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\begin{document}

\title{Public Knowledge, attitude, and practice towards COVID-19 in Iran}



\author[1]{Reza Gholamnia}%
\author[2]{Reza Saeedi}%
\author[1]{Davoud Eskandari}%
\author[1]{Amin Bagheri}%
\author[1]{Rana Fekri}%
\author[1]{Mohammad Hossein Vaziri}%
\author[1]{Mehrnoosh Abtahi}%
\author[2]{mohsen sadani}%
\author[3]{Mohammad Ansarizadeh}%
\affil[1]{Shahid Beheshti University of Medical Sciences}%
\affil[2]{Shaheed Beheshti University of Medical Sciences}%
\affil[3]{Shiraz University of Medical Sciences}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\selectlanguage{english}
\begin{abstract}
The first cases of novel coronavirus disease (COVID-19) were reported in
late December 2019 in Wuhan City, Hubei Province of China. It has spread
rapidly around the world. Taking preventive measures by the public plays
the most important role in infection prevention and control of the
COVID-19. One of the major challenges in preventing and controlling
COVID-19 has been the proliferation of misinformation on social media.
In such a special epidemic, assessment of knowledge and attitude of the
public will help to reduce the uncoordinated social behavior arising
from misinformation. The purpose of this cross-sectional online survey
was to determine the level of knowledge, attitude and practice (KAP) of
Iranian population toward outbreak of COVID-19. Data were collected by
self-administrated questionnaire. Analytical statistics were performed
on the results. The mean scores of respondents' KAP were 87.7, 59.3, and
89.6, respectively. Married and females participants, who work in
healthcare systems, participants in the age group of 36 to 45 years with
a higher level of education, and those who studied in the fields related
to health gained significantly higher knowledge scores. Most respondents
(63.7\%) had a negative attitude towards the observance of appointed
prevention principles by others. Also, the results showed a
statistically significant positive correlation between all sections of
KAP. Our findings suggest that despite the rapid dissemination of
reliable and unreliable information about COVID-19 through cyberspace,
the Iranian people have sufficient knowledge to deal with COVID-19
outbreak.%
\end{abstract}%



\sloppy


\textbf{INTRODUCTION}

According to the WHO report, the first cases of novel pneumonia with
unknown etiology were reported in late December 2019 in Wuhan City,
Hubei Province of China. One week later, Chinese authorities identified
a new type of coronavirus as causal agent of the disease (WHO, 2019).
This novel coronavirus disease 2019 (COVID-19) has spread rapidly around
the world. On 11 March 2020, WHO declared the outbreak a global pandemic
(CDC, 2020b; WHO, 2020c). The first cases of infection were identified
in Iran on 19 February 2020(WHO, 2020b). After that, the rate of the
disease has increased rapidly in the country, so that on 18 May 2020,
over 122,000 cases of the disease and about 7000 deaths have been
reported(Worldmeters.info, 2020).

The disease can mainly transmit through contact with respiratory and
saliva droplets and also objects and surfaces contaminated to the
droplets. According to the transmission routes, implementing the basic
preventive measures by the public plays the most important role in
infection prevention and control of the COVID-19 (Peng et al., 2020;
WHO, 2020d). Effective public awareness of correct information on the
COVID-19 outbreak through a variety of media is crucial to achieve a
suitable practice of the protective measures by the public. On the other
hand, one of the major challenges in preventing and controlling COVID-19
has been the proliferation of misinformation on social media (Frenkel,
Alba, \& Zhong, 2020; Pennycook, McPhetres, Zhang, \& Rand, 2020).
Propagation of this misinformation via popular messengers among the
community has confused the public in adopting the correct preventive
measures and has plagued the scientific community (Mian \& Khan, 2020).
Kouzy et al. provided the definition of misinformation as a ``claim of
fact that is currently false due to lack of scientific evidence (Kouzy
et al., 2020). The lack of evidence and unproven results of some studies
have also led to controversy among the public and even scientific
community about disease-related issues such as the use of masks, the
type and concentration of disinfectants, and transmission rout which
ultimately may change the public behavior (Eikenberry et al., 2020;
Huynh, 2020).

