provision of adequate PPE would improve compliance with quarantine measures.

The Level of Knowledge, Attitudes, and Practices in a Caribbean Colombian Population That Recovered from COVID-19 during the Pandemic

This study aimed to assess the knowledge, attitudes, and behaviors related to COVID-19 among Colombians. A cross-sectional descriptive study was carried out during the pandemic between November 2020 and May 2021 using a survey that focused on knowledge, attitudes, and practices regarding COVID-19. The online survey was completed by 1424 participants who had a history of COVID-19 illness, and the study spanned 3 months. Many respondents were male students who demonstrated adequate knowledge of COVID-19 symptoms and prevention measures, although their understanding of its transmission routes was limited. Nevertheless, 65.9% expressed optimism that COVID-19 would ultimately be successfully controlled, and 71.8% had confidence in the Colombian government's handling of the crisis. Additionally, more than half of the participants admitted to visiting crowded places, and this practice was more common among those who were less informed about COVID-19. However, many respondents reported using face masks in public. This highlights a significant gap between theoretical knowledge and actual practices that need to be addressed. To bridge this gap, establishing an interdisciplinary support network is crucial, as is launching mass education campaigns targeting specific population groups, and compiling reports on successful practices implemented during the pandemic. These efforts are essential for enhancing the overall level of knowledge, and the attitudes and practices related to COVID-19, and also for preparing for future health emergencies.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic

BACKGROUND

Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures.

METHODS

We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect.

RESULTS

Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries.

CONCLUSION

The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.

Public Anxiety, Attitudes, and Practices towards COVID-19 Infection in the Eastern Province of Saudi Arabia: A Cross-Sectional Study

Coronavirus disease 2019, or COVID-19, still has a terrifying potential due to its continuous genetic variation. Although vaccines have been created, adherence to preventive measures remains a privileged choice to tackle the pandemic. This study aims to investigate the anxiety, attitudes, and practices (KAPs) towards COVID-19 infection in the Eastern Province of Saudi Arabia. In this cross-sectional study, data were collected from 400 participants via an online self-structured questionnaire. Anxiety, attitude, and practice scores were calculated by summing the points of the statements under the corresponding domain multiplied by 100 over 12, 21, or 15, respectively. Chi-square and one-way analysis of variance were used to investigate the relationships between vaccination, anxiety, attitude, practice scores, and demographic characteristics. More than half of the participants were female (58.5%; mean age of 29.5 years; the majority in the age groups of <20 years and 21-30 years). Only 21.5% of the participants were suffering from or previously had chronic diseases. Notably, 22.3% of the male participants were vaccinated (p = 0.000). The old age groups (41-50 years and >50 years) were more vaccinated (16.3% and 24.1%, respectively, p = 0.000), as well as the unemployed (36.4%; p = 0.000). The mean scores of anxiety, attitude, and practice were 66.8, 72.3, and 85.2, respectively. Females had an anxiety score of 68.5% (p = 0.008) and a higher attitude score of 68.5% (p = 0.008). Infected male participants had a lower practice score of 80% (p = 0.038), while females recorded higher practice scores (85.7 ± 11.6). The results highlight the importance of reliable communication from health representatives and legislators in educating the public and promoting their knowledge about non-therapeutic interventions. Efficient intervention approaches are required to fill the gap during the implementation of non-therapeutic measures. Also, it is recommended that awareness programs, during COVID-19 or any other similar pandemics, should be tailored to target Eastern Province inhabitants, especially males.

The General Public Knowledge, Attitude, and Practices Regarding COVID-19 During the Lockdown in Asian Developing Countries

The recent outbreak of coronavirus disease (COVID-19) is the worst global crisis. Since no successful treatment and vaccine have been reported, efforts to improve the public's knowledge, attitudes, and practices are critical to reducing the spread of COVID-19. This study aims to investigate the general public knowledge, attitude, and practices regarding COVID-19. A cross-sectional online survey was conducted in three developing countries (China, India, and Pakistan). The reason for choosing only three countries is to identify the cross-border effect statistically and data collection constraints. The IBM SPSS version 23.0 was used for descriptive, univariate, and multivariate analysis of the study. One thousand one hundred and sixty participants completed the study, one-quarter of them were female, and three-quarters were male. The study's findings evidenced that the knowledge and attitude correlation was 58.4% and between knowledge and practices 18.2%. Furthermore, the knowledge was found lower in females, among India and Pakistan, and people aged less and equivalent to 30 years. The attitudes among respondents were found poorer among unmarried females and India and Pakistan residents. While the practices found lower among employed, unemployed and, respondents had a bachelor's degree, and females reside in India. And future studies should focus on factors that influence the government regarding the imposition of lockdown, boost the economy in the pandemic, and motivate the general public to follow the health institution's instructions.

Knowledge, attitudes, and practices towards COVID-19 among the population of the state of São Paulo, Brazil

BACKGROUND

The population's adherence to COVID-19 preventive measures is influenced by their knowledge, attitudes, and practices (KAP) towards the disease, making research into people's awareness of the disease essential. The present survey was designed to assess KAP towards COVID-19 among the population of the state of São Paulo, Brazil.

METHODS

An online questionnaire was disseminated via social media between September 14 and October 5, 2020. The intended population was Brazilians over the age of 18, living in the state of São Paulo.

RESULTS

A total of 1,111 individuals completed the questionnaire. The majority were women (71.6%), 31.6% were aged 31-40 years old, and 82.8% had higher education. Among the participants, 17.5% reported that they had taken some medication without a medical prescription to prevent COVID-19. The participants showed good knowledge about the transmission and prevention of the disease. The knowledge mean score was lower among participants with complete high school or less, with poor self-perception of their health status, who almost never seek information about COVID-19, and those who are not sure to belong to a risk group for the disease. Only 51.3% of the participants believed that COVID-19 would finally be successfully controlled, and 56.6% were confident that Brazil could win the battle against the virus.

CONCLUSIONS

Participants demonstrated good knowledge of COVID-19 but were pessimistic about the pandemic's future. The findings of this study can help in the development of effective health communication strategies to promote better knowledge and a positive attitude about prevention measures.

Perceived barriers and facilitators for adhering to COVID-19 preventive measures in Chile: a qualitative study in three large cities

BACKGROUND

Globally, it has been reported that different social determinants of health -structural, sociodemographic, economic, living conditions and cultural factors- may affect opportunities to adhere to prevention measures against SARS-CoV-2. The objective of this study was to explore the perceptions around barriers and facilitators for adherence to COVID-19 prevention measures among the adult population residing in three large cities in Chile from a social determinants of health perspective.

METHODS

Qualitative paradigm, multiple case-study design. Online semi-structured interviews were conducted with men and women aged 18 and over from different socioeconomic groups residing in three large cities. For participant recruitment and selection, purposive contacts were made based on community and social media networks, followed by snowball sampling. Saturation was reached at 61 participants, after which a thematic analysis was carried out with the support of AtlasTi software. The Ethics Committee of the Universidad del Desarrollo in Chile approved this study.

