Knowledge, attitude, and practice of the Saudi population toward COVID-19 vaccination: A cross-sectional study

Abstract

Coronavirus Disease 2019 (COVID-19) vaccination is the most effective protective measure to control the spread of infections and provide protection against hospitalization and mortality during the pandemic. There was a necessity to measure public knowledge and acceptance for COVID-19 vaccines in different countries. Thus, the current study is aimed at evaluating the knowledge, attitude, and practice of the population in all regions of Saudi towards COVID-19 vaccination. This was a cross-sectional, online self-reported survey of Saudi residents that was conducted between March 2021 and April 2021. To be eligible for the study, participants had to be above 18 years old. All participants were adult, Arabic speakers and residents of Saudi Arabia. In total, 1658 adults participated in this study and showed high knowledge (81.8%), attitude (71.2%), and practice (59.3%). The level of knowledge, attitude, and practice differed based on different demographic characteristics. Regression analysis showed that having a low income, low education level, and middle-aged status, living in a village, and being married were associated with lower scores in knowledge, attitude, or practice. Targeted education and campaigns should be provided for these populations to increase their knowledge, attitude, and practice towards COVID-19 vaccination.

1. Introduction

The first case of severe acute respiratory syndrome coronavirus 2, which causes Coronavirus Disease 2019 (COVID-19), in the Kingdom of Saudi Arabia was reported in March 2020. Today, the total number of reported cases in the Kingdom exceeds 800,000, resulting in a high hospitality rate.^[1] There was a prompt response from the Saudi government to prevent the spread of the virus in the community, including implementing protective measures that varied in severity from the beginning of the pandemic until now.^[2] At the beginning, the imposition of home quarantine and the travel ban was important, and gradually, restrictions reduced to mask-wearing in public places.^[3] Throughout the pandemic, the Ministry of Health intensified community awareness regarding the prevention measures, which helped control the spread of the virus.^[3]

Since there is no treatment for COVID-19 to date, the government implied free COVID-19 vaccination for all populations, citizens, and non-citizens.^[4] Vaccination is reported to be the most effective protective measure to control the spread of infections worldwide. As expected, many studies show that COVID-19 vaccines are highly effective in providing protection against hospitalization and mortality during the pandemic.^[5,6] During the past centuries, there are many infectious diseases that threatened the existence of humanity, but due to vaccinations, they have vanished and became forgotten.^[7] Despite the general knowledge that is available about the effectiveness of currently applied vaccinations in protecting against infections, society acceptance of COVID-19 vaccines greatly varies by country.^[8,9] In Saudi Arabia, approximately 74% of the population received at least 1 dose of the COVID-19 vaccine last year.^[10]

There are many factors that contribute to the lack of acceptance or hesitation towards COVID-19 vaccines. The main factor that influences the rest is the limited knowledge of the vaccines and their potential impact, effectiveness, and safety. Unacceptance of COVID-19 vaccines is a major setback towards the effectiveness of the vaccinations on a national and global scale.^[11] Therefore, it becomes essential to understand the causes and factors of vaccination refusal by analyzing the population knowledge, attitude, and practice towards COVID-19 vaccination. Several studies show that the population knowledge and acceptability of the COVID-19 vaccine in the Kingdom of Saudi Arabia is affected by socio-demographic characteristics.^[12–14] Similar studies were conducted to measure public knowledge and acceptance of COVID-19 vaccines targeting specific cities or regions in the Kingdom.^[15,16] This, however, is a cross-sectional study to evaluate the knowledge, attitude, and practice of the population in all geographical regions of Saudi Arabia towards COVID-19 vaccination.

2. Materials and methods

2.1. Methodology

This cross-sectional study was conducted from March 2021 to April 2021 using an online, self-reported questionnaire to evaluate public knowledge, attitude, and practice with regard to COVID-19 vaccination. The questionnaire was written and designed in Arabic and distributed via social media platforms (WhatsApp, Snapchat, and Twitter). Social media platforms were used to ensure wide coverage of the Saudi population with different demographic characteristics. Participants were allowed to fill out the questionnaire if he/she was aged 18 years or older, residents of Saudi Arabia, and agreed to complete the attached consent form. Ethical approval was received from Hail University ethical committee under ethical approval number H-2021-78.

