Study design and subjects’ selection
We modified and expanded a specially-designed questionnaire provided by researchers from Chest Department, Assuit University hospital. This survey was conducted by sending electronic questionnaire to minimize personal contact during the outbreak between 1st April and 12th April, 2020.
Sampling was done by sending the electronic surveys to a representative stratified random sample of 1500 adults at Assuit governate, Egypt. The study was approved by the Faculty of Medicine Ethics Committee, Assiut University. The objectives of the study were explained to subjects before enrollment. Their voluntary participation was documented with their written consent on the first page of the questionnaire. Data collection took place over two weeks during the outbreak of (2019-nCoV).
The questionnaire used was partially adapted from previously published studies [7,8]. The authors included additional questions related to the (2019-nCoV) outbreak.
The structured questionnaire considered the following questions: (1) demographic data; (2) precautionary measures against (2019-nCoV) in the past 14 days; (3) self-health evaluation and the psychological impact during (2019-nCoV) outbreak; (4) knowledge and concerns about (2019-nCoV); and (5) appraisal of crisis management.
Basic demographic questions included age, gender, education level, marital and employment status.
The first part of the survey, we addressed the precautionary measures against (2019-nCoV) in the past 2 weeks before the interview based on a scale from 1 (Always) to 5 (Don't know). This part discussed washing hands, covering mouth when sneezing or coughing, using soap or disinfectants, wearing mask in public areas, using serving utensils for shared food, avoiding public places (e.g. restaurants), and washing hands after touching objects.
We constructed a composite index indicating the total number (from 0 to 8) of preventive measures taken. A dichotomous indicator of preventive behavior was calculated based on the mean number of precautions taken (4.65): “low” (<5) versus “high” (>6).
The next part of the survey composed of 3 sets dealt with the respondents’ perception of their own health.
The first set covered seven physical health complaints over the previous 2 weeks. We created a composite index of symptoms by adding all instances of health complaints.
The second set of survey assessed level of anxiety using General Anxiety Disorder 7-item (GAD-7) scale . It is a 7 item questionnaire was developed that asked patients how often, during the last 2 weeks, they were bothered by each symptom. Response options were “not at all,” “several days,” “more than half the days,” and “nearly every day,” scored as 0, 1, 2, and 3, respectively. The total anxiety score was divided into (0–4) = minimal anxiety, (5–9) = mild anxiety, (10–14) = moderate anxiety, and >14 = severe anxiety). The scale had an Alpha reliability coefficient of 0.824.
The third set addressed respondents’ risk perception in terms of their likelihood of contracting (2019-nCoV) and survival if diagnosed with the disease. Scores were 4 (very likely) to 0 (don’t know). On the basis of the average score (3.4; standard deviation [SD] 0.11), we created a dichotomous variable to contrast respondents who believed they were susceptible to contracting (2019-nCoV) (scores 3 and 4) with those who did not (scores 0–2).
III-Knowledge of (2019-nCoV):
We also administered basic questions on (2019-nCoV) mode of transmission. Responses were scored 0 (incorrect) or 1 (correct); a composite index indicated the number of correct answers, from none correct (0) to all three correct (3).
In addition, we asked about various sources of this information; Internet; social media as Facebook and Whats app, WHO web sites, official statements by radio and television, family member, or others.
IV-Appraisal of Crisis Management:
We addressed respondents’ appraisal of crisis management. Five questions carried out (Alpha reliability 0.813) to assess opinions on information distribution. Scores were 1 (very negative) to 6 (very positive). On the basis of the mean score (4.83; SD 0.617), we calculated a dichotomous index: negative appraisal (scores <4.7) versus positive appraisal (scores >4.8).
Finally, we evaluated the public’s acceptance of quarantine regulations. The scores were dichotomized into “agreement” (1) versus “no agreement” and “don’t know” (2).
All statistical analyses were conducted using SPSS, version 21 (IBM Inc., Armonk, NY, USA). Quantitative measurement was expressed by medians and qualitative variables were presented as absolute frequency and percentage. Factor analysis examined trends among four factors ((nCoV-2019) prevention, perception of self-health, knowledge of (nCoV-2019), and perception of health authorities’ crisis management). Logistic regression was used to calculate the odds ratio (OR) with a 95% confidence interval in order to identify predictors for greater adoption of the recommended precautionary measures (defined as at least five of the eight specified strategies). P values of less than 0.05 were regarded as statistically significant.