In recent years, the number of Internet users in Iran has grown (over
80\% penetration rate). According to datareportal.com (Digital-2019-
Iran), more than 47 million of Iranian ( \selectlanguage{english}57\%) are active users of
social networks (Kemp, 2019). Hence, Iranian users are known as one of
the biggest users of social networks in the world (Honari, 2015).
Undoubtedly, one of the main ways to obtain information and knowledge
about health issues like COVID-19 has been social networks. Assessment
of knowledge and attitude of the public will help to prevent or reduce
the uncoordinated social behavior in such special conditions as COVID-19
epidemic. Generally, different aspects of knowledge, attitude, and
practices (KAP) affect Health-related behavior in any kind of society
(Launiala, 2009).

Several KAP surveys have been conducted regarding various viral disease
outbreaks around the world, such as the Studies on Ebola Virus Disease
(EVD) in Nigeria (Iliyasu et al., 2015), Sudan (Alfaki, Salih, Elhuda,
\& Egail, 2016), and Iran (Holakouie-Naieni et al., 2015), on Middle
East Respiratory Syndrome Corona Virus (MERS-CoV) in Saudi Arabia
(Al-Hazmi, Gosadi, Somily, Alsubaie, \& Saeed, 2018; Nour, Babilghith,
Natto, Al-Amin, \& Alawneh, 2015), on Severe Acute Respiratory Syndrome
(SARS) in Qatar (Bener \& Al-Khal, 2004) and Singapore (Vijaya et al.,
2004) and also on Avian Influenza in China(Xiang et al., 2010) and
Influenza A in India (Kamate et al., 2010). This kind of survey will
help the decision-makers and health authorities to upgrade their
educational programs in combating the crisis of outbreaks.

The purpose of this survey was to determine the level of knowledge,
attitude, and practice of Iranian population toward the outbreak of
COVID-19. Also, using this study, we tried to assess the efficiency of
public education by measuring their knowledge. In another word, we
aspired to find out which one would be the winner: misinformation
through invalid sources or scientific training by official media?



\textbf{METHODS}

A cross-sectional online survey was conducted in March 2020(three weeks
after the onset of outbreak in country) to assess the knowledge,
attitude, and practices (KAP) about COVID-19 among Iranians. Data were
collected by a self-administrated questionnaire, which was developed
based on validated questionnaires used in recent study by Zhong \emph{et
al} . (Zhong et al., 2020), country instruction for novel
Coronavirus(MOHME, 2020), and also current issues come up. Since
sampling was not possible in the whole country and also due to
concurrence of the Iranian New Year holidays with the beginning of home
quarantines, the best way to achieve an unbiased sample was sending
randomly the questionnaire link to the groups and channels of popular
messengers in Iran such as WhatsApp, Telegram and one internal
messenger. Prior to the response, all potential participants were
provided adequate information about the survey and only those who click
on the satisfaction button were included in the study. During the two
weeks that the questionnaire was available, 2986 individuals visited it,
and finally, 1628 individuals completed it. It should be noted that the
sample was fairly similar to the Iranian public on age, gender,
education, and also pattern of their distribution.

The content~validity~of~the~questionnaire~was~confirmed~by~a panel of
experts consisting of 3 environmental and occupational health
specialists, 1 epidemiologist, 1 public health expert, and 1 infectious
diseases specialist. After checking the applicability of the questions,
the suggestions provided by experts were incorporated and the
questionnaire was piloted with 10 participants to check relevance,
clarity and ambiguity of questions and estimate the time required to
complete the questionnaire. Afterward, an online platform of the
questionnaire was made using \emph{Porsline.ir} , an Iranian web-based
questionnaire and survey form builder.

The questionnaire had 29 questions/items and divided into 4 sections.
The first section solicited 8 demographic variables (first column of
Table 2). The knowledge, attitude and practice sections had 13, 4, and 4
questions/items, respectively. The KAP questions/ items (Table 1)
covered issues such as clinical symptoms of the disease, treatment
protocol, transmission routes, and prevention/control measures including
physical distancing, disinfection, home quarantine, and etc.

