Knowledge, Attitude, Practice, and Associated Factors Regarding the Novel Coronavirus Disease 2019 (COVID-19) Pandemic

Figures & data

Table 1 Lists of the Studies Done on Knowledge and Associated Factors Regarding COVID-19

Authors	Study Features							Major Finding
	SS	Sampling Technique	Participants	Study Designs	Instrument	Period	Country
Abdelhafiz et al^Citation14	559	Convenient	Unmedical worker	CS survey	OQ	After FCR	Egypt	The level of knowledge was good, with a mean score of 16.39 out of 23.
								Significantly lower among older age, less educated, lower income, and rural residents
Afzal et al^Citation15	1004	Voluntary	Residents	CS survey	OQ	After FCR	Pakistan	50.1% had knowledge of human-to-human transmission, 46.6% has seen COVID-19 patient, and 54.7% did not know that physical contact is the main cause of infection spread, while 45.3% were aware of it.
Akalu et al^Citation16	404	Consecutive	Chronic disease patients	CS study	IQ	After FCR	Ethiopia	33.9% of them had good knowledge towards the COVID-19 pandemic.
								Age, educational status of cannot read and write, rural residence, and monthly income were factors significantly associated with poor knowledge.
Al-Hanawi et al^Citation17	3388	Voluntary	Population	CS study	OQ	After DOO	Saudi Arabia	Most of the participants were knowledgeable about COVID-19, with a mean score of 17.96 (SD=2.24, range=3–22).
Azlan et al^Citation18	4850	Voluntary	Residents	CS survey	OQ	After DOO	Malaysia	77.2% had an acceptable level of knowledge about COVID-19 with an average knowledge score of 10.5 (SD=1.4, range=0–13).
Bhagavathula et al^Citation19	453	Voluntary	HCWs	CS study	WBQ	After FCR	Globally	They had poor knowledge about COVID-19 transmission (61%) and symptom onset (63.6%).
								Age and profession were factors associated with inadequate knowledge.
Ferdous et al^Citation20	2017	Voluntary	Population	CS survey	OQ	After DOO	Bangladesh	48.3% of them had more accurate knowledge regarding COVID-19.
								Factors like age and residence were significantly associated with knowledge.
Geldsetzer^Citation21	2986 US & 2988 UK	Voluntary	Residents	CS survey	OQ	After FCR	U.S & U.K	They had good knowledge of the main mode of transmission and common symptoms of COVID-19.
Giao et al^Citation22	327	Systematic	HCWs	CS study	SAQ	After FCR	Vietnam	The majority (88.4%) of them had good knowledge about COVID-19, with a mean score of 8.17±1.3 (range=4–10).
Alzoubi et al^Citation23	592	Voluntary	University students	CS study	OQ	After FCR	Jordan	A positive response of the overall knowledge about the symptoms of COVID-19 was observed in more than 90% of the students, with a mean score of 0.81±0.15.
Hussain et al^Citation24	114	Voluntary	PHCP	CS study	OQ	After DOO	Pakistan	The majority (90.7%) of them had knowledge towards COVID-19, with a mean score of 12.7±0.89 (range=0–14).
Zhong et al^Citation25	6910	Voluntary	Residents	CS survey	OQ	After FCR	China	The overall correct rate of the knowledge was 90%, with a mean score of 10.80.
								Knowledge scores were significantly different across genders, age-groups, categories of marital status, education levels, and residence places (P<0.001).
