Public knowledge, beliefs, psychological responses, and behavioural changes during the outbreak of COVID-19 in the Middle East
Main Article Content
COVID-19, Disease Outbreaks, Quarantine, Health Knowledge, Attitudes, Practice, Attitude to Health, Fear, Problem Behavior, Social Media, Surveys and Questionnaires, Cross-Sectional Studies, Middle East
Objective: To evaluate the knowledge, believes, psychological and behavioural impact of COVID-19 on the general population in the Middle East, exploring how it impacted public lives.
Methods: A descriptive cross-sectional online survey was sent to a convenience sample in the Middle East through social media (Facebook and WhatsApp) between 16th of June and 30th of June 2020. The questionnaire was designed to collect the demographic, participant’s source of information regarding COVID-19, knowledge and believes about COVID-19, the psychological consequences of COVID-19, impact of COVID-19 on participant’s behaviour. The final version of the questionnaire was further tested for content validity by experts in the field.
Results: A total of 2,061 participants completed the survey, with the majority being females (n=1394, 67.6%), from urban areas (n=1896, 92%) and the majority were from countries of The Levant (n=1199, 58.1%), followed by the Arabian Peninsula (n=392, 19.1%), Iraq (n=300, 14.6%) and Egypt (n=138, 6.7%). Few participants (3.0%) reported to have been infected and many (n=1847, 89.6%) were committed to quarantine at home. Social media platforms were the most common sources of information (41.2%). Many (63%) believed that COVID-19 is a biological weapon and were afraid of visiting crowded places (85%). The majority avoided public facilities (86.9%) such as prayer places and believed that the news about COVID-19 made them anxious (49.5%).
2. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151. https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003
3. World Health Organization. Risk communication and community engagement readiness and response to coronavirus disease (COVID-19): interim guidance, https://apps.who.int/iris/bitstream/handle/10665/331513/WHO-2019-nCoV-RCCE-2020.2-eng.pdf?sequence=1&isAllowed=y (accessed Jan 12 2021).
4. World Health Organization. Coronavirus disease ( COVID-19). https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (accessed Jan 12 2021).
5. Pandey SJJCMR. Gupta A. Bhansali R, Balhara S, Katira P, Fernandes G. Corona virus (COVID-19) awareness assessment-a survey study amongst the Indian population. J Clin Med Res. 2020;2(4):1-11. https://doi.org/10.37191/Mapsci-2582-4333-2(3)-041
6. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/s0140-6736(20)30183-5
7. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published correction appears in JAMA. 2021 Mar 16;325(11):1113]. JAMA. 2020;323(11):1061-1069. https://doi.org/10.1001/jama.2020.1585
8. Masoud AT, Zaazouee MS, Elsayed SM, et al. KAP-COVIDGLOBAL: a multinational survey of the levels and determinants of public knowledge, attitudes and practices towards COVID-19. BMJ Open. 2021;11(2):e043971. https://doi.org/10.1136/bmjopen-2020-043971
9. Giacalone A, Rocco G, Ruberti E. Physical Health and Psychosocial Considerations During the Coronavirus Disease 2019 Outbreak. Psychosomatics. 2020;61(6):851-852. https://doi.org/10.1016/j.psym.2020.07.005
10. 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.
11. Basheti IA, Nassar R, Barakat M, et al. Pharmacists' readiness to deal with the coronavirus pandemic: Assessing awareness and perception of roles. Res Social Adm Pharm. 2021;17(3):514-522. https://doi.org/10.1016/j.sapharm.2020.04.020
12. Balkhi F, Nasir A, Zehra A, Riaz R. Psychological and Behavioral Response to the Coronavirus (COVID-19) Pandemic. Cureus. 2020;12(5):e7923. https://doi.org/10.7759/cureus.7923
13. Lau JT, Yang X, Tsui H, Kim JH. Monitoring community responses to the SARS epidemic in Hong Kong: from day 10 to day 62. J Epidemiol Community Health. 2003;57(11):864-870. https://doi.org/10.1136/jech.57.11.864
14. Kebede Y, Yitayih Y, Birhanu Z, Mekonen S, Ambelu A. Knowledge, perceptions and preventive practices towards COVID-19 early in the outbreak among Jimma university medical center visitors, Southwest Ethiopia. PLoS One. 2020;15(5):e0233744. https://doi.org/10.1371/journal.pone.0233744
15. 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;8:599007. https://doi.org/10.3389/fpubh.2020.599007
16. Al-Hanawi MK, Angawi K, Alshareef N, et al. Knowledge, Attitude and Practice Toward COVID-19 Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study. Front Public Health. 2020;8:217. https://doi.org/10.3389/fpubh.2020.00217
17. COVID-19 Knowledge, Attitudes and Practices (KAP) Survey: Northwest Syria. https://reliefweb.int/report/syrian-arab-republic/covid-19-knowledge-attitudes-and-practices-kap-survey-northwest-syria-5 (accessed Jan 12, 2021).
18. Qutob N, Awartani F, Asia M, Khader IA. Knowledge and practices towards COVID-19 among Palestinians during the COVID-19 outbreak: A second round cross-sectional survey. https://www.medrxiv.org/content/10.1101/2020.10.13.20211888v1 (accessed Jan 12, 2021).