\textbf{Table 1-} Questions/Items used in each section of the
questionnaire

Knowledge questions with correct responses were scored 1 and wrong and
``I don't know'' responses were scored 0. Grading of correctness (5
points Likert scale) was used for responding to attitude and practice
questions, and they were scored from 0 to 4 depending on the options.
According to this grading system, the lowest and highest score of
knowledge section were 0 and 13, respectively, and the lowest and
highest score of both attitude and practice sections were 0 and 16,
respectively. In order to have a unique scale, all scores were
transformed to a scale of 0 to 100 using equation 1.

SS\textsubscript{n} = 100 \selectlanguage{ngerman}× SQ\textsubscript{n} \selectlanguage{english}-
S\textsubscript{min}\emph{/} {[}S\textsubscript{max} \selectlanguage{english}- Smin{]}

Where SS\textsubscript{n} is scaled score of question n,
SQ\textsubscript{n} is the obtained score of question n and
S\textsubscript{max} and S\textsubscript{min} are highest and lowest
score of section that the question n is in it.

The statistical analyses were carried out using SPSS version 16.0. Also,
significance was assessed by the T-test and ANOVA. A P value
\textless{}.05 was considered to indicate statistical significance.

\textbf{RESULTS}

The first three columns of Table 2 depict frequency distributions of the
participants' demographic characteristics. Similar to the country's
demographic pattern, 67 percent of participants were between the ages of
26 and 45. Due to the nationwide home quarantine, the majority of
respondents were male and also married (about 56 and 69 percent,
respectively). A large proportion of participants had degrees of
bachelor or master, and about 26 percent of university-educated
respondents studied in health sciences. Less than 10 \% work in
healthcare systems and about 37\% of the participants were employees.
Only 3.8\% of the participants live in villages.

Table 2 also shows the mean scores of knowledge, attitude, and practice
and their standard deviation for different demographics groups of
participants. The mean, minimum, and maximum knowledge scores of total
participants were 87.7, 15, and 100, respectively. Based on the P-values
obtained from ANOVAs and T-tests, the mean scores of knowledge among all
demographic groups were significantly different except for the urban and
rural residents (Table 2). Married and females participants, respondents
who work in healthcare systems, participants in the age group of 36 to
45 years with a higher level of education, and those who studied in the
fields related to health gained significantly higher knowledge scores.

The mean, minimum, and maximum attitude scores of all participants were
59.3, 13, and 100, respectively. Based on statistical analysis, there
was no significant difference between the mean scores of participants'
attitudes in gender, education levels, and place of residence groups.
Married participants, aged between 46 and 55, and those who worked and
studied in the health field received the highest attitude scores (Table
2). The mean, minimum, and maximum practice scores of all participants
were 89.6, 38, and 100, respectively. The results showed that there was
no significant difference between the mean practice scores of
respondents in different groups of the three demographic variables of
marital status, level of education, and place of residence. In general,
females and participants over the age of 46 and those who worked and
studied in the health field had higher practice scores than others.
Surprisingly, the 18- to 25-year-olds had the lowest scores in all three
sections. Although married participants showed a slightly higher level
of knowledge and practice than singles, their attitude was significantly
more positive. Moreover, the higher the level of education, the higher
the scores of knowledge and practice and the lower the attitude score.

\textbf{Table 2-} Demographic characteristics of respondents and KAP
scores by demographic variable

The participants' knowledge of COVID-19 was assessed in terms of
preventive measures, disease control, treatment, clinical symptoms, and
transmission routes. The main categories of knowledge questions and the
average response status are presented in Table 3.

\textbf{Table 3-} Main categories of knowledge questions and average
responses to each option

Besides, Figure 1 shows the responses of participants to knowledge
questions regarding preventive measures. Except for the using masks in
all places, the respondents' knowledge about preventive measures was
pretty near perfect. These findings show that public knowledge regarding
preventive measures was promoted to an optimal level because of the
proper public education provided by health authorities.

