COVID-19 awareness among the public in Saudi Arabia

Ahad Al-Somali ¹

*Correspondence to: Ahad Al-Somali,

Copyright

© 2023 Ahad Al-Somali. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 23 June 2023

Published: 01 July 2023

Abstract

Introduction: In December 2019, COVID-19 was publicly announced as a global pandemic. The Saudi government has taken preventive and precautionary measurements against it that can significantly limit the spread of infection. However, public commitment is influenced by the level of knowledge, attitude, and practice (KAP). This study aims to assess the level of (KAP) in the Saudi population towards COVID-19 pandemic.

Method: A cross-sectional study was conducted from 15th of January 2021 to 11th of February 2021 to assess (KAP) among the population of Saudis via an online self-reported questionnaire. The questionnaire was made available through social media. Data were analyzed using IBM® SPSS®, and ANOVA (F-test) was used to compare mean values for (KAP), p-value of ≤ 0.05 was considered significant. This research was applied to Institutional Review Board to acquire ethical approval.

Result: Our study involved 1679 participants. The findings show that participants aged between 43-50 years showed a higher level of knowledge, attitude, and good practice (p=0.016, p<0.001, and p=0.003, respectively). Postgraduate reported higher knowledge (p=0.031); however, respondents with elementary school education showed higher practice (p=0.051). Participants who had income between 16000 and 25000 reported a higher level of knowledge (p=0.002), participants who had income between 11000 and 15000 reported a higher level of attitude (p<0.001). Governmental sector workers showed higher knowledge (p=0.002) and attitude (p<0.001) levels.

Conclusion: This study provides evidence that most of Saudi Arabia's population has sufficient knowledge and good practice. However, a more negative attitude was found. This study emphasized that a higher level of education and adequate income are positively associated with increased public awareness regarding COVID-19 disease.

Keywords: COVID-19, KAP, Knowledge, Attitude, Practice, awareness, Saudi Arabia

Introduction

In December 2019, COVID-19, which is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China. It is a highly contagious virus that causes progressive respiratory symptoms, and it can lead to severe complications, including organ failure [1][2][3]. Moreover, it is mostly asymptomatic or generally has an incidence of symptoms that include dry cough, fever, dyspnea, and fatigue. In a short time, it spread all over the world and became a global concern. Due to the rapid spreading of the virus globally, Saudi Arabia implemented proactive precautionary measures to prevent the virus from reaching the country.

Despite these initial efforts, Saudi Arabia confirmed its first case of COVID-19 on the 2nd of March 2020, and the numbers of confirmed positive cases escalate. Immediately, a stricter precaution has been implemented to contain the virus from an outbreak. [4][5] These measures include curfews, lockdown, and travel restrictions [6]. Besides, the government started encouraging public health protocols that involve practicing social distancing, proper hand hygiene or sanitizing, and staying at home. Although these measures are significant, pandemic management's success or failure depends on the public's commitment to country regulations, and effective pandemic management requires support from the population.

Unfortunately, all the implementations have resulted in fear and created a physiological reaction. Thus, a lesson learned from the SARS outbreak is that knowledge, attitude, and practice are associated with anxiety, panic, and mental health issues. Therefore, it will affect the measures taken to contain the spread of disease and the population behavior. [7].

Nevertheless, spreading awareness for such measures and increasing the level of knowledge is essential to improve people’s adherence to protective measures [8]. To spread knowledge about the disease, Saudi Arabia utilized different platforms to raise awareness. Moreover, evidence showed that social media plays a significant role in people's awareness. It is a powerful tool if used correctly to change behavior and improve health awareness among the public during COVID-19 pandemic [9]. Twitter was used by ministers, physicians, healthcare providers, and academics to answer people’s concerns. [10].

Therefore, a common tool used to quantify and analyze data is knowledge, attitudes, and practices (KAP) study. In this crisis, KAP plays an essential role in recognizing people's behavior toward COVID-19 [11].

It provides baseline information that helps understand the level of awareness, And It provides better insight into poor KAP regarding COVID-19. Consequently, determining the intervention required to control the spread of infection, realizing the gap, and improving public campaigns.

In order to stand against the pandemic, useful information must be provided. Our study was conducted to determine and assess the KAP of the Saudi population towards COVID-19. It also looks for the association between socio-demographic factors and the population behavior related to disease prevention.

We are expecting that the majority of participants are aware of COVID-19. We also predict that the level of knowledge, attitude, and practice will be noticeably varying among the population. The findings are also expected to provide information that will influence the population's behavior.