19. Sallam M, Dababseh D, Yaseen A, et al. COVID-19 misinformation: Mere harmless delusions or much more? A knowledge and attitude cross-sectional study among the general public residing in Jordan. PLoS One. 2020;15(12):e0243264. https://doi.org/10.1371/journal.pone.0243264
20. Abdel Wahed WY, Hefzy EM, Ahmed MI, Hamed NS. Assessment of Knowledge, Attitudes, and Perception of Health Care Workers Regarding COVID-19, A Cross-Sectional Study from Egypt. J Community Health. 2020;45(6):1242-1251. https://doi.org/10.1007/s10900-020-00882-0
21. Iorfa SK, Ottu IFA, Oguntayo R, et al. COVID-19 Knowledge, Risk Perception, and Precautionary Behavior Among Nigerians: A Moderated Mediation Approach. Front Psychol. 2020;11:566773. https://doi.org/10.3389/fpsyg.2020.566773
22. Olapegba PO, Iorfa SK, Kolawole SO, et al. Survey data of COVID-19-related Knowledge, Risk Perceptions and Precautionary Behavior among Nigerians. Data Brief. 2020;30:105685. https://doi.org/10.1016/j.dib.2020.105685
23. Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus Disease-2019: Knowledge, Attitude, and Practices of Health Care Workers at Makerere University Teaching Hospitals, Uganda. Front Public Health. 2020;8:181. https://doi.org/10.3389/fpubh.2020.00181
24. Ali KF, Whitebridge S, Jamal MH, Alsafy M, Atkin SL. Perceptions, Knowledge, and Behaviors Related to COVID-19 Among Social Media Users: Cross-Sectional Study. J Med Internet Res. 2020;22(9):e19913. https://doi.org/10.2196/19913
25. Kakemam E, Ghoddoosi-Nejad D, Chegini Z, 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;8:585302. https://doi.org/10.3389/fpubh.2020.585302
26. Al-Dmour H, Masa'deh R, Salman A, Abuhashesh M, Al-Dmour R. Influence of Social Media Platforms on Public Health Protection Against the COVID-19 Pandemic via the Mediating Effects of Public Health Awareness and Behavioral Changes: Integrated Model. J Med Internet Res. 2020;22(8):e19996. https://doi.org/10.2196/19996
27. Zhong BL, Luo W, Li HM, 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;16(10):1745-1752. https://doi.org/10.7150/ijbs.45221
28. Nooh HZ, Alshammary RH, Alenezy JM, et al. Public awareness of coronavirus in Al-Jouf region, Saudi Arabia [published online ahead of print, 2020 Feb 13]. Z Gesundh Wiss. 2020;1-8. https://doi.org/10.1007/s10389-020-01209-y
29. Parsons Leigh J, Fiest K, Brundin-Mather R, et al. A national cross-sectional survey of public perceptions of the COVID-19 pandemic: Self-reported beliefs, knowledge, and behaviors. PLoS One. 2020;15(10):e0241259. https://doi.org/10.1371/journal.pone.0241259
30. Abdelrahman M. Personality Traits, Risk Perception, and Protective Behaviors of Arab Residents of Qatar During the COVID-19 Pandemic. Int J Ment Health Addict. 2020; [ahead of print]. https://doi.org/10.1007/s11469-020-00352-7
31. Murthy RS. COVID-19 pandemic and emotional health: Social psychiatry perspective. Ind J Soc Psychyat. 2020;36(5):24. . https://doi.org/10.4103/ijsp.ijsp_293_20
32. Fitzpatrick KM, Harris C, Drawve G. Living in the midst of fear: Depressive symptomatology among US adults during the COVID-19 pandemic. Depress Anxiety. 2020;37(10):957-964. https://doi.org/10.1002/da.23080
33. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations [published correction appears in Gen Psychiatr. 2020 Apr 27;33(2):e100213corr1]. Gen Psychiatr. 2020;33(2):e100213. https://doi.org/10.1136/gpsych-2020-100213
34. Pierce M, Hope H, Ford T, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry. 2020;7(10):883-892. https://doi.org/10.1016/s2215-0366(20)30308-4
35. El-Zoghby SM, Soltan EM, Salama HM. Impact of the COVID-19 Pandemic on Mental Health and Social Support among Adult Egyptians. J Community Health. 2020;45(4):689-695. https://doi.org/10.1007/s10900-020-00853-5
36. Alkhamees AA, Alrashed SA, Alzunaydi AA, Almohimeed AS, Aljohani MS. The psychological impact of COVID-19 pandemic on the general population of Saudi Arabia. Compr Psychiatry. 2020;102:152192. https://doi.org/10.1016/j.comppsych.2020.152192
37. Shuwiekh HAM, Kira IA, Sous MSF, et al. The differential mental health impact of COVID-19 in Arab countries [published online ahead of print, 2020 Nov 2]. Curr Psychol. 2020;1-15. https://doi.org/10.1007/s12144-020-01148-7
38. Badahdah A, Khamis F, Al Mahyijari N, et al. The mental health of health care workers in Oman during the COVID-19 pandemic [published online ahead of print, 2020 Jul 8]. Int J Soc Psychiatry. 2020;20764020939596. https://doi.org/10.1177/0020764020939596
39. Vijai C, Suryalakshmi SJCC, Special Issue. Awareness, Attitudes, and Practices Related to Coronavirus (COVID-19) Pandemic among Public in Chennai City, India. Cape Comorin. 2020;2(5):27-37.