RESULTS

The main perceived barriers to adherence to COVID-19 preventive measures are linked to structural social determinants of health such as income, occupation, gender, access to basic supplies, and housing. Perceived facilitators are the fear of contagion and the incorporation of measures into daily habits. The social communication of preventive measures by health authorities is perceived as punitive, affecting adherence once the fear of contagion decreased in the country. It is also perceived that the recommended preventive measures are disconnected from communities' cultural practices and people´s identity, as well as affected by gender inequities and socioeconomic conditions that stakeholders in the country do not sufficiently address.

CONCLUSION

Study findings suggest that adherence to preventive measures, such as social distancing, mask use, and hand washing, could be promoted through their incorporation into the daily life habits of people and communities. These measures should consider the structural social determinants that generate multiple barriers to adherence, like poverty, occupational risks, and overcrowding. Socio-cultural dimensions of health and everyday risks need further understanding among the different communities in the country, allowing for differences in viewpoints and practices based on gender, age, place, and social identity.

Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence

BACKGROUND

The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.

METHODS

A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.

CONCLUSIONS

This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.

Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: A cross sectional study

OBJECTIVE

To examine the associations of sociodemographic, socioeconomic, and behavioral factors with depression, anxiety, and self-reported health status during the COVID-19 lockdown in Ecuador. We also assessed the differences in these associations between women and men.

DESIGN, SETTING, AND PARTICIPANTS

We conducted a cross-sectional survey between July to October 2020 to adults who were living in Ecuador between March to October 2020. All data were collected through an online survey. We ran descriptive and bivariate analyses and fitted sex-stratified multivariate logistic regression models to assess the association between explanatory variables and self-reported health status.

RESULTS

1801 women and 1123 men completed the survey. Their median (IQR) age was 34 (27-44) years, most participants had a university education (84%) and a full-time public or private job (63%); 16% of participants had poor health self-perception. Poor self-perceived health was associated with being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status. For women, self-employment, having solely public healthcare system access, perceiving housing conditions as inadequate, having cohabitants requiring care, having very high difficulties to cope with household chores, having COVID-19, and having a chronic disease increased the likelihood of having poor self-reported health status. For men, poor or inadequate housing, presence of any chronic disease, and depression increased the likelihood of having poor self-reported health status.

CONCLUSION

Being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status in Ecuadorian population.

Sex-related disparities in students' disaster responses in the post-COVID-19 era

This study aimed to understand whether sex-related variations existed in responses to the pandemic as well as campus climate change of anti-epidemic measures. An online survey was distributed to full-time undergraduates in 13 postsecondary institutions located in an eastern province in China. First, we matched "similar" students in terms of a set of observational variables. Second, we compared female students with these "similar" male peers in terms of their responses to COVID-19 and responses to the campus climate change of anti-epidemic measures. Finally, the robustness of matching estimators was checked for the potential biases that might be caused by unobserved variables. The primary results showed that female students had higher awareness, preparedness, and fear, but lesser knowledge of the pandemic, and considered getting vaccinated of lesser necessity compared with male students. Also, we observed a pronounced pattern of sex-related difference in responding to campus climate changes; male students were more likely to be indifferent in keeping social distance, adopting other measures, and participating in campus activities. The findings inform postsecondary administrators and other related stakeholders to avoid making the existing sex-related disparities larger and help every student well prepare for and appropriately respond to COVID-19.

How local outbreak of COVID-19 affect the risk of internet public opinion: A Chinese social media case study

Motivated by the realistic demand of controlling the Internet public opinion risk caused by the local outbreak of COVID-19, this paper creatively proposes a COVID-19 local outbreak Internet public opinion risk grading research framework. The SMAA-FAHPSort II method combining Analytic Hierarchy Process Sort II (AHPSort II) method with Stochastic Multicriteria Acceptability Analysis (SMAA-2) method is introduced into this framework, to evaluate the Internet public opinion risk level of social media during the local outbreak of COVID-19. In addition, this framework is applied to a case of Internet public opinion risk evaluation on Microblog platform of China. According to the number of new cases per day in mainland China, this paper divides the period from May 7, 2020 to September 3, 2021 into seven stages. A total of more than 10,000 Microblog hot topics were collected, after screening and preprocessing, 5422 related topics are remained to help complete the Internet public opinion risk evaluation. The case study analysis results show that the number of days classified as moderate risk and above has reached more than 280. This proves that the local outbreak of COVID-19 will indeed increase the risk of Internet public opinion, and correlation analysis confirms that the level of public opinion risk is positively correlated with the severity of the epidemic in the real world. Furthermore, the effectiveness and advantages of the proposed method are verified by comparative analysis and sensitivity analysis. Finally, some effective public opinion management suggestions have been put forward. This paper can provide reference for the government to formulate or improve relevant strategies, and also has great significance for reducing the risk of Internet public opinion in social media.

COVID-19 Vaccine Hesitancy in Three Latin American Countries: Reasons Given for Not Becoming Vaccinated in Colombia, Ecuador, and Venezuela

Although vaccines have been developed to prevent COVID-19, vaccine hesitancy is a significant barrier for vaccination programs. Most research on COVID-19 vaccine hesitancy has blamed misinformation and misstated concerns about effectiveness, safety, and side effects of these vaccines. The preponderance of these studies has been performed in the Global North. Although Latin American has been substantially and negatively impacted by COVID-19, few studies have examined COVID-19 vaccine hesitancy there. We explored reasons volunteered for COVID-19 vaccine hesitancy from a sample of 1,173 Colombians, Ecuadorians, and Venezuelans. Overall, COVID-19 vaccine hesitancy in these three countries is higher than desirable, but most people who are COVID-19 vaccine hesitant offered one reason or fewer. The reasons offered are diverse, including myths and exaggerations, but also individual-level contraindications for vaccination and structural barriers. Because of the diversity of reasons, single-issue mass campaigns are unlikely to bring about large shifts in COVID-19 vaccine hesitancy in Colombia, Ecuador, and Venezuela. Our data suggest that interpersonal communication, particularly in Ecuador, and addressing structural concerns, particularly in Venezuela, are likely to have the greatest impact on vaccine uptake.

A Community-Based Participatory Research Approach to Developing and Testing Social and Behavioural Interventions to Reduce the Spread of SARS-CoV-2: A Protocol for the 'COPAR for COVID' Programme of Research with Five Interconnected Studies in the Hong Kong Context

BACKGROUND

While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public's motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5).

METHODS

We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake.

DISCUSSION

Theory-driven interventions will address each study's focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.

Case Fatality Rate of COVID-19 and its Relationship to Sociodemographic Characteristics in Ecuador, 2020

Objective: To analyze sociodemographic factors’ influence on COVID-19 case fatality rate (CFR) in Ecuador on a subnational level.

Methods: Publicly available register-based observational study. A retrospective cohort of COVID-19 infections between epidemiological weeks 8–53 in the Ecuadorian public healthcare system was determined from available records. Statistical analyses were conducted to evaluate CFR trends according to factors such as sex, age, location, and healthcare provider.

Results: Overall CFR was 9.4%; by canton, median CFR was 5.2%, with some cantons with much higher rates, like Santa Elena (39.1%). Overall CFR decreased during the period, from 16.6% (week 8) to 2.63% (week 53). Being in a rural area was an independent protective factor. Patients over 65 had a hazard ratio of 11.38 (95% CI [11.05, 11.72]). Sex, ethnicity, and treatment from public facilities were also associated with death risk.

