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Public Knowledge, Attitudes, and Practice Towards COVID-19 Pandemic in Saudi Arabia: a Web-Based Cross-Sectional Survey

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Public Knowledge, Attitudes, and Practice Towards COVID-19 Pandemic in Saudi Arabia: a Web-Based Cross-Sectional Survey medical sciences Article Public Knowledge, Attitudes, and Practice towards COVID-19 Pandemic in Saudi Arabia: A Web-Based Cross-Sectional Survey Ali Hassan A. Alnasser 1,*,† , Jaffar A. Al-Tawfiq 2,3,4,† , Mohammed Sheker H. Al-Kalif 5,6 , Rubayyi Faris B. Shahadah 7 , Khawlah Saad A. Almuqati 8 , Bashayer Sulaiman A. Al-Sulaiman 9, Khulud Khalid S. Alharbi 10,11 , Fatimah Yousef M. Alabbad 12 , Jamilah Yousf M. Alabbad 13, Ibrahim Abdulrahman I. Alquwaiz 14 and Ibrahim Khalil I. Almashama 15 1 Department of Laboratory, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran 31942, Saudi Arabia 2 Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia; jaltawfi@yahoo.com 3 Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA 4 Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA 5 College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; [email protected] 6 Technical and Vocational Training Corporation, Riyadh 11472, Saudi Arabia 7 Citation: Alnasser, A.H.A.; College of Dentistry, Taibah University, Madinah 42313, Saudi Arabia; [email protected] 8 King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh 11211, Saudi Arabia; Al-Tawfiq, J.A.; Al-Kalif, M.S.H.; [email protected] Shahadah, R.F.B.; Almuqati, K.S.A.; 9 First Health Cluster in Eastern Province, Dammam 31444, Saudi Arabia; [email protected] Al-Sulaiman, B.S.A.; Alharbi, K.K.S.; 10 College of Applied Medical Science, Umm Al-Qura University, Makkah 21955, Saudi Arabia; Alabbad, F.Y.M.; Alabbad, J.Y.M.; [email protected] Alquwaiz, I.A.I.; et al. Public 11 The Panuska College of Professional Studies, The University of Scranton, Scranton, PA 18510, USA Knowledge, Attitudes, and Practice 12 Department of Orthopedic Surgery, Dammam Medical Complex, Dammam 31463, Saudi Arabia; towards COVID-19 Pandemic in [email protected] 13 Saudi Arabia: A Web-Based Department of Pediatrics, Anak General Hospital, Qatif 31911, Saudi Arabia; [email protected] 14 Cross-Sectional Survey. Med. Sci. College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; [email protected] 2021, 9, 11. https://doi.org/ 15 College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; 10.3390/medsci9010011 [email protected] * Correspondence: [email protected] Academic Editor: Antoni Torres † These authors contributed equally to this work. Received: 11 December 2020 Abstract: (1) Background: COVID-19 has become a worldwide public health problem. No previous Accepted: 9 February 2021 study has investigated factors associated with COVID-19 knowledge, attitude, and practice (KAP) Published: 16 February 2021 after completely lifting the curfew in all Saudi Arabia regions and cities. Therefore, adequate knowledge, a positive attitude, and correct control of COVID-19 are essential to eradicate the disease. Publisher’s Note: MDPI stays neutral Hence, this study aims to assess factors associated with KAP of COVID-19; (2) Methods: This with regard to jurisdictional claims in cross-sectional web-based survey was performed with the participation of 4305 individuals aged published maps and institutional affil- over 15 years living in Saudi Arabia from 11 to 19 August 2020. They were included using the iations. snowball sampling method; (3) Results: Of the 4305 participants, 94.9% were Saudis, 60% females, and 45.4% were in the age group of 20–34 years, 61.7% married, and 49.3% from the Eastern Province of Saudi Arabia. Most of the participants demonstrated good KAP levels (89.6%, 87.2%, and 87.2%) towards the COVID-19 pandemic, respectively. In addition, most of the participants (85.8%) used Copyright: © 2021 by the authors. the internet and social media as a source for COVID-19 information (4) Conclusions: The finding Licensee MDPI, Basel, Switzerland. showed that most of the participants demonstrated good knowledge of COVID-19, positive attitudes, This article is an open access article and demonstrated good practices for preventing the spread of disease infection. distributed under the terms and conditions of the Creative Commons Keywords: the coronavirus disease 2019; SARS-CoV-2; 2019-nCoV; awareness; public awareness; Attribution (CC BY) license (https:// public practice; social distancing; preventive measures; perception; COVID-19; social media; KAP creativecommons.org/licenses/by/ 4.0/). Med. Sci. 2021, 9, 11. https://doi.org/10.3390/medsci9010011 https://www.mdpi.com/journal/medsci Med. Sci. 2021, 9, 11 2 of 12 1. Introduction Coronaviruses (CoVs) are respiratory viruses and belong to a large family of RNA viruses known for more than 55 years [1]. Moreover, these viruses affect a wide variety of hosts and result in a wide range of disease severity from the common cold to more deadly disease [1]. Recently, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) emerged and caused high