40. Bailey SC, Serper M, Opsasnick L, et al. Changes in COVID-19 Knowledge, Beliefs, Behaviors, and Preparedness Among High-Risk Adults from the Onset to the Acceleration Phase of the US Outbreak. J Gen Intern Med. 2020;35(11):3285-3292. https://doi.org/10.1007/s11606-020-05980-2
41. Moro M, Vigezzi GP, Capraro M, et al. 2019-novel coronavirus survey: knowledge and attitudes of hospital staff of a large Italian teaching hospital. Acta Biomed. 2020;91(3-S):29-34. https://doi.org/10.23750/abm.v91i3-s.9419
42. Deschasaux-Tanguy M, Druesne-Pecollo N, Esseddik Y, et al. Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March-May 2020): results from the French NutriNet-Santé cohort study. Am J Clin Nutr. 2021;113(4):924-938. https://doi.org/10.1093/ajcn/nqaa336
43. Zachary Z, Brianna F, Brianna L, et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract. 2020;14(3):210-216. https://doi.org/10.1016/j.orcp.2020.05.004
44. Cheikh Ismail L, Osaili TM, Mohamad MN, et al. Eating Habits and Lifestyle during COVID-19 Lockdown in the United Arab Emirates: A Cross-Sectional Study. Nutrients. 2020;12(11):3314. https://doi.org/10.3390/nu12113314
45. Kouzy R, Abi Jaoude J, Kraitem A, et al. Coronavirus Goes Viral: Quantifying the COVID-19 Misinformation Epidemic on Twitter. Cureus. 2020;12(3):e7255. https://doi.org/10.7759/cureus.7255
46. Health Communication Capacity Collaborative GoLMoH. National Knowledge, Attitudes, and Practices (KAP) Survey on Ebola Virus Disease in Liberia. https://healthcommcapacity.org/wp-content/uploads/2017/07/Liberia_KAP-II_Report_Final-May-2017_HC3.pdf (accessed Apr 30 2021).
47. Boufkhed S, Harding R, Kutluk T, Husseini A, Pourghazian N, Shamieh O. What Is the Preparedness and Capacity of Palliative Care Services in Middle-Eastern and North African Countries to Respond to COVID-19? A Rapid Survey. J Pain Symptom Manage. 2021;61(2):e13-e50. https://doi.org/10.1016/j.jpainsymman.2020.10.025
48. Refugees UNHCf. UNHCR Jordan COVID-19 response. https://data2.unhcr.org/en/documents/details/85614 (accessed Apr 30 2021).
49. FIP. Coronavirus 2019-nCoV outbreak: Information and interim guidelines for pharmacists and the pharmacy workforce. https://www.fip.org/files/content/priority-areas/coronavirus/FIP_Webinar_Coronavirus_response_20200210.pdf (accessed Apr 30 2021).
50. Basheti IA, Nassar R, Barakat M, et al. Pharmacists' perceived barriers towards delivering their emergency roles during the COVID-19 pandemic and perceived policymakers' responsibilities. J Pharm Policy Pract. 2020;13:62. https://doi.org/10.1186/s40545-020-00254-y
51. Kretchy IA, Asiedu-Danso M, Kretchy JP. Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from low-and middle-income countries. Res Social Adm Pharm. 2021;17(1):2023-2026. https://doi.org/10.1016/j.sapharm.2020.04.007
52. Administration USFaD. FDA takes key action in fight against COVID-19 by issuing emergency use authorization for first COVID-19 vaccine. https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19 (accessed Jan 12 2021).
53. Administration USFaD. FDA takes additional action in fight against COVID-19 by issuing emergency use authorization for second COVID-19 vaccine. https://www.fda.gov/news-events/press-announcements/fda-takes-additional-action-fight-against-covid-19-issuing-emergency-use-authorization-second-covid (accessed Jan 12 2021).
54. European Centre for Disease Prevention and Control. First COVID-19 vaccine authorised for use in the European Union. https://www.ecdc.europa.eu/en/news-events/first-covid-19-vaccine-authorised-use-european-union (accessed Jan 12 2021).
55. Weintraub RL, Subramanian L, Karlage A, Ahmad I, Rosenberg J. COVID-19 Vaccine To Vaccination: Why Leaders Must Invest In Delivery Strategies Now. Health Aff (Millwood). 2021;40(1):33-41. https://doi.org/10.1377/hlthaff.2020.01523
56. Coustasse A, Kimble C, Maxik K. COVID-19 and Vaccine Hesitancy: A Challenge the United States Must Overcome. J Ambul Care Manage. 2021;44(1):71-75. https://doi.org/10.1097/jac.0000000000000360