Four multidisciplinary researchers developed the questionnaire based on a review of relevant literature. The questionnaire was created using a Google form, and all questions were validated by 5 multidisciplinary experts to ensure that the outcome measure is designed to address the research objective. Each expert checked the relevance of the questionnaire to the study aim. After reading the questionnaire and aim, the expert was asked to answer the following several questions: Does the outcome measure address all the study objectives Do you think the written language for the outcome measure is appropriate for the targeted population. Are all questions easy to understand? Do you have any recommendations regarding the outcome measure? The responses were collected from experts, and a meeting was conducted by the researchers to address the suggested changes. A pilot study was conducted using 10 participants from the targeted population to clarify the language of the questionnaire. Feedback was applied to create the final version of the questionnaire (study version) with concise, and easy-to-understand questions that meet the objectives of the study (Supplemental Digital Content (Table A-1, http://links.lww.com/MD/K54)).

The preliminary part of the questionnaire included the purpose and objectives of the study and the consent form to ensure voluntary participation and understanding of the purpose of the study. The data were collected anonymously to maintain the confidentiality of the participants. The questions were broadly divided into 2 sections. The first part consisted of questions related to the sociodemographic information (age, gender, marital status, education level, monthly income, job, geographical region, living in a city or village, having current or previous psychological health issues, having a family member or self with a confirmed previous COVID-19 infection, and having a chronic or serious disease status). The second part of the questionnaire pertained to knowledge, attitude, and practice towards vaccination and COVID-19 vaccination. The knowledge section consisted of 13 questions, the attitude section consisted of 7 questions, and the practice section consisted of 2 questions. Each question has 3 possible answers (yes, no, or to some extent) with a maximum score of one and a minimum score of zero. The scoring depends on each question and to some extent, the answer was scored as 0.5 in some questions and 0 in others. The maximum possible scores are 13, 7, and 2, indicating high levels of knowledge, attitude, and practice, respectively (Supplemental Digital Content (Table A-2, http://links.lww.com/MD/K55, Table A-3, http://links.lww.com/MD/K57, Table A-4, http://links.lww.com/MD/K59, and Table A-5, http://links.lww.com/MD/K60)).

2.2. Study population and sample size

The minimum required sample for multinomial logistic regression was 10 participants for each variable.^[17] This study had 44 independent variables; therefore, 30 participants were calculated for each variable for better accuracy, which yielded a total of 1320 participants. In total, 330 cases (22%) were added to the sample to account for any case with missing data, which resulted in a total of 1650 participants. For analytical reasons (not having an adequate sample size), some of the categories were merged as divorced and single, which resulted in 35 independent variables.

2.3. Statistical analysis

After data collection, the data were downloaded as an Excel spreadsheet from Google Forms. The data were then coded and transferred to the SPSS version 23. Then, data analysis was performed, and the descriptive data were presented as count, percentage, mean, and standard deviation. To investigate whether there are any differences regarding, knowledge, attitude and practice in demographic characteristics, an independent sample t-test (when only 2 groups were available) or a one-way analysis of variance (ANOVA) test (when more than 2 groups were available) was employed if the assumptions were met, while the Mann–Whitney U test (when only 2 groups were available) or the Kruskal–Wallis test (when more than 2 groups were available) were employed when the assumptions were not met. Multiple linear regression (stepwise method) was applied to identify the demographic characteristics associated with total knowledge, attitude, and practice scores. To quantify the relationship, the slope of regression, standard error, and 95% confidence interval were calculated. The statistically significant level was considered below 0.05.

3. Results

3.1. Demographic characteristics of recruited population

1658 individuals submitted questionnaires for the current study. The majority of the participants were 25 to 34 years old (30%), were married (63.3%), had a bachelor degree (58%), were employed (50.5%) and received monthly salaries <3000SAR (35.3%). Most of the participants were living in a city (89.4%), and more than a third of participants were from the western region of Saudi Arabia (35.5%), followed by those from the middle region (29%) (Table 1).

Table 1.

Demographic characteristics of recruited population.

