The current study was conducted to assess and compare the KAP scores of different population groups with respect to COVID-19 in China. This evaluation was essential to improve protective practices for preventing COVID-19 infection among the public because no vaccine is available and no specific treatment is 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 revealed that the Chinese public has good knowledge of COVID-19, with an overall correct response rate of 91.2%. This result may be attributed to the demographic characteristics of the participants (90.3% junior college degree or higher, 57.5% medical staff, and 81.5% urban residents) because significant associations between these demographic variables and KAP towards COVID-19 were verified in the present study. This result coincides with those of other similar studies performed among public and healthcare professionals in China and abroad [10-14]. The result was expected because Chinese 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. The accuracy rate of 11 items ranged between 83.3% and 99.5%, with two items falling below this range, "family gatherings may spread infection" and "a suspected case can be ruled only out after two consecutive negative tests of respiratory pathogenic nucleic acid (at least one day apart)”. On the one hand, this result implies that the public has incomplete knowledge of COVID-19, especially regarding some professional topics, and still needs further education. On the other hand, this infectious disease has caused infection within family groups[15, 16]. 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[10, 17-19], 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[20]. 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 to prevent fear of spreading.
The majority of the public adhered to good practices with respect to COVID-19 infection, potentially because they had 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”. Perhaps the shortage of protective equipment, such as medical alcohol and chlorine-containing disinfectants, during the outbreak made it difficult to disinfect the home environment. This result suggests that during infectious disease outbreaks, 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 a factor influencing the public's grasp of COVID-19. The population younger than 32 years old (the median age of the study subjects) had less knowledge than their counterparts, which is potentially attributed to the increases in social experience and knowledge reserves with age. Marital status, education, occupation, and place of residence all had impacts on KAP. 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, have a more positive attitude, and engage in proactive protective actions. People with a college degree or above had better KAP than their counterparts. Higher degrees may correlate with broader knowledge and a stronger 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 at people with different educational levels and different needs for health education. For the less educated population, easy-to-understand publicity materials may be more effective[21]. Medical personnel had more knowledge, better attitudes, and higher 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 preventing and controlling COVID-19, the average person needs more education on knowledge regarding COVID-19 than medical staff. Compared with rural or urban residents, those living in cities had higher KAP scores, which was potentially due to the following reasons. (a) Information sources are more available and spread faster in cities, and people can obtain first-hand information quickly[22]. (b) The cultural literacy of city residents is generally higher than that of people living in rural or urban areas[23]. (c) The composition of people in the city is more complex, and the population density is high, which increases the likelihood of COVID-19 dissemination. As a result, citizens are more proactive in epidemic prevention. (d) Medical and protective supplies in cities are more abundant than in rural areas, and citizens thus have more opportunities to obtain relevant protective supplies and take protective action.
In mastering the basic knowledge on COVID-19 prevention and control, the ultimate goal is application in practice, i.e., to be able to properly take protective measures, control the roots of infection, cut off the transmission route, and protect vulnerable groups. Multiple linear regression analysis results 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[24]. Therefore, improving people’s knowledge and fostering positive attitudes towards epidemic prevention are indispensable for improving protective behaviour to fight against the COVID-19 pandemic. 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, especially for non-medical staff, people with low levels of education, and township villagers. These results can be used by health policymakers to develop more targeted policies to fight against the COVID-19 pandemic.
This study has several 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 samples was uneven, mainly including females, 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 have exaggerated 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. Last, cross-sectional studies are unable to provide evidence on causality. Therefore, the mechanisms for improving COVID-19 protection practices need to be further explored.