Abstract
Since the SARS-CoV-2 virus, the virus that causes COVID-19, has been spreading globally, variants have emerged and been identified in many countries around the world. This descriptive cross-sectional study aimed to explore the level of knowledge, attitude, and adherence to coronavirus variant preventive measures among residents of the Kingdom of Saudi Arabia. This is a cross-sectional online survey that was conducted between April and November 2020 and involved the residents of the Kingdom of Saudi Arabia. An electronic invitation for participation was sent to prospective participants, including the link to the research instrument, using social media websites. A total of 780 participants responded to a 4-part online survey developed by the investigators. The findings revealed that 72.9% of the participants (95% CI: 69.6%–75.9%) had a high level of knowledge about COVID-19; 78.2% said they supported all precautionary measures put in place by health authorities; only 29% wore face masks; and 93% wash their hands at least 5 times a day. Furthermore, 69% of the residents were always covering their mouth and nose when coughing or sneezing with a piece of tissue paper, while 71% were observing physical distancing. Participants showed a positive attitude towards supporting all the precautionary measures being put in place by the health authorities and the efforts made by healthcare workers in the kingdom. Residents in Saudi Arabia showed a high level of knowledge of COVID-19 variants. Higher levels of education, being employed, and higher income were factors that influenced participants’ knowledge positively (P < .05). Females and younger age were predictors of a better attitude towards COVID-19 (P < .01).The majority of the residents were afraid of the spread and mutation of the coronavirus. This study highlights the value of continuing community service learning programs for raising knowledge retention and adherence to coronavirus variant prevention strategies.
Keywords: adherence, attitudes, COVID-19, level of knowledge, preventive measures
1. Introduction
Saudi Arabia is part of the COVID-19 global pandemic, and the Saudi Ministry of Health reported the first confirmed COVID-19 case on 2nd of March 2020.[1–5] The emergence of any infection within a community has the potential to threaten public health security since it might cause serious health impacts and increase the risk of respiratory tract infections . Saudi Arabia plays a significant role in the global efforts to combat the coronavirus pandemic due to various factors, such as its role as a destination for the annual pilgrimage to Makkah, its economic importance, and its engagement in global collaboration.[6–8] The economic well-being of the nation, which exhibits a strong interdependence with the oil sector, carries significant ramifications for global economic stability. Following the COVID-19 epidemic, Saudi Arabia played a pivotal role in the stabilization of oil markets by engaging in collaborative efforts with other prominent oil-producing countries to mitigate the adverse effects of plunging oil prices.[9] The management of the Hajj pilgrimage during the ongoing pandemic emerged as a subject of worldwide significance. The implementation of limitations on the Hajj and Umrah pilgrimages by Saudi Arabia in 2020, together with the introduction of diverse health regulations in 2021, had significant ramifications on the worldwide Muslim population.[8]
Variants of the SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), have emerged and been identified in numerous nations around the world since the virus has been spreading globally, posing a serious threat to public health due to the virus’ alarming levels of spread and severity and the inaction of some governments to contain the virus.[10] Omicron, which accounts for > 98% of viral sequences shared on the Global Influenza Surveillance and Response System (GISAID) after February 2022, is currently the prevalent variety circulating globally, according to the WHO. In response to the Omicron VOC widespread transmission around the world and the anticipated rise in viral diversity that will follow, WHO has introduced a new category to its variation tracking system called “Omicron subvariants.” The main goal of this category is to determine whether these lineages, in comparison to other circulating viruses, could constitute.[11,12]
Coronavirus variants have gained serious attention from global health organizations and health regulatory authorities since their emergence.[13] Various challenges and consequences for communities in terms of health, social, mental, and economic aspects can emerge as a result of outbreaks or pandemics.[14–20] In order to reduce some of the consequences, Sigfrid et al (2019) emphasized the importance for countries to “address political, economic, administrative, regulatory, logistical, ethical, and social challenges when it comes to strengthening global preparedness for emerging epidemics.[21] The Centers for Disease Control and Prevention (CDC) emphasized the importance of each community having mitigation strategies in place in order to slow down the transmission when a virus with pandemic potential emerges.[22] As each community is unique, these strategies must be based on local factors such as epidemiology, community characteristics, healthcare, and public health capacities.[23,24]
