Knowledge and Attitude Regarding COVID-19 among Students from Multiple Professional Background in Riyadh Region, Saudi Arabia: A Cross-sectional Study.

INTRODUCTION: Coronavirus disease 2019 is abbreviated as "COVID-19" caused by the severe acute respiratory syndrome-corona virus 2 first emerged in Wuhan, China, on December 2019. On 15th of March, this disease has been classified by the World Health Organization as a pandemic and a global public health emergency.
OBJECTIVE: The study's aim was to evaluate the knowledge and behavior toward the virus among professional students of Riyadh, Saudi Arabia.
METHODOLOGY: A cross-sectional study done on 753 students which were invited to complete a Google document using a 20-item electronic questionnaire that was design to gauge knowledge and attitude toward COVID-19. The study was conducted from February 20 to March 18, 2020 in Alkharj and Riyadh region.
RESULTS: The predominant sex is male (73%), the common age is <25 years old, more medical students were involved in the study than any other specialty and the predominant educational degree of the participants was bachelors. The awareness of mode of transmission of novel coronavirus infection is less in business administration participants compare to others and is highly significant (P ˂ 0.001). Most of the participants (588 [98%]) were aware of coronavirus but only 302 (50%) of respondents are aware of COVID-19 which is highly significant (P ˂ 0.001).
CONCLUSION: The results are mostly uniform among different professional students with the exception of some knowledge-related questions. The Internet was the main source of information, so there is a need to create more awareness about COVID-19 through social media. Copyright:

INTRODUCTION

It is important to distinguish the difference between severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) and coronavirus disease 2019 (COVID-19). SARS-CoV2 (formerly known as novel corona virus) refers to the virus, whereas COVID-19 is the infectious disease caused by SARS-CoV2.[1] This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The symptoms of COVID-19 include fever, fatigue, and a dry cough. Some patients may develop aches, nasal congestion, runny nose, sore throat, and/or diarrhea. These symptoms are usually mild and begin gradually. It is possible for a person to contract the virus and not show any symptoms or fall ill with the disease at all (i.e., asymptomatic).[12] Most people (approximately 80%) recover from the disease without requiring special treatment. However, one out of every six people who contract COVID-19 becomes seriously ill and develops breathing difficulties. Senior citizens and those with underlying medical problems, such as hypertension, cardiovascular conditions, or diabetes mellitus, are more likely to develop serious symptoms.[2] With this information in mind, it is crucial to determine how much the population knows about the disease to better educate the masses regarding effective infection control measures. Ultimately, reaching a success outcome is largely dependent on people's adherence to these control measures, which is crucial to reducing the risk of transmission, and it is principally affected by their knowledge and attitudes toward COVID-19 in harmony with knowledge, attitudes, and practices theory.[34]

Objective

To evaluate the knowledge of professional students in the Riyadh region of Saudi Arabia regarding COVID-19, as well as their behavior toward the disease and how it should be handled.

METHODOLOGY

A study launched in the dental college at Prince Sattam bin Abdul Aziz University, Alkharj. For the purposes of this study, participants were deemed eligible to participate in the survey if they were studying to obtain a professional degree in any specialty of Riyadh region. To avoid participant bias, all participants were asked to fill out the survey only once and to answer truthfully. The survey tool used in this study was a self-administered electronic survey constructed in Google documents as a structured 20-item questionnaire. The questionnaire was sent in both Arabic and English versions. The questionnaire was designed to gauge how knowledgeable the participants were and to ascertain their behavior toward the virus and how it should be handled. A study sample of 753 professional students from the Riyadh region participated in the study. The ethical clearance was obtained from the institutional ethical review board, and study was conducted from February 20 to March 18, 2020.

Statistical analysis was done using SPSS version 23 (IBM Corp., Armonk, N.Y., USA), and descriptive statistics were applied. Chi-square test was used to check statistical significant difference with 95% confidence interval and a P < 0.05.

