Participants and data collection
This was a cross-sectional study conducted through an internet-based survey between 1st May and 4th May, 2020. The survey ended on 4th May 2020, which corresponds to the date on which COVID-19 related partial curfew from 06:00 to 21:00 ended in Northern Cyprus, in order to have reliable data on self-isolation and coherence to curfew measurements. As of 1st May, the total number of reported COVID-19 cases in Northern Cyprus was 108 (Turkish Republic of Northern Cyprus Ministry of Health 2020). A total of 406 citizens were included in this study. Participants were recruited via authors’ networks with local citizens living in Northern Cyprus. A recruitment poster with a link to questionnaire was posted to online pages with local COVID-19 related media as well as Facebook, emails and WhatsApp, which contained information on the background, objective, voluntary nature of participation, indications how to fill in the questionnaire as well as the declarations of anonymity and confidentiality of participants. No ethical approval was required for this survey.
Assessment of sociodemographic characteristics
The first part of the questionnaire consisted of the assessment of sociodemographic attributes in which participants responded to demographic variables including gender, age, education status, occupation, current district of residency, smoking (smoker/non-smoker), chronic disease (present/non-present) and seasonal influenza vaccination history (vaccinated/non-vaccinated).
Assessment of knowledge on COVID-19
Participants were asked to answer questions regarding the transmission routes of SARS-CoV-2 among choices including droplet, aerosol and indirect transmission (touching contaminated surfaces and then touching eyes, mouth and nose) routes or indicate if they did not know the transmission route of infection. Participants also responded to a question on the incubation period for SARS-CoV-2. Among the choices 1-2 days, 2-4 days, 2-14 days, 27 days and “I do not know the incubation period” option were present.
Assessment of WHO recommended personal protective control measures
Participants were asked to indicate which of the personal protective control measures including hand hygiene, social distance, avoiding touching nose, mouth and eyes, and use of face mask they implemented during the pandemic and the frequency of implementation for each measure. For each option, the scale was designed as always, sometimes, rarely and never. Participants also responded to a question which assessed their coherence to the curfew imposed by the local government, outside of their working hours, with a scale of always, generally, rarely, and never.
The application of personal protective equipment by ordinary citizens was evaluated. Individuals were asked to indicate which PPE they used in public areas such as supermarkets, with choices including gloves, surgical masks, vented masks, cloth masks, wrap/scarf, face shield, goggles, and “I do not use any PPE”. Participants were also assessed if they applied hand hygiene before and after PPE use, and if they adhered to social-distancing rules while wearing face masks.
Assessment of hand hygiene events per day
Questions were designed to evaluate the hand hygiene measures applied by citizens. Individuals were initially asked which products they use when they apply hand hygiene and selected from various options including water, soap and water, alcohol-based hand sanitizer, pure alcohol, cologne with at least 70% alcohol content, wet tissues or “I do not use any products”. The number of hand hygiene events per day was also evaluated. Participants reported the mean number hand hygiene events based on soap and water and alcohol-based hand sanitizers per day.
Assessment of the availability of personal protective equipment during the pandemic
As the use of PPE and application of hand sanitation can be affected by their availability in a local town or city, participants were asked to report their access to these products during the pandemic. Participants responded to questions for the availability of masks, gloves and hand sanitizers with a scale of always, generally, rarely and never for each product.
Assessment of the attitude towards healthcare facilities during the pandemic
The citizens were asked if, during the pandemic, they felt any reservation from visiting hospitals or any healthcare facility where they responded as yes or no. Additionally, participants were asked if they would go for a COVID-19 test in a mobile test center in a hospital carpark without leaving their car for which they responded as yes or no.
Assessment on the source of COVID-19 related information
In this survey, the use of reliable source of personal protective procedures as well as the source of COVID-19 related updates by participants were evaluated. Individuals were asked to choose among World Health Organization, Turkish Republic of Northern Cyprus Ministry of Health, Turkish Republic of Northern Cyprus Medical Association, newspapers, TV and social media for the most commonly used source of personal protective procedures. Citizens also indicated the most commonly used sources of COVID-19 related updates among scientific articles, TV, radio, internet sites, newspapers, brochures/flyers, social media, family/friends/relatives and WhatsApp group.
Statistical analyses were performed using IBM SPSS Statistics for Windows, version 23 (IBM, Japan, Tokyo, Japan). Knowledge and attitudes and practices of different individuals according to demographic characteristics were compared with independent samples t test or Chi-square test as appropriate. Binary linear regression analysis using demographic variables as independent variables and knowledge or practices as the outcome variable was conducted to identify factors associated with attitudes and practices. P value 0.05 or less was considered significant.