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During the first week of March, the coronavirus disease 2019 (COVID-19) outbreak reached more than 100 countries with over 100,000 cases. Health care authorities have already initiated awareness and preparedness activities worldwide. A poor understanding of the disease among health care workers (HCWs) may result in delayed treatment and result in the rapid spread of the infection.
This study aimed to investigate the knowledge and perceptions of HCWs about COVID-19.
A cross-sectional, web-based study was conducted among HCWs about COVID-19 during the first week of March 2020. A 23-item survey instrument was developed and distributed randomly to HCWs using social media; it required 5 minutes to complete. A chi-square test was used to investigate the level of association among variables, with significance set to
Of 529 participants, a total of 453 HCWs completed the survey (response rate: 85.6%); 51.6% (n=234) were male, 32.1% (n=147) were aged 25-34 years, and most were doctors (n=137, 30.2%) and medical students (n=134, 29.6%). Most participants (n=276, 61.0%) used social media to obtain information on COVID-19. A significant proportion of HCWs had poor knowledge of its transmission (n=276, 61.0%) and symptom onset (n=288, 63.6%) and showed positive perceptions of COVID-19. Factors such as age and profession were associated with inadequate knowledge and a poor perception of COVID-19.
As the global threat of COVID-19 continues to emerge, it is critical to improve the knowledge and perceptions of HCWs. Educational interventions are urgently needed to reach HCWs worldwide, and further studies are warranted.
Coronavirus (CoV) infections are emerging respiratory viruses that are known to cause illness ranging from the common cold to severe acute respiratory syndrome (SARS) [
COVID-19 is spread by human-to-human transmission through droplet, feco-oral, and direct contact and has an incubation period of 2-14 days [
Knowledge can influence the perceptions of HCWs due to their past experiences and beliefs [
A web-based, cross-sectional study was conducted using a survey instrument to obtain responses from HCWs globally during the first week of March 2020.
A 23-item survey instrument was developed using WHO course materials on emerging respiratory viruses, including COVID-19 [
Refinements were made as required to facilitate better comprehension and to organize the questions before the final survey was distributed to the study population through a URL link. Briefly, we used Telegram, a cloud-based instant messaging app, used by more than 200 million people every month. The “Clinical Updates” group was established on December 28, 2017 to provide the latest medical research updates. The group includes more than 2500 active members of HCWs all over the world. In the group, the survey link was advertised to the target population and was opened in March 2020 for 10 days.
The survey instrument comprised 23 closed-ended questions and took approximately 5 minutes to complete. The 23-item questionnaire was divided into three parts: participant characteristics (3 items), awareness of COVID-19 (2 items), source of information (4 statements/4-point Likert scale: 1 [least used] to 4 [most used]), knowledge about symptoms of COVID-19-affected patients (2 items), different modes of transmission (2 items), precautions and risk prevention (3 items) and perceptions of COVID-19 (7 items/true or false questions) (
Knowledge was assessed by questions focusing on COVID-19 etiology, signs and symptoms, transmission, and risk prevention. Each response was scored as “1” (correct) and “0” (wrong), with scores ranging from 1 to 7. A cutoff level of ≤4 was considered to indicate poor knowledge about COVID-19 whereas >4 was considered adequate knowledge about COVID-19.
Perceptions toward COVID-19 were assessed using 7 items, and each question was labeled as good (scored as “1”) or poor perception (scored as “0”). Scores ranged from 0 to 7. The participants’ perceptions are classified as good (score >5) or poor (score ≤5).
The obtained data were coded, validated, and analyzed using SPSS version 24 (IBM). Descriptive analysis was applied to calculate frequencies and proportions. The chi-square test was used to investigate the level of association among variables. A
Confidentiality of personal information was maintained throughout the study by making participants' information anonymous and asking participants to provide honest answers. Eligible HCWs’ participation in this survey was voluntary and was not compensated. Electronic informed consent was shown on the initial page of the survey. The study was performed following the Declaration of Helsinki as revised in 2013. The study was conducted following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines [
A total of 529 HCWs participated, 453 of whom completed the study questionnaire (85.6% response rate), including 234 (51.6%) men and 219 (48.3%) women. Most participants were below 44 years of age (n=378, 82.4%). The majority of participants were doctors (n=137, 30.2%) or medical students (n=134, 29.6%) and were from Asia (n=308, 68%).