Health authorities might refer to earlier pandemic control strategies that were successful as models. As a result, multiple public health protocols for disease prevention measures have been established in the affected countries in accordance with the guidance of the WHO and CDC to restrict the rapid spread of COVID-19.[22,25,26] Avoiding close contact with sick people or social withdrawal are some of these preventive measures, as are routine cleaning and disinfecting of certain important areas of the home, equipment, and furniture, such as doorknobs, tables, light switches, handles, keyboards, phones, toilets, sinks, and faucets.[22]
Knowledge of these coronavirus preventive measures is essential since it shapes peoples’ behavior toward the disease and encourages positive preventive practices to curb the increase in mortality.[17] Nevertheless, the rapid spread of this virus has created fear and dread, especially for those who belong to the unaffected population.[27,28] The social norms governing people health and safety have a significant impact on how this disease is spread and managed. Washing hands with soap and water or a disinfectant solution, refraining from touching or rubbing, disinfecting newly purchased objects, cleaning the environment in the car and home, avoiding close contact with others, and keeping to one own home are some preventive behaviors that can break the cycle of the disease.[29] According to a previous study, health education initiatives focusing on enhancing COVID-19 knowledge helped Chinese citizens retain healthy behaviors and positive attitudes.[30]
In this pandemic, managing health services to prevent illness spread and issues with human behavior and lifestyle make up the majority of the primary concerns. The longevity of such accomplishment, however, necessitates teamwork, and the general public must pay close attention and swiftly alter attitudes and behaviors to support the health authorities’ effort.[31] Over time, considerable and in-depth research has been done on the relationship between public behavior and disease knowledge. Knowledge, attitude, and practice (KAP) surveys are frequently used in public health investigations during pandemics. The purpose of a KAP survey is to gather pertinent data on knowledge (what is known), attitudes (what is considered or perceived), and practices (what is done) regarding certain issues among a given population or cohort.[32] This study investigates how well residents of the Kingdom of Saudi Arabia adhere to preventative measures against coronavirus variants.
2. Methods
2.1. Study design
This is a cross-sectional online survey that was conducted between April and November 2020 and involved the residents of the Kingdom of Saudi Arabia.
2.2. Sampling technique
The study utilized the convenience sampling technique. Participants who were aged 18 years and older, both genders, whether they had received previous training, education, or workshops about coronavirus preventive measures or not, were asked to respond to the questionnaire. Social media websites (Facebook, Instagram, Snapchat, and Telegram) were used to distribute the survey link.
2.3. Research instruments and data collection
The research instrument was an online questionnaire developed by the researchers, which was divided into 5 sections: sociodemographic profile, health status, knowledge, attitude, and practices regarding coronavirus variants and preventive measures. It was pre-tested among a small group of individuals similar to the study population. Modifications were made based on the output of the pretest. Both English and Arabic versions were made available. An electronic invitation for participation was sent to prospective participants, including the link to the research instrument, using social media websites.
The questionnaire tool was translated using the forward-backward translation technique. This technique involved the translation by 2 independent reviewers, focusing on the concept for each item and not on word-by-word translation. The reliability of the attitude items was checked using Cronbach alpha measure (α = 0.83), which reflected good internal consistency. The questionnaire instrument was evaluated and confirmed by 2 independent researchers. Participants were questioned on the questions’ readability, ease of comprehension, and overall validity. They were also asked if they found any of the questions unpleasant. They reported that filling out the questionnaire was easy. They confirmed items clarity, comprehensibility, relevance, and appropriateness of response options (the face validity). Besides, they confirmed the adequacy of the survey length, completion time, and the appropriateness of the scale employed. Before the questionnaire was administered to the entire community, researchers conducted a pilot study to gauge interest and comprehension. The survey was distributed to a sample of 30 individuals in Saudi Arabia who satisfied the specified criteria for inclusion in the research. The participants were inquired about the level of clarity and readability of the questionnaire, as well as whether they had any challenges in comprehending the questions. The respondents said that they found the questionnaire to be easily understandable and manageable to complete.
