Document Type : Original Article

Authors

1 Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

4 Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Knowledge and awareness of disease transmission modes and basic hygiene principles during a public health crisis are crucial for developing effective control measures. The researchers aimed to evaluate Iranians’ knowledge, attitude, and practice (KAP) throughout the coronavirus disease 2019 (COVID-19) pandemic to detect related sociodemographic variables.
Methods: This cross-sectional, web-based survey was conducted from the 2nd - 8th March 2020 among the general population of Iran above 15 years of age. A 76-item self-designed questionnaire regarding KAP towards COVID-19 was used, and the participants’ demographic characteristics and sources of information were collected. The Snowball sampling method was applied for data collection, and responses were scored based on the Likert scale. Simple and multiple linear regression was performed using SPSS version 26. The statistical significance level was P<0.05.
Results: Among 8591 participants, the overall achieved knowledge, attitude, and practice score regarding COVID- 19 characteristics were 90%, 90%, and 89%. Also, an overall score of 85% was achieved regarding the knowledge of the transmission mode and high-risk groups for COVID-19. There was a significant association between female gender, higher age, and higher education with knowledge, attitude, and practice. Male gender, being single, and lower education levels were associated with lower scores in knowledge and practice (P<0.001) and poorer attitudes towards COVID-19 (P<0.001, 0.002, and <0.001, respectively).
Conclusion: During its outbreak, the Iranian population demonstrated decent knowledge, appropriate practice, and a positive attitude towards COVID-19. Furthermore, health education programs, mainly targeting lower-knowledge individuals regarding COVID-19, are essential for encouraging a positive attitude and maintaining safe practices. Hopefully, by increasing knowledge via public health policymakers and the cooperation of the Iranian authorities and the general population, optimistic control and elimination of the disease can be anticipated.

