Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude, and Four Nonpharmaceutical Interventions During the Late Period of the COVID-19 Epidemic in China: Online Cross-Sectional Survey of 8158 Adults

Abstract

Background So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. Objective This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. Methods An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. Results Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; P<.001). Conclusions We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs.

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

“…The subset of participants with a higher perception of risk was found to be more likely to adopt NPIs in both. Interestingly, several surveys confirm the expectation coming from the health belief model pointing to the fact that knowledge about the disease and perceived risks are predictors behavioral changes [198] , [204] , [206] , [208] , [214] , [215] , [216] . The adoption of face masks has been found to be negatively affected by perception of shortage in New Zealand [206] , and positively influenced by national guidelines in the USA [211] .…”

SARS-CoV-2 Threat Perception and Willingness to Vaccinate: The Mediating Role of Conspiracy Beliefs

“…Threat perception concerning SARS-CoV-2 was documented as a significantly associated factor of COVID-19 compliance to preventive measures (e.g., social distancing, hand washing, and wearing a mask) (Pan et al, 2020 ; Xu et al, 2020 ) and acceptance of COVID-19 vaccination (Fu et al, 2020 ). Previous findings suggest that one of the routes of this influence is through some of the psychological factors described by the Theory of Planned Behavior (TPB; Ajzen, 2011 ), which has been extensively used in predicting health-related behaviors.…”

Development and psychometric assessment of the public health emergency risk perception scale: Under the outbreak of COVID-19

“…The novel coronavirus that causes COVID-19 is a new viral strain that humans had never been exposed to and has multiple transmission routes that are not yet fully understood. Humans are generally susceptible to this disease, which is difficult to detect at the initial stage, and asymptomatic patients may also become infection sources [ 15 ]. Therefore, the high-unknowingness nature of the epidemic is also an important contributor to the public perception of risk.…”

“…In addition, public risk perception can potentially be a powerful modifier of the epidemic evolution, as it can influence the number of newly infected cases [ 9 ]. To identify the behavior and response pattern of people in a crisis or pandemic, we should start by understanding how people perceive the crisis [ 14 , 15 ]. Therefore, appropriate tools are needed to assess people’s risk perception in the face of public health emergencies, which is of great significance for governments or organizations to construct management strategies correctly.…”