RESULTS

Six hundred out of the 753 participants successfully completed the questionnaire, which translated to a response rate of around 80%. Among the respondents, 436 (73%) were males and 164 (27%) females. The distribution of study participants according to gender and educational qualification is presented in Table 1.

Table 1

Distribution of study participants according to gender

Gender	Age (years)					Total
	Under 20	20-24	25-29	30-24	35 and older
Males (%)	48 (64.9)	248 (73.8)	64 (82.1)	8 (28.6)	68 (81.0)	436 (72.7)
Females (%)	26 (35.1)	88 (26.2)	14 (17.9)	20 (71.4)	16 (19.0)	164 (27.3)

Most of the participants (588 out of 600; 98%) were aware of the virus, SARS-CoV2, but only 302 (50%) respondents were aware of COVID-19, which was statistically highly significant (P ˂ 0.001). In this study, a majority of the participants understood that SARS-CoV2 was contagious, while approximately half of them were not aware of COVID-19 treatment methods, both of which were found to be statistically significant (P = 0.017 and P = 0.003, respectively). The majority of students in the colleges of business administration, engineering, and medicine knew that COVID-19 is viral, while respondents from the college of education were not aware of its origin; this difference was statistically highly significant (P ˂ 0.001).

The knowledge-based survey questions are presented in Table 2 along with the participants' raw response data, which is indicative of their knowledge regarding the virus. The attitude-based survey questions are presented in Table 3, along with the participants' raw response data, which is indicative of their attitudes toward the virus. As shown in Table 3, the attitudes of the participants indicated that most of them though early diagnosis would improve the treatment, and they acknowledged the importance of isolation for those suspected of being exposed or infected. These results were found to be significant (P ˂ 0.001). A vast majority of participants believed that the novel coronavirus infection cannot be treated at home, which was a particularly significant finding (P ˂ 0.001), and a majority of participants also thought that health education can prevent the spread of the disease.

Table 2

Knowledge-based questions regarding coronavirus

Questions	Response	Study participants						Statistics (χ2, P)
		Business admin (%)	Education (%)	Engineering (%)	Medical (%)	Others (%)	Total (%)
Have you heard about coronavirus	Yes	36 (100)	40 (100)	84 (100)	264 (96.4)	164 (98.8)	588 (98.0)	7.605, 0.107 (NS)
	No	0 (0)	0 (0)	0 (0)	10 (3.6)	2 (1.2)	12 (2.0)
Have you heard about novel coronavirus?	Yes	18 (50.0)	18 (45.0)	36 (42.9)	174 (63.5)	56 (33.7)	302 (50.3)	39.64, <0.001 (HS)
	No	18 (50.0)	22 (55.0	48 (57.1)	100 (36.5)	110 (66.3)	298 (49.7)
Is novel coronavirus contagious?	Yes	36 (100)	40 (100)	84 (100)	254 (92.7)	158 (95.2)	572 (95.2)	12.10, 0.017 (S)
	No	0 (0)	0 (0)	0 (0)	20 (7.3)	8 (4.8)	8 (4.8)
Is there a treatment for novel coronavirus?	Yes	20 (55.6)	24 (60.0)	40 (47.6)	124 (45.3)	106 (63.9)	314 (52.3	16.17, 0.003 (S)
	No	16 (44.4)	16 (40.0)	44 (52.4)	150 (54.7)	60 (36.1)	286 (47.7)
Which of the following is the cause of novel corona infection?	Bacteria	6 (16.7)	6 (15.0)	4 (4.8)	6 (2.2)	16 (9.6)	38 (6.3)	63.78, <0.001 (HS)
	Virus	24 (66.7)	16 (40.0)	56 (66.7)	212 (77.4)	92 (55.4)	400 (66.7)
	Fungus	4 (11.1)	4 (10.0)	2 (2.4)	14 (5.1)	4 (2.4)	28 (4.7)
	Don’t know	2 (5.6)	14 (35.0)	22 (26.2)	42 (15.3)	54 (32.5)	134 (22.3)

