The survey objects of this study were rural residents in various provinces with wide coverage. The respondents included women, people of Han nationality, those with a junior high school education and below, unmarried/divorced/widowed people, farmers, people with middle-level family income, those without chronic diseases, people with no confirmed cases in their residential area, not having been to an epidemic area (such as Hubei Province in China) and having experienced the SARS epidemic. The areas were mainly related to the place where the questionnaire respondents were located or their schools. The average age of the rural residents in this study was 30.05 years old. Enterprise workers and students accounted for 70% of the total rural residents in this survey and 60% of returnees during the Spring Festival. However, during the epidemic, the state placed restrictions on personnel flow, resumed work and resumed production. Requirements such as delays in spring ploughing and home isolation for at least 14 days have a definite impact on the social economy, and enterprise workers account for more than 60% of labor-intensive industries and enterprises such as manufacturing, construction, and service industries . Students over the age of 14 are usually high school/secondary school/university/graduate students. They have the characteristics of highly concentrated personnel, extensive social connections, and collective activities. After the winter vacation, students will return to the university, and the university will soon become the main battlefield for epidemic prevention and control. Students are also one of the most vulnerable groups. Once the epidemic spreads in schools, it will affect the stability of families, schools, and society . Therefore, relevant research on the impact of the epidemic on the industry should be considered, and corresponding countermeasures should be implemented.
Rural residents’ overall knowledge, belief/attitude and practice of the prevention and control of COVID-19
According to our research results, the scores for knowledge, belief/attitude, and practice were 65.5%, 84.7%, and 65.3%, respectively. The overall knowledge and behavior of rural residents are at a medium level, and attitudes are at a high level. These achievements are related to the new edition of the COVID-19 Education Manual issued by the government, health committees, disease control centers, and university hospitals and to the publicity, education, and supervision of communities, villages, and the media. Effective risk communication in the early stages of infectious diseases, timely understanding of relevant knowledge, and attitudes and behaviors of the public are very important to reduce the negative and panic mentality caused by the epidemic, adopt targeted health education strategies and measures, and effectively prevent and control the spread of disease . This epidemiological study conducted a rapid assessment of rural residents' knowledge, beliefs and actions during the rising stage of the new crown pneumonia epidemic, which can provide a basis for the government to develop targeted health education and behavioral intervention strategies.
Analysis of COVID-19 Knowledge, Belief/Attitude, Behavioral Items and Influencing Factors among Rural Residents
This survey shows that the source of COVID-19 infection, the route of transmission, incubation period, main symptoms, time of close contact isolation and observation, and awareness rate of personal protective measures are above 70% and the score rate of 20 of the 24 protective measures is above 80%, indicating that most rural residents have better knowledge of new crown pneumonia prevention and control, which is inseparable from government departments' propaganda and education for villagers. The scoring rates for new crown pneumonia infectious diseases, susceptible populations, and transmission rates are below 60%, at 45.3%, 54.6%, and 16.2%, respectively. The reasons for these findings may be that this COVID-19 knowledge is highly specialized, and rural residents often cannot obtain COVID-19 knowledge through simple WeChat and news information. Instead, it is necessary to develop rural publicity and education methods based on the characteristics of rural populations. Systematic knowledge and practice is an area that needs to be strengthened in subsequent publicity and education work. .
