Since the first confirmed case announced in Yemen on 10th April 2020, in Ash Shihr, (a port city in the Hadhramaut Province of southern Yemen), rising fear and anxiety extended to other provinces from the possibility of contracting COVID-19 and its outbreak. The HCPs as the front line of defence and older people were the most vulnerable in contracting COVID-19 that the majority of other people. During this time, there was also a critical shortage of PPE given the current conflict in the region, and civil unrest in the country [14]. Equally important was the need during this period to understand the level of preparedness of HCPs’ in order to cope with the outbreak of COVID-19 in the country. This fact motivated the need to undertake the current study aiming to explore the level of knowledge, attitude, anxiety, and preventive behaviours among HCPs towards the outbreak of COVID-19 in the country.
The findings have shown that while the majority of respondents (60.0%) had never attended COVID-19 training courses with respect to COVID-19, most (69.80%) had acquired an adequate level of knowledge about the outbreak of the virus. On the other hand, the four (4) statements reflecting the importance of wearing face masks in the community, having to wear N95 face masks only during intubation, suction, bronchoscopy, and cardiopulmonary resuscitation, the possibility to treat the disease using antiviral drugs and antibiotics as first-line treatment scored the lowest at 69.9%, 68.8% 28.47% and 27.3%, respectively. This result possibly highlights the need to direct more attention toward developing educational courses and programmes related to COVID-19.
Likewise, the adequate level of knowledge among the respondents could be attributed to their educational level since most (73.0%) of respondents held a bachelor’s degree or higher, (i.e. a master’s degree). Accordingly, an educated professional group such as this could help to collect knowledge of COVID-19 from a variety of information sources. Moreover, the results also showed that only (20.0%) of HCPs gained information about COVID-19 from the official websites of the Ministry of Public Health and Population and WHO. This suggests that health authorities should direct more attention towards encouraging HCPs to use official websites as an essential and credible source of information about COVID-19. Likewise, 57.1% of HCPs seemed to use social media and news media as the main source of information, which is a significant concern given the reliability of this information. This is because utilising such media can mislead HCPs by spreading fabricated and unverified information. It is also worth highlighting that the respondents’ level of knowledge was only statistically significantly different according to their age, occupation, and educational level.
Furthermore, these results are consistent with the results of a previous study [20] which reported that the level of knowledge towards COVID-19 differs significantly across different age groups, educational levels, and levels of different professions. The results are also in line with the results of Giao et al. [9] and Saqlain et al. [21] regarding the difference in the level of respondents’ anxiety based on their profession. Concerning the level of respondents’ attitude, it was found to differ based on the participants’ occupations significantly. This corroborates with a study by Giao et al. [9], which reported a significant association between respondents’ attitude and their occupation.
However, in contrast, the result seems in differ from the results of Saqlain et al. [21] and Rahman and Sathi [20], who stated that a positive attitude toward COVID-19 did not significantly vary nor differ across different occupations. Equally, the results revealed that the respondents’ level of anxiety was significantly different based on their gender and educational levels. These results support the findings reported by Al-Hanawi et al. [22] that respondents’ level of worry or concern attributed to COVID-19 differs significantly across gender and educational level. This result is also in line with previous studies [23, 24] carried out in China, indicating that females have higher levels of anxiety compared to males.
Similarly, the respondents’ level of self-reported preventive behaviour significantly differed according to their gender, occupation, years of working experience, and educational level. These results are in agreement with the results by Rahman and Sathi [20] on the variation of respondents’ preventive behaviour according to different age groups, Al-Hanawi et al. [25] regarding the gender of respondents, Saqlain et al. [21] regarding the respondents’ years of working experience and Khasawneh et al. [26] about the respondents’ educational level.
With respect to the attitude of the respondents’, the result showed that 85.10% of respondents had an optimistic attitude towards COVID-19, though unfortunately, the findings also revealed that 75.1 % believe that they avoid infection, and close to 29.4% of respondents were willing to relocate to protect themselves from COVID-19. This result suggests that most of the respondents were either confident of protecting themself from the virus or unaware about the nature of COVID-19 how contagious it is. Similarly, one-third of respondents would look to leave their work and relocate for fear of infection, which contributed to the shortage of HCPs if the situation was to become more serious, i.e. rising infections.
Accordingly, based on the results and the information presented above, it is imperative given the seriousness of the issue that training courses and awareness programmes be created on COVID-19 and disseminating such information via official websites. Regarding the high level of optimism and attitude of respondents in the current study, this could also be explained, at this stage, by the limited number of cases reported in Yemen, and the adequate level of knowledge they had gained since the outbreak of the virus, and until this research study was conducted.