NS: Not significant, HS: High significant, S: Significant

Table 3

Attitude-based questions regarding novel coronavirus

Questions	Response	Study subjects						Statistics (χ2, P)
		Business admin (%)	Education (%)	Engineering (%)	Medical (%)	Others (%)	Total (%)
Do you think the early diagnosis improves the treatment?	Yes	32 (88.9)	38 (95.0)	84 (100)	252 (92.0)	150 (90.4)	556 (92.7)	9.21, 0.056 (NS)
	No	4 (11.1)	2 (5.0)	0	22 (8.0)	16 (9.6)	44 (7.3)
Do you think the isolation of the suspected cases at emergency department is important?	Yes	36 (100.0)	36 (90.0)	84 (100)	264 (96.4)	156 (94.0)	576 (96.0)	10.60, 0.031 (S)
	No	0	4 (10.0)	0	10 (3.6)	10 (6.0)	24 (4.0)
Do you think that the novel coronavirus infection can be treated at home?	Yes	4 (11.1)	12 (30.0)	2 (2.4)	16 (5.8)	32 (19.3)	66 (11)	40.19, <0.001 (HS)
	No	32 (88.9)	28 (70)	82 (97.6)	258 (94.2)	134 (80.7)	534 (89.0)
Do you think that health education can help to prevent the disease?	Yes	36 (100)	40 (100)	82 (97.6)	262 (95.6)	160 (96.4)	580 (96.7)	3.82, 0.430 (NS)
	No	0	0	2 (2.4)	12 (4.4)	6 (3.6)	20 (3.3)

NS: Not significant, HS: High significant, S: Significant

Table 4 presents the raw response data related to the participants' knowledge regarding the symptoms of the novel coronavirus infection, and while more than half were aware of them, participants from the college of business administration were less, which was highly significant (P ˂ 0.001).

Table 4

Response of study subjects to symptoms of novel coronavirus

Questions	Response	Studying						Statistics (χ2, P)
		Business admin (%)	Education (%)	Engineering (%)	Medical (%)	Others (%)	Total (%)
Which of the following is (are) symptom (s) of novel corona infection?	High temperature	14 (38.9)	10 (25.0)	32 (38.1)	62 (22.6)	26 (15.7)	144 (24.0)	115.48, <0.001 (HS)
	Cough	0 (0)	0 (0)	2 (2.4)	2 (0.7)	4 (2.4)	8 (1.3)
	Sore throat	0 (0)	2 (5.0)	0 (0)	0 (0	0 (0)	2 (0.3)
	Difficulty of breathing	0 (0)	0 (0)	0 (0)	2 (0.7)	4 (2.4)	6 (1.0)
	All of the above	16 (44.4)	22 (55.0)	44 (52.4)	188 (68.6)	90 (54.2)	360 (60.0)
	Unsure	2 (5.6)	0 (0)	0 (0)	10 (3.6)	0 (0)	12 (2.0)
	Others	4 (11.1)	6 (15.0)	6 (7.1)	10 (3.6)	42 (25.3)	68 (11.3)

HS: High significant

Table 5 and Figure 1 presents the raw response data related to the participant's knowledge regarding the modes of transmission of the novel coronavirus infection, which revealed that participants from the college of business administration were less knowledgeable about modes of transmission compared to other participants, and again, the results were found to be highly significant (P ˂ 0.001).

Table 5

Response of study subjects to modes of transmission of novel coronavirus

Questions	Response	Studying			Statistics
		Business admin (%)	Education (%)	Engineering (%)	Medical (%)	Others (%)	Total (%)	Statistics (χ2, P)
Which of the following is (are) the mode (s) of transmission of novel corona infection?	Direct transmission during coughing	16 (44.4)	6 (15.0)	28 (33.3)	76 (27.7)	48 (28.9)	174 (29.0)	117.76, <0.001 (HS)
	Touching surfaces contaminated with the virus	0 (0)	0 (0)	4 (4.8)	2 (0.7)	8 (4.8)	14 (2.3)
	Consuming milk and meat of infected animals	0	4 (10.0)	0 (0)	0 (0)	0 (0)	4 (0.7)
	Direct contact with an infected patient	0	4 (10.0)	0	0	10 (6.0)	14 (2.3)
	All of the above	14 (38.9)	18 (45.0)	44 (52.4)	162 (59.1)	82 (49.4)	320 (53.3)
	Unsure	4 (11.1)	8 (20.0)	8 (9.5)	24 (8.8)	12 (7.2)	56 (9.3)
	Others	2 (5.6)	0	0	10 (3.6)	6 (3.6)	18 (3.0)