Methodology

This is a cross-sectional study conducted from 15th of January 2021 to 11th of February 2021 among the general population of Saudi Arabia. Data were collected using an online google form; the questionnaire was based on a previously published study, Knowledge, Attitude, and Practice toward COVID-19 among Egyptians [12]. The local ethical committee approved the questionnaire (IRB-UGS-2020-03-438). The link was made available to the participants through social media. This study aimed to assess public awareness and commitment to preventative measures. The inclusion criteria were Saudi residents aged between 18 and 65. All participants agreed on being part of this study, and informed consent was obtained before starting the questionnaire.

The survey consists of four primary sections, (1) demographic information, (2) Knowledge of COVID-19, (3) Attitude toward the pandemic, and (4) Practice of preventive measurements questions. Demographic data were considered as independent variables. While the level of knowledge, attitude, and practice were considered as a dependent variable. The answers were scored from high to low values, with a higher score denoting a satisfactory level of knowledge, positive attitude, and good practice. Data were statistically analyzed using IBM® SPSS® Statistics software version 26. ANOVA (F-test) was used to compare mean values for knowledge, Attitude, and Practice scores.

Results

A total of 1679 participants were included in this study, disturbed as (73.3%) females and (26.3%) males. The majority of the sample (59.9%) were between the age of 18 and 25 years. Participants from the eastern region represented (85.9%) of the total sample. (74.3%) of the participants were undergraduates. Students represented (49.4%) of the sample. Income was >5000 SR for the majority of the participants (62.6%). [Table 1].

(99.2%) of the respondents heard of COVID-19 and (94.7%) reported that a virus causes it. The main reported modes of transmission were cough and sneezing (97.2%), infected hands (70.6%), and infected surface (68.7%). The majority of the respondents reported fever (92.7%) and dry cough, and difficulty in breathing (92.1%) as the symptoms of COVID-19, diarrhea, no fever, and lack of knowledge were reported by (46.6%),(4.5%), and (2.6%) respectively. Regarding COVID-19 vaccine availability and seasonal influenza vaccine protection against COVID-19, (77.9%) reported that there is a vaccine for the disease, and (68.7%) reported that the seasonal influenza vaccine could not protect from COVID-19. [Table 2].

The knowledge section showed that (98.8%) of the participants think that crowding and gatherings are the reason behind increasing COVID-19 cases. Read for disease containment, (53.2%) believe that the disease will be contained soon, while (18.3%) think that it will not, and (28.4%) did not know. (45.6%) of the respondents were afraid of COVID-19; however, (47.9%) were not. [Table 3].

To evaluate the attitude, seven questions were asked. Only (10.5%) of the respondents tested positive for COVID-19; however, (3.5%) were not aware if they had the infection or not. When feeling sick, (53.1%) believe that the best behavior is to consult the physician by telephone, (34.5%) think it is better to stay at home, and (12.4%) prefer to consult a physician at the clinic. (95.8%) of the participants are committed to the country's institutions to limit the disease [Table 4].

Regarding the population practice, (51.8%) of the respondents had sufficient knowledge [Figure 1], (39%) had a positive attitude [Figure 2], and (51.2%) reported good practice. [Figure 3]. Participants aged between 43-50 years showed a higher level of knowledge, attitude, and good practice (p=0.016, p<0.001, and p=0.003, respectively). Postgraduate reported higher knowledge (p=0.031); however, respondents with elementary school education showed higher practice (p=0.051). Participants who had income between 16000 and 25000 reported a higher level of knowledge (p=0.002), participants who had income between 11000 and 15000 reported a higher level of attitude (p<0.001). Governmental sector workers showed higher knowledge (p=0.002) and attitude (p<0.001) levels. [Table 5]

Discussion

This cross-sectional study was conducted to evaluate the level of KAP among the public in Saudi Arabia towards COVID19. KAP can significantly influence the public adherence to preventative measures and regulations enforced by the government, which is vital to contain the pandemic [12]. A study conducted in Havana, Cuba, concluded that in case of an increase in knowledge, the attitudes toward disease prevention would improve and subsequently related practices [13]. A variety of socio-demographic characteristics were considered in an attempt to guide future awareness campaigns. Given this, our study included 1679 participants, and the findings indicated that the respondents have good knowledge about COVID-19 and good practice [Figure 1][Figure 3]. However, they showed a negative attitude towards the pandemic [Figure 2].

Significant predictors of knowledge and practice in this study were age, educational level, and income level. These findings were not surprising. It is possible to have since most participants were between the age of 18-25 years (59.9%) [Table 1]. This could be attributed to the fact that the majority reported that social media was their primary source of information on COVID-19 (76.6%) [Table 2]. Our study findings show that COVID-19 knowledge, attitude, and practice are differed by socio-demographic factors. The participant with groupage from 43-50 years and the postgraduate had a Significant impact on knowledge and practice. This can be explained by the fact that they are more involved in COVID-19 campaigns. They are aware of the preventive measure presented in social media that disseminates knowledge [15]. It is also due to the better understanding by the highly educated group.

