The current study was conducted to assess and compare the knowledge, attitudes and practices of different population groups with respect to COVID-10 in China. This evaluation was essential to improve protective practices for preventing COVID-19 infection among the public because there is no vaccine available and no specific treatment being offered against the disease at present. In our study, 2,136 people participated, and the response efficiency was 100%.
The results of this study showed that the Chinese public has good knowledge of COVID-19, with an overall correct response rate of 91.2%, which is coincident with other similar studies published earlier[12–16]. This result was expected because governmental offices at all levels have released relevant education materials in a timely manner and have delivered COVID-19-related content through various channels, including television, the Internet, WeChat, and publicity boards, since the outbreak began. Except for the two items "Family gatherings may spread infection" and "A suspected case can only be ruled out after two consecutive negative tests of respiratory pathogenic nucleic acid (at least one day apart)”, the accuracy rate of the remaining 11 items was between 83.3% and 99.5%. On the one hand, this implies that the public has incomplete knowledge of COVID-19, especially regarding some professional knowledge, and still needs further education. On the other hand, this infectious disease has caused infection within family groups[17, 18]. Hence, health authorities should further increase publicity to raise public awareness of the disease.
In the present study, participants showed extremely positive attitudes towards COVID-19. A total of 99.7% of the public paid close attention to the development of the epidemic situation, 98.0% thought they played an important role in controlling the epidemic, 94.7% believed that the outbreak would soon be contained, and 99.7% expressed willingness to cooperate with the relevant departments to take prevention and control measures. The results are similar to those of other published studies[12–15], likely because the Chinese government at different levels has attached great importance to the epidemic and adopted strict prevention and control measures in a timely manner against the disease after the outbreak[19]. In addition, with the COVID-19 pandemic and media reports, the Chinese public understands the severity of the epidemic. Therefore, they desire to actively participate in epidemic prevention and control. In addition, 97.5% of the public expressed fear of infection for themselves and their families, indicating that health authorities should continue to organize corresponding health education and publicity in a timely manner to prevent fear from spreading.
The majority of the public adhered to good practices with respect to COVID-19 infection. This may be because the public has good COVID-19 knowledge and a positive attitude, which ultimately translates into good practice. However, the least common practice among participants was “Home environment disinfection”. It may be that during the outbreak, the shortage of protective equipment, such as medical alcohol and chlorine-containing disinfectants, made it difficult to disinfect the home environment. This result suggests that during the outbreak of infectious diseases, government departments should try their best to provide sufficient supplies of protective equipment so that the public can take protective actions.
Further analysis found that age was an influencing factor of the public's grasp of COVID-19. The population younger than 32 years old (the median age of the study subjects) had poorer knowledge than their counterparts. This may be due to the increase in social experience and knowledge reserves with age. Marital status, education, occupation, and place of residence all had an impact on knowledge, attitudes, and practices. Married people had a better grasp of knowledge, more active protective attitudes, and higher adherence rates to protective behaviours than unmarried, divorced, or widowed individuals. This may be because married people have the responsibility of caring for their families in addition to self-protection. Therefore, they tend to learn more about protection, take a more positive attitude, and engage in proactive protective actions. People with a college degree or above had better knowledge, attitudes and practices than their counterparts. It may be that the higher the degree one has, the broader one’s knowledge and the stronger one’s learning ability, making it easier to grasp the relevant knowledge regarding COVID-19, adopt a protective attitude and be more positive. It has been suggested that health education should be targeted to people with different educational levels and with different needs for health education. For the less educated population, easy-to-understand publicity materials may be more effective[20]. Medical personnel had higher knowledge, attitude, and behaviour scores than non-medical respondents, because medical personnel generally have a college degree or higher and have received more professional medical training. Hence, in the process of the prevention and control of COVID-19, the average person needs more education on COVID-19-related knowledge than medical staff. Compared with rural or urban residents, those living in cities had higher scores for knowledge, attitudes, and practices. The possible reasons are as follows. (a) Information sources are more available and spread faster in cities, and people can obtain first-hand information quickly[21]. (b) The cultural literacy of city residents is generally higher than that of people living in rural or urban areas[22]. (c) The composition of people in the city is more complex, and there is high population density, which increases the likelihood of COVID-19 dissemination. As a result, citizens are more proactive in epidemic prevention. (4) Medical and protective supplies in cities are more abundant than in rural areas, so citizens have more opportunities to obtain relevant protective supplies and take active protective action.
In mastering the basic knowledge on COVID-19 prevention and control, the ultimate goal is to be able to apply it in practice, that is, to be able to properly take protective measures, control the roots of infection, cut off the transmission route, and protect vulnerable groups. The results of multiple linear regression analysis showed that knowledge, attitude, occupation, education level, and place of residence were the main factors affecting the public's protective behaviour. According to the KAP model, knowledge is the basis and attitude is the driving force of behaviour change[23]. Therefore, improving people’s knowledge and fostering positive attitudes toward epidemic prevention are indispensable for improving protective behaviour. Moreover, this result indicates that it is necessary to take targeted measures to improve people’s protective behaviour effectively based on their profession, education level and area of residence.
This study has two limitations. First, while we conducted this non-random sampling online survey involving 30 provinces or municipalities by convenience sampling, nearly 80% of the respondents came from Guizhou Province, and the composition of the sample was uneven, mainly including medical staff (who have a high education level), city residents and young people. Therefore, the generalizability of the research results has certain limitations. In addition, this study was based on self-reported information about knowledge, attitudes and practices with respect to COVID-19. It is possible that participants looked up the answers before answering some of the questions, which may exaggerate the accuracy rate of COVID-19 knowledge. To alleviate this bias, we made the questionnaire anonymous and emphasized anonymity during the survey, and we stressed the importance of answering questions honestly before completing the questionnaire.