2.4. Sample size
It targeted a minimum sample size of 768 based on an anticipated frequency of 50%, a margin of error of 5%, a confidence level of 95%, and a design effect of 2.
2.5. Statistical analysis
The collected data were checked, cleaned, and edited in the associated Google Sheet of the utilized Google Form. The resulting dataset was exported to Stata MP version 14. Relative frequencies in percentage were generated for qualitative variables, while the mean and standard deviation were computed for the participants scores on the 10-item coronavirus variant knowledge inventory. Participants with scores ranging from 8 to 10 points were classified as high-level, 4 to 7 points as moderate-level, and 3 points and lower as low-level of knowledge. The mean knowledge score was used to define the dummy variable for the binary logistic regression analysis, which was used to identify predictors of better knowledge. For the attitude section, the level of agreement on each of the 8 perception statements regarding COVID-19 and its effects was reported as a percentage. The level of agreement was measured using a 5-point Likert scale that ranged from strongly disagreeing to strongly agreeing. A score of 5 was given for participants who reported “strong agreement” for statements that reflect a positive attitude towards COVID-19, and a score of one was given for participants who reported “strong disagreement” for statements that don’t reflect a positive attitude towards COVID-19. The maximum attainable score is 40; the higher the score, the more positive the attitude. We defined the midpoint of the score as the cutoff point to define a positive attitude. Similarly, the mean attitude score was used to define the dummy variable for the binary logistic regression analysis, which was used to identify predictors of positive attitude. The proportions of the study population adhering to the various coronavirus preventive measures were estimated using the Wilson method, and the corresponding 95% confidence intervals were presented.
3. Results
3.1. Profile of study participants
A total of 780 individuals participated in the study. Out of the said number, 9 cases were excluded from the analysis due to incomplete responses to the main study variables or illogical responses. More than half of the respondents were male, with ages below 45 years. Roughly 90% of the respondents were Saudi Arabian, while the others were from the Philippines, India, Pakistan, Egypt, Sudan, and other countries in the Middle East and Northern African region. Most of the respondents resided in the Eastern and Central regions.
A high proportion of the respondents were at least bachelor degree holders. Almost 3-quarters of the respondents were employed either in the government or private sector and were predominantly engaged in non-health related activities. Furthermore, a huge number of respondents have an average monthly family income of at least SAR 10,000. Table 1 presents the distribution of the respondents according to the various socio-demographic characteristics.
Table 1.
Socio-demographic profile of the respondents.
| Socio-demographic characteristics | Count (n = 771) | Proportion |
|---|---|---|
| Sex: Male Female |
448 323 |
58.1 41.9 |
| Age: Below 25 yr old 25 to 34 yr old 35 to 44 yr old 45 to 54 yr old 55 yr old and over |
114 307 203 124 23 |
14.8 39.8 26.3 16.1 3.0 |
| Nationality: Saudi Arabian Non-Saudi Arabian |
693 78 |
89.9 10.1 |
| Region: Eastern Central Western Northern Southern |
445 227 70 8 21 |
57.7 29.4 9.1 1.0 2.7 |
| Educational attainment: High School Diploma or lower Technical/Vocational Certificate Bachelor Master or Doctorate |
112 73 418 168 |
14.5 9.5 54.2 21.8 |
| Employment: Unemployed Employed in the Government sector Employed in the Private sector Self-employed/own a business |
203 376 168 24 |
26.3 48.8 21.8 3.1 |
| Nature of Employment among presently employed (n = 568): Health-related Non-health related |
190 378 |
33.5 66.6 |
| Average family income per month: below SAR5,000 SAR5,000 to SAR9,999 SAR10,000 to SAR 19,999 SAR20,000 and over |
118 164 290 199 |
15.3 21.3 37.6 25.8 |
About 2% of the respondents have been infected with COVID-19, while 3.6% of them have a family member, relative, or friend who has been diagnosed with COVID-19. Table 2 presents the distribution of the respondents according to the said attributes.
Table 2.