Keywords

  1. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). 2020. Available from: https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). Accessed 11 December 2020.
  2. World Health Organization. WHO announces COVID-19 outbreak a pandemic, 2020. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic. Accessed 7 December 2020.
  3. anadolu Agency. Iran confirms first two deaths from coronavirus, 2020. Available from: https://www.aa.com.tr/en/health/iran-confirms-first-two-deaths-from-coronavirus/1738679. Accessed 23 February 2020.
  4. BNO News. WORLDTracking coronavirus: Map, data and timeline 2020, Feb 26. Available from: https://bnonews.com/index.php/2020/02/the-latest-coronavirus-cases/. Accessed 3 October 2021.
  5. Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020 Jun 18;20(1):427. doi: 10.1186/s12879-020-05128-x. PMID: 32552751; PMCID: PMC7301075.
  6. Shafiekhani M, Niknam T, Tara SA, Mardani P, Mirzad Jahromi K, Jafarian S, Arabsheybani S, et al. COVID-19 versus applied infection control policies in a Major Transplant Center in Iran. Cost Eff Resour Alloc. 2023 Feb 27;21(1):17. doi: 10.1186/s12962-023-00427-x. PMID: 36849978; PMCID: PMC9969367.
  7. Parvar SY, Ghamari N, Pezeshkian F, Shahriarirad R. Prevalence of anxiety, depression, stress, and perceived stress and their relation with resilience during the COVID-19 pandemic, a cross-sectional study. Health Sci Rep. 2022 Jan 6;5(1):e460. doi: 10.1002/hsr2.460. PMID: 35024455; PMCID: PMC8733840.
  8. Maharlouei N, Hosseinpour P, Erfani A, Shahriarirad R, Raeisi Shahrakie H, Rezaianzadeh A, et al. Factors associated with reluctancy to acquire COVID-19 vaccination: A cross-sectional study in Shiraz, Iran, 2022. PLoS One. 2022 Dec 12;17(12):e0278967. doi: 10.1371/journal.pone.0278967. PMID: 36508442; PMCID: PMC9744289.
  9. Mirahmadizadeh A, Ranjbar K, Shahriarirad R, et al. Evaluation of students' attitude and emotions towards the sudden closure of schools during the COVID-19 pandemic: a cross-sectional study. BMC Psychol. 2020;8(1):134. doi: 10.1186/s40359-020-00500-7.
  10. Ranjbar K, Hosseinpour H, Shahriarirad R, Ghaem H, Jafari K, Rahimi T, et al. Students’ attitude and sleep pattern during school closure following COVID-19 pandemic quarantine: a web-based survey in south of Iran. Environ Health Prev Med. 2021;26(1):33. doi:10.1186/s12199-021-00950-4.
  11. Shahriarirad R, Erfani A, Ranjbar K, Bazrafshan A, Mirahmadizadeh A. The mental health impact of COVID-19 outbreak: a Nationwide Survey in Iran. Int J Ment Health Syst. 2021;15(1):19. doi: 10.1186/s13033-021-00445-3.
  12. Mirahmadizadeh A, Heiran A, Sahebi R, Azadian F, Shahriarirad R, Sharifi M. Parents’ Attitude to School Reopening before the Emergence of Omicron Variant of SARS-CoV-2: A Retrospective Web-based Survey. Health Management & Information Science. 2022 Jul 1;9(3):145-53.
  13. Sabetian G, Azimi A, Kazemi A, Hoseini B, Asmarian N, Khaloo V, et al. Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study Based on Machine-learning Approach from Iran. Indian J Crit Care Med. 2022 Jun;26(6):688-695. doi: 10.5005/jp-journals-10071-24226. PMID: 35836646; PMCID: PMC9237161.
  14. Tachfouti N, Slama K, Berraho M, Nejjari C. The impact of knowledge and attitudes on adherence to tuberculosis treatment: a case-control study in a Moroccan region. Pan Afr Med J. 2012;12:52. Epub 2012 Jun 28. PMID: 22937192; PMCID: PMC3428172.
  15. Hosseini Z, Shahriarirad R, Sarkari B. Cystic Echinococcosis: Knowledge, Attitude, and Practices (KAP) among Surgically Operated Cases in Fars Province, Southern Iran. J Parasitol Res. 2021 Apr 8;2021:9976548. doi: 10.1155/2021/9976548. PMID: 33927897; PMCID: PMC8049810.
  16. Ghoddusi Johari H, Fatehpoor S, Mardani P, Shahriarirad R, Ranjbar K. An Investigation of the Knowledge of General Surgeons in Fars Province in Terms of the Complications of Central Venous Stenosis and Thrombosis Following Insertion of a Double-Lumen Subclavian Catheter. Sadra Medical Journal, 2021; 9(1): 35-42. doi: 10.30476/smsj.2021.87782.1157
  17. Bell D.M.; World Health Organization Working Group on International and Community Transmission of SARS. Public health interventions and SARS spread, 2003. Emerg Infect Dis. 2004 Nov;10(11):1900-6. doi: 10.3201/eid1011.040729. PMID: 15550198; PMCID: PMC3329045.
  18. Siddiquea BN, Shetty A, Bhattacharya O, Afroz A, Billah B. Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis. BMJ Open. 2021 Sep 14;11(9):e051447. doi: 10.1136/bmjopen-2021-051447. PMID: 34521674; PMCID: PMC8441223.
  19. Moradzadeh R, Nazari J, Shamsi M, Amini S. Knowledge, Attitudes, and Practices Toward Coronavirus Disease 2019 in the Central Area of Iran: A Population-Based Study. Front Public Health. 2020 Dec 8;8:599007. doi: 10.3389/fpubh.2020.599007. PMID: 33364226; PMCID: PMC7752894.
  20. Heydari MR, Joulaei H, Zarei N, Fararouei M, Gheibi Z. An Online Investigation of Knowledge and Preventive Practices in Regard to COVID-19 in Iran. Health Lit Res Pract. 2021 Jan 11;5(1):e15-e23. doi: 10.3928/24748307-20201130-01. PMID: 33433629; PMCID: PMC7801262.
  21. Honarvar B, Lankarani KB, Kharmandar A, Shaygani F, Zahedroozgar M, Haghighi MRR, et al. Knowledge, attitudes, risk perceptions, and practices of adults toward COVID-19: a population and field-based study from Iran. Int J Public Health. 2020;65(6):731-739. doi:10.1007/s00038-020-01406-2.