When we asked about participants’ source for reliable information about COVID-19, the primary sources mentioned were official government websites and social media (
Sociodemographic characteristics of health care workers (N=453).
Characteristic | Participants, n (%) | |
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Male | 234 (51.6) |
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Female | 219 (48.3) |
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<25 | 145 (31.6) |
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25-34 | 147 (32.1) |
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35-44 | 86 (18.7) |
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45-54 | 47 (10.2) |
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55-64 | 28 (6.1) |
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Doctor | 137 (30.2) |
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Medical student | 134 (29.6) |
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Pharmacist | 61 (13.5) |
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Academic doctor | 61 (13.5) |
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Nurse | 24 (5.3) |
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Lab technician | 22 (4.9) |
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Dentist | 14 (3.1) |
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Asia | 308 (68) |
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Africa | 72 (15.9) |
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Europe | 40 (8.8) |
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North America | 11 (2.4) |
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South America | 7 (1.5) |
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Unspecified | 13 (2.9) |
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Yes | 443 (97.8) |
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No | 10 (2.2) |
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Yes | 200 (44.1) |
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No | 253 (55.8) |
aCOVID-19: coronavirus disease 2019.
Participants’ sources for reliable information about coronavirus disease 2019 (COVID-19) (N=453).
Response | Source of COVID-19 information | |||
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News media, n (%) | Social media, n (%) | Government websites, n (%) | Family and friends, n (%) |
Least used | 134 (29.56) | 139 (30.62) | 151 (33.41) | 53 (11.73) |
Sometimes | 139 (30.72) | 139 (30.62) | 101 (22.51) | 91 (20.00) |
More often | 115 (25.40) | 104 (22.97) | 121 (26.71) | 179 (39.51) |
Most used | 65 (14.34) | 72 (15.9) | 78 (17.21) | 129 (28.47) |
Knowledge about coronavirus disease 2019 (COVID-19) among health care workers (N=453).
Question | Doctors (n=137), n (%) | Allied health workers (n=316), n (%) | Total correct responses, n (%) | |
COVID-19 is thought to originate from bats | 90 (65.7) | 176 (55.7) | 266 (58.7) | .046 |
COVID-19 is transmitted through air, contact, fecal-oral routes | 50 (36.5) | 127 (40.2) | 177 (39) | .46 |
Headache, fever, cough, sore throat, and flu are symptoms of COVID-19 | 109 (79.6) | 223 (70.6) | 332 (73.2) | .046 |
The incubation period of COVID-19 (2-14 days) | 62 (45.3) | 103 (32.6) | 165 (36.4) | .01 |
COVID-19 leads to pneumonia, respiratory failure, and death | 115 (84) | 238 (75.3) | 353 (77.9) | .04 |
Supportive care is the current treatment for COVID-19 | 114 (83.2) | 193 (61) | 307 (67.7) | .001 |
Hand hygiene, covering nose and mouth while coughing, and avoiding sick contacts can help in the prevention of COVID-19 transmission | 117 (85.4) | 271 (85.6) | 388 (85.6) | .96 |
a
Over 78% (n=353) of the HCWs exhibited a positive perception of COVID-19. The majority of HCWs knew that sick patients should share their recent travel history (n=420, 92.7%), that flu vaccination is not sufficient to prevent COVID-19 (n=411, 90.7%), and that COVID-19 is not fatal (n=401, 88.5%). In addition, 87% (n=394) felt that washing hands with soap and water could help to prevent COVID-19 transmission; 84.3% (n=394) knew that symptoms appear in 2-14 days; and 85.6% (n=388) agreed that all equipment used in wet markets should be cleaned every day. However, 20.9% (n=95) of HCWs answered “no” when asked about eating well-cooked meat during the outbreak (
Items related to perceptions of COVID-19 among HCWs were analyzed separately using a chi-square test to examine their association with age and sex and across different professions (
Health care workers’ perceptions toward coronavirus disease 2019 (COVID-19) (N=453).