Demographic characteristics		Count	Percentage
Gender	Male	806	48.6%
	Female	852	51.4%
Age group	18–24 yr	370	22.3%
	25–34 yr	497	30.0%
	35–44 yr	484	29.2%
	45–54 yr	185	11.2%
	55 and above	122	7.4%
Marital status	Single	609	36.7%
	Married	1049	63.3%
Educational level	Secondary and lower	300	18.1%
	Diploma	115	6.9%
	Bachelor	962	58.0%
	Master	184	11.1%
	PhD	97	5.9%
Monthly income	<3000 SR	585	35.3%
	Between 3000–9999 SR	380	22.9%
	Between 10000–19999 SR	451	27.2%
	20000 SR and above	242	14.6%
Job status	Unemployed (student, retired, others)	821	49.5
	Employed (government, private, entrepreneur)	837	50.5
Which geographical regions of Saudi Arabia are you from	Middle	480	29.0%
	East	143	8.6%
	North	300	18.1%
	South	147	8.9%
	West	588	35.5%
Do you live in	City	1483	89.4%
	Village	175	10.6%
Do you have or have you had any psychological health issue	Yes	154	9.3%
	No	1504	90.7%
Do you suffer from any chronic or serious disease	No	1337	80.6%
	Yes (heart disease, diabetes, hypertension, others)	321	19.4%
Have you been infected with COVID-19 confirmed by test result	Yes	217	13.1%
	No	1441	86.9%
Do you have any relative, who has/have been infected with COVID-19 confirmed by test result	Yes	1202	72.5%

The majority of the participants (90.7%) had no psychological health issues and chronic diseases (80.6%), while 19.4% of the participant had chronic diseases including hypertension and heart disease. Among the study population, 13.1% of the participants had been infected with COVID-19, while 72.5% of the participants had family members who suffered from COVID-19 infection (Table 1).

3.2. Knowledge scores

Knowledge was high among the majority of participants (81.78%), who gave scores ranging from 9 to 13 (Supplemental Digital Content (Table A-2, http://links.lww.com/MD/K55)). The statistical test showed a significant difference in total knowledge scores among age group, educational level, monthly income, job status, geographical region, residents of a city or village, and those with a relative/relatives who has/have been infected with COVID-19 (P value < .01) (Table 2). The linear regression model was significant (P value < .01) and showed that individuals with a minimum salary of 20000SR (β 0.69, P < .01), individuals with salaries between 10000 SR and 19999 SR (β 0.26, P < .01), individuals with relatives infected with COVID-19 (β 0.32, P < .01), individuals with a PhD (β 0.79, P < .01), individuals with a bachelor degree (β 0.28, P < .01), and individuals living in the eastern region (β 0.42, P = .01) were associated with a high knowledge score. In contrast, individuals aged 45 to 54 years old (β −0.74, P = .01), individuals aged 35 to 44 years old (β −0.47, P = .01) and individuals with a salary <3000 SR (β −0.29, P = .01) were linked to a low knowledge score (Table 3). Answers to questions related to knowledge among participants were presented in Supplemental Digital Content Table A-3, http://links.lww.com/MD/K57.

Table 2.

Average knowledge scores (out of 13) based on demographic characteristics of participants.

Variable		Mean	Standard deviation	P value
Gender	Male	10.32	1.92	.12
	Female	10.17	1.90
Age group	18–24 yr	10.13	1.76	<.01
	25–34 yr	10.46	1.85
	35–44 yr	10.17	1.99
	45–54 yr	9.90	2.09
	55 and above	10.53	1.92
Marital status	Single	10.16	1.85	.21
	Married	10.29	1.95
Educational level	Secondary and lower	9.87	1.84	<.01
	Diploma	9.78	2.06
	Bachelor	10.30	1.92
	Master	10.42	1.85
	PhD	11.01	1.69
Monthly income	<3000 SR	9.96	1.86	<.01
	Between 3000–9999 SR	10.16	1.87
	Between 10000–19999 SR	10.35	1.98
	20000 SR and above	10.86	1.83
Job status	Unemployed (student, retired, others)	10.11	1.94	<.01
	Employed (government, private, entrepreneur)	10.37	1.88
Which geographical regions of Saudi Arabia are you from	Middle	10.41	1.85	<.01
	East	10.59	1.99
	North	10.12	1.88
	South	10.22	2.01
	West	10.09	1.92
Do you live in	City	10.27	1.91	.049
	Village	9.97	1.89
Do you have or have you had any psychological health issue?	Yes	10.03	1.98	.15
	No	10.26	1.91
Do you suffer from any chronic or serious disease?	No	10.23	1.89	.69
	Yes (heart disease, diabetes, hypertension, others)	10.28	1.09
Have you been infected with COVID-19 confirmed by test result	Yes	10.43	1.83	.12
	No	10.21	1.93
Do you have any relative, who has/have been infected with COVID-19 confirmed by test result	Yes	10.33	1.84	<.01
	No	10.00	2.08