Conclusion: CFR is a proxy indicator of COVID-19 impact in Ecuador, and this location-based analysis provides new information on the disease’s specific impact subnationally. Overall COVID-19 CFR during the entire period was high, suggesting the need to improve COVID-19 care in Ecuador.

Transmission and Cleaning Misconception During the COVID-19 Pandemic Time in Riyadh, Saudi Arabia

OBJECTIVES

 This study aimed to investigate the knowledge and attitude of the public in Saudi Arabia toward the concept of surface decontamination during the COVID-19 pandemic.

METHODS

 A cross-sectional, web-based study was conducted over six months, from February 2021 to July 2021. We included adult Saudi and non-Saudi males and females living in Riyadh, Saudi Arabia.  Results: Six hundred and twenty-six responses from Saudi (92.7%) and non-Saudi (7.3%) participants with a median age of 24 years and interquartile range (IQR) of 21-29 years were received. Regarding knowledge level, 32.10% of the participants had good knowledge of respiratory virus transmission, and only 3.4% had good knowledge of decontamination products. Overall, 58.1% of the participants had a positive attitude toward decontamination products, and 28% had a negative attitude. Older participants, females, and participants who received their information from the Ministry of Health had higher odds of having a positive attitude toward disinfectant (OR = 1.022, 95% CI: 1.004 to 1.039, p = 0.013), (OR = 3.05, 95% CI: 2.08 to 4.47, p < 0.001), and (OR = 2.95, 95% CI: 1.44 to 6.05, p = 0.003), respectively.  Conclusion: The current evidence suggests that the knowledge in the general population of Saudi Arabia is low regarding the transmission of COVID-19 infection and disinfectant products. The prevalence of using decontamination products and attitude toward it is average. Continuous awareness campaigns are required to increase the public's awareness toward such products to change the population's attitude and practice, improve the prevention, and reduce the spread of the infection and its related misconception.

Work Engagement, Work Environment, and Psychological Distress during the COVID-19 Pandemic: A Cross-Sectional Study in Ecuador

Work environments can interfere with the mental health of workers as generators or reducers of psychological distress. Work engagement is a concept related to quality of life and efficiency at work. The aim of this study was to find the relationship between work environment factors and work engagement among the Ecuadorian general population during the first phase of the COVID-19 pandemic to assess their levels of psychological distress. For this purpose, a cross-sectional, descriptive study using a set of questionnaires was performed. Sociodemographic and work environment data, work engagement (UWES-9 scale) scores, and General Health Questionnaire (GHQ-12) scores were collected. The variables that predicted 70.2% of psychological distress during the first phase of the pandemic were being female, with a low level of vigour (work engagement dimension), being stressed at work, and low job satisfaction. The sample showed an intermediate level of engagement in both the global assessment and the three dimensions, being higher in those without psychological distress. With effective actions on work environment factors, mental health effects may be efficiently prevented, and work engagement may be benefited. Companies can reduce workers’ psychological distress by providing safe and effective means to prevent the risk of contagion; reducing the levels of work conflict, work stress, or workload; and supporting their employees with psychological measures in order to maintain ideal working conditions.

Non-Adherence to Preventive Behaviors and the Risk of COVID-19: A Comparative Study

Background: Transmission routes of COVID-19 have been well identified and documented. Considering the high prevalence of the Covid-19 and its impacts on the population, this study aimed to assess the status of preventive behaviors against coronavirus infection and estimate the odds of its transmission routes among people. Methods: A comparative study was conducted from March to April 2021. A total of 1256 participants were randomly selected, including 262 COVID-19 patients and 994 healthy people from 10 counties in Khuzestan, southwest Iran. A two-part questionnaire was used for data collection that included items on demographic and adherence to preventive behaviors. Statistical analysis was performed using the statistical software SPSS 18.0.0 applying logistic regression. Results: The mean age of participants was 37.60±11.48 years (female: 36.49±11.15 years; male: 38.86±11.74 years). The results showed that having contact with infected patient at home (OR = 4.90, 95%CI = 3.32-7.25), going to the hospital for not-necessary medical reasons (OR = 4.47, 95%CI = 3.05-6.55), leaving home for essential daily services (OR = 2.49, 95% CI = 1.63-3.81), and going to doctors' office (OR = 1.78, 95% CI = 1.20-2.63) could increase the odds of infection. Conclusion: The findings suggest that different factors are responsible for the increased spread of the Covid-19. Indeed, since the intervention for every single factor will have a small contribution to reducing the prevalence of the disease, it seems essential to design comprehensive interventions while emphasizing isolation and contacts tracing. The study provides evidence for multi-level and multi-faceted policy and interventions for promoting adherence to COVID-19 preventive behaviors.

Practice Level and Associated Factors Towards the Preventive Measures of COVID-19 Among the General Population; A Systematic Review and Meta-Analysis

Background

Studies conducted on the practice of COVID-19 preventive methods across the world are highly inconsistent and inconclusive. Hence, this study intended to estimate the pooled preventive practice and its determinants among the general population.

Methods

This study was conducted using online databases (PubMed, HINARI, Scopus, EMBASE, Science Direct, and Cochrane library database), African Journals online, Google Scholar, open gray and online repository accessed studies. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS). STATA 14.0 software for analysis. The existence of heterogeneity between studies was checked using Cochran Q test and I2 test statistics and then, the presence of publication bias was detected using both funnel plot and Egger's test.

Results

51 studies were included and the pooled level of practice toward the preventive measures of COVID-19 was 74.4% (95% CI: 70.2-78.6%, I2 = 99.7%, P < 0.001] using a random effects model. Being female [OR = 1.97: 95% CI 1.75, 2.23; I2 = 0.0%, P < 0.698], rural residence [OR = 0.53: 95% CI 0.44, 0.65; I2 = 73.5%, P < 0.013], attending higher education level [OR = 1.47: 95% CI 1.18, 1.83; I2 = 75.4%, P < 0.001], being employed [OR = 2.12: 95% CI 1.44, 3.12; I2 = 91.8%, P < 0.001], age < 30 [OR = 0.73: 95% CI 0.60, 0.89; I2 = 73.9%, P < 0.001], and knowledgeable [OR = 1.22: 95% CI 1.09, 1.36; I2 = 47.3%, P < 0.077] were the independent predictors of adequate practice level.

Conclusions

nearly three-fourths of the general population has an adequate preventive practice level toward COVID-19. Thus, the global, regional, national, and local governments need to establish policies and strategies to address the identified factors.

Knowledge about COVID-19 Best Practices in the North of Portugal and the Importance of Health Education in the Prevention of Pandemic Events

The rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made COVID-19 one of the biggest pandemics of all time, with several devastating public health challenges. In this study, we investigated the knowledge towards COVID-19 best practices in the north of Portugal. Methods: A descriptive cross-sectional study was performed with a convenience sample of the population of northern Portugal to assess their knowledge about COVID-19, SARS-CoV-2 and measures to prevent and mitigate pandemics. An online validated questionnaire was completed by 411 participants, from September to October 2020. Results: The overall correct knowledge was 81.3%, which indicates a good knowledge by the northern Portuguese respondents about COVID-19. The correct answer score differed considerably between men and women, being significantly higher among the latter (12.28 ± 1.22; p = 0.011). Moreover, the highest knowledge was observed in participants who attended high school or above (12.27 ± 1.21; p < 0.000). Conclusion: This study contributes to the analysis of COVID-19 knowledge by the northern Portuguese population, emphasizes the crucial role of health education in the control and mitigation of the COVID-19 pandemic, and provides field-based evidence to prevent the next pandemic event.