We also found that participants with high income (>16000 SAR) have high KAP about COVID-19 (p=0.002, p<0.0001, and p=0.013, respectively). This agrees with the previously mentioned study in Havana, Cuba, that reports that there is a direct association higher level of knowledge was detected among participants aged between 43 to 50 years, postgraduate, participants with income between 16000 to 25000 SAR, and governmental sector workers. Meanwhile, good practice was reported among the same age group as with the higher level of knowledge and participants with elementary school education. The negative attitude was significantly associated with participants aged 18 to 25 years, high school education participants, students, and participants with income below 5000 SAR. This study emphasized that a higher level of education and sufficient income are positively associated with an increase in the level of public awareness regarding COVID-19 disease.

References

1. Shereen, M.A., Khan, S., Kazmi, A., Bashir, N. and Siddique, R., 2020. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of advanced research, 24, pp.91-98.

2. Ali, M., Uddin, Z., Banik, P.C., Hegazy, F.A., Zaman, S., Ambia, A.S.M., Siddique, M.K.B., Islam, R., Khanam, F., Bahalul, S.M. and Sharkar, M.A., 2020. Knowledge, attitude, practice and fear of COVID-19: A cross-cultural study. medRxiv.

3. Dariya, B. and Nagaraju, G.P., 2020. Understanding novel COVID-19: its impact on organ failure and risk assessment for diabetic and cancer patients. Cytokine & growth factor reviews.

4. Alahdal, H., Basingab, F. and Alotaibi, R., 2020. An analytical study on the awareness, attitude, and practice during the COVID-19pandemic in Riyadh, Saudi Arabia. Journal of infection and public health, 13(10), pp.1446-1452.

5. Obied, D.A., Alhamlan, F.S., Al-Qahtani, A.A. and Al-Ahdal, M.N., 2020. Containment of COVID-19: the unprecedented response of Saudi Arabia. The Journal of Infection in Developing Countries, 14(07), pp.699-706.

6. Nurunnabi, M., 2020. The preventive strategies of COVID-19 pandemic in Saudi Arabia. Journal of Microbiology, Immunology, and Infection.

7.  Tao, N., 2003. An analysis on reasons of SARS-induced psychological panic among students. Journal of Anhui Institute of Education, 21(2), pp.78-9.

8. Al-Hanawi, M.K., Angawi, K., Alshareef, N., Qattan, A.M., Helmy, H.Z., Abudawood, Y., Alqurashi, M., Kattan, W.M., Kadasah, N.A., Chirwa, G.C. and Alsharqi, O., 2020. Knowledge, attitude and practice toward COVID-19among the public in the Kingdom of Saudi Arabia: a cross-sectional study. Frontiers in Public Health, 8.

9.  Al-Dmour, H., Salman, A., Abuhashesh, M. and Al-Dmour, R., 2020. Influence of social media platforms on public health protection against the COVID-19pandemic via the mediating effects of public health awareness and behavioral changes: integrated model. Journal of medical Internet research, 22(8), p.e19996.

10. Algaissi, A.A., Alharbi, N.K., Hassanain, M. and Hashem, A.M., 2020. Preparedness and response to COVID-19in Saudi Arabia: Building on MERS experience. Journal of infection and public health.

11. du Monde, M., 2012. THE KAP SURVEY MODEL (KNOWLEDGE, ATTITUDES, & PRACTICES) CONTENT SUMMARY.

12. Kasemy, Z.A., Bahbah, W.A., Zewain, S.K., Haggag, M.G., Alkalash, S.H., Zahran, E. and Desouky, D.E., 2020. Knowledge, Attitude and Practice toward COVID- 19among Egyptians. Journal of epidemiology and global health, 10(4), p.378.

13. Castro, M., Sánchez, L., Pérez, D., Sebrango, C., Shkedy, Z., & Van der Stuyft, P. (2013). The relationship between economic status, knowledge on dengue, risk perceptions and practices. PLoS One, 8(12), e81875.

14. Tanveer, M., Bhaumik, A., Hassan, S. and Ul Haq, I., 2020. Covid-19 pandemic, outbreak educational sector and students online learning in Saudi Arabia. Journal of Entrepreneurship Education, 23(3), pp.1-14.

15. Al-Mohrej, O. A., Al-Shirian, S. D., Al-Otaibi, S. K., Tamim, H. M., Masuadi, E. M., & Fakhoury, H. M. (2016). Is the Saudi public aware of Middle East respiratory syndrome?. Journal of infection and public health, 9(3), 259-266.