Distribution of respondents according to infection with coronavirus variants.
| Infection with COVID- 19 | Count (n = 771) | Proportion |
|---|---|---|
| Has been got COVID-19: Yes No Prefer not to disclose |
16 747 8 |
2.1 96.9 1.0 |
| Has a family member, relative or friend diagnosed with COVID-19: Yes No Prefer not to disclose |
28 738 5 |
3.6 95.8 0.7 |
3.2. Estimated level of knowledge retention regarding coronavirus variants
The mean score of the respondents on the 10-item true or false questionnaire is 8.1 with a standard deviation of 1.9, representing 81.0% of the total maximum score and indicating a high level of knowledge retention regarding coronavirus variants. About 22.05% of them garnered all 10 correct answers, while 1.43% failed to achieve even a single correct answer.
The proportion of residents who possess a high level of knowledge regarding coronavirus variants was estimated at 72.9% (95% CI: 69.6%–75.9%). Around 23.8% of the participants showed moderate level of knowledge and 3.4% of them showed low level of knowledge. Table 3 presents the estimated proportions of various levels of knowledge regarding COVID-19 with the corresponding 95% confidence interval. Table 4 presents participants’ responses to the knowledge section. The most commonly answered question correctly in the knowledge section was that “staying at home and practicing social distancing is an effective way to prevent transmission of COVID-19.” (95.9%). The least commonly answered question correctly in the knowledge section was that “only those who are infected with COVID-19 and their caregiver should avoid wearing a face mask.” (28.5%), Table 4.
Table 3.
Estimated proportion of residents possessing high level of knowledge retention regarding COVID-19.
| Level of knowledge retention | Proportion | 95% confidence interval | |
|---|---|---|---|
| High level | 72.9% | 69.63% | 75.92% |
| Moderate level | 23.8% | 20.86% | 26.88% |
| Low level | 3.4% | 2.30% | 4.91% |
Table 4.
Participants’ responses to knowledge and attitude sections.
| Number | Description | True | False | |||
|---|---|---|---|---|---|---|
| Knowledge section | ||||||
| 1 | Taking antibiotics will cure COVID-19. | 67.8% | 32.2% | |||
| 2 | Having been vaccinated with the influenza vaccine will protect you from getting COVID-19. | 73.8% | 26.2% | |||
| 3 | It is possible for a person infected with COVID-19 not to show any signs or experience any symptoms. | 81.1% | 18.9% | |||
| 4 | COVID-19 spreads though close contact from person to person like handshaking, kissing, etc. | 93.4% | 6.6% | |||
| 5 | COVID-19 spreads when a person touched a contaminated item, table, surfaces, doorknobs, etc then later touches his face. | 94.0% | 6.0% | |||
| 6 | COVID-19 spreads through inhalation of droplets released in the air when an infected individuals coughs, sneezes or speaks. | 85.7% | 14.3% | |||
| 7 | Regular handwashing for 20 s will protect me from COVID-19. | 74.4% | 25.6% | |||
| 8 | In the absence of soap and water, applying hand sanitizers will be effective enough. | 76.5% | 23.5% | |||
| 9 | Staying at home and practicing social distancing is an effective way to prevent transmission of COVID-19. | 95.9% | 4.1% | |||
| 10 | Only those who are infected with COVID-19 and their carer should avoid wear a face mask. | 28.5% | 71.5% | |||
| Number | Description | Strongly agree | Agree | Neutral | Disagree | Strongly disagree |
| Attitude section | ||||||
| 1 | I am afraid of COVID-19. | 1.8% | 4.2% | 12.4% | 37.3% | 44.3% |
| 2 | I am hopeful that coronavirus mutation will be over soon. | 36.8% | 40.8% | 14.5% | 6.0% | 1.9% |
| 3 | COVID-19 negatively effects my financial capacity. | 4.7% | 22.8% | 24.6% | 25.1% | 22.8% |
| 4 | I support all the precautionary measures being put in place by the health authorities. | 78.2% | 16.7% | 3.9% | 0.9% | 0.3% |
| 5 | I am determined that my family and I will not be affected by COVID-19. | 19.6% | 28.1% | 33.8% | 14.3% | 4.2% |
| 6 | The healthcare workers in the kingdom are doing their best to solve this problem. | 83.8% | 12.7% | 3.4% | 0.0% | 0.1% |
| 7 | COVID-19 is the worst problem the world has experienced so far. | 50.4% | 20.3% | 15.4% | 9.6% | 4.2% |
| 8 | It is safe to go out and have fun with my friends. | 5.6% | 3.4% | 7.9% | 23.1% | 60.1% |
3.3. Assessment of the participants’ attitudes about coronavirus variants
The mean attitude score was 27.7 with a standard deviation of 3.0, representing 69.3% of the total maximum score and indicating a positive attitude towards COVID-19.