Online survey of university students' perception, awareness and adherence to COVID-19 prevention measures

BACKGROUND

Determining factors correlated with protective measures against COVID-19 is important to improve public health response. This study describes student opinions related to university COVID-19 preventive measures.

METHODS

In fall 2020, 643 US university students completed an online survey on perception, awareness, and adherence to COVID-19 preventive measures. Outcomes included protocol effectiveness (self or others), protocol adherence (self or others), consequences of protocol violation, knowledge of violations, and level of concern for COVID-19. Multiple linear regression models determined correlates of outcome variables. Covariates included gender, race, residence, area of study, class, and knowledge of someone with a positive COVID-19 test.

RESULTS

Overall, students agreed with protective measures (equivalent to higher scores). In adjusted linear models, females (versus males) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.005), and concern about COVID-19 (p < 0.001). Asian/Pacific Islander (versus white) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.008), and concern about COVID-19 (p = 0.001). Graduate students (versus freshman) had higher scores for protocol effectiveness (self) (p < 0.001), protocol adherence (self) (p = 0.004) and concern about COVID-19 (p < 0.001). In contrast, participants who had a positive COVID-19 test had significantly lower scores for protocol effectiveness (self) (p = 0.02), protocol adherence (self) (p = 0.004), and consequences of protocol violation (p = 0.008).

CONCLUSION

Overall, females, Asian/Pacific Islanders, and graduate students were more likely to agree with or adhere to COVID-19 prevention guidelines but those who tested positive for COVID-19 were less likely to do so. These results may inform future prevention efforts.

A Cross-Sectional Study of Knowledge, Attitudes, and Practices concerning COVID-19 Outbreaks in the General Population in Malang District, Indonesia

Lack of knowledge often leads to nonchalant attitudes and improper practices that expose people to greater risks during a pandemic. Therefore, improving the general public’s knowledge, attitudes, and practices (KAP) concerning coronavirus disease (COVID-19) can play a pivotal role in reducing the risks, especially in a country such as Indonesia with its scarcity of health resources for testing and tracing. Using the case of Malang District, this study set out to evaluate KAP regarding COVID-19 and its risk factors immediately after the Malang health authorities implemented various preventive measures. A population-based survey involving 3425 individuals was carried out between 1 May and 20 May 2020. Our findings revealed that less than half of the respondents demonstrated accurate knowledge (25.3%), positive attitudes (36.6%), or frequent best practices (48.8%) with regard to COVID-19 prevention. The results of logistic regression analyses showed that more accurate knowledge was associated with more positive attitudes and more frequent best practices (OR = 1.603, p-value < 0.001; OR = 1.585, p-value < 0.001, respectively). More positive attitudes were also associated with more frequent best practices (OR = 1.126, p-value < 0.001). The level of KAP varied according to sociodemographic characteristics, access to the services of community health workers, and mobile health technology for COVID-19 screening. Some global health proposals to improve health behaviors among the general public in the context of the scarcity of health resource settings are suggested based on the study findings.

Lessons Learned From a Qualitative COVID-19 Investigation Among Essential Workers With Limited English Proficiency in Southwest Kansas

In this commentary, we briefly describe our methodology in conducting a remote qualitative investigation with essential workers from southwest Kansas, and then describe some key considerations, challenges, and lessons learned in recruiting and conducting interviews remotely. From August 4, 2020 through August 26, 2020, Centers for Disease Control and Prevention (CDC) staff conducted five phone interviews with culturally and linguistically diverse employees in southwest Kansas to understand COVID-19 knowledge, attitudes, and practices and communication preferences. Our experience details the potential challenges of the federal government in recruiting individuals from these communities and highlights the possibilities for more effectively engaging health department and community partners to support investigation efforts. Optimizing recruitment strategies with additional participation from community partners, developing culturally and linguistically appropriate data collection tools, and providing supportive resources and services may augment participation from refugee, immigrant, and migrant (RIM) communities in similar remote investigations.

Children's resilience during Covid-19 confinement. A child's perspective-Which general and media coping strategies are useful?

This study explored how children (9-13 years old) coped with the uncertain situation during the first Covid-19 confinement period (Spring 2020) and whether media helped them handle the situation. Based on a survey among 667 West-European (Belgian) children, we concluded that children used various strategies to cope with the situation. Seeking social support via social media and searching for distraction was applied by most children. Creating a comforting atmosphere was used by many, although not evaluated as an effective strategy. Whereas older children searched for Covid-19-related information, younger children indicated to avoid news media to regulate their emotions. The Covid-19 anxiety of parents in the confinement period impacted upon the general level of concerns of their children. The results offer policy recommendations on how to support children in handling the tensive Covid-19 situation, especially during lockdown periods.

Factors Associated to Psychological Distress During the COVID-19 Pandemic Among Healthcare Workers in Ecuador

Objective: The global COVID-19 pandemic has challenged health systems. Healthcare professionals had to face harsh conditions that have caused psycho-emotional consequences. Ecuador has been one of the countries hit hardest by the pandemic in Latin America. The objective of this study was to analyse the levels of psychological distress among healthcare workers in Ecuador during the COVID-19 pandemic.

Methods: A cross-sectional descriptive study was conducted with a convenience sample of 1,056 healthcare professionals, assessing their psychological distress, physical symptoms of COVID-19, state of health, the preventive measures adopted, and the history of contact with people infected with the SARS-CoV2 virus.

Results: showed that 66.0% of the participants manifested psychological distress, with significantly higher levels in women with symptoms of COVID-19 and previous contact with infected people or objects (p < 0.001). However, adherence to preventive measures and perception of health were associated with less psychological distress (p < 0.001).

Conclusions: The importance of monitoring the mental health of healthcare workers during the COVID-19 pandemic was confirmed, having identified factors associated with the development of psychological distress among professionals in Ecuador.

A cross-sectional survey of COVID-19: attitude and prevention practice among Syrians

Introduction

Coronavirus disease of 2019 has overwhelmed public health systems worldwide and forced governments to impose draconian lockdowns on entire populations. With no vaccine or treatment during the early days of the pandemic, it is of paramount importance to assess the public’s awareness about COVID-19 so that prevention-focused educational campaigns can be sufficiently deployed. This study aimed to gauge the Syrian public’s adherence to infection control measures by assessing attitudes and practices during the pandemic which ravaged an already war-torn Syria.

Methods

The web-based cross-sectional study was conducted in March 2020, nearly 11 years into the Syrian crisis. The survey contained 3 sections: socio-demographic characteristics, attitudes, and practice. Multivariable logistic regression analysis was performed to identify factors associated with good practices and negative attitudes. Data were analyzed using the Statistical Package for Social Sciences version 25.0.

Results

Of the 3586 participants, 68.2% were females, 50.8% were unemployed, and 79.2% were college-educated. Only 1402 (39.1%) participants wore face masks when leaving their homes. Multiple logistic regression analysis revealed that female, age, and residence were factors associated with good practices such as avoiding mass gatherings, wearing face masks, and maintaining a 1-meter interpersonal distance. However, age and occupation were factors associated with negative attitudes towards the closure of universities and schools, travel bans, and quarantines for travellers.