mortality [2]. At the end of December 2019, in Wuhan city, China, a cluster of acute respiratory disease cases caused by an unknown pathogen was reported [2,3]. Subsequently, the virus was identified as a novel coronavirus on 7 January 2020 [3] and was designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease was called Coronavirus disease 2019 (COVID-19) [3]. SARS-CoV-2 causes a wide range of symptoms from dry cough, fever, shortness of breath, and fatigue [4–6]. The SARS-CoV-2 virus remains on surfaces for a few hours to several days, depending on the environmental conditions [7]. SARS-CoV-2 has caused outbreaks in hospitals and led to increased morbidity and mortality rates [1]. Globally, on 13 February 2021, there were a total of 107,686,655 con- firmed cases of COVID-19, including 2,368,571 deaths [8]. The Kingdom of Saudi Arabia is the largest country in the Arabian Gulf region and has a population of more than 34 million. Initial COVID-19 cases in this area were travel-related cases from travelers from Iran and Iraq to Bahrain and Kuwait [9,10]. Similarly, the first COVID-19 case in Saudi Arabia was reported in Qatif, Eastern Province, in a returning traveler [9,11]; that case was reported on 2 March 2020 [3]. Saudi Arabia took multiple interventions to prevent the spread and transmission of SARS-CoV-2, such as canceled mass gatherings, schools’ closure, and limiting Hajj pilgrimage, curfew, and lockdown of localities with increased transmission [9–11]. As of 13 February 2021, in Saudi Arabia, there were 372,073 confirmed cases of COVID-19 with 6,424 deaths [8]. Misconceptions about infection prevention and treatment persist among the public. They are limited studies exploring knowledge, attitudes, and practices (KAP) among the general population during the COVID-19 pandemic in the Middle East and Saudi Arabia. To our knowledge, there are two studies [2,7] from Saudi Arabia on KAP among citizens and residents, conducted during curfews and city closures. In one of these studies, most of the included population had high knowledge, optimistic attitudes, and good practices [2]. Another study showed KAP of COVID-19 was related to educational level [7]. An ad- ditional study showed a similar finding, and there were multiple myths as well [12]. A recent study showed that 93.7% of the surveyed population in Saudi Arabia were aware of asymptomatic carriers and that the majority were aware of preventive measures [13]. Other studies about KAP in relation to COVID-19 in Saudi Arabia were related to health- care workers and not the general population. In addition, there is no previous research investigating factors associated with COVID-19 KAP after lifting the country-wide curfew of the Kingdom of Saudi Arabia. Therefore, we conducted this study of KAP after lifting these measures and compared the results with previous studies of the COVID-19 KAP. 2. Design and Methods 2.1. Study Area, Design, and Period This web-based cross-sectional survey was conducted over nine days from 11 August to 19 August 2020, several weeks after the complete lifting of curfew in all regions of Saudi Arabia. 2.2. Study Participants This snowball sampling study targeted adult citizens and Saudi Arabia residents aged 15 years or over who were in Saudi Arabia during the COVID-19 pandemic. 2.3. Questionnaire Design The questionnaire was planned to evaluate the KAP of the Saudi MOH guidelines for awareness and prevention of the COVID-19 pandemic. The questionnaire was intended Med. Sci. 2021, 9, 11 3 of 12 to identify opportunities for improvements in COVID-19 awareness, assess the practices that potentially contribute to the persistence of COVID-19 in Saudi Arabia, and assess the community’s attitudes towards the COVID-19 pandemic. The study’s authors team developed a questionnaire of 20 closed-ended type questions with multiple choice answers. The questionnaire was available in both English and Arabic languages. The questionnaire has five parts. The first part was about the participant’s sociode- mographic data and has seven items (Nationality, Gender, Age, Marital status, Place of living, Educational level, Occupational status). The second part has four items and as- sessed knowledge about the COVID-19 pandemic. Each item had multiple choices with correct choices and other incorrect choices. These questions included the most affected groups, typical symptoms of COVID-19, the most common modes of transmission of the SARS-CoV-2 virus, and the needed self-protection measures to reduce the possibility of COVID-19 infection. The third part has four items about the attitude towards the COVID-19 pandemic. Attitudes’ items have a 5-point Likert scale with a positive direction assessing the attitude of participants to the following: reducing the number of pilgrims during the Hajj season will reduce the number of COVID-19 cases, the need to wear face masks to protect themselves from COVID-19 infection, COVID-19 will be successfully controlled, and individuals are committed to the precautions set by the Ministry of Health.
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