  22. Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li W.T., et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020 Mar 15;16(10):1745-1752. doi: 10.7150/ijbs.45221. PMID: 32226294; PMCID: PMC7098034.
  23. World Health Organization. Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response, and control, 2020. Available from: https://openwho.org/courses/introduction-to-ncov. Accessed on 1 February 2020.
  24. Kakemam E, Ghoddoosi-Nejad D, Chegini Z, Momeni K, Salehiniya H, Hassanipour S, et al. Knowledge, Attitudes, and Practices Among the General Population During COVID-19 Outbreak in Iran: A National Cross-Sectional Online Survey. Front Public Health. 2020 Dec 10;8:585302. doi: 10.3389/fpubh.2020.585302. PMID: 33363083; PMCID: PMC7758225.
  25. Shahbaznejad L, Navaeifar MR, Movahedi FS, Hosseinzadeh F, Fahimzad SA, Serati Shirazi Z, et al. Knowledge, attitude and practice of Sari birth cohort members during early weeks of COVID-19 outbreak in Iran. BMC Public Health. 2021 May 25;21(1):982. doi: 10.1186/s12889-021-11039-6. PMID: 34034709; PMCID: PMC8148405.
  26. Nakhostin-Ansari A, Aghajani F, Khonji MS, Aghajani R, Pirayandeh P, Allahbeigi R, et al. Did Iranians respect health measures during Nowruz holidays? A study on Iranians' knowledge, attitude and practice toward COVID-19. J Prev Med Hyg. 2021 Jan 14;61(4):E501-E507. doi: 10.15167/2421-4248/jpmh2020.61.4.1576. PMID: 33628953; PMCID: PMC7888389.
  27. Hashemipour MA, Nassab ARG, Nassab AHG. Knowledge, practices and attitudes toward covid-19 in Iranian population. International Journal of Medical Dentistry. 2021; 25(1):14-23.
  28. Ghaderi E, Mahmoodi H, Sharifi Saqqezi P, Ghanei Gheshlagh R, Moradi G, Shokri A, et al. Knowledge, attitudes, practices and fear of COVID-19 among Iranians: A quick online survey. Health Soc Care Community. 2022 May;30(3):1154-1162. doi: 10.1111/hsc.13382. Epub 2021 Apr 23. PMID: 33891794; PMCID: PMC8251274.
  29. Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li W.T., et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020 Mar 15;16(10):1745-1752. doi: 10.7150/ijbs.45221. PMID: 32226294; PMCID: PMC7098034.
  30. Srichan P, Apidechkul T, Tamornpark R, Yeemard F, Khunthason S, Kitchanapaiboon S, et al. Knowledge, attitudes and preparedness to respond to COVID-19 among the border population of northern Thailand in the early period of the pandemic: a cross-sectional study. WHO South East Asia J Public Health. 2020 Sep;9(2):118-125. doi: 10.4103/2224-3151.294305. PMID: 32978344.
  31. Jiao JG, Tang XL, Li HW, Chen J, Xiao Y, Li A. Survey of knowledge of villagers in prevention and control of SARS in Hainan Province. China Trop Med. 2005;5:703-5.
  32. Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study. JMIR Public Health Surveill. 2020 Apr 30;6(2):e19160. doi: 10.2196/19160. PMID: 32320381; PMCID: PMC7193987.
  33. Sabetian G, Moghadami M, Hashemizadeh Fard Haghighi L, Shahriarirad R, Fallahi MJ, Asmarian N, et al. COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran. Virol J. 2021 Mar 17;18(1):58. doi: 10.1186/s12985-021-01532-0. PMID: 33731169; PMCID: PMC7968574.
  34. Sabetian G, Shahriarirad S, Moghadami M, Asmarian N, Shahriarirad R, Askarian M, et al. High Post-infection Protection after COVID-19 Among Healthcare Workers: A Population-Level Observational Study Regarding SARS-CoV-2 Reinfection, Reactivation, and Re-positivity and its Severity. Iran J Med Sci; 2021. DOI: 10.21203/rs.3.rs-772662/v1.
  35. Thomas Z. WHO says fake coronavirus claims causing ‘infodemic’. BBC News. 2020. Available from: https://www.bbc.com/news/technology-51497800. Accessed 09 March 2020.
  36. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020 Mar;55(3):105924. doi: 10.1016/j.ijantimicag.2020.105924. Epub 2020 Feb 17. PMID: 32081636; PMCID: PMC7127800.
  37. Shimizu K. 2019-nCoV, fake news, and racism. Lancet. 2020 Feb 29;395(10225):685-686. doi: 10.1016/S0140-6736(20)30357-3. Epub 2020 Feb 11. PMID: 32059801; PMCID: PMC7133552.
  38. Mejova Y, Kalimeri K. Advertisers Jump on Coronavirus Bandwagon: Politics, News, and Business. arXiv; 2020.
  39. Zhou WK, Wang AL, Xia F, Xiao YN, Tang SY. Effects of media reporting on mitigating spread of COVID-19 in the early phase of the outbreak. Math Biosci Eng. 2020 Mar 10;17(3):2693-2707. doi: 10.3934/mbe.2020147. PMID: 32233561.
  40. Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020 Mar 13;27(2):taaa020. doi: 10.1093/jtm/taaa020. PMID: 32052841; PMCID: PMC7107565.
  41. Cobey KD, Stulp G, Laan F, Buunk AP, Pollet TV. Sex differences in risk taking behavior among Dutch cyclists. Evol Psychol. 2013 May 14;11(2):350-64. PMID: 23674522.
  42. Pawlowski B, Atwal R, Dunbar RIM. Sex Differences in Everyday Risk-Taking Behavior in Humans. Evol Psychol. 2008;6(1):29-42. doi: 10.1177/147470490800600104.
  43. Duell N, Steinberg L, Icenogle G, Chein J, Chaudhary N, Di Giunta L, et al. Age Patterns in Risk Taking Across the World. J Youth Adolesc. 2018 May;47(5):1052-1072. doi: 10.1007/s10964-017-0752-y. Epub 2017 Oct 19. Erratum in: J Youth Adolesc. 2019 Apr;48(4):835-836. PMID: 29047004; PMCID: PMC5878702.
  44. Zhong BL, Chen SL, Tu X, Conwell Y. Loneliness and Cognitive Function in Older Adults: Findings From the Chinese Longitudinal Healthy Longevity Survey. J Gerontol B Psychol Sci Soc Sci. 2017 Jan;72(1):120-128. doi: 10.1093/geronb/gbw037. Epub 2016 Mar 24. PMID: 27013536; PMCID: PMC5156491.