Lau et al^Citation26	2090	Voluntary	Income-poor households	CS study	IQ	After FCR	Philippines	89.5% identified coughing and sneezing as a transmission route, and 72.6% recognized transmission route was indirect hand contact. 82.2% identified hand washing, 32.4% identified social distancing, and 40.6% avoiding crowds as preventive measures.
Taghrir et al^Citation27	240	Voluntary	Medical students	CS study	OQ	After FCR	Iran	79.6% of them had high, 13.8% of them had moderate, and 6.7% of them had low level knowledge towards COVID-19.
Moro et al^Citation28	2046	Voluntary	Hospital staff	CS survey	OQ	After FCR	Italy	There was good knowledge on control measures. The mean of correct answers on general aspects of epidemic was 71.6% for HCWs and 61.2% for non-HCWs. A mean of correct answers on patient management was 57.8% among HCWs.
Haque et al^Citation29	2045	Voluntary	Population	CS survey	OQ	After DOO	Bangladesh	More than half (54.87%) of them had good knowledge towards COVID-19.
								Knowledge was significantly diverged across age, gender, educational levels, residences, income groups, and marital status.
Nemati et al^Citation30	85	Voluntary	Nurses	CS study	WBQ	After FCR	Iran	56.5% of nurses had good knowledge about sources, transmission, symptoms, signs, prognosis, treatment, and mortality rate of COVID-19.
Olum et al^Citation31	136	Voluntary	HCWs	CS study	OQ	After DOO	Uganda	69% of the HCWs had sufficient knowledge towards COVID-19.
								Age >40 years and news media were factors associated with knowledge (P<0.05).
Reuben et al^Citation32	589	Snowball	Population	CS survey	OQ	After DOO	Nigeria	The majority (99.5%) of them had good knowledge about COVID-19.
Roy et al^Citation33	662	Snowball	Population	CS study	OQ	After DOO	India	They had a moderate knowledge about COVID-19 and adequate knowledge about its preventive aspects. 29.5% of them answered that a virus spreads through multiple modes like touching, kissing, sneezing, and food, 43% regarded COVID-19 as highly contagious. 97% acknowledged that washing hands frequently could stop the spread of infection, and 18.2% regarded fever as a symptom of COVID-19.
Rugarabamu et al^Citation34	400	Random	Residents	CS survey	OQ	After DOO	Tanzania	84.4% of them had good knowledge about COVID-19.
								Educational level was significantly associated with good knowledge (P=0.001).
Saqlain et al^Citation35	414	Voluntary	HCWs	CS survey	OQ	After DOO	Pakistan	93.2% of HCWs had good knowledge about COVID-19.
Shi et al^Citation36	311	Voluntary	Medical staff	CS survey	OQ	After FCR	China	89.51% of them had good knowledge towards COVID-19.
Wolf et al^Citation37	630	Voluntary	Adults with chronic conditions	CS survey	IQ	After DOO	U. S	53.6% of them reported that infected persons will have only mild symptoms, 14.2% reported that an infected person will die of COVID-19, 71.7% correctly identified three symptoms, and 69.8% identified the ways to prevent infection.
Zhang et al^Citation38	1357	Voluntary	HCWs	CS survey	SAQ	After FCR	China	89% showed sufficient knowledge. Doctors’ show a higher knowledge score (38.56±3.31) than nurses (37.85±2.63) and paramedics (36.72±4.82).
Papagiannis et al^Citation39	461	Convenient	HCPs	CS study	IQ	After FCR	Greece	The majority (88.28%) of them had a good level of knowledge towards COVID-19.