Table 4 represents the distribution of the respondents according to the respective level of agreement with a set of attitude statements related to coronavirus variants. These statements were: I am afraid of getting coronavirus infection; I am hopeful that coronavirus mutation will be end; coronavirus negatively affects my financial capacity; I support all the precautionary measures being put in place by the Health authorities; I am determined that my family and I will not be affected by COVID-19; the healthcare workers in the kingdom are doing their best to solve this problem; COVID-19 is the worst problem the world has experienced so far; and it is safe to go out and have fun with my friends. The most agreed-upon statement in the attitude section was that “the healthcare workers in the kingdom are doing their best to solve this problem.” (96.5%). The least commonly agreed upon statement was that “I am determined that my family and I will not be affected by COVID-19.” (18.5%), Table 4.
3.4. Adherence to precautionary measures related to COVID-19
The various preventive measures related to coronavirus variants and the corresponding proportions of residents practicing such measures with 95% confidence interval estimates are presented in Table 5.
Table 5.
Estimated proportion of residents practicing preventive measures related to coronavirus.
| Coronavirus preventive practices measures | Proportion | 95% confidence interval | |
|---|---|---|---|
| Wearing of facemask: All the time Sometimes Never |
|||
| 28.5% | 25.5% | 31.8% | |
| 34.1% | 30.8% | 37.5% | |
| 37.4% | 34.0% | 40.8% | |
| Daily handwashing: <5 times 5 times More than 5 times |
8.9% |
||
| 6.9% | 5.3% | ||
| 12.1% | 9.9% | 14.6% | |
| 81.1% | 78.1% | 83.7% | |
| Manner of handwashing: |
14.0% |
||
| With soap and water for <20 s | 11.5% | 9.5% | |
| With soap and water for 20 s | 47.5% | 44.0% | 51.0% |
| With soap and water for 40 s | 39.4% | 36.3% | 42.9% |
| With water only | 1.6% | 0.9% | 2.7% |
| Observing mouth and nose etiquette: |
71.9% |
||
| All the time | 68.7% | 65.4% | |
| Sometimes | 29.1% | 26.0% | 32.4% |
| Never | 2.2% | 1.4% | 3.5% |
| Observing physical distancing: |
74.6% |
||
| All the time | 71.5% | 68.2% | |
| Sometimes | 26.5% | 23.5% | 29.7% |
| Never | 2.1% | 1.3% | 3.4% |
Full adherence to different preventive measures ranged between 6.9% and 71.5%. Around 29 out of every 100 residents adhere to wearing the facemask, while 37 out of every 100 residents don’t wear it. It is estimated that 93 out of 100 residents wash their hands at least 5 times per day. Approximately 87 out of 100 residents wash their hands with soap and water for at least 20 seconds, as prescribed by the Ministry of Health. The remaining proportions were either washing their hands with soap and water for <20 seconds or washing their hands with plain water. Roughly 75% of the respondents clean commonly touched items like phones, car steering wheels, doorknobs, and other surfaces at least twice per day.