Bold indicates significant.

Table 3.

Regression of knowledge results based on demographic variables of population.

Variable	β	Std. error	P value	Lower bound	Upper bound
(Constant)	9.92	0.14	<.01	9.63	10.20
Monthly income (20000 SR and above)	0.69	0.16	<.01	0.38	1.01
Monthly income (Between 10000–19999 SR)	0.26	0.13	<.01	0.00	0.52
Age group (45–54 yr)	−0.74	0.16	<.01	−1.04	−0.43
Having relative, who has/have been infected with COVID-19 confirmed by test result (Yes)	0.32	0.10	<.01	0.12	0.52
Education level (PhD)	0.79	0.22	<.01	0.36	1.22
Age group (35–44 yr)	−0.47	0.11	<.01	−0.69	−0.26
Education level (Bachelor)	0.28	0.10	<.01	0.09	0.47
Region (East)	0.42	0.16	.01	0.10	0.75
Monthly income (<3000 SR)	−0.29	0.13	.021	−0.54	−0.04

Bold indicates significant.

β = slope of the regression line, negative slope indicates negative correlation between 2 variable and vice versa.

3.3. Attitude of Saudi population towards COVID-19 vaccination

Attitude score was high among the majority of participants (72.3%), who gave scores from 5 to 7 (Supplemental Digital Content (Table A-2, http://links.lww.com/MD/K55)). There was a significant difference in participants’ attitude based on age group, geographical region, previous COVID-19 infection, and having relatives infected with COVID-19 (P value ≤ .01) (Table 4). The multivariable linear regression model was significant (P < .01) and revealed that individuals living in the middle region (β 0.23, P < .01) and individuals with a PhD (β 0.45, P = .01) were associated with high attitude scores. Individuals previously infected with COVID-19 (β −0.28, P = .01), individuals aged 35 to 44 years old (β −0.32, P < .01), individuals aged 45 to 54 years old (β −0.40, P < .01), and individuals with salaries <3000 SR (β −0.18, P = .03) were associated with low attitude scores (Table 5). Answers to questions related to attitude among participants were presented in Supplemental Digital Content Table A-4, http://links.lww.com/MD/K59.

Table 4.

Average attitude scores (out of 7) based on demographic characteristics of participants.

Variable		Mean	Standard Deviation	P value
Gender?	Male	5.13	1.49	.85
	Female	5.12	1.49
Age group?	18–24 yr	5.15	1.56	<.01
	25–34 yr	5.22	1.41
	35–44 yr	4.99	1.53
	45–54 yr	4.94	1.50
	55 and above	5.46	1.27
Marital status?	Single	5.20	1.51	.136
	Married	5.08	1.48
Educational level?	Secondary and lower	5.07	1.53	.124
	Diploma	5.05	1.54
	Bachelor	5.13	1.48
	master	5.02	1.55
	PhD	5.48	1.24
Monthly income?	<3000 SR	5.04	1.54	.09
	Between 3000–9999 SR	5.09	1.49
	Between 10000–19999 SR	5.15	1.43
	20000 SR and above	5.32	1.43
Job status	Unemployed (student, retired, others)	5.14	1.51	.73
	Employed (government, private, entrepreneur)	5.11	1.47
Which geographical regions of Saudi Arabia are you from?	Middle	5.31	1.37	.01
	East	5.16	1.47
	North	4.98	1.46
	South	5.16	1.60
	West	5.02	1.56
Do you live in.......?	City	5.13	1.46	.40
	Village	5.03	1.71
Do you have or have you had any psychological health issue?	Yes	5.06	1.53	.59
	No	5.13	1.48
Do you suffer from any chronic or serious disease?	No	5.11	1.49	.57
	Yes (heart disease, diabetes, hypertension, others)	5.17	1.49
Have you been infected with COVID-19 confirmed by test result?	Yes	4.86	1.57	<.01
	No	5.16	1.47
Do you have any relative, who has/have been infected with COVID-19 confirmed by test result?	Yes	5.07	1.48	.02
	No	5.27	1.50