Abbreviations: HCWs, healthcare workers; PHCPs, primary healthcare providers; HCPs, healthcare professionals; US, United States; UK, United Kingdom; OQ, online questionnaire; IQ, interviewer questionnaire; CS, cross-sectional; WBQ, web-based questionnaire; SAQ, self-administered questionnaire; SS, sample size; FCR, first case report; DOO, declaration of outbreak.

Table 2 The List of the Studies Conducted on Attitude and Associated Factors Towards COVID-19

Authors	Study Features							Major Findings
	SS	Sampling Technique	Participants	Study Designs	Instrument	Period	Country
Abdelhafiz et al^Citation14	559	Convenient	Unmedical workers	CS study	OQ	After FCR	Egypt	The majority of them had a positive attitude towards different preventive measures.
Afzal et al^Citation15	1004	Voluntary	Residents	CS study	OQ	After FCR	Pakistan	93.0%, 57.1%, and 42.9% of them showed a positive attitude for the requirement of masks and hand sanitizers, treatment facilities, and vaccination campaigns, respectively.
Akalu et al^Citation16	404	Consecutive	Chronic disease patients	CS study	IQ	After FCR	Ethiopia	36.1% perceived that they have a moderate risk of infection, 28.7% reported that they undertook high care to prevent it, 52.54% reported being infected with the virus was highly threatening of chronic disease patients, and 51.7% of them perceived that practicing a physical distance is very difficult.
Alahdal et al^Citation40	1767	Voluntary	Residents	CS study	OQ	After DOO	Saudi Arabia	The majority (95%) of them had a high attitude. 99.77% agreed staying at home helps to reduce the spread of the virus, 99.89% agreed isolating infected people can help to limit the spread of disease, 97.51% agreed stopping schools and universities can reduce the spread of the virus, 96.38% agreed closure of malls can reduce the spread of the virus, and 96.49% agreed stopping traveling between cities can control the spread of the disease.
Al-Hanawi et al^Citation17	3388	Voluntary	Population	CS study	OQ	After DOO	Saudi Arabia	They had optimistic attitude towards COVID-19, with a mean score of 28.23 (SD=2.76, range=6–30).
Azlan et al^Citation18	4850	Voluntary	Residents	CS survey	OQ	After DOO	Malaysia	83.1% of them agreed that COVID-19 would successfully be controlled.
								The attitude of successfully controlling COVID-19 was significantly associated with age group, region, and occupation.
Ferdous et al^Citation20	2017	Voluntary	Population	CS survey	OQ	After DOO	Bangladesh	The majority (62.3%) of them had a positive attitude towards COVID-19.
								Older age, higher education, employment, monthly family income (>30,000 BDT), and having more frequent prevention practices were factors significantly associated with a positive attitude.
Giao et al^Citation22	327	Systematic	HCWs	CS study	SAQ	After FCR	Vietnam	The majority of them had a positive attitude towards COVID-19, with a mean score of 1.86±0.43 (range=1–5).
Alzoubi et al^Citation23	592	Voluntary	University students	CS study	OQ	After FCR	Jordan	99.7% agreed that hand washing is necessary for prevention of infection, 68.4% believed that mask wearing would prevent the infection, 20.6% and 19.2% believed antibiotics and smoking to be a protective measure against the infection, respectively.
Hussain et al^Citation24	114	Voluntary	PHCP	CS study	OQ	After DOO	Pakistan	The majority (90%) of them had a positive attitude towards COVID-19 infection, with a mean score of 8.9±4.1.