Regression analysis shows that men's knowledge scores are higher than women's knowledge scores. Possible reasons are that men's information processing speed and execution ability are generally higher than women's. Due to the influence of traditional ideas (rural masculinism), rural women mainly undertake housework and have a relatively low education level. Some females have dropped out of junior high school and have poor knowledge of COVID-19 ; those with a junior high school education or below with a knowledge score lower than that of junior high school may be subject to this level of education. COVID-19 knowledge is limited in its grasp and understanding. WeChat and related news and information alone cannot make provide relevant knowledge, and it is best to have professional guidance. Farmers have lower knowledge scores than enterprise workers, students, and other occupations. This result may be due to the fact that farmers’ COVID-19-related knowledge is relatively simple. They rely mainly on the compulsory management of village/town leaders, such as not allowing clusters (e.g., playing mahjong). In addition, only 12.5% of the surveyed villages/towns had confirmed cases, which did not cause the necessary vigilance in thought or the willingness to actively acquire knowledge. Rural residents with poor household economic scores have lower knowledge scores than those with medium and high economic conditions. Residents with poor economic conditions may not pay much attention to health care and may not have the motivation to actively master knowledge. Rural residents with chronic disease have less information than those without. High knowledge scores among residents may be related to previous research reports (40% of patients with COVID-19 died of chronic diseases) . People with chronic diseases experienced preventive treatment of the disease in the early stage and were more concerned about their own body changes; 81.5% of rural residents had experienced SARS, and rural residents who had experienced SARS had higher knowledge scores than rural residents who had not experienced SARS. The possible reasons are that SARS is similar to COVID-19, and both are infectious diseases of the respiratory tract. The prevention and control measures are basically the same, so it is necessary to conduct timely drills and multi-department cooperation to allow residents to obtain epidemic-related knowledge, effectively improve the level of epidemic prevention and control of residents in rural communities, and provide security for rural residents who experience public health emergencies. Prevention and control provide effective methods. It is suggested that in the promotion of knowledge about the prevention and control of new coronary pneumonia, women, farmers, families with poor economic conditions, people with no chronic diseases, those with no confirmed cases in their villages and towns, and people who have not experienced SARS should be the key educational objects.
The analysis of information sources shows that the main way for rural residents to obtain prevention and control knowledge is the mass media, indicating that mainstream media (such as WeChat, online news platforms, and television) play a very important role in disseminating prevention and control knowledge. Studies have shown that the integrity of the early warning system and the public's timely access to information will directly affect the ability to respond to public health emergencies . Therefore, it is necessary to further strengthen the construction of modern communication network infrastructure and give full play to the active role of mainstream media in the process of disseminating news on public events and health education so that information is timely, accurate, scientific and accessible.
Seventy-eight percent of rural residents think that they and their family members may be infected. The main reasons may be the high contagion level of COVID-19 and the lack of effective treatment methods. This finding suggests that in the rising stage of the disease epidemic, timely and accurate transmission of key information to rural areas is very important to help the public through the crisis . We should continue to organize corresponding health education and publicity in a timely manner and address the concerns of rural residents according to the latest epidemic situation. More than 97% of the respondents believe that personal protection, community protection, and government decision-making are necessary for epidemic control and are willing to cooperate with the community and government's prevention and control work. This may be related to the Chinese government's high emphasis on the prevention and control of new coronary pneumonia and the restrictions imposed, including a series of measures related to personal travel in key areas and social mobilization [15-16]. A total of 98.6% of residents’ held the attitude toward edible game that they “do not eat it themselves, and they are also opposed to eating by others”. Of rural residents, 97.1% agree that the country currently has a law prohibiting the hunting, buying and selling of wild animals, which may be related to the source of the epidemic. With regard to wild animals, rural residents have a more positive attitude toward prevention and control and a stronger sense of social responsibility. This is also one of the important factors in controlling the epidemic. After two months of prevention and control cooperation, newly diagnosed cases of new coronary pneumonia in rural residents have basically not increased. This phenomenon is inseparable from the efforts of rural individuals, communities, and the government and is a positive reflection of qi and other public attitudes about new coronary pneumonia. The results are consistent . The analysis also shows that even though 98.7% of the respondents in this survey were residents of severely affected areas (Hubei Province), only 21.7% believed that they could not be infected, and 20.3% believed that their families could not be infected. This shows that village residents have a good perception of the danger of the epidemic; however, this may also have a certain impact on the public's psychology and cause panic, which needs to be further explored.