Table 5.

Regression of Attitude results.

Variable	β	Std. error	P value	Lower bound	Upper bound
(Constant)	5.27	0.07	<.01	5.13	5.41
Region (Middle)	0.23	0.08	<.01	0.08	0.39
Previous infection with COVID-19 (Yes)	−0.28	0.11	.01	−0.49	−0.07
Education level (PhD)	0.45	0.16	.01	0.13	0.76
Age group (35–44 yr)	−0.32	0.09	<.01	−0.49	−0.15
Age group (45–54 yr)	−0.40	0.12	<.01	−0.63	−0.16
Monthly income (<3000 SR)	−0.18	0.08	.03	−0.34	−0.02

Bold indicates significant.

β = slope of the regression line, negative slope indicates negative correlation between 2 variable and vice versa.

3.4. Practice of participants towards COVID-19 vaccination

Practice scores were high among 59.3% of the participants, ranging from 1.5 to 2 (Supplemental Digital Content (Table A-2, http://links.lww.com/MD/K55)). There was a significant difference in practice score among recruited participants based on gender, age group, educational level, monthly income, job status, geographical region, living in a city or a village, and having any relative/relatives who has/have been infected with COVID-19 (P value < .05) (Table 6). The multivariable linear regression model was significant (P < .01) and showed that individuals aged 18 to 24 years old (β 0.16, P = .01), individuals living in the middle region (β 0.14, P < .01), individuals with a PhD degree (β 0.25, P < .01), individuals aged 55 and above (β 0.29, P = .03), and employed individuals (β 0.11, P = .045) were associated with a high practice score. Individuals with a salary <3000 SR (β −0.22, P < .01), individuals with secondary school degrees and lower education levels (β −0.26, P < .01), individuals living in a village (β −0.25, P < .01), and married individuals (β −0.10, P = .045) were associated with low practice scores (Table 7). Answers to questions related to practice among participants were presented in Supplemental Digital Content Table A-5, http://links.lww.com/MD/K60.

Table 6.

Total practice scores (out of 2) based on demographic characteristics of participants.

Variable		Mean	Standard deviation	P value
Gender?	Male	1.50	0.73	<.01
	Female	1.30	0.77
Age group?	18–24 yr	1.32	0.77	<.01
	25–34 yr	1.38	0.77
	35–44 yr	1.43	0.76
	45–54 yr	1.36	0.78
	Above 55	1.66	0.62
Marital status?	Single	1.36	0.76	.19
	Married	1.42	0.76
Educational level?	Secondary and lower	1.10	0.82	<.01
	Diploma	1.37	0.78
	Bachelor	1.42	0.75
	master	1.58	0.65
	PhD	1.74	0.55
Monthly income?	<3000 SR	1.19	0.81	<.01
	Between 3000–9999 SR	1.41	0.73
	Between 10000–19999 SR	1.51	0.70
	20000 SR and above	1.68	0.66
Job status	Unemployed (student, retired, others)	1.28	0.80	<.01
	Employed (government, private, entrepreneur)	1.51	0.70
Which geographical regions of Saudi Arabia are you from?	Middle	1.54	0.69	<.01
	East	1.44	0.72
	North	1.30	0.78
	South	1.36	0.80
	West	1.33	0.79
Do you live in.......?	City	1.44	0.74	<.01
	Village	1.07	0.82
Do you have or have you had any psychological health issue?	Yes	1.33	0.76	.285
	No	1.40	0.76
Do you suffer from any chronic or serious disease?	No	1.38	0.77	.12
	Yes (heart disease, diabetes, hypertension, others)	1.46	0.70
Have you been infected with COVID-19 confirmed by test result?	Yes	1.40	0.77	.97
	No	1.40	0.76
Do you have any relative, who has/have been infected with COVID-19 confirmed by test result?	Yes	1.42	0.74	.03
	No	1.33	0.81

Bold indicates significant.