About 69% of the residents always cover their mouth and nose when coughing or sneezing with a piece of tissue paper. Those who are occasionally practicing it are about 29%, while a little over 2% are not practicing it at all. Only 81.34% immediately dispose of the tissue they used to cover their mouth and nose in the trash bin. In the absence of tissue paper, 66.58% use their elbows to cover their mouth and nose all the time when coughing or sneezing, while 26.74% sometimes practice it. It is estimated that 71 out of 100 residents were observing physical distancing, while 26 per 100 and 2 per 100 were observing it sometimes or none at all, respectively. Among those who practice physical distancing, 11.3%, 58.6%, and 22.9% kept a distance of 0.5-meter, 1 meter, and 2 or more meters, respectively. While 7.2% of them, do not mind the distance.
3.5. Predictors of participants’ knowledge and attitude towards COVID-19
Table 6 presents the findings of the binary logistic regression analysis that was conducted to identify predictors of better knowledge and a positive attitude towards COVID-19. Higher levels of education, being employed, and higher income were factors that influenced participants’ knowledge positively (P < .05). Females and younger age were predictors of a better attitude towards COVID-19 (P < .01).
Table 6.
Predictors of better knowledge and positive attitude towards COVID-19.
| Socio-demographic characteristics | Odds ratio of having better knowledge (95% confidence interval) | Odds ratio of having positive attitude (95% confidence interval) |
|---|---|---|
| Sex: Female (Reference group) Male |
1.00 1.26 (0.92–1.73) |
1.00 0.62 (0.45–0.84)** |
| Age: Below 25 yr old (Reference group) 25 to 34 yr old 35 to 44 yr old 45 to 54 yr old 55 yr old and over |
1.00 1.14 (0.72–1.83) 1.14 (0.69–1.89) 1.29 (0.73–2.28) 0.93 (0.37–2.36) |
1.00 0.41 (0.25–0.67)*** 0.27 (0.16–0.45)*** 0.36 (0.20–0.64)*** 0.20 (0.08–0.51)*** |
| Nationality: Saudi Arabian (Reference group) Non-Saudi Arabian |
1.00 1.99 (0.89–4.42) |
1.00 0.55 (0.28–1.08) |
| Educational attainment: High School Diploma or lower (Reference group) Technical/Vocational Certificate Bachelor Master or Doctorate |
1.00 1.76 (0.95–3.26) 1.91 (1.24–2.93)** 3.77 (2.13–6.68)*** |
1.00 1.01 (0.56–1.85) 1.23 (0.80–1.88) 0.53 (0.31–0.89)* |
| Employment: Unemployed (Reference group) Employed in the Government sector Employed in the Private sector Self-employed/own a business |
1.00 1.82 (1.25–2.64)** 1.65 (1.05–2.58)* 1.01 (0.42–2.41) |
1.00 0.67 (0.46–0.96)* 0.75 (0.49–1.16) 0.78 (0.33–1.85) |
| Nature of employment among presently employed: Health-related (Reference group) Non-health related |
1.00 0.52 (0.35–0.75)*** |
1.00 1.26 (0.90–1.77) |
| Average family income per month: below SAR5,000 (Reference group) SAR5,000 to SAR9,999 SAR10,000 to SAR 19,999 SAR20,000 and over |
1.00 1.31 (0.79–2.16) 1.94 (1.23–3.07)** 2.01 (1.23–3.30)** |
1.00 1.38 (0.84–2.28) 1.29 (0.82–2.01) 1.17 (0.73–1.89) |
SAR: Saudi riyal.
P < .05;
P < .01;
P < .001.
4. Discussion
Many SARS-CoV-2 variants have emerged globally after the World Health Organization declared the COVID-19 outbreak pandemic. According to a study conducted in Saudi Arabia, the alpha (B.1.1.7), beta (B.1.351), and delta (B.1.617.2) variations have been detected, and the community should take the utmost precautions to prevent infection.[33] Prior research was done to assess COVID-19 knowledge, attitudes, and behaviors (KAP) at the time of the pandemic.[34,35] Therefore, the goal of our study was to evaluate knowledge retention and adherence to preventative measures, which are crucial for preventing and managing the novel coronavirus types.