HS: High significant

Figure 1

Awareness, attitudes, and practices related to coronavirus pandemic among public in Saudi Arabia

Table 6 presents additional raw response data related to the participant's knowledge. The results revealed that participants from the college of education were less likely to be aware of the time of appearance of the symptoms of the disease compared to participants from other colleges. Most participants agreed that traveling is a risk factor for coronavirus infection, and a vast majority of all the groups thought that all three of the listed preventive measures (i.e., washing hands with hand wash, paying attention to avoid touching eyes, nose with hands, and paying attention to other health habits) were effective. All the results presented in Table 6 were found to be highly significant.

Table 6

Response of study subjects to symptoms of novel corona virus

Questions	Response	Studying						Statistics (χ2, P)
		Business admin (%)	Education (%)	Engineering (%)	Medical (%)	Others (%)	Total (%)
Symptoms appear after which of the following?	Within 2-5 days of infection	2 (5.6)	8 (20.0)	22 (26.2)	38 (13.9)	32 (19.3)	102 (17.0)	29.104, <0.001 (HS)
	5-14 days of infection	24 (66.7)	14 (35.0)	44 (52.4)	160 (58.4)	68 (41.0)	310 (51.7)
	Unsure	10 (27.8)	18 (45.0)	18 (21.4)	76 (27.7)	66 (41.0)	188 (31.3)
Which of the following is (are) the risk factor (s) of novel corona infection?	Pregnant women	2 (5.6)	0 (0)	0 (0)	30 (10.9)	12 (7.2)	44 (7.3)	46.07, <0.001 (HS)
	Travelling	32 (88.9)	28 (70.0)	74 (88.1)	224 (81.8)	116 (69.9)	474 (79.0)
	Unsure	2 (5.6)	12 (30.0)	10 (11.9)	20 (7.3)	38 (22.9)	82 (13.7)
Which of the following is (are) prevention measure (s) of novel corona virus?	Wash hands with water and soap	2 (5.6)	0 (0)	4 (4.8)	26 (9.5)	34 (20.5)	66 (11.0)	74.23, <0.001 (HS)
	Avoid touching the eyes, nose with hands	0 (0)	6 (15.0)	0 (0)	8 (2.9)	0 (0)	14 (2.3)
	Pay attention to other health habits	6 (16.7)	4 (10.0)	12 (14.3)	10 (3.6)	12 (7.2)	44 (7.3)
	All of above	28 (77.8)	30 (75.0)	68 (81.0)	230 (83.9)	120 (72.3)	476 (79.3)

HS: High significant

Table 7 presents the response data related to the participants' sources of information regarding the novel coronavirus, which indicated that social media were the most common (520 out of 600; 86.7%). A total of 370 participants (61.7%) thought that the risk of spread is higher among general practitioners (P ˂ 0.001).

Table 7

Response of study subjects to source of information and higher risk professionals of novel corona virus