Table 7.

Regression of practice results.

Variable	β	Std. error	P value	Lower bound	Upper bound
(Constant)	1.44	0.06	<.01	1.32	1.56
Month income (<3000 SR)	−0.22	0.05	<.01	−0.32	−0.11
Education level (Secondary and lower)	−0.26	0.05	<.01	−0.36	−0.16
Where do you live (Village)	−0.25	0.06	<.01	−0.36	−0.13
Age group (18–24 yr)	0.16	0.06	.01	0.04	0.28
Region (Middle)	0.14	0.04	<.01	0.06	0.21
Education level (PhD)	0.25	0.08	<.01	0.10	0.40
Age group (55 yr and above)	0.29	0.08	<.01	0.14	0.44
Job status (Employed)	0.11	0.05	.03	0.01	0.21
Marital status (Married)	−0.10	0.05	.045	−0.19	0.00

Bold indicates significant.

β = slope of the regression line, negative slope indicates negative correlation between 2 variable and vice versa.

4. Discussion

It is established how knowledge affects people actions towards new medical interventions. With regard to vaccinations, studies have found that a lack of knowledge is one of the main causes of vaccine hesitation or a lack of acceptance.^[18] Unfortunately, this anti-vaccination attitude leads to the failure of vaccination effectiveness as a protective measure, which is aimed at limiting the spread of infection.^[19]

This study analyses the knowledge of the population in the Kingdom of Saudi Arabia towards COVID-19 vaccination, and thus their practice and attitude. This is not the only study that addresses the population knowledge regarding the COVID-19 vaccine in the country however, it is one of only 2 studies that targeted responses from all the regions of Saudi Arabia.^[12] It is important, nevertheless, to highlight that this study also analyzed respondents’ attitudes and practices towards vaccinations in general as well as COVID-19 vaccination in particular.

According to the responses of 1658 individuals, this study has reported a high level of overall knowledge (81.8%), attitude (72.3%), and practice (59.3%), which is consistent with another study.^[18] According to the data in this study, knowledge is substantially affected by many demographic characteristics. Based on the total knowledge scores, there was a significant difference among age group, educational level, monthly income, job type, geographical region, living in a city or a village, and having relatives previously infected with COVID-19. According to previously published research, these findings are consistent with the notion that knowledge is affected by demographic characteristics in Saudi Arabia as well as in some gulf cooperation council countries.^[12,20] Unlike other studies conducted in Saudi Arabia, there was no significant difference between male and female knowledge towards the COVID-19 vaccine. The data are also in agreement with a similar study conducted in China that showed that education level and marital status positively affect the level of knowledge towards the vaccine.^[21]

Since knowledge directly affects attitude and behavior, positive attitude results were expected from the population in this study. As the level of knowledge towards the vaccine was high, the population general attitude level in this study was good (72.3%). The majority of the participants (73.3%) believed in vaccination and were willing to give or recommend it to family or friends (73.6%). These results indicate people acceptance of vaccinations in general, which is evident by the success of public vaccination campaigns in the country. According to a global, large-scale retrospective study, the Kingdom of Saudi Arabia is one of the countries in which the majority of the population agree that vaccines are important.^[22] The participants’ attitudes regarding COVID-19 vaccination in particular was similarly good yet variable. Although 76.2% of the participants think that the COVID-19 vaccine is important, only 72.9% are willing to recommend it to family or friends. Hesitation towards the COVID-19 vaccine is a worldwide phenomenon mainly caused by uncertainty about vaccine safety and effectiveness or distrust of the country of manufacturing.^[22,23] Nevertheless, in this study, 75.3% of the participants believe that pharmaceutical companies can develop safe and effective COVID-19 vaccines. On the other hand, only 42.3% of the participants think that COVID-19 vaccines made in Europe and the USA are more trustworthy than those made in other countries.

