Characteristics of the study population
The total number of participants in the study who completed the questionnaire was 1540. The mean age of study participants was 22 years (median: 21 years, interquartile range (IQR): 20-22 years). Females predominated the study population (n=1145, 74.4%) and the majority were Jordanians (n=1386, 90.2%). Undergraduate students comprised 89.5% (n=1378) of the study participants and 43.1% (n=664) were students at Health Schools, with highest participation from the School of Dentistry (n=259, 16.8%), while the lowest number was from the School of Law (n=4, 0.3%, Supplementary File 2). The highest number of study participants reported a household monthly income of 500-1000 JDs (n=646, 41.9%). The vast majority of participants were single (n=1440, 94.1%, Table 1) and spent the last two weeks of curfew with their families (n=1407, 91.7%).
Knowledge of COVID-19 transmission, prevention and control
Regarding knowledge on signs and symptoms of the disease, fever was the most frequent sign to be correctly identified by the participants (n=1500, 97.4%) followed by shortness of breath (n=1448, 94.0%) and cough (n=1309, 85.0%).
For possible transmission routes of the virus, touching infected surfaces (fomites) was the most common route to be correctly identified (n=1485, 96.4%) followed by coughing and sneezing (n=1325, 86.0%). Close contact in crowded places was missed as a potential route of transmission in 21.0% of the participants (n=324). Transmission via blood was incorrectly identified by 17.8% of the participants (n=274).
Of the eight protective and control measures that were asked in the survey, the majority of participants precisely identified all protective measure (n=1193, 77.5%) and an additional 134 participants missed only a single protective measure out of the eight items in the survey (8.7%), followed by 85 participants who missed two items (5.5%).
Regarding the current lack of an effective vaccine against SARS-CoV-2, the vast majority of participants provided a correct answer (n=1433, 93.1%). In addition, the majority of participants identified the useless effect of antibiotics in treating COVID-19 (n=1365, 88.6%). Summer heat ability to inactivate the virus was incorrectly reported by 40.3% of the study participants (n=621).
Attitude towards COVID-19
Regarding the attitude of the participants towards the perceived danger of the disease, the majority reported that COVID-19 is moderately dangerous (n=1079, 70.1%) and 428 participants reported that the disease is very dangerous (27.8%). Males were more likely to report that COVID-19 is very dangerous compared to females (38.6% vs. 24.1%, p<0.001; χ2, Table 2). Jordanian participants had a significantly higher likelihood to report that the disease is very dangerous compared to their non-Jordanian colleagues (28.5% vs. 21.2%, p=0.020; χ2, Table 2). Participants with families of lower income were more likely to feel that COVID-19 is very dangerous compared to those with higher income (38.0% vs. 22.1%, p<0.001; χ2, Table 2). Higher level of anxiety was found more frequently among participants who felt the disease is more dangerous as estimated using anxiety scores (mean anxiety score of 8.1 among those who reported the disease as moderately dangerous, as opposed to mean anxiety score of 9.2 among those who reported that COVID-19 is very dangerous, p<0.001; K-W, Figure 1). Correlation of age, level of study, marital status and belief in conspiracy regarding the origin of the virus with perception of COVID-19 danger did not result in statistically significant differences (Table 2). The vast majority of participants followed the government-issued quarantine measures (n=1506, 98.2%). Married participants were less likely to adhere to quarantine measures compared to single students (7.1% vs. 1.5%, p=0.001; χ2). In addition, male participants were less likely to adhere to quarantine measures compared to females (3.3% vs. 1.2%, p=0.007; χ2). Also, postgraduate students were more likely to break the quarantine measures (3.7% vs. 1.5%, p=0.047; χ2).
Correlation of COVID-19 knowledge to different variables
The overall knowledge regarding the disease and the virus among the participants was generally high with 9.5 as the mean K-score. Older age was associated with higher level of knowledge (mean K-score: 9.7 vs. 9.3, p<0.001; t-test). Postgraduate students had higher mean K-score compared to their undergraduate counterparts (9.7 vs. 9.5, p=0.035; M-W). The highest mean K-score was found among students at Health Schools followed by the Scientific Schools, while the lowest mean K-score was found among the Humanities Schools (9.8 vs. 9.4 vs. 9.1, p<0.001; K-W). Higher mean K-score was observed among those who felt that COVID-19 is very dangerous compared to those who felt that the disease is moderately dangerous, however, without statistical significance (p=0.150; K-W). For gender, marital status, nationality and family income, no statistically significant differences were found as well.