Regression analysis showed that gender, age, economic level, and experience of SARS are predictors of beliefs/attitudes. Higher information levels among males, those 30 years of age and below, and experience with the SARS epidemic indicate that the SARS epidemic response experience has a positive effect on confidence in epidemic prevention and control. Female residents who are over 30 years old and in poor economic condition should be the focus group for epidemic prevention and control.
An analysis of the items showed that 18 of the 27 behaviors had scores above 80%. Low-scoring items indicated that the implementation of infrequent prevention and control measures needs to be further strengthened, such as "eating with chopsticks or splitting meals" and "taking Chinese herbal medicine ingredients for yin, qi, spleen and lungs." Not using public chopsticks for meals may be related to the constraints of traditional Chinese concepts. Many people still think that using public chopsticks is a manifestation of distrust and mutual disapproval among people, especially when eating with family members. The Municipal Health Promotion Committee and the Office of the Shanghai Municipal Committee for the Advancement of Spiritual Civilization issued an initiative suggesting that when people have dinner, they should not forget to add chopsticks or a spoon for each dish . A total of 47.5% of rural residents always or frequently take Chinese herbal medicine to assist in health care, indicating that residents have high recognition of the preventive effect of Chinese herbal medicine .
The results of the regression analysis suggest that prevention and control interventions should be strengthened for females, people over 30 years of age, farmers, people with poor economic conditions, those with no chronic diseases, people with no confirmed cases in their rural villages, and rural residents who have not experienced SARS. During the epidemic prevention and control period, 85.6% of rural residents knew that wiping household products with alcohol or chlorine-containing disinfectant can prevent and control infection, but only 66.2% of rural residents wiped household products with alcohol or chlorine-containing disinfectant. This finding indicates that in some rural areas, residents' implementation of protective measures is not in place, and there is a risk of infection. This may be related to the lack of disinfection materials for rural residents. It is recommended that government departments reasonably allocate disinfection materials to rural areas. Of rural residents, 97.8% knew that attending parties would increase the chance of viral infection, but only 82.1% of rural residents reflected this knowledge in action. Feedback from open questions included clustering and playing mahjong; these issues require relevant epidemic prevention and control personnel. It is important to give villagers necessary knowledge in a timely manner.
Difficulties and Challenges:
The analysis and summary in this survey show that 72.4% of the residents had difficulties and challenges in epidemic prevention and control. The greatest difficulty is the lack of protective equipment (40.15%): rural residents, especially those in remote mountainous areas, purchase no masks, alcohol, or disinfectant, and rural medical workers, traffic police, and village staff on duty do not have protective clothing, such as isolation clothing and goggles. It is recommended that government departments give rural residents, especially those in remote mountainous areas, more front-line personnel when distributing protective materials. Furthermore, another issue is the inconvenience of travel (23.69%): vehicles are stopped and roads are obstructed (closed villages) and return trips are difficult (foreign residents are separated from their homes for 14 days at the destination), prompting government departments to humanely set up protective measures to close roads in closed villages and to adopt rational settings. Weak protection awareness (16.96%) is mainly reflected in the incubation period to conceal the illness. The elderly do not wear masks outside, go outside during the epidemic period, and play mahjong, and family members do not wash their hands when they return home. These findings indicate that knowledge, attitude, and behavior scores are positively correlated. To solve the problem of persuasion ineffectiveness, villagers must have a good understanding of COVID-19 to encourage them to adopt a positive attitude and correct behavior and to prevent psychological problems (5.73%). Long-term isolation and inactivity in homes will inevitably lead to boredom and panic about the disease. Villagers should be provided with appropriate psychological counseling or corresponding counselling channels during the epidemic so that they can report their mental disorders. At the same time, it is important to strengthen the rural network platform, appropriately reduce or exempt network traffic consumption, and let villagers chat with each other via video or play mahjong online, thereby reducing the chance of cross-infection.