Knowledge, Attitude and Practice of Saudi Population towards COVID-19

Elsadig Yousif Mohamed^1*, Abdulaziz Abdullah Almutairi², Fahad Muthyib Albaqami², Abdulrahman Mobark Alosimi², Mohammed Salem Alanizy², Fahad Dhaifallah Almutairi², Sultan Mohammed Alqahtani², May Musaad Alelaiwi², Ghadeer Hamdan Alanezi², Eman Yahya Hazazi³ and Saja Dawi Alyami⁴

^*Correspondence: Elsadig Yousif Mohamed, Department of Community Medicine and Public Health, Majmaah University, Saudi Arabia, Email:

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Introduction

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). There are seven different strains of corona virus, including the novel coronavirus which causes coronavirus disease 2019, or COVID-19 [1].

At the end of 2019, a novel coronavirus was recognized as the cause of a cluster of pneumonia cases in Wuhan, China. In February 2020, the World Health Organization designated the disease as Coronavirus disease 2019 (COVID-19) [2]. COVID-19 is an emerging respiratory infection characterized by rapid transmission mainly by close contact with an infected person as person- to person transmission [3-8]. The incubation period for COVID-19 is thought to be within 14 days following exposure, with most cases occurring approximately four to five days after exposure [9]. The disease is highly prevalent, a study conducted in china, reported that among 138 patients infected with the disease, 43 percent acquired the infection in a hospital setting [10]. Since the disease has no vaccines or treatment, the rational and appropriate use of personal protection equipment (PPE) is essential to prevent transmission and controlling the infection [11,12].

In Saudi Arabia, the first reported case of COVID-19 was a citizen who was in contact with a previously reported case [13]. The Saudi government have developed a country specific strategy in line with the WHO guidelines in dealing with the pandemic [14]. Public adherence to the measures established by the government is highly important for COVID-19 prevention and control. Public knowledge of and attitude towards the disease are corner stones in the success of the preventive strategy [15,16]. Assessment of population knowledge and attitude towards COVID -19 will help to identify public perceptions, influences of public health practices and identify gap in public knowledge that helps to strengthen the ongoing preventive efforts. The objectives of the current study were to determine Saudi population knowledge and practice of COVID-19 and to determine their attitude towards the disease.

Methods

A cross-sectional study was conducted in the Kingdom of Saudi Arabia. The five regions: North, South, East, West and Central were included in the study. The selected cities for the study were Mecca, Al-Madina, Riyadh, Qassim, Dammam and Abha. Three thousand six hundred and fortytwo Saudis responded to the pre-tested online questionnaire.

Inclusion and exclusion criteria: Saudi nationality who agreed to participate was considered in the study. Non-Saudi nationality and those infected with COVID-19 were excluded from the study.

Data were collected by a pre-tested, validated and electronic questionnaire. Data collection was performed between April 22 and May 26.2020. Liker scale was used to determine the level of COVID-19 knowledge and attitude. Nine questions about the disease were asked. Respondents who answered 7 to 9 questions correctly were considered to have good (adequate) knowledge. Participants who answered correctly 4 to 6 and Zero to 3 questions were considered to have average and poor knowledge respectively.

To determine the attitude towards COVID-19, three questions about attitude towards the disease were asked. Respondents who employed two to three attitudes consistently were considered to have positive attitude towards COVID-19. Respondents who applied Zero to one attitude consistently were considered to have negative attitude towards the disease.

Data analysis was performed by statistical package for social sciences (SPSS), version 23 (SPSS, Chicago, Illinois, USA). Descriptive and inferential statistics were employed. Comparison between qualitative variables was performed by person’s chi-square to test significance; p value less than 0.05 was considered significant. The study acquired ethics approval from Majmaah University IRB. Informed consent was obtained from the participants.

Results

The demographic characteristics of the participants are shown in Table 1. Most of the sample was between the age group 21-30 years (38.8%). Males were slightly more in number than female (52.8% versus 47.2%). Most of the population were single (51,1%), married were (46,1%). Most of the participants were having bachelor’s degree (52,3%). The central region of Saudi Arabia was the place of residence for most of the study population (53.4%).

Table 1: Demographic characteristics (n=3642).

Table 2 shows the knowledge questions about COVID-19. The question which was answered correctly by most of the subjects (97.2%) is “Maintaining a good hand washing is one of the ways to prevent COVID-19”. The most poorly answered question (47.7%) was related to prevention methods against the COVID-19. The mean score for knowledge question was 81.5%.

Table 2: Knowledge of participants about COVD-19 (n=3.642).

Knowledge score of Saudi population about COVID-19 is presented in Figure 1. Most of the participants had moderate knowledge about COVI-19 (52.7%). Good knowledge was acquired by (44.8%) of the participants and (2.4%) had poor knowledge. Table 3 shows the attitude and practice of Saudi population towards covid-19. The mean score of attitudes towards Covid-19 was 89.7%, the range was between 72.8% and 98.8%. The mean score of Saudi population practice towards Covid-19 was 84.0%, the range was between 81.8% and 88.3%.

Figure 1. Knowledge score of Saudi population about COVID-19.

Table 3: Population Attitude and preventive practices towards COVID-19 (n=3,642).