Statement | Yes, n (%) | No, n (%) |
COVID-19 symptoms appear in 2-14 days | 394 (84.3)a | 71 (15.6) |
COVID-19 is fatal | 52 (11.4) | 401 (88.5)a |
Flu vaccination is sufficient for preventing COVID-19 | 42 (9.2) | 411 (90.7)a |
During the outbreak, eating well-cooked and safely handled meat is safe | 358 (78.1)a | 95 (20.9) |
Sick patients should share their recent travel history with health care providers | 420 (92.7)a | 33 (7.3) |
Disinfect equipment and working area in wet markets at least once a day | 388 (85.6)a | 65 (14.3) |
Washing hands with soap and water can help in the prevention of COVID-19 transmission | 394 (87)a | 59 (13) |
aIndicates the correct answer.
Association between respondent characteristics and perceptions of coronavirus disease 2019 (COVID-19).
Question and response | Sex | Age | Profession | ||||||||||||||||||||
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Male (n=234), n (%) | Female (n=219), n (%) | <25 years (n=145), n (%) | 25-44 years (n=233), n (%) | 45-65 years (n=75), n (%) | Doctors (n=137), n (%) | Medical students (n=134), n (%) | Others (n=182), n (%) | |||||||||||||||
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.75 |
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Yesb | 198 (84.6) | 183 (83.5) |
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130 (89.6) | 207 (88.8) | 39 (52) |
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126 (92) | 116 (86.5) | 146 (80.2) |
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No | 36 (15.3) | 36 (16.4) |
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15 (10.4) | 26 (11.1) | 36 (48) |
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11 (8) | 18 (13.5) | 36 (19.8) |
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.19 |
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.78 |
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.31 | ||||||||||||||
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Yes | 22 (9.4) | 29 (13.2) |
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127 (87.5) | 207 (88.8) | 68 (90.6) |
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116 (84.6) | 112 (83.5) | 143 (78.5) |
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Nob | 212 (90.6) | 190 (86.7) |
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18 (12.5) | 26 (11.1) | 7 (9.4) |
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21 (15.4) | 22 (16.5) | 39 (21.5) |
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.94 |
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.07 |
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.11 | ||||||||||||||
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Yes | 24 (10.2) | 22 (10.1) |
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21 (14.5) | 19 (8.1) | 5 (6.6) |
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18 (13.1) | 16 (12) | 36 (19.8) |
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Nob | 210 (89.7) | 197 (89.9) |
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124 (85.5) | 214 (91.9) | 70 (93.4) |
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119 (86.9) | 118 (88) | 146 (80.2) |
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.67 |
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.13 |
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Yesb | 192 (82) | 183 (83.5) |
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113 (77.9) | 200 (85.8) | 63 (84) |
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114 (83.2) | 98 (73.1) | 136 (74.7) |
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No | 42 (18) | 36 (16.4) |
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32 (22) | 33 (14.2) | 12 (16) |
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23 (16.8) | 36 (26.9) | 46 (25.3) |
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.84 |
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.51 |
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Yesb | 228 (97.4) | 214 (97.7) |
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141 (97.2) | 229 (98.2) | 72 (96) |
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131 (95.6) | 124 (92.5) | 158 (86.8) |
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No | 6 (2.6) | 5 (2.3) |
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4 (2.8) | 4 (1.8) | 3 (4) |
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6 (4.4) | 10 (7.5) | 24 (13.2) |
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.26 |
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.54 |
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.41 | ||||||||||||||
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Yesb | 205 (87.6) | 199 (90.8) |
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131 (90.3) | 206 (88.4) | 64 (85.3) |
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116 (84.6) | 117 (87.3) | 149 (81.8) |
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No | 29 (12.4) | 20 (9.2) |
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14 (9.7) | 27 (11.6) | 11 (14.7) |
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21 (15.4) | 17 (12.7) | 33 (18.2) |
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.58 |
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.24 |
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.88 | ||||||||||||||
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Yesb | 204 (87.2) | 187 (85.3) |
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120 (82.7) | 207 (88.8) | 65 (86.6) |
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118 (86.1) | 116 (86.5) | 160 (87.9) |
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No | 30 (12.8) | 32 (13.6%) |
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25 (17.3) | 26 (11.1) | 10 (13.4) |
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19 (13.9) | 18 (13.5) | 22 (12.1) |
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aSignificant at
bIndicates the correct answer.