The level of knowledge about COVID-19 was lower among participants who believed that the disease is part of a conspiracy, compared to those who did not have such a belief (mean K-score: 9.0 vs. 9.7, p<0.001; M-W). In addition, the mean K-score showed a gradual decrease going from those who denied the existence of conspiracy to those who answered maybe, and ending in participants who had such a belief (mean K-score: 9.0 vs. 9.5 vs. 9.7; p<0.001; K-W, Figure 2).
Anxiety level in relation to other variables
For the whole study population, the mean anxiety score was 8.4 (median=8.0, IQR (5.0-12.0)). Males showed lower level of anxiety compared to females (mean anxiety scores: 7.7 vs. 8.6, p=0.002; M-W). Higher level of anxiety was found among participants with the lowest monthly income as compared to the other two groups (8.9 vs. 8.3 vs. 8.1, p=0.043; K-W, Supplementary File 2). In addition, higher level of anxiety was also noticed among non-Jordanians, however, without statistical significance (mean anxiety score: 9.2 vs. 8.3, p=0.068; M-W). Nevertheless, significantly higher level of anxiety was found among non-Jordanian females compared to their Jordanian counterparts (mean anxiety score: 10.0 vs. 8.5; p=0.011; M-W, Supplementary File 2).
Anxiety scores were significantly higher among the study participants who believed that COVID-19 is the result of a global conspiracy compared to those who denied such a belief (mean anxiety score: 9.0 vs. 7.7, p=0.004; M-W). In addition, a gradual increase in the level of anxiety was observed moving from a mean score of 7.7 among those who did not believe in the role of conspiracy, to a mean score of 8.6 among those who answered maybe, and reaching the highest mean score of 9.0 among those who had such a belief (p=0.001; K-W, Figure 3). On the other hand, no significant differences in anxiety scores were observed for study level, Schools, nationalities and conditions of living during the quarantine.
Association of belief in conspiracy with other variables
The total number of participants who stated that COVID-19 is not part of a conspiracy was 518 representing 33.6% of the study population. On the other hand, 16.4% of the participants stated that they believe in the role of conspiracy in the origin of the disease (n=253), and those who answered maybe represented 49.9% of the study population (n=769).
Upon comparing different variables depending on whether the participants had a belief that COVID-19 is part of a global conspiracy or not, we found that females were more inclined to have such a belief compared to males (36.3% vs. 23.8%; p=0.001; χ2 test). Those with lower income had higher likelihood to believe that the disease is the result of a global conspiracy (74.6% answered yes or maybe among participants with income <500 JD, compared to 59.0% who answered yes or maybe among participants with income >1000 JD, p<0.001; χ2 test). In addition, the participants who believed in conspiracy had higher tendency to believe that there is a vaccine for COVID-19 (8.2% vs. 4.4%, p=0.001; χ2 test), and to believe that the disease can be treated with antibiotics (13.7% vs. 6.8%, p<0.001; χ2 test). Also, those who believed either entirely or indicated a possibility of conspiracy had the doubtful belief that summer heat will inactivate SARS-CoV-2 (45.8% vs. 29.5%, p<0.001; χ2 test). Level of study, nationality and living conditions during the quarantine did not have statistically significant differences in relation to belief in conspiracy.
Sources of information regarding COVID-19
Regarding the most frequent sources of information about the disease and the virus that were reported by the students, the Jordanian Ministry of Health (MoH) website was the most frequent one (n=1018), followed by television programs and news releases (n=918), social media (n=913), medical doctors (n=684), scientific journals (n=462) and the UJ websites (n=362). The WHO website was the most frequent reported source of information mentioned in the “others” option (n=18). The majority of students reported more than one source of information about the pandemic (n=1238). For social media platforms, Facebook was the most frequent source of information (n=911), followed by Instagram (n=283), WhatsApp (n=270) and Twitter (n=209).