Table 4 shows the association between COVID-19 knowledge and the socio-demographic characteristics of the sample. Males had better COVID-19 knowledge compared to females. Nine hundred and ninety-two (48.3%) and 704 (40.9%) of males and females had good knowledge respectively. Good COVI-19 knowledge in the age group 15-20 years was 28.8%. Good COVI-19 knowledge in the age groups 21-30, 31-40, 41-50 and above 50 years was 43.8%, 50.6%, 51.8% and 63.8% respectively. The good COVI-19 knowledge for the single, the married, the divorced and the widow were 38.2%, 52.3%, 47.9% and 27.6% respectively. The level of COVID-19 knowledge among primary and secondary school students was 36.1% and 42% respectively while among Bachelor and PHD holders was 46.1% and 59.5% respectively. The residents of the Western region had the highest level of COVID-19 knowledge (50.6% had good knowledge) followed by the population of the central region (45% had good knowledge).

Table 4: Relation between level of knowledge and Socio-demographic factors.

Table 5 shows the association between attitude towards COVID-19 and Socio-demographic characteristics of the population. Females had more positive attitude towards COVID -19 than males (98.4% versus 95.5%). Positive COVI-19 attitude in the age group 15-20 years was 95.2%. Positive COVI-19 attitude in the age groups 21-30, 31-40, 41-50 and above 50 years was 95.8%, 98.2%, 98.8% and 99.5% respectively. The positive COVI-19 attitude for the single, the married, the divorced and the widow was 95.7%, 98.2%, 97.3% and 96.6% respectively. 1015 (95.8%) General school students had positive attitude towards COVID-19 compared to 2514 (97.4%) who had university education and above. The residents of the Southern region had the highest level of COVID-19 attitude (99.1%) followed by the population of the Western region (97.4%). 45.4%of the population with positive attitude have good knowledge of COVID-19, 26.5% of population with poor knowledge have negative attitude. The relation is significant (p > 0.001) (Table 6).

Table 5: Association between attitude and sociodemographic factors.

Table 6: Relation between knowledge and attitude towards COVID-19.

Discussion

Three thousand six hundred and forty-two participants were included in this research. Population who acquired a good level of knowledge were 1663 (44.8%). This finding is lower than the level of knowledge reported among general population of Saudi Arabia [17,18], it is also lower than the findings reported by Zhong et al. in China [19]. A study conducted in Lahore among medical students showed that 80% of participants had good knowledge about coronavirus [20]. In a study conducted in Jordan among University students, the overall knowledge about COVID-19 was reported in more than 90% of the respondents [21].

Males have better COVID-19 knowledge compared to females and the relation is significant (p=<0.001). This finding is consistent with Alahdal et al. who demonstrated a higher level of OVID-19 knowledge among males compared to females in Riyadh, Saudi Arabia [18]. However, it contradicts other studies [17,22,23]. The higher level of males’ awareness regarding COVID-19 compared to females may be explained by the fact that the literacy level of males is higher than females in Saudi Arabia will give males better access to educational materials [24].

Level of COVID-19 knowledge increases as the age of the respondents increases; the relation is significant (p<0.001). This finding is consistent with studies conducted elsewhere [23,25]. The level of COVID-19 knowledge is more in the married compared to the singles, divorced and widow; and the relation is significant (p=<0.001). This may be explained by the fact that the responsibility of the married population goes beyond themselves to care for the families which may include children and elder population who need more care to prevent COVID-19.

The level of COVID-19 knowledge increases as the educational level increases. and the relation was significant (p=<0.001). This finding is consistent with another study [23]. COVID -19 is a very Serious condition, this was more realized by the higher educated compared to those with lower education level.

Population of the western region acquired more knowledge of COVID-19 compared to other regions of Saudi Arabia (p<0.001).This may be explained that, Mecca Almokaramh is in this region, many visitors go to Umrah and Hajj, so the population feel that they are at high risk of acquiring the virus, so they tend to increase knowledge about COVID-19.

In this study the mean score of attitudes towards Covid-19 was 91.2%. This finding is in line with studies that reported positive attitude of the Saudi population towards COVID-19 [17,18,20]. Positive attitude towards COVID-19 was also demonstrated in studies conducted in Pakistan, Malaysia and Jordan [20,22,23]. The level of COVID -19 practice among the population is good (range 81.8%-88.3%). This finding is consistent with other studies conducted in Saudi Arabia and Malaysia [17,18,22].

This result showed that population with good knowledge have positive attitude (p=<0.001), this finding is consistent with Alahdal et al. [18]. In a study conducted among secondary school students in Majmaah area, Saudi Arabia the students’ attitude towards MERS-CoV was significantly associated with the disease knowledge [26].

The main source of COVID-19 knowledge in this research was the social media (Twitter) followed by the television [21,26]. Another study showed that the World health organization (WHO) and the Ministry of Health (MOH) were the main sources of COVID-19 information [18].

Conclusion

The study concluded that the level of COVID-19 knowledge of Saudi population is average and the attitude of most population is positive. Males have better knowledge and lower attitude towards COVID-19 compared to females. The level of COVID-19 knowledge increases with age and education level of the population. The married have better COVID-19 knowledge and attitude compared to the singles. Population of the western region acquired the best COVID -19 knowledge and the residents of the Northern region acquired the lease level of knowledge. Population of the southern region have the best COVID -19 attitude and those reside in the Northern region acquired the lease level of attitude towards the disease. Populations who have a higher level of COVID-19 knowledge have the positive level of attitude. The social media (Twitter) is the main source of COVID-19 information for the Saudi population.

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