Conclusion

This survey highlights the need to address specific populations using various measures; there should be a specialized method of prevention for each occupation, age group, and place of residence to contain further outbreaks of COVID-19. This can be achieved through targeted awareness campaigns.

Correlates of Covid-19 Vaccine Acceptance among Residents of Ohio: A Cross-sectional Study

BACKGROUND

Recent studies in the United States have shown that between 56 to 74% are willing to receive the COVID-19 vaccine. A significant portion of the population should be vaccinated to avoid severe illness and prevent unnecessary deaths. We examined correlates of COVID-19 vaccine acceptance among a representative sample of adults residing in Ohio.

METHODS

We conducted a cross-sectional study using an online platform (n = 2358). Descriptive statistics, chi-square test and multivariable regression analysis were performed.

RESULTS

Overall, 59.1% of the participants indicated COVID-19 vaccine acceptance to be vaccinated. In the multivariable model, the likelihood of COVID-19 vaccine acceptance was lower for younger individuals compared to those 55 years and older. The odds of COVID-19 vaccine acceptance were lower for: females compared to males (OR 0.58, 95% CI: 0.47-0.71; P = 0.001), non-Hispanic blacks compared to non-Hispanic whites (OR: 0.49 95% CI: 0.35-0.70; P = 0.001), previously married (OR 0.64 95% CI: 0.49-0.84; P = 0.002) and never been married (OR 0.75 95% CI: 0.59-0.96; P = 0.023) compared to married people, individuals with less than high school (OR 0.21 95% CI: 0.08-0.60; P = 0.003) and high school education (OR: 0.45 95% CI: 0.36-0.55; P < 0.001) compared to those with education beyond high school, and for individuals who had no confidence in the abilities of the state government (OR 0.69 95% CI: 0.53-0.89; P = 0.005) and other world governments to combat COVID-19 (OR 0.67 95% CI: 0.50-0.91; P = 0.009). A one unit increase in knowledge about COVID-19 (OR 1.19, 95% CI: 1.13-1.26; P < 0.001), behavioral adherence (OR 1.25, 95% CI: 1.15-1.37; P < 0.001), perceived susceptibility (OR 1.10, 95% CI: 1.03-1.17; P = 0.004), perceived severity (OR 1.09, 95% CI: 1.03-1.16; P = 0.003), and trust in COVID-19 messages from the government scores (OR 1.08, 95% CI: 1.06-1.10; P < 0.001) were associated with an increase in the likelihood of COVID-19 vaccine acceptance.

CONCLUSIONS

COVID-19 vaccine acceptance differed by sociodemographic and other modifiable factors. Findings can inform local public health authorities in the development of effective, context-specific communication strategies to improve vaccination uptake.

What Prompted the Adoption of Self-Protective Behaviors in Response to COVID-19? Evidence From Women Living in the Rural Areas of Western China

Background

Self-protective behaviors, such as handwashing and mask-wearing, are effective to reduce the spread of coronavirus disease (COVID-19), but few studies have focused on women living in rural areas who bear the brunt of the impacts of the pandemic due to their economic and social vulnerabilities. This study explores what prompted the adoption of self-protective behaviors in response to COVID-19 among women living in rural areas of western China.

Methods

The study sample consisted of 1,524 women from 116 townships across 10 counties in rural western China. We collected data in May and August 2020 on women's socioeconomic characteristics, exposure to COVID-19-related information, psychological response to COVID-19, and adoption of self-protective behaviors. Structural equation modeling (SEM) analyses were conducted to analyze the relations among the variables.

Results

During the lockdown, 1,221 (80.12%) of the 1,524 women in the study sample reported wearing a mask every time when they went outside and 1,021 (66.99%) reported handwashing with soap every time after they came home. Perceived efficacy had the strongest association with self-protective behaviors (β = 0.38; p < 0.001). Receiving public health guidance (β = 0.18; p < 0.001) was indirectly associated with more self-protective behaviors via greater perceived efficacy. Higher socioeconomic status was also directly associated with increased adoption of self-protective behaviors (β = 0.24; p < 0.001). Other variables, such as receiving surveillance and risk information, communication channels, perceived risks, and fear, were indirectly associated with the adoption of self-protective behaviors with smaller effect sizes (all β were lower than 0.10).

Conclusions

Not all women were able to adopt self-protective behaviors, such as mask-wearing and handwashing, during the COVID-19 pandemic in western China. To further encourage behavioral changes in response to public health crises, the government should develop clear and actionable guidelines and adopt targeted health communication strategies to reach the most disadvantaged groups of society. These findings may inform tailored responses to COVID-19 in other low- and middle-income countries.

Knowledge, Attitude, and Practice among Physical Therapists toward COVID-19 in the Kingdom of Saudi Arabia-A Cross-Sectional Study

To curb the COVID-19 pandemic, the knowledge, attitude, and practice (KAP) of preventive measures play an essential role, and healthcare workers have had to endure a burden to care for COVID-19 patients. Thus, this study aimed to assess the weight of the KAP of physiotherapists in Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, where we circulated an online KAP questionnaire to 1179 physical therapists, and among those, 287 participated and completed the questionnaire. The collected responses were analyzed using descriptive statistics, t-test, ANOVA, correlation, and regression analyses, and p-value ≤ 0.05 was considered statistically significant. Both males and females participated in almost equal numbers; most of the participants were <40 years, had a bachelor’s level of education, and were from the central region of Saudi Arabia. Social media and the internet were the primary sources of COVID-19-related information (74.6%). Knowledge components A (92%) and B (73.9%) were excellent among most participants. Approximately half of the participants (50.5%) had a moderate attitude toward COVID-19, and regarding the practice component, most participants (74.6%) scored moderately. Correlation analysis showed a low positive relationship between knowledge A, attitude, and practice components. Still, there was a very low positive relationship between knowledge B, attitude, and practice components, but both were statistically significant. Our study showed that physical therapists in Saudi Arabia exhibit good knowledge, attitude, and practice toward COVID-19.

Multi-stage Internet public opinion risk grading analysis of public health emergencies: An empirical study on Microblog in COVID-19

In the period of Corona Virus Disease 2019 (COVID-19), millions of people participate in the discussion of COVID-19 on the Internet, which can easily trigger public opinion and threaten social stability. This paper creatively proposes a multi-stage risk grading model of Internet public opinion for public health emergencies. On the basis of general public opinion risk grading analysis, the model continuously pays attention to the risk level of Internet public opinion based on the time scale of regular or major information updates. This model combines Analytic Hierarchy Process Sort II (AHPSort II) and Swing Weighting (SW) methods and proposes a new Multi-Criteria Decision Making (MCDM) method - AHPSort II-SW. Intuitionistic fuzzy number and linguistic fuzzy number are introduced into the model to evaluate the criteria that cannot be quantified. The multi-stage model is tested using more than 2,000 textual data about COVID-19 collected from Microblog, a leading social media platform in China. Seven public opinion risk assessments were conducted from January 23 to April 8, 2020. The empirical results show that in the early COVID-19 outbreak, the risk of public opinion is more serious on macroscopic view. In details, the risk of public opinion decreases slowly with time, but the emergence of important events may still increase the risk of public opinion. The analysis results are in line with the actual situation and verify the effectiveness of the method. Comparative analysis indicates the improved method is proved to be superior and effective, sensitivity analysis confirms its stability. Finally, management suggestions was provided, this study contributes to the literature on public opinion risk assessment and provides implications for practice.

Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-Care and Anxiety in Pregnancy: A Cross-Sectional Study

COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially pregnant women. This study aimed to assess the association between knowledge, perceived severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy. This cross-sectional study was performed on 440 pregnant women. Data were collected using demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-19. Nonetheless, health anxiety had a significant and inverse association with knowledge and perceived controllability, while there was a positive and significant correlation between perceived severity and health anxiety. Based on linear regression, three variables of knowledge, perceived severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in self-care and health anxiety, respectively. It is suggested that due to the critical importance of prenatal care, managers, and health-care providers promote the use of such methods as telehealth and home-based caregivers, especially in areas with inadequate access to health care. So, the pregnant women can be followed up and receive medical care devoid of any stress and anxiety.

Disparity between knowledge and practice regarding COVID-19 in Thailand: A cross-sectional study of older adults

The efficacy of the public health measures to mitigate COVID-19 is influenced by health literacy which includes the level of knowledge about the disease and the preventive behaviours adopted by individuals. Thailand, being a low- and middle-income country with an ageing society, has to consider both the challenges that its health system has in disseminating information and the disparities in health literacy among its older population. This study investigated the knowledge and behaviour of older adults in Thailand regarding COVID-19 using the Impact of COVID-19 on Older Persons in Thailand, a cross-sectional survey. The data was primarily collected online and included 1,230 adults aged at least 60 years from nine provinces of the five regions of the country. The associated factors with the health literacy outcomes were tested using bivariate logistic regression analyses. It was observed that 43% of the older adults in the sample had proper knowledge of the disease and 33% adopted preventive behaviours. Knowledge about the disease was not associated with preventive behaviour. The associated factors common between the increased levels of knowledge and adoption of behaviours were rural area residence and higher educational attainment levels. Obtaining information from the internet was observed to increase knowledge while having the television and radio as sources of information had negative relationship. Many older adults continued to be employed during the lockdown period and this was associated with decreased adoption of preventive behaviour. The context of vulnerable populations, particularly older adults, is different with regard to their access to information and concern about income. Health information has to be tailored for targeted populations. Their needs also have to be addressed as they have increased risks because of financial and health susceptibilities.

Factors related to preventive COVID-19 behaviors using health belief model among general population: a cross-sectional study in Iran

BACKGROUND

Coronavirus disease (COVID-19) pandemic has become one of the biggest challenges to global health and economy. The present study aimed to explore the factors related to preventive health behaviors during the COVID-19 pandemic in Khuzestan Province, South of Iran, using the Health Belief Model (HBM).

METHODS

The present cross-sectional study was conducted in the period between July 2020 and September 2020. A total of 1090 people from Khuzestan province participated in the study. The data collection method included a multistage cluster sampling method with a random selection of provincial of health centers. The questionnaire collected socio-demographic information and HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and COVID-19 preventive behaviors). Data were analyzed using ANOVA, t-test, hierarchical multiple linear regression, and SPSS version 22.

RESULTS

The mean age of the participants was 35.53 ± 11.53, more than half of them were female (61.6%) and married (65.3). The results showed that 27% of the variance in the COVID-19 preventive behaviors was explained by HBM constructs. The regression analysis indicated that female gender (β = 0.11), perceived benefits (β = 0.10), perceived barriers (β = - 0.18), external cues to action (β = 0.25), and internal cues to action (β = 0.12) were significantly associated with COVID-19 preventive behaviors (p < 0.05).

CONCLUSION

Designing an educational intervention on the basis of HBM might be considered as a framework for the correction of beliefs and adherence to COVID-19 behavior. Health information campaigns need to (1) emphasize the benefits of preventive behaviors including avoiding the likelihood of getting a chronic disease and complications of the disease, (2) highlight the tips and advice to overcome the barriers (3) provide cues to action by means of showing various reminders in social media (4) focusing on adoption of COVID-19-related preventive behaviors, especially among men.

Knowledge, attitudes, and practices related to COVID-19 among patients at Hospital Universitario de Caracas triage tent: A cross-sectional study

INTRODUCTION

The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures.

OBJECTIVE

To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent.

MATERIALS AND METHODS

We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey.

RESULTS

Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients.

CONCLUSIONS

This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.

Capturing the Trajectory of Psychological Status and Analyzing Online Public Reactions During the Coronavirus Disease 2019 Pandemic Through Weibo Posts in China

When a major, sudden infectious disease occurs, people tend to react emotionally and display reactions such as tension, anxiety, fear, depression, and somatization symptoms. Social media played a substantial awareness role in developing countries during the outbreak of coronavirus disease 2019 (COVID-19). This study aimed to analyze public opinion regarding COVID-19 and to explore the trajectory of psychological status and online public reactions to the COVID-19 pandemic by examining online content from Weibo in China. This study consisted of three steps: first, Weibo posts created during the pandemic were collected and preprocessed on a large scale; second, public sentiment orientation was classified as "optimistic/pessimistic/neutral" orientation via natural language processing and manual determination procedures; and third, qualitative and quantitative analyses were conducted to reveal the trajectory of public psychological status and online public reactions during the COVID-19 pandemic. Public psychological status differed in different periods of the pandemic (from December 2019 to May 2020). The newly confirmed cases had an almost 1-month lagged effect on public psychological status. Among the 15 events with high impact indexes or related to government decisions, there were 10 optimism orientation > pessimism orientation (OP) events (2/3) and 5 pessimism orientation > optimism orientation (PO) events (1/3). Among the top two OP events, the high-frequency words were "race against time" and "support," while in the top two PO events, the high-frequency words were "irrationally purchase" and "pass away." We proposed a hypothesis that people developed negative self-perception when they received PO events, but their cognition was developed by how these external stimuli were processed and evaluated. These results offer implications for public health policymakers on understanding public psychological status from social media. This study demonstrates the benefits of promoting psychological healthcare and hygiene activity in the early period and improving risk perception for the public based on public opinion and the coping abilities of people. Health managers should focus on disseminating socially oriented strategies to improve the policy literacy of Internet users, thereby facilitating the disease prevention work for the COVID-19 pandemic and other major public events.

Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis

OBJECTIVE

To assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19.

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed.

RESULTS

Out of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants' COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger's regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed.

CONCLUSIONS

This study's findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations.

PROSPERO REGISTRATION NUMBER

CRD42020203476.

Community's misconception about COVID-19 and its associated factors in Satkhira, Bangladesh: A cross-sectional study

INTRODUCTION

Misconception related to coronavirus disease-2019 (COVID-19) have been spread out broadly and the the World Health Organization declared these as a major challenge to fight against the pandemic. This study aimed to assess COVID-19 related misconception among rural people in Bangladesh and associated socio-demographic and media related factors.

