Intending to understand the perception and attitude, particularly, with regard to communication on COVID-19 prevention and control, and thereby contribute to improving the outcomes of efforts at preventing the spread of COVID-19 and maximizing the benefits of vaccination, this descriptive survey employed an online-based sampling method. A look at the representation of the participants showed a bias for persons with tertiary education (Table 1). This implies that the views analysed in this report are of those with the ability and capacity to seek further information, and who are most likely able to better understand most of the information on COVID-19 as well as verify and identify misinformation and disinformation.
Additionally, it is reasonable therefore to expect that the levels of knowledge, perceptions, and attitudes particularly on communication on COVID-19 prevention and control of such persons will be the high-end among the populace in Ghana. In other words, although arguable, it is expected that the general populace will not have levels of knowledge higher than determined in this study nor have perceptions and attitudes that may be better than determined in this study.
With these limitations and assumptions in mind, the levels of knowledge on the cause (97.6%) and symptoms (Table 3) were expected to be as high as was determined given that education and sharing of information on the COVID-19 pandemic had been going on for a little over a year. This correlates with the findings of a study carried out in Nigeria among 589 participants, where a majority (99.5%) of them had good knowledge about COVID-19 . Furthermore, it can be deduced from this study that the levels of knowledge on all the symptoms of the disease were at least adequate. Comparing this to an earlier study conducted in Ghana among a specific group of health professionals , difficulty in breathing was similarly the most and appropriately known symptom; (WAI of 1.7 on a scale of 2 to -2 for this study and WAI of 4.7 on a scale of 1 to 5 for the other study). However, the levels of knowledge on some of the symptoms were lower in the other studies. This may be because the respondents in this study are at the high-end of the level of knowledge and/or that there has been an improvement in knowledge gained over time between the two studies. Additionally, the fact that difficulty in breathing was the prevalent symptom may explain the commonly stated perception held by some section of Ghanaians that the disease does not exist because they do not see people present with dyspnea and needing ventilators similar to what they observe in countries in Europe and the USA and China. That is to say, if the most known symptoms (difficulty in breathing and dry cough) are rarely observed, then the virus may not be present, which is the faulty logic of that perception.
The findings as presented in Figure 1 show a low level of testing, 25.0% and correspondingly a lower level of active cases and recovery. However, it remained unclear how the prevalence of COVID-19 cases is relatively very low in most African countries including Ghana. However, what is of interest in our data is the extent to which those who have recovered, and those who had active cases at the time of the survey were uncertain about their symptoms. It may be intuitive that as much as 65.0% of those who were negative would be uncertain about their symptoms, however, the fact that those who had an active case and those who had recovered indicated that they were not certain about their symptoms at the time of the survey may imply one of the two possibilities. Firstly, because the prevalent symptoms (as indicated in Table 3) were not common among those they had, and also because the common symptoms in Ghana were less known and non-specific; the respondents were not associating these with COVID-19. Secondly, this may be suggestive of the level of asymptomatic cases circulating in the country, which our finding suggests being between 29.0% and 40.0%.
The study’s next interest was to determine the extent to which non-COVID-19 protocol related perceptions were held by the respondents, irrespective of the extent of adherence to the prevention protocols of COVID-19. Table 5 shows that each of the five (5) perceptions studied were generally denied. This implies that these were not likely to interfere with the adherence to the prevention protocols and, therefore, were not threats to the transmission of the virus. Additionally, it was not surprising that the least denied perception (in other words, this was the leading perception) was “prayer to God for protection against coronavirus”. This is because Ghanaians are generally religious people and it is common for them to include religion in the health-seeking behaviour. The cases of patients going to prayer camps to seek cancer treatment are quite common in Ghana . Again, the finding that self-medication with orthodox medicine was the most denied was not surprising since there was no clear orthodox medication confirmed for COVID-19 treatment. The speculation about hydroxyl chloroquine as a treatment for COVID-19 had been debunked at the time of this study and overtime during the pandemic. In the absence of a confirmed orthodox medicine, the perception of the use of herbal preparations to boost immunity was understandably the second least denied among the five.
The finding that (Table 6) adherence to the prevention protocols had the highest occurrence as the action perceptive to prevent the infection by SARS-CoV-2 is a positive indication to the prevention of COVID-19 during the second wave. It also confirms the earlier claim that the non-COVID-19 related prevention actions were mostly denied and, therefore, not held alone by the few who held them. The interesting twist was that, in combination with the prevention protocols, “eating well” (i.e., eating a well-balanced diet) was now more common than the use of herbal preparations to boost immunity by a greater margin (50.0% compared to 29.1%, respectively). Though few, the proportion of respondents that indicate both the prevention protocols and the non-COVID-19 prevention action could protect against the viral infection was unexpected among respondents of such a demographic distribution, and indicate the need for more explanation on how specifically the protocols work to prevent infection. This may also imply that a greater proportion among the general population may hold this view.
When the study further sought insight about adherences, the finding that a little less than 42.5% (Fig. 2) of the respondents adhered to six or more of both the COVID-19 and non-COVID-19 prevention protocols implied the need to rethink the means of encouraging adherence to the prevention protocols. As has been indicated by other claims, people behave less cautiously if they perceive those innovations are reducing risk and actual outcomes are reducing [9, 10]. Therefore, once the restrictions were being eased, it will be expected that people will be less adherent, but it was not expected to be very low. However, the good news was that the additional analysis showed that three of the four COVID-19 prevention protocols were always part of six or more prevention protocols adhered to; that which was absent was social distancing (Table 7). The analysis also showed that three of the four non-COVID-19 prevention actions were always taken in addition to two or more of the other prevention protocols (never done alone); a situation which is very encouraging since these non-COVID-19 protocols were being used in addition to the COVID-19 protocols. However, comparing the present findings to that observed from the beginning of the pandemic in Ghana, particularly, focusing on participants that were generally at the lower end of the educational status indicated that the level of adherence revealed by this study was high than during the onset of the pandemic .
The present findings showed that self-driven factors do not enhance adherence as much as externally driven factors do. More so, both were not as much as COVID-19 related information that indicated how each individual and/or related loved ones were at high risk of infection or an undesirable outcome (Table 8). Ning et al. . reported that communication is very essential for the public to obtain knowledge and comply with COVID-19 interventions, however, they did not report such nuances . Therefore, communication on COVID-19 related prevention, particularly, in respect of the current efforts at the control of transmission (or control of the next wave of infections, if it should occur) and during the ongoing vaccination should avoid giving the impression that individuals were living at their own risk, and will have to act as they will to protect themselves and to protect others. Rather it should focus on how the evolving COVID-19 situation and new facts put individuals, their loved ones, and other groups they care about in immediate danger and foreseeable high risk of undesirable outcomes. Dryhurst et al.  indicated that people are generally less tolerant of risks arising from new, unfamiliar knowledge than they are of risk arising from familiar or usual information. Thus, other studies on COVID-19 had reported similar results with more nuances [18, 19]. Traditionally, when self-driven factors do not do much, particularly, in cases of populations at risk, the need for some level of enforcement or mandatory action may be necessary. Such paternalism to avert large population-level harm may not be ethically impermissible .