\textbf{Figure 1-} Knowledge level of participants regarding preventive
measures questions

Table 4 indicates how people answer different questions in the attitude
section. Most respondents (63.7\%) had a negative attitude towards the
observance of appointed prevention principles by others, while the
majority believed in their own knowledge about the prevention measures.

\textbf{Table 4} -Attitude of respondents toward prevention and control
of COVID-19

The participants' responses to the questions of the practice section are
also shown in Table 5. According to the results, most people have
behaved well during COVID-19 outbreak. Although this is a very common
and important event during the New Year holidays in Iran, more than 80\%
of the respondents had never visited their relatives.

\textbf{Table 5} - Practice of respondents regarding COVID-19 control
and prevention

The correlation between participants' scores of knowledge, attitude, and
practice was examined by Pearson correlation test. The results showed a
statistically significant positive correlation between knowledge and
attitude, attitude and practice, and also knowledge and practice. Table
4 indicates the correlation coefficients and P values.

\textbf{Table 6} -The results of Pearson correlation test

\textbf{DISCUSSION}

According to our searches, so far, the survey is the first and only
nationwide KAP study conducted in Iran regarding COVID-19. Several KAP
studies have been carried out in Iran about the epidemic of viral
diseases such as Ebola, Crimean-Congo hemorrhagic fever, and H1N1
influenza, but all targeted specific groups such as students, residents,
and healthcare workers as study population (Askarian, Danaei, \& Vakili,
2013; Holakouie-Naieni et al., 2015; Rahnavardi et al., 2008; Salimi et
al., 2016). Consequently, it was not possible to compare the level of
knowledge, attitude, and practice of Iranians towards different type of
viral disease epidemics. As we used some information from the recent KAP
study conducted in China to compile our questionnaire, it was possible
to compare some parts of the results between the two countries.

Since identifying demographic factors associated with KAP will be useful
for health policy-makers to recognize target populations for COVID-19
prevention and health education (Zhong et al., 2020), the effect of
different demographic groups on participants' KAP was examined. In our
study, as in China, females had significantly more knowledge than males.
Similar results were obtained in KAP studies of SARS in Qatar and
Singapore (Bener \& Al-Khal, 2004; Vijaya et al., 2004). Contrariwise,
results of the Indians KAP study regarding the H1N1 influenza epidemic
indicated males had higher knowledge than females (Kamate et al., 2010).
This discrepancy may be attributed to differences in the value of
countries' indicator of adult female literacy rate. According to the
World Bank data, value of the indicator in Singapore(2018), China(2018),
Qatar(2017), Iran(2016) and India(2018) is 96, 95, 95, 81 and 66 \%,
respectively(World Bank, 2019). In terms of age, younger respondents (18
to 25 years old) had poorer knowledge, attitude, and practice than other
age groups. Further, based on the post-hoc test, their practice score
was significantly lower than other age groups. Some studies have also
reported poorer knowledge in younger groups (Iliyasu et al., 2015;
Kamate et al., 2010; Zhong et al., 2020). According to data reported
from US CDC in March 16, 2020, showed that younger adults can be among
the at-risk groups of COVID-19, and some may need hospitalization, even
ICU (CDC weekly report)(CDC, 2020b). Therefore, they should be
considered as an important target group for further education. The mean
scores of marrieds' knowledge, attitudes, and practice were higher than
singles. These findings agree with other studies (Iliyasu et al., 2015;
Kamate et al., 2010; Zhong et al., 2020).

Like many KAP studies (Iliyasu et al., 2015; Kamate et al., 2010; Xiang
et al., 2010; Zhong et al., 2020, the respondents' knowledge was
directly related to their education level. However, there was no
significant difference between respondents' attitude and practice with
different levels of education. In the KAP study of COVID-19 in China,
similarly, respondents with higher education had a slightly weaker
attitude, albeit the difference was not significant (Zhong et al.,
2020).