The attitudes of the participants differed according to their demographic characteristics. There was a significant difference in attitude between regions of Saudi Arabia and age groups. More importantly, the participants who have confirmed COVID-19 infections had surprisingly low attitude scores compared to those who had no COVID-19 infection. Regardless of their immunization status, the COVID-19 infection to which this group was exposed may be asymptomatic or self-limiting. Therefore, they may consider vaccination unnecessary, which may explain their negative attitude towards it. This study investigated the level of practice of the population towards vaccines in general, which was low (59%) compared to the level of knowledge and attitude. Only 64.9% of the participants actually received a vaccine during their lifetime, and 70.3% of participants allowed their children and family to take them. Reasons for such low practice should be the focus of future investigations.

Interestingly, several factors were found to be positively or negatively associated with knowledge, attitude, and practice, such as education level, age group, monthly income, region, previous COVID-19 infection, and having relatives previously infected with COVID-19. Lower education level, lower monthly income, individuals living in a village, and married individuals were associated with lower attitude scores. These populations should be targeted by health campaigns. Surprisingly, individuals aged 35 to 54 years old with low monthly incomes were associated with lower knowledge and attitude, which may be attributed to a busy lifestyle and working hard to afford family needs. Therefore, stockholders in the Ministry of Health should focus on enhancing the knowledge and attitudes of these populations.

Given the timing of the study, there was not enough accumulated data of COVID-19 vaccination, since the first vaccination campaign in Saudi Arabia commenced at the end of 2020. Therefore, future investigation of the population practice and acceptance is fundamental to highlight factors of successful vaccination campaigns. Furthermore, the number and diversity of the participants in this study, although better than other studies, is still limited. As the COVID-19 infection protective measures were implemented at the time of this study, the data were collected using a web survey distributed via social media platforms. Furthermore, there are many factors of response rates and the number of participants in web surveys, such as exposure and view logarithms of social media platforms.^[24] The data and interpretation in this study still reflect a diverse group of people from the general population of the Kingdom of Saudi Arabia. Therefore, a careful interpretation of the findings is recommended.

5. Conclusions

The COVID-19 pandemic led to millions of deaths. Vaccination is the most effective measure to protect people from the disease, and assessing public knowledge towards vaccination is crucial. The current study showed that knowledge, attitude, and practice towards vaccination and COVID-19 are high. Linear regression results showed that individuals with low incomes, middle-age status, and low education levels, living in a village, and married were associated with lower levels of either knowledge, attitude, or practice. Policymakers should educate as well as increase practice among these populations.

Acknowledgments

We appreciate the involvement of the participants, who have provided a valuable contribution to our study. We would like to express our gratitude to Princess Nourah bint Abdulrahman University for supporting this project through the Princess Nourah bint Abdulrahman University Researchers Supporting Project (no. PNURSP2023R422), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Author contributions

Conceptualization: Yasser Alzamil, Meshari Almeshari, Amjad Alyahyawi, Omar W. Althomali.

Data curation: Yasser Alzamil, Meshari Almeshari, Amjad Alyahyawi, Ahmad Abanomy, Omar W. Althomali.

Formal analysis: Asma W. Al-Thomali, Omar W. Althomali.

Funding acquisition: Bodor Bin Sheeha.

Methodology: Ahmad Abanomy, Omar W. Althomali, Bodor Bin Sheeha.

Supervision: Amjad Alyahyawi.

Writing – review & editing: Asma W. Al-Thomali, Bader Alshomar, Omar .W. Althomali, Heba Barnawi.

Writing – original draft: Bader Alshomar, Heba Barnawi, Abdulrahman S.

Supplementary Material

medi-102-e35360-s001.docx ^{(17.2KB, docx)}

medi-102-e35360-s002.docx ^{(14.5KB, docx)}

medi-102-e35360-s003.docx ^{(17.4KB, docx)}

medi-102-e35360-s004.docx ^{(15.3KB, docx)}

medi-102-e35360-s005.docx ^{(14KB, docx)}