According to Roy et al. [2], adequate awareness often leads to optimistic attitudes, which could positively affect the preparedness of HCPs to address pandemic issues. Furthermore, the results of the current study showed a positive correlation between the respondents’ knowledge and their attitude, which could support this conjecture. Moreover, the findings of the current study are consistent with a study by Giao et al. [9], that healthcare workers had a high level of knowledge and a positive attitude towards COVID-19. These findings are also in line with the results of a cross-sectional study conducted among Saudi health college students [27], which revealed that more than half of the students had a positive attitude towards MERS-CoV.
Concerning the respondents’ level of anxiety, the results indicated that nearly half (51%) of the respondents had a moderate level of anxiety and 27.70% had a high level of anxiety regarding the COVID-19 outbreak. According to Roy et al. [2], fear and anxiety within a population are usually expected given the significant impact of the pandemic on the community, which could also affect the mental well-being of people and influence their behaviour in the wider community. In this study, only 27.7% of the respondents exhibited a high level of anxiety concerning COVID-19, which could possibly be attributed to their level of knowledge given they were still experiencing the first wave of the virus COVID-19. Interesting, the current study indicated lower anxiety level results compared to other studies that were carried out during the outbreak as reported by Huang and Zhao [28] on Chinese healthcare workers and Nemati et al. [29] on Iranian nurses. In these studies, the results showed that the level of anxiety among healthcare workers was higher compared to other people. The high anxiety level among the HCPs could be attributed to the uncontrolled nature of the pandemic and concerns of becoming infected, particularly given the shortage of healthcare institutions and PPE.
Concerning the self-reported preventive behaviours, it was found that the majority (87.70%) of respondents had a high-performance level of preventive behaviours towards COVID-19, which could be attributed to the having an adequate level of knowledge and awareness among the respondents towards COVID-19. As reported in a previous study, those who had acquired adequate knowledge exhibited optimistic attitudes and appropriate, it not proactive practices toward COVID-19 [30]. Another study revealed that the level of good or sound knowledge in a given population about COVID-19 is significantly reflected in their behaviour and attitude [2].
However, the findings from the current study were seemingly lower than a study conducted during COVID-19 by Taghrir et al. [18] on medical students in Iran finding that 94.2% of the respondents showed relatively high-performance in preventive behaviours toward COVID-19. According to the results of this study, females were found to exhibit a higher-performance-level in preventive behaviours compared to their male counterparts, possibly due to their better compliance in preventive measures towards COVID-19. This result is consistent with the result by Taghrir et al. [18] that females demonstrated more precautionary behaviours compared to males.
Notwithstanding, another key result in this study was of the positive linear correlation between knowledge-attitude, knowledge-anxiety, knowledge-preventive behaviours, attitude-anxiety, attitude-preventive behaviours, and anxiety-preventive behaviours. This result confirms the relationship between the respondents’ level of knowledge and their level of anxiety, attitude, and preventive measures towards COVID-19. Such a correlation could be explained by the Theory of Reasoned Action (TRA) [31], which states that a person’s intention to carry out a specific behaviour is determined by their attitude towards this behaviour.
In the current study, the findings are in line with the results of other studies [20, 30, 32] showing that acquiring a good level of knowledge of COVID-19 is correlated with optimistic attitudes and proper practices towards COVID-19. However, in contrast, the results of this study disagree with the results by Nemati et al. [29] in which they found that most Iranian nurses displayed their anxiety and that of their families as a result of COVID-19 though the knowledge they had acquired about COVID-19 to be sufficient. Lin et al. [24] found that the level of knowledge of COVID-19 did not influence anxiety levels. However, they found that higher levels of attitude were highly associated with high levels of anxiety.
Furthermore, in a study carried out in Hong Kong by Leung et al. [33], the results revealed that the level of anxiety during the SARS outbreak was highly associated with behavioural responses such as wearing face masks. In a separate study by Roy et al. [2], they revealed that people’s level of anxiety correlated with their behaviour. The results showed that under the effect of rumours, people tend to modify their behaviour positively compared to an undesirable one. Reuben et al. [20] also reported the relationship between respondents’ attitudes and their preventive behaviours. Regarding the relationship between the respondents’ attitudes and their preventive behaviour, Rubin et al. [34] conducted a study during the swine flu outbreak, reporting a significant association between the respondents’ attitude and their behavioural change (e.g. performing one or more avoidance behaviours).
Nevertheless, several limitations were inherent in this study which should be addressed for future research. The first limitation concerns the nature of collecting the data. The data in this study were collected via a web-based survey since it was not possible to conduct a face-to-face survey among Yemeni HCPs during given the uncertainty surrounding the outbreak of the virus and level of contagious. Therefore, the data may be seen as being less reliable having less accountability compared to face-to-face interviews and the lack of a trained interviewer. Secondly, collecting the data was challenging, given the availability of respondents and cooperation. Thirdly, the exclusiveness of the study to HCPs. Therefore, future research should involve a more diverse community or population, employing a community-based study design.