Background: To control the spread of COVID-19, protect citizens, and ensure their well-being, Saudi Arabia has taken unprecedented and stringent preventive and precautionary measures. The public’s knowledge and attitude toward COVID-19 influence their adherence to preventive measures. During the pandemic, this study looked into the Saudi public’s knowledge, attitudes, and practices regarding COVID-19.
Methods: This is a cross-sectional study in which data from 3,388 participants was collected via an online self-reported questionnaire. The data were subjected to univariate and multivariable regression analyses in order to assess differences in mean scores and identify factors associated with knowledge, attitudes, and practices toward COVID-19.
The majority of the study participants were familiar with COVID-19. The mean knowledge score on the COVID-19 was 17.96 (SD = 2.24, range: 3–22), indicating a high level of knowledge. The mean attitude score was 28.23 (SD = 2.76, range: 6–30), indicating positive attitudes.
The mean practice score was 4.34 (SD = 0.87, range: 0–5), indicating that the practices were good. However, men have less knowledge, less optimistic attitudes, and less good practice with COVID-19 than women. We also discovered that older adults are more likely than younger people to have superior knowledge and practices.
Conclusions: Our findings suggest that targeted health education interventions should be directed toward this vulnerable population, which may be at higher risk of contracting COVID-19. For example, if health education programs are specifically targeted at men, COVID-19 knowledge may increase significantly.
Coronavirus disease 2019 (COVID-19) is an illness caused by a new coronavirus known as Severe Acute Respiratory Syndrome Coronavirus 2. (SARS-CoV-2; formerly called 2019-nCoV). COVID-19 is a new respiratory infection that was discovered in Wuhan, Hubei Province, China, in December 2019.
(1). SARS-CoV-2 is part of a larger family of RNA viruses that cause infections ranging from the common cold to more serious diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV) (2). The primary symptoms of COVID-19 are fever, dry cough, fatigue, myalgia, shortness of breath, and dyspnea (3, 4).
COVID-19 spreads quickly and can be contracted through close contact with an infected person (5–9). The disease’s specifics are still being worked out. As a result, this may not be the only method of transmission. COVID-19 has spread rapidly from Wuhan to other parts of the world, endangering the lives of many people (10).
By the end of January 2020, the World Health Organization (WHO) declared a public health emergency of international concern and urged all countries to work together to prevent its rapid spread. COVID-19 was later declared a “global pandemic” by the WHO (11).
Following the WHO declaration, countries worldwide, including the Kingdom of Saudi Arabia (KSA), have relied on response plans to combat the pandemic and contain the virus.
Following the confirmation of its first case of COVID-19 on Monday, March 2, 2020, the Saudi government has been closely monitoring the situation and developing country-specific measures to combat the outbreak in accordance with WHO guidelines (12).
These include the suspension of all inbound and outbound flights, the closure of all malls and shops in the country (except pharmacies and grocery stores), and the closure of all schools and universities. Umrah visas and prayers at mosques, including the two Holy Mosques in Mekkah and Almadina, have been suspended. On March 24, 2020, the government imposed a nationwide curfew to restrict people’s movements during the day.
Despite unprecedented national efforts to combat the outbreak, the success or failure of these efforts is heavily reliant on public behavior. To prevent the spread of the disease, public adherence to preventive measures established by the government is critical.
The public’s knowledge and attitudes toward COVID-19 are likely to influence adherence. Evidence suggests that public awareness is critical in the fight against pandemics (13, 14).
Deeper insights into existing public perception and practices can be gained by assessing public awareness and knowledge about the coronavirus, assisting in the identification of attributes that influence the public in adopting healthy practices and responsive behavior (15).
It is also necessary to assess public knowledge in order to identify gaps and strengthen ongoing prevention efforts. Thus, the purpose of this study is to look into the knowledge, attitudes, and practices (KAP) of KSA residents regarding COVID-19 during the pandemic spike.
To the best of the researchers’ knowledge, this is the first study to look into COVID-19 KAP and associated sociodemographic characteristics in the KSA’s general population.
The findings of this study are expected to provide policymakers with useful information about KAP among the Saudi population at this critical time. The findings may also help public health officials plan future COVID-19 outbreak interventions, raise awareness, and improve policy.
Materials and Procedures
Sample and Study Design
From March 20 to March 24, 2020, a cross-sectional study was conducted among Saudi Arabia’s general population. Given the social distancing (physical distancing) measures and restricted movement and lockdowns, data were collected online using SurveyMonkey and a self-reported questionnaire.
Given the high level of internet usage in the Kingdom of Saudi Arabia, a link to the survey was distributed to respondents via Twitter and WhatsApp groups. The link was also posted on the website of King Abdulaziz University.
The larger the target sample size, the greater the study’s external validity and generalizability (16). The goal of this study was to reach as many people as possible and collect as much data as possible. Saudi Arabia has a population of 34,218,169 people, according to the most recent KSA census (17).
A sample size calculator was used to calculate the representative target sample size required to achieve the study objectives and sufficient statistical power (18). Using a margin of error of 4%, a confidence level of 99 percent, a 50% response distribution, and 34,218,169 people, the sample size calculator calculated 1,037 participants.
Data Analysis and Measurement
The authors created a self-reported questionnaire based on Centers for Disease Control and Prevention (CDC) guidelines for the COVID-19 community (19).