According to the current study, 2 out of every 10 residents had a moderate level of knowledge, while nearly 7 out of every 10 residents had a high level of knowledge retention and practiced preventive measures. This might be the case given that the vast majority of participants claimed they had never had a coronavirus infection. Due to the way the respondents used the online survey technology to reply, there is a good chance that the results were misclassified. This is consistent with a prior study that evaluated the KAP of the Saudi community and found that the majority of study participants had a general understanding of new coronavirus infections, scoring an average of 81.64% on the knowledge test (2020). This conclusion conflicts with earlier research that found that Saudi Arabians were well informed about outbreaks like MERS.[36–38]
Our study found that the general public in Saudi Arabia has a high level of knowledge about COVID-19. These results are in line with those of additional investigations carried out in the Kingdom of Saudi Arabia.[31,36,39] According to one study done in Saudi Arabia by Al-Hanawi et al, the knowledge test total accuracy rate was 81.6%,[36] which is similar to our findings. The results of this survey agreed with those of a different study carried out in Malaysia by Azlan et al, which revealed that the general level of public knowledge was 80.5%.[40] However, a global survey that was carried out in Saudi Arabia, Kuwait, and Jordan, as well as the Middle East, indicated that the combined knowledge score of the 3 nations was 66.1%. The Saudi MOH later launched intense campaigns to raise awareness through its effective wide-scale communication networks and effective health system, and this may be the reason why the public level of knowledge in our study was higher (81.3%) than its findings. The highest score was among Jordanians (70.3%), while the level of public knowledge in Saudi Arabia was <70.3%.[41]
In our study, higher levels of education, being employed, and higher income were factors that positively influenced participants’ knowledge (P < .05). This was confirming the findings of a previous study in China.[42] Higher educated and wealthier individuals typically have better access to a variety of informational resources, better health literacy, a better comprehension of scientific concepts, and more time and resources to acquire better knowledge and, ultimately, a more positive attitude. Based on the most recent statistical data, it can be observed that the mean monthly salary for a public sector employee in Saudi Arabia in 2020 was approximately 11,400 SAR.[43] In recent years, Saudi Arabia has demonstrated notable progress in implementing reforms, which have resulted in positive changes to its economy as well as improvements in fiscal and debt management.[44] The proposed reforms encompass several strategies aimed at promoting economic diversification and expanding the tax revenue sources beyond the oil sector. Additionally, these reforms include substantial social liberalization measures that contribute to the stimulation of consumer demand.[44] Furthermore, the world economy continues to derive advantages from Saudi Arabia prominent position as the foremost individual exporter of oil on a global scale.[44]
In general, the current study showed that there is a positive attitude towards COVID-19 and that most of the participants adhered to coronavirus preventive practices measures. In contrast to our findings, a study conducted in Bangladesh by Haque et al found that only half of the subjects had positive attitudes and behaviors concerning COVID-19 during the epidemic.[45] Furthermore, a negative attitude is not always a result of knowledge. This was noted in a Chinese study where participants’ knowledge of COVID-19 was reported to be low compared to a high positive attitude.[42] The authors attributed this observation and the high positive attitude to the drastic measures taken by the Chinese government to contain the virus’ spread.[42]
The preventive measures play an essential role in reducing infection rates and controlling the spread of the disease. This indicates the necessity of public adherence to preventive and control measures, which is affected by their knowledge, attitudes, and practices. Al-Hanawi et al (2020) conducted a cross-sectional study that investigated 3388 Saudi Arabian participants in an attempt to measure the current level of awareness, perception, and practices of the Saudi Arabian public towards COVID-19.[36] While the findings revealed that the participants in the region have sufficient knowledge, a positive attitude, and acceptable practices towards COVID-19, policy-makers would be better informed if the research took into account the ways through which Saudi public sources derive better COVID-19 information. Besides, having some basic information related to COVID-19 and the accompanying precautionary measures.[46,47] Furthermore, with the previous experience of the Middle East Respiratory Syndrome-Coronavirus outbreak, the majority of the residents are observing the minimum health standards set by the health authorities.