Questions	Response	Studying						Statistics (χ2, P)
		Business admin (%)	Education (%)	Engineering (%)	Medical (%)	Others (%)	Total (%)
From what kind of media have you learned about corona virus	Internet	34 (94.4)	30 (75.0)	76 (90.5)	242 (88.3)	138 (83.1)	520 (86.7)	25.65, 0.059 (NS)
	TV	0	4 (10.0)	6 (7.1)	14 (5.1)	20 (12.0)	44 (7.3)
	Newspaper	0	2 (5.0)	2 (2.4)	4 (1.5)	4 (2.4)	12 (2.0)
	Word of mouth	0	0	0	2 (0.7)	0	2 (0.3)
	Radio	2 (5.6)	4 (10.0)	0	12 (4.4)	4 (2.4)	22 (3.7)
The risk of spread is higher among	Dentist	0	0	12 (14.3)	30 (10.9)	16 (9.6)	58 (9.7)	40.02, <0.001 (HS)
	General practitioner	22 (61.1)	18 (45.0)	46 (54.8)	190 (69.3)	94 (56.6)	370 (61.7)
	Surgeon	4 (11.1)	4 (10.0)	8 (9.5)	12 (4.4)	8 (4.8)	36 (6.0)
	Others	10 (27.8)	18 (45.0)	18 (21.4)	42 (15.3)	48 (28.9)	136 (22.7)

NS: Not significant, HS: High significant

DISCUSSION

COVID-19 is prejudiced by the spread of the disease and the seriousness of the risks to human health. COVID-19 continues to spread in Saudi Arabia and around the world, and the number of mortalities associated with it continues to increase, which will likely affect the public's interest in understanding more about it. Maintaining precautionary measures at the community and individual levels also play a pivotal role in preventing community spread. Very few studies have been conducted in Saudi Arabia among the professional students about COVID-19. Hence, this study was designed.

In this study, the allocation of the sociodemographic characteristics included a high percentage of male participants. Notably, the age of the participants seemed to vary, though the most common age was <25-year-old (62%). A majority of the participants were pursuing their bachelor's degree (76%).

It was surprising that 98% of the participants knew about the coronavirus (middle east respiratory syndrome coronavirus – CoV). This finding was similar to that found by Khan et al. (2014) in the Al Qassim region, though it is distinguishable because about half of the respondents were not aware of COVID-19, which was also similar to the ALdowyan et al. study.[5]

Almost half of the respondents indicated they knew there are many symptoms associated with COVID-19 such as high temperature (fever), cough, sore throat, and breathing difficulties, which was less compare to ALdowyan et al.'s study.[5] Results also indicted that 40%–53% of respondents reported that all listed modes of transmission were possible including coughing, touching surfaces contaminated with the virus, and direct contact with infected patients, which was also less than ALdowyan et al.'s study.[5] Few respondents in this study reported that consuming milk and meat of infected animals would lead to the public thinking animals such as camels could be a source of COVID-19 infection, which was identical to the results reported by Samapthkumar.[6]

The current study results showed that preventive actions, such as handwashing with soap and water, avoiding touching the eyes and nose with your hands, are well known, which is similar to the findings reported in Al Hazmi et al.'s[7] study.

Public awareness about COVID-19 in Saudi Arabia showed that people depended on social media as the main source of their information, while a previous study by Almutairi et al. reported that television was the primary source of information for participants.[8]

This study was conducted on a well-educated population sample, and thus, we found most participants had knowledge about COVID-19, similar to a study by Zhong et al.[9]

CONCLUSION

Based on the survey results, the participants had a knowledge, a positive attitude, and were aware of the preventive measures that can reduce the risk of contracting COVID-19. The questions regarding the participants' sources of knowledge signify that most students sought and received their knowledge from social media rather than newspaper or television, and hence, efforts to increase public awareness about COVID-19 will be more effective if social media are incorporated into the strategy for distributing information and educating the public. More generally, the Internet plays a vital role in educating the public about COVID-19. Consequently, special efforts should be made to inform the vulnerable members of the population such as older adults and those living in rural areas because they are more likely to be less knowledgeable, express negative attitudes, and fail to implement appropriate COVID-19 preventive practices.

Limitations and bias

A possible limitation was the sample size for large region, the Kingdom. The intended sample size was 753, but it was reduced because of the extended time it took to recruit the participants, who were conveniently recruited using Whatsapp Groups. The study can be conducted on a larger scale or in any other country that is facing an outbreak.

Financial support and sponsorship

Self-sponsored.

Conflicts of interest

There are no conflicts of interest.