The questionnaire was administered in Arabic. It was written in English by H.Z.H. and Y.A., and it was translated into Arabic by M.K.A and M.A. N.A and W.K translated the questionnaire and then returned to English to ensure that the content was understood.
The background and objectives of the study were clearly stated on the first page of the online questionnaire. Respondents were informed that they could withdraw at any time and for any reason, and that all information and opinions provided would be anonymous and confidential.
Respondents in Saudi Arabia who are 18 years of age or older, understand the content of the questionnaire, and agree to participate in the study were instructed to complete the questionnaire. Before beginning the questionnaire, online informed consent was obtained.
The questionnaire was divided into four sections. The first section collected information on respondents’ sociodemographic characteristics, such as age, gender, marital status, level of education, work status, region of residence, and income level.
The second section tested participants’ understanding of COVID-19. There were 22 items in this section about modes of transmission, clinical symptoms, treatment, risk groups, isolation, prevention, and control. The third section used a five-point Likert scale to assess participants’ attitudes toward COVID-19.
Respondents were asked to rate their level of agreement with each of six statements, ranging from “strongly disagree” to “disagree,” “undecided,” “agree,” or “strongly agree.” The questionnaire’s final section evaluated the respondents’ practices.
This section included five questions about practices and behavior, such as (a) attending large-group social events, (b) going to crowded places, (c) avoiding cultural behaviors such as shaking hands, (d) practicing social distancing, (e) washing hands after sneezing, coughing, nose-blowing, and, most recently, being in a public place.
Variables that are unrelated
Gender was coded as one for men and zero for women for sociodemographic variables. The age variable was classified as 18–29 (reference category), 30–39, 40–49, 50–59, and 60. Marital status was recorded as a binary value, with one representing marriage and zero representing non-marriage.
Education was divided into three categories: high school or less (reference category), college/university degree, and postgraduate degree. Work status was classified as government (reference category), non-government, retiree, self-employed, or unemployed.
Monthly income was divided into eight categories: SR 3,000 (reference category), SR 3,000 to 5,000, SR 5,000 to 7,000, SR 7,000 to 10,000, SR 10,000 to 15,000, SR 15,000 to 20,000, SR 20,000 to 30,000, and SR 30,000 or more. We were also in charge of the following 13 administrative regions: Almadina Almonawra, Albaha, Aljouf/Quriat, Aseer/Bisha, Eastern Region, Haiel, Jazan, Najran, Northern Borders, Qaseem, Riyadh, Tabouk, and Western Region.
Variables That Are Dependent
Respondents were asked to mark knowledge items as true or false, with a “don’t know” option available. Incorrect or uncertain (don’t know) answers received a score of zero, while correct answers received a score of one. The total knowledge score ranged from 0 to 22, with higher scores indicating greater knowledge of COVID-19. Cronbach’s alpha was used to assess item internal reliability. Cronbach’s alpha was 0.70, indicating internal consistency (20).
In the section on attitudes, scores were calculated based on the respondents’ responses to each attitudinal statement, with 1 indicating strongly disagree, 2 indicating disagree, 3 indicating undecided, 4 indicating agree, and 5 indicating strongly agree.
The scores were calculated by averaging the responses of respondents to the six statements. The total score ranged from six to thirty, with higher scores indicating more positive attitudes. Cronbach’s alpha was used to assess the internal reliability of the Likert scales.
Cronbach’s alpha was 0.81, indicating internal consistency. Respondents were asked to answer “yes” or “no” to the items in the section on practices. Answers that demonstrated good practice received a one, while answers that demonstrated poor practice received a zero. The overall score ranged from 0 to 5, with higher scores indicating better practices.
Methods of Analysis
This research relied heavily on univariate and multivariable regression data analyses. The frequency of social and demographic statistics was tabulated using univariate analysis. To assess differences in mean values for KAP scores, a one-way analysis of variance (ANOVA) was used.
The overall mean differences were estimated using a Bartlett test because the scores were continuous (21, 22). To identify factors related to knowledge, attitudes, and practice, a multivariable linear regression analysis was performed. STATA software was used for all analyses (StataCorp LP, Texas, USA).
All procedures involving human participants in this study were carried out in accordance with the institutional and/or national research committee ethical standards, as well as the 1964 Helsinki declaration and subsequent amendments or equivalent ethical standards.
The study was designed and carried out in accordance with King Abdulaziz University’s ethical principles. As a result, the Biomedical Ethics Research Committee, Faculty of Medicine, King Abdulaziz University provided ethical approval (Ref-180-20).
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Characteristics of Social and Demographic Groups
The questionnaire was completed by 3,427 people. After excluding 39 respondents who stated they lived outside of the KSA, the final sample size was 3,388 people. Table 1 displays the study participants’ social and demographic characteristics.
The mean COVID-19 knowledge score was 17.96 (SD = 2.24, range: 3–22), and the overall accuracy rate for the knowledge test was 81.64 percent (17.96/22 * 100), as shown in Table 1. COVID-19 had a mean attitude score of 28.23 (SD = 2.76, range: 6–30), indicating positive attitudes.
COVID-19’s mean score for practices was 4.34 (SD = 0.87, range: 0–5), indicating good practices. 1966 (58.03 percent) of the total sample were women, while 1422 (41.97 percent) were men.
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