METHODS

Multistage sampling method was used to collect data (n = 210) from three unions of Satkhira District, Bangladesh. The dependent variable was the presence of COVID-19 related misconception (Yes, No) which was generated based on respondents' responses to a set of six questions on various types of misconception. Exposure variables were respondents' socio-demographic characteristics, mass media and social media exposure. Descriptive statistics were used to describe the characteristics of the respondents. Bivariate and multivariate logistic regression models were used to determine the factors associated with COVID-19 misconception.

RESULTS

More than half of the study respondents had one or more COVID-19 related misconception. Over 50% of the total respondents considered this disease as a punishment from God. Besides, many of the respondents reported that they do not think the virus causing COVID-19 is dangerous (59%) and it is a disease (19%). Around 7% reported they believe the virus is the part of a virus war (7.2%). The bivariate analysis found the presence of socio-demographic factors of the respondents, as well as the factors related to social and mass media, were significantly associated with the COVID-19's misconception. However, once all factors considered together in the multivariate model, misconception were found to be lower among secondary (AOR, 0.33, 95% CI: 0.13-0.84) and tertiary (AOR, 0.29, 95% CI: 0.09-0.92) educated respondents compared to the respondents with primary education.

CONCLUSION

This study obtained a very higher percentage of misconception about the COVID-19 among the respondents of Satkhira district in Bangladesh. This could be a potential challenge to fight against this pandemic which is now ongoing. Prioritizing mass and social media to disseminate evidence-based information as well as educate people about this disease are necessary.

A Cross-Sectional Study to Assess Knowledge of COVID-19 among Undergraduate Students in North-Central Ecuador

Adherence to preventive measures is influenced by people’s knowledge, attitudes and practices towards a disease; therefore, assessing knowledge of COVID-19 is critical in the overall effort to contain the outbreak. This cross-sectional study was conducted among undergraduates (n = 3621) of different programs and different levels of education associated with universities in north-central Ecuador. The form consisted of 32 questions covering demographics, symptoms, detection, treatment, transmission, prevention and knowledge of the virus. The rate of correct answers was 75.5% (21.1 ± 5 out of 28), with differences observed regarding program of study, educational level and location of institution (α = 0.05), although effect size analyses showed that these differences could not be considered large. Multiple linear regression analyses showed that lower scores were associated with initial stages of education, careers related to social sciences and location of institution. Participants possessed sufficient knowledge about detection, transmission and prevention, although they overestimated fatality rate and were less confident about the characteristics of the virus and the effectiveness of traditional medicine. Consequently, future educational programs must place emphasis on addressing deficient knowledge. Certainly, improving COVID-19 literacy will promote the appropriate application of protective measures aimed at preventing the virus’ spread.

The Effect of a Wordless, Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial

Background

Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience.

Objective

The objectives of this study were to (1) establish the CoVideo’s effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo’s effectiveness in increasing behavioral intent toward COVID-19 prevention.

Methods

In May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments.

Results

Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors.

Conclusions

Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises.

Trial Registration

German Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbn

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-020-04942-7

COVID-19-related knowledge, attitudes and practices: a mixed-mode cross-sectional survey in Liberia

OBJECTIVES

To examine the knowledge, attitudes and practices (KAP) of COVID-19 of rural and urban residents in Liberia to inform the development of local social and behaviour change communication strategies.

DESIGN

Cross-sectional, mixed-mode (online and telephone) survey using non-probability sampling.

SETTING

All 15 counties in Liberia with a focus on Maryland County.

PARTICIPANTS

From 28 May to 28 June 2020, data were collected from a total of 431 adults aged 18 years and older (telephone 288 (66.8%); online 143 (33.2%)) out of a total of 741 contacts.

MAIN OUTCOME MEASURES

KAP scores. Frequencies and proportions were calculated, followed by univariate and multivariable analyses to examine the association between KAP scores and the sociodemographic variables.

RESULTS

Around 69% of the online survey respondents were younger than 35 years of age, compared with 56% in the telephone interviews. The majority (87%) of online respondents had completed tertiary education, compared with 77% of the telephone respondents. Male participants, on average, achieved higher knowledge (52%) and attitude scores (72%), in contrast to females (49% and 67%, respectively). Radio (71%) was the most cited source for COVID-19 information, followed by social media (63%). After controlling for sociodemographic variables, adaptive regression modelling revealed that survey mode achieved 100% importance for predicting knowledge and practice levels with regard to COVID-19.

CONCLUSIONS

The survey population demonstrated moderate COVID-19 knowledge, with significant differences between survey mode and educational level. Correct knowledge of COVID-19 was associated with appropriate practices in Maryland County. Generalisation of survey findings must be drawn carefully owing to the limitations of the sampling methods. Yet, given the differences in knowledge gaps between survey modes, sex, education, occupation and place of residence, it is recommended that information is tailored to different audiences.

The Effect of Knowledge, Attitudes, and Practices of Korean Correctional Officers about COVID-19 on Job Stress

The purpose of this study was conducted to investigate the effects of corrective officers' knowledge, attitudes, and practices on job stress. The subjects of this study were 375 randomly selected male correctional officials working at five South Korean correctional facilities that had been affected by COVID-19. This study considered data collected with approval from 17 May 2021 to 14 June 2021. Knowledge, attitudes, practices, and job stress in relation to COVID-19 were assessed using a personal questionnaire. The data were analyzed using mean, standard deviation, t-test, one-way ANOVA, and post-test using Pearson's correlation coefficient. The job stress of participants was negatively correlated with knowledge, attitudes, and practices. Significant factors influencing job stress included knowledge and practices. These factors explained 38% of the variance. In this study, knowledge and practices were identified as influencing the job stress of correctional officers. These results are intended to contribute to the development of programs that can enhance the COVID-19-related knowledge and practices of correctional officers and reduce job stress.

Assessment of early COVID-19 compliance to and challenges with public health and social prevention measures in the Kingdom of Eswatini, using an online survey

Public health and social measures have been implemented around the world in a bid to prevent the spread of COVID-19. Public compliance with these measures is key in successfully controlling the pandemic. This online survey assessed the compliance and attitude of adults residing in the southern African Kingdom of Eswatini to government protection, activity and travel measures aimed at controlling the spread of COVID-19. A rapid online survey, comprising of 28 questions, was administered in May 2020. More than 90% of respondents knew the virus could kill anyone and most respondents (70%) reported to be compliant to public health and social measures. Females, those who did not use public transport and those aged 30 years and above were significantly (p<0.01) more compliant, particularly to protective and travel measures. Social media, television and official government websites were the primary source of ongoing COVID-19 information for respondents of this online survey, and these methods should continue to be employed to reach the public who regularly use the internet. More than half of essential workers who responded to the online survey reported to have their own personal protective equipment; however, 32% either did not have any protective equipment or shared their equipment with other staff members. Due to the survey being online, these results should not be generalised to populations of low socioeconomic status.