Nearly 90% (n=130) of the youngest participants (<25 years) and 92% (n=126) of the doctors believed that the symptoms of COVID-19 appeared as early as 2-14 days; the differences among the respondent groups were statistically significant (
At present, COVID-19 is a global topic of discussion in the media and among the public, especially among HCWs and patients. With the currently mounting COVID-19 transmission raising tensions for everyone, including for health officials and health systems, an important question arises regarding how we manage information to help frontline HCWs in times of public health crisis. For this reason, we investigated HCWs’ knowledge and perceptions of the prevention and control of COVID-19 at the pandemic level.
Knowledge and perceptions of COVID-19 varied across different categories of HCWs. Our study revealed that HCWs have insufficient knowledge about COVID-19 but showed positive perceptions of COVID-19 transmission prevention. We also found that more than 33% (n=151) of HCWs used official government websites as a primary source of information about COVID-19. This indicates that the COVID-19-related updates posted online by official government health authorities had positive implications for improving HCWs’ knowledge levels. Obtaining information from authentic sources is pivotal for disseminating unbiased and reliable data about the emerging COVID-19 infection and is essential for HCWs’ preparedness and response. However, a finding of considerable concern is that more than 61% (n=278) of HCWs used social media as a source of information. Currently, there is a vast diversity of information available through the internet, including unverified malicious information, that can spread quickly and misguide HCWs. In particular, health authorities and scientists have warned that widespread misinformation about COVID-19 is a serious concern causing xenophobia worldwide [
The findings of this study suggest a significant gap between the amount of information available on COVID-19 and the depth of knowledge among HCWs, particularly about the mode of transmission and the incubation period of COVID-19. Additionally, many allied health workers had inaccurate knowledge of COVID-19 (eg, can be treated with antivirals and that there is a vaccine available). This is unfortunate because the surge of COVID-19 is globally devastating, and a large number of resources are provided by health care authorities to educate HCWs and improve their knowledge of COVID-19. One possible explanation for these differences in knowledge is that doctors are more educated in infectious diseases and pharmacotherapy because of their continuous professional development. Therefore, our findings suggest that greater encouragement from health authorities is needed to distribute COVID-19-related knowledge to all categories of HCWs.
Generally, most participants had a positive perception of the prevention and control of COVID-19. However, discrepancies were identified in the perceptions of different categories of HCWs. For instance, only half (n=32, 52%) of the HCWs aged 45-65 years believed that the symptoms of COVID-19 appeared as early as 2 or as late as 14 days (
We used WHO training material for the detection, prevention, response, and control of COVID-19 to develop a validated questionnaire. The developed questionnaire was pilot tested, and open-ended questions were limited to reduce information bias.
However, this study has some limitations that should be considered. This is a cross-sectional study conducted online among HCWs during a time (ie, first week of March 2020) when an alarming number of cases were being reported globally; this might limit generalizations. In addition, the data presented in this study are self-reported and partly dependent on the participants' honesty and recall ability; thus, they may be subject to recall bias. Lastly, due to the 4-week closure of higher educational institutions in the United Arab Emirates during the COVID-19 outbreak [
We identified a significant gap in information source, poor knowledge levels, and discrepancies in perceptions of COVID-19 among our study participants. As the global threat of COVID-19 continues to emerge, greater efforts through educational campaigns that target HCWs and the wider population beyond borders are urgently needed.
Survey questionnaire.
Checklist for Reporting Results of Internet E-Surveys (CHERRIES).
Centers for Disease Control and Prevention
Checklist for Reporting Results of Internet E-Surveys
coronavirus
coronavirus disease 2019
health care worker
Middle East respiratory syndrome coronavirus
severe acute respiratory syndrome
World Health Organization
We thank all study participants for their voluntary participation and for providing essential information.
ASB designed the study, developed the questionnaire, collected the data, analyzed the data, and prepared the manuscript. WAA designed the questionnaire and conducted the pilot test and the literature review. MAM and JR distributed the questionnaire and filtered and analyzed the data. All authors read and approved the final manuscript.
None declared.