Zhong et al^Citation25	6910	Voluntary	Residents	CS survey	OQ	After FCR	China	The majority (90.8%) of them had an optimistic attitude towards COVID-19.
								The attitude towards the final success in controlling COVID-19 was significantly different across genders, educational levels, occupation categories, and residence places (P<0.05).
Khader et al^Citation41	368	Randomly	Dentists	CS study	OQ	After FCR	Jordan	55.2% dentists reported that COVID-19 symptoms often resolve with time and do not require any special treatment, 74.7% dentists believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease transmission, and 82.6% dentists reported that they prefer to avoid working with a patient with a suspected case of COVID-19.
Lau et al^Citation26	2090	Voluntary	Income-poor households	CS study	IQ	After FCR	Philippines	49.4% said they would contact a barangay health worker or seek health advice elsewhere, 43.6% indicated they would visit a public hospital, and 34.4% consider visiting a rural health unit if they exhibited symptoms like a fever, cough, or sore throat.
Haque et al^Citation29	2045	Voluntary	Population	CS survey	OQ	After DOO	Bangladesh	The attitudes of respondents regarding COVID-19 were unimpressive.
Olum et al^Citation31	136	Voluntary	HCWs	CS study	OQ	After DOO	Uganda	21% of the HCWs had a positive attitude towards COVID-19.
Reuben et al^Citation32	589	Snowball	Population	CS survey	OQ	After DOO	Nigeria	79.5% of them had a positive attitude towards the adherence of government IPC measures with 92.7%, 96.4%, and 82.3% practicing social distancing/self-isolation, improved personal hygiene, and using a face mask, respectively.
Roy et al^Citation33	662	Snowball	Population	CS study	OQ	After DOO	India	Above 96% of them agreed to quarantine/isolate themselves if they had a fever and cough, 98% thought social distancing is essential to stop the virus from spreading, 88.7% of them considered traveling within the country to be safe during the pandemic, and 60% believed that patients recovered from COVID-19 infection should not be allowed to stay within the community at this time.
Rugarabamu et al^Citation34	400	Randomly	Residents	CS survey	OQ	After DOO	Tanzania	The majority (96%) of them had a positive attitude. They agreed that COVID-19 will finally be successfully controlled.
Saqlain et at.^Citation35	414	Voluntary	HCWs	CS survey	OQ	After DOO	Pakistan	The majority of the HCWs had a positive attitude (mean=8.43, SD=1.78)
Shi et al^Citation36	311	Voluntary	Medical staff	CS survey	OQ	After FCR	China	77.17% of them had a positive attitude. They were willing to care for patients suffering from COVID-19.
Wolf et al^Citation37	630	Voluntary	Adults of chronic conditions	CS survey	IQ	After DOO	U. S	24.6% of them said that they were very worried about getting the coronavirus, 12.9% were not worried at all, 50.4% were worried about COVID-19 and influenza the same, and 42.6% were more worried about getting COVID-19.
Zhang et al^Citation38	1357	Voluntary	HCWs	CS survey	SAQ	After FCR	China	More than 85% of them feared self-infection with virus
Papagiannis et al^Citation39	461	Convenient	HCPs	CS study	IQ	After FCR	Greece	84.8% had a positive attitude towards the prevention of COVID-19 infection.
								Knowledge score was significantly associated with attitudes score (P=0.011).