Demystifying media sources of information and levels of knowledge about COVID-19: a rapid mini-review of cross-sectional studies in Africa

COVID-19 control is highly affected by knowledge levels which are also affected by receipt of information on the disease. Therefore, this review examined knowledge levels and media sources of information findings of the studies on knowledge, attitudes, perceptions, and practices towards COVID-19 done in low- and middle-income countries in Africa to shed light on the interplay of the use of different media platforms and populations’ knowledge about the COVID-19 pandemic and identify shorter- and longer-term priorities for COVID-19 research to improve the continent’s capacity to not only deal with COVID-19 but also future pandemics. Searches were conducted in PubMed and CINAHL databases/sites with major terms being “knowledge”, “attitudes”, “perceptions”, “practices”, “COVID-19 “, and “Africa”. 319 were where identified and subjected to the exclusion and inclusion criteria retaining only 10 free, full-text research articles related to knowledge, attitudes, perceptions, and practices towards COVID-19. This review summarized the levels of knowledge and media information sources among African populations. The review indicated a largely higher level of knowledge towards COVID-19 among populations who received information through various media platforms and alluded to the different media platforms that could be appropriate to spread COVID-19 related information to African populations.

Public knowledge, attitude, practices, and level of anxiety toward the COVID-19 pandemic among people living in Oman

The purpose was to examine knowledge, attitudes and preventive practices, as well as anxiety and stress of people living in a Gulf country with a diverse population toward the coronavirus disease 2019 (COVID‐19) pandemic. A descriptive cross‐sectional, exploratory design was used to meet the aims of this study. The target population was all individuals aged 18 years and older and who can read and write Arabic, English, or Hindi. The results showed that most individuals demonstrated a high level of knowledge regarding COVID‐19. Most individuals believed that COVID‐19 is not fatal and that countries can control the COVID‐19 virus. Despite the lower levels of anxiety and stress among this population, many individuals reported high levels of stress and anxiety. Higher levels of anxiety, higher levels of knowledge, and being married were associated with more preventive practices. This study showed that the level of knowledge is positively associated with compliance with preventive measures. Providing the public with accurate and consistent information regarding COVID‐19 may enhance their compliance with preventive measures. Using different risk communication strategies will ensure collaboration from the public and encourage them to be active members when facing contagious diseases

Community knowledge, attitude and practices to SARS-CoV-2 disease 2019 (COVID-19): A cross-sectional study in Woldia town, Northeast Ethiopia

SARS-CoV-2 disease 2019 (COVID-19) is pandemic and currently becomes a serious cause of death worldwide. It is caused by a SARS-CoV-2 belonging to a family known as corona virus. The aim of this study is to assess the community knowledge, attitude and practice strategy implementation on SARS-CoV-2 disease 2019 (COVID-19). A cross-sectional survey study was done from July to October, 2020 in Woldia town, Northeast Ethiopia. Interviewer-administered questionnaire was used to collect data from 404 respondents. Data collected were analyzed using descriptive statistics and chi-square test with a 95% confidence interval to know the association of socio-demographic characteristics with the knowledge, attitude and practices towards COVID-19. From a total of 404 responses collected (64.1%, n = 259/404), (50.7%, n = 205/404) and (39.6%, n = 160/404) of the respondents were between ages 18–39 years, males and were diploma and above, respectively. The majority of the respondents had good knowledge about the transmission mode and symptoms of COVID-19 and they obtained information mainly through mass media. The knowledge of the respondents about the transmission mode of COVID-I9 through coughing and sneezing, direct contact with infected person and touching contaminated materials was statistically associated with education and occupation (p <0.001). Among the total respondents (53.7%, n = 217/404) had a negative attitude that COVID-19 pandemic will not be controlled. The attitude of the respondents towards successfully controlling of COVID-I9 was statistically associated in terms of age, marital status, education and occupation (p < 0.001). Most of the respondents (63.1%, n = 255/404), (58.9%, n = 238/404), (66.8%, n = 270/404) and (63.9%, n = 258/404) did not wash hands with soap, avoidance of touching the nose and mouth, practicing social distancing and wearing of face masks in public or crowded places, respectively. The practices of the respondents towards COVID-19 were statistically associated with sex, marital status, education and occupation (p < 0.01). COVID-19 is currently the cause of death and it has a great impact on the economy, politics and social interactions in the study area. The government should strength the health system by increasing surveillance activities in detecting cases. Our findings suggest that the community should practice the WHO and EMoH recommendations to minimize the spread of the virus.

Knowledge, attitudes, and practices towards COVID-19 among Venezuelans during the 2020 epidemic: An online cross-sectional survey

Background

COVID-19 threatens health systems worldwide, but Venezuela’s system is particularly vulnerable. To prevent the spread of COVID-19, individuals must adopt preventive behaviors. However, to encourage behavior change, we must first understand current knowledge, attitudes, and practices (KAPs) that inform response to this health threat.

Methods

We explored KAPs among Venezuelans using a cross-sectional, internet-based questionnaire. The questionnaire explored individuals’ knowledge about COVID-19; their attitudes toward the world’s and the Venezuelan authorities’ abilities to control it; and their self-reported practices. We also collected demographic data. Binomial logistic regression analyses were used to predict the adoption of preventive behaviors based on demographic variables, individual knowledge level, and individual attitudes.

Results

3122 individuals completed the questionnaire. Participants had a high level of knowledge about COVID-19. They expressed high levels of optimism that the world would eventually control COVID-19, but they were very pessimistic about the public authorities in Venezuela. Most participants adopted preventive practices. Binomial regression suggests younger people, less educated people, and manual laborers hold lower levels of knowledge, and these groups, as well as men, were less likely to adopt preventive practices. Knowledge, by itself, had no association with optimism and little association with self-reported practices.

Conclusions

As other KAP studies in Latin America found, knowledge is not sufficient to prompt behavior change. Venezuelans’ pessimism about their own country’s ability should be explored in greater depth. Health promotion in Venezuela may wish to target the most at risk groups: men, younger people, less educated people, and manual laborers.

Knowledge, attitudes, and practices of the general population about Coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis with policy recommendations

Objectives

This study aimed to investigate and synthesize the current evidence on knowledge, attitudes, and practices (KAPs) of the general population regarding COVID-19.

Study design

This is a systematic review and meta-analysis.

Methods

We conducted a systematic search on PubMed/LitCovid, Scopus, and Web of Sciences databases for papers in the English language only, up to 1 January 2021. We used the Joanna Briggs Institute checklist developed for cross-sectional studies to appraise the quality of the included studies. All stages of the review conducted by two independent reviewers and potential discrepancies were solved with a consultation with a third reviewer. We reported the result as number and percentage. A meta-analysis conducted using a random effect model with a 95% confidence interval.

Results

Forty-eight studies encompassing 76,848 participants were included in this review. 56.53% of the participants were female. The mean age of the participants was 33.7 years. 85.42% of the included studies were scored as good quality, 12.50% as fair quality, and the remaining (2.08%) as low quality. About 87.5% examined all three components of the KAPs model. The knowledge component was reported as good and poor in 89.5% and 10.5% of the included studies, respectively. Of the studies that examined the attitude component, 100% reported a positive attitude. For the practice component, 93.2% reported satisfactory practice, and 6.8% poor practice. The result of the meta-analysis showed that the overall score of KAPs components about COVID-19 were 78.9, 79.8, and 74.1, respectively.

Conclusions

This systematic review and meta-analysis showed that the overall KAP components in the included studies were at an acceptable level. In general, knowledge was at a good level, the attitude was positive and practice was at a satisfactory level. Using an integrated international system can help better evaluate these components and compare them between countries.

PROSPERO registration code

(CRD42020186755).