This study, which is not the first to look at knowledge, attitudes, and behaviors during the pandemic in Saudi Arabia, is considered to represent continual monitoring of the pandemic situation. It supplies profile information for upcoming meta-analysis inquiries by demonstrating the evolution in knowledge level, attitude, and practices relative to earlier published research. There are several limitations to this study. The generalizability of our results may have been affected by convenience sampling. As a consequence, some demographic groupings could have been absent when the data was gathered. This research was conducted using a web-based survey methodology (using social media as distribution platform), which resulted in the exclusion of certain vulnerable persons who lack internet access and are unfamiliar with online questionnaires. This is obvious given that the majority of the participants in our research were under 34 and from the Eastern area (which limited our ability to conduct more in-depth analysis of regional differences). A serious and irreversible limitation is that we evaluated our newly constructed (non-standardized) questionnaire instrument on a small number of participants without further validation procedures. The methodology of the research, a cross-sectional survey (lacking of longitudinal data), limited our capacity to find causal relationships between study variables. There are few research that have evaluated the knowledge, attitudes, and behaviors of the general population during the COVID-19 pandemic using comparable survey instruments since various studies used different instruments, limiting our ability to compare data. In this research, we adopted a quantitative technique with predetermined responses, which may have prevented participants from providing diverse but relevant qualitative data. In addition, we were unable to calculate the response rate since we could not estimate the number of people who requested to participate in the survey. This might enhance the probability of non-response bias. The study design based on self-reporting is not exempt from limitations. Two common biases that can affect the accuracy of responses in surveys are response bias and recall bias. Response bias occurs when respondents supply incorrect or biased information owing to factors such as social desirability bias, which is the tendency to give answers that are socially acceptable or positive. Similarly, recall bias refers to the tendency of respondents to remember events or information inaccurately, leading to biased responses. Additionally, it is worth noting that individuals involved in the study may encounter challenges when attempting to recall past events or specific details with precision, perhaps resulting in inaccuracies within their responses. This aspect holds special significance when inquiring about events or experiences that occurred a long time ago. Furthermore, our study did not examine all socioeconomic factors. Hence, our results must be interpreted with caution.
5. Conclusion
People in Saudi Arabia demonstrated a high degree of familiarity with COVID-19 variations. In addition, they had a positive attitude toward many aspects of coping with different sorts of variations. The vast majority of the residents feared the expansion and mutation of the coronavirus. This research demonstrates the significance of continued community service-learning programs for enhancing information retention and adherence to coronavirus variation preventive efforts.
Author contributions
Conceptualization: Ahmed M. Al Rajeh
Data curation: Ahmed M. Al Rajeh, Abdallah Y Naser
Formal analysis: Ahmed M. Al Rajeh
Funding acquisition: Ahmed M. Al Rajeh
Investigation: Ahmed M. Al Rajeh, Abdallah Y Naser
Methodology: Ahmed M. Al Rajeh
Project administration: Ahmed M. Al Rajeh
Resources: Ahmed M. Al Rajeh
Software: Ahmed M. Al Rajeh
Supervision: Ahmed M. Al Rajeh
Validation: Ahmed M. Al Rajeh, Abdallah Y Naser
Visualization: Ahmed M. Al Rajeh, Abdallah Y Naser
Writing – original draft: Ahmed M. Al Rajeh
Writing – review & editing: Ahmed M. Al Rajeh, Abdallah Y Naser
Abbreviations:
- CDC
- Centers for Disease Control and Prevention
- CI
- confidence interval
- COVID-19
- Coronavirus diseases 2019
- GISADI
- Global Influenza Surveillance and Response System
- KAP
- knowledge, attitude, and practice
- WHO
- World Health Organization
The authors extend their appreciation to the Deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number (Grant No: INST117).
Ethical approval was obtained from the research ethics committee at King Faisl University, Al-Ahsa, Saudi Arabia (Approval date: 07/01/2020; Reference number: KFU-REC/2020-07-02).
Informed consent was obtained from all subjects involved in the study.
All data generated or analyzed during this study are included in this published article [and its supplementary information files].
The authors have no conflicts of interest to disclose.
How to cite this article: Al Rajeh AM, Naser AY. Knowledge, attitude, and adherence to coronavirus preventive measures among residents of the Kingdom of Saudi Arabia. Medicine 2023;102:48(e36427).
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