Abbreviations: HCWs, healthcare workers; PHCP, primary healthcare providers; HCPs, healthcare professionals; US, United States; UK, United Kingdom; OQ, online questionnaire; IQ, interviewer questionnaire; CS, cross-sectional; WBQ, web-based questionnaire; SAQ, self-administered questionnaire; SS, sample size; SD, standard deviation; IPC, infection prevention and control.

Table 3 The List of the Studies Conducted on Practice and Associated Factors Towards COVID-19

Authors	Study Features							Major Findings
	SS	Sampling Technique	Participants	Study Designs	Instrument	Period	Country
Afzal et al^Citation15	1004	Voluntary	Residents	CS survey	OQ	After FCR	Pakistan	55.9%, 43.4%, and 68.6% of them had exposure to unknown people, met people with an international travel history, and their work include public dealing, respectively. 85.5% of them wash hands frequently, 59.8% wash hands before eating, and 92.6% wash hands after coming home. 50.5% covers face when sneezing or coughing, and 92.8% of them practiced maintaining a safe physical distance.
Akalu et al^Citation16	404	Consecutive	Chronic disease patients	CS study	IQ	After FCR	Ethiopia	25.9% of them had a good practice towards COVID-19.
								Marital status of unmarried, educational status; cannot read and write, and read and write, rural residence, monthly income of less than the mean, and poor knowledge were found to be significantly associated with poor practice at P<0.05.
Alahdal et al^Citation40	1767	Voluntary	Residents	CS study	OQ	After DOO	Saudi Arabia	Generally, 81% of them presented with adequate practice regarding COVID-19.
Al-Hanawi et al^Citation17	3388	Voluntary	Population	CS study	OQ	After DOO	Saudi Arabia	Overall, they had good practice towards COVID-19, with a mean score of 4.34 (SD=0.87, range=0–5).
Azlan et al^Citation18	4850	Voluntary	Residents	CS survey	OQ	After DOO	Malaysian	83.4% of them were taking precautions such as avoiding crowds, 87.8% of them practices proper hand hygiene in the week before the movement control order started, and the wearing of face masks was less common in 51.2% of them.
Ferdous et al^Citation20	2017	Voluntary	Population	CS survey	OQ	After DOO	Bangladesh	55.1% had more frequent practices regarding COVID-19 prevention, 98.7% of them wore a face mask in crowded places, 98.8% of them agreed to report a suspected case to health authorities, and 93.8% of them implemented washing hands with soap and water.
								More frequent prevention practice factors were associated with female sex, older age, higher education, family income>30,000 BDT, urban area residence, and having more positive attitudes.
Alzoubi et al^Citation23	592	Voluntary	University students	CS study	OQ	After FCR	Jordan	96.8% of them do avoid hand shaking, 98.8% of them wash their hands, 93.3% of them use alcoholic rub, 95.8% of them cough or sneeze in a tissue and dispose it in waste bin, 51% of them will drink ginger with honey, and 42.7% of them eat garlic for infection prevention.
Hussain et al^Citation24	114	Voluntary	PHCP	CS study	OQ	After DOO	Pakistan	The mean practice score of participants toward COVID-19 was 7.3±1.2, which suggests that overall COVID-19 preventive practices were good.
Zhong et al^Citation25	6910	Voluntary	Residents	CS survey	OQ	After FCR	China	96.4% of them had not visited any crowded place, and 98.0% of them wore masks when going out.
Lau et al^Citation26	2090	Voluntary	Income-poor households	CS study	IQ	After FCR	Philippines	89.9% them applied hand washing as a preventive practice to COVID-19, 62.9% of them reported that they now avoided crowded places because of COVID-19, 40.6% selected avoiding large crowds as a preventive measure against the virus, 32.4% of them selected social distancing as an option, and 28.0% of them reported wearing face masks as a response to the virus.
Taghrir et al^Citation27	240	Voluntary	Medical students	CS study	OQ	After FCR	Iran	The majority (94.2%) of them had a high performance in preventive behaviors.
Haque et al^Citation29	2045	Voluntary	Population	CS survey	OQ	After DOO	Bangladesh	Generally, the practice of respondents towards COVID-19 was unimpressive.
Olum et al^Citation31	136	Voluntary	HCWs	CS study	OQ	After DOO	Uganda	74% of the HCWs had a good practice towards COVID-19.
Reuben et al^Citation32	589	Snowball	Population	CS survey	OQ	After DOO	Nigeria	90.2% of them reported social distancing/avoiding crowd, 78.8% of them reported avoiding handshakes, and (74.4%) of them reported avoiding face kissing as the practices to reduce the spread of COVID-19.
Rugarabamu et al^Citation34	400	Randomly	Residents	CS survey	OQ	After DOO	Tanzania	77% of them had not visited any crowded place, 80.0% of them wore masks when going out, and 98% of them correctly identified that COVID-19 is transmitted by respiratory droplets and also factors such as chronic illnesses and obesity can lead to a serious case.
Saqlain et at.^Citation35	414	Voluntary	HCWs	CS survey	OQ	After DOO	Pakistan	88.7% of the HCWs had good practice regarding COVID-19.
Zhang et al^Citation38	1357	Voluntary	HCWs	CS survey	SAQ	After FCR	China	89.7% of them had good practice towards COVID-19.
Papagiannis et al^Citation39	461	Convenient	HCPs	CS study	IQ	After FCR	Greece	24.9% reported that they washed their hands before and after contact with the patient/patient’s environment.
								Knowledge score was significantly associated with practices score (P<0.001).

Abbreviations: HCWs, healthcare workers; PHCP, primary healthcare providers; HCPs, healthcare professionals; US, United States; UK, United Kingdom; OQ, online questionnaire; IQ, interviewer questionnaire; CS, cross-sectional; SAQ, self-administered questionnaire; SS, sample size; SD, standard deviation; FCR, first case report; DOO, declaration of outbreak.

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