Similar to the Chines study, in which respondents received a mean score
of 90/100, in our study, the respondents' level of knowledge was
assessed as very good with a mean score of 87.7/100. This shows that the
public education provided by the Ministry of Health through the national
official media at the beginning of the epidemic has greatly increased
the knowledge of Iranians and also reveals that the spread of
misinformation through informal media such as messengers has not had a
significant effect on public awareness. Furthermore, it can be
interpreted that the public has actively learned about COVID-19 due to
the serious situation of the epidemic and extensive news coverage (Zhong
et al., 2020).

One of the most challenging parts in the knowledge section of this
survey was the question about using face masks outside the home.
Contradictory news and misinformation about the virus being airborne in
the media may be one of the main reasons for this discrepancy. Health
authorities in different countries have also adopted different
decisions. In the latest documentary regarding the use of masks in the
context of COVID-19 which was released on April 6, 2020, WHO did not
consider the use of masks alone to be a complete preventative, and
declared that the use of masks not recommended for everyone (WHO,
2020a). The US CDC has also recommended that face masks should be worn
in public places, especially in places where it is not possible to
maintain social distance (CDC, 2020a). The disagreements in scientific
communities and even among health authorities around the world due to
the unknown nature of the virus and its characteristics can affect
public knowledge, attitudes, and practice and also confused them by the
propagation of misinformation without evidence. For example, a study in
Taiwan at the time of the outbreak showed that Internet searches for
COVID-19 and face masks were rapidly increased in the country
(Husnayain, Fuad, \& Su, 2020). Despite the WHO's advice and also the
recommendation of Iranian Health authorities, there are still some
resources and references have emphasized the use of masks for healthy
people in the community (Feng et al., 2020).

The results in the attitude section were slightly different. For
example, the results of the Chines study showed that 90.8\% believed
that COVID-19 will finally be successfully controlled. In our study,
only 47.1\% of respondents had a positive attitude toward the same
question. There are several possible reasons for the difference. First,
in the attitude section of our study, the 5 points Likert scale was used
to respond, so participants had more options than yes or no. For
example, in Chines study, the first question was a three-choice and the
second was a two-choice approach (Zhong et al., 2020). We also added two
more questions to the attitude section. Another notable rationale is
that, unlike China, this is the first widespread viral disease epidemic
in the country in recent decades that has affected everyone. Therefore,
the lack of experience in this field may cause a poor attitude among the
people. For instance, the level of healthcare providers' attitude toward
MERS-CoV infection was reported to be very poor due to the novelty of
disease and lack of experience in dealing with it (Nour et al., 2015).
The other important reason for the relatively negative attitude of
Iranians compared to the Chinese toward the common question may be
attributed to the current economic and political situation of Iran
because of the imposition of the toughest sanctions(Takian, Raoofi, \&
Kazempour-Ardebili, 2020), an important factor that can undermine
people's confidence.

Due to proper public education and raising the level of knowledge, our
findings suggest that Iranians behaved well in the early stages of the
COVID-19 outbreak. Further, the outcomes of Pearson correlation test
indicated a positive correlation between sample knowledge, attitude and
practice. So sufficient public training will undoubtedly affect people's
behavior. According to the Worldmeters data on 30 April 2020, from early
April, the daily Coronavirus active and new cases and also its death
have been declining (Worldmeters.info, 2020). Definitely, proper
practice of people in observing national preventive protocols is one of
the most important causes of the reduction of cases.

\textbf{CONCLUSION}

In summary, our findings suggest that despite the rapid dissemination of
reliable and unreliable information about COVID-19 through cyberspace,
the Iranian people have sufficient knowledge to deal with COVID-19
outbreak. Although they may not have enough confidence and a good
attitude toward success in the battle for a variety of reasons, the
proper behavior of the people ultimately helped the government to
control the disease in a desirable way.

\textbf{ACKNOWLEDGMENT}

This research has been financially supported by the grant (Project No:
23423) from Shahid Beheshti University of Medical Sciences (SBMU),
Tehran, Iran. In addition, the authors are grateful to express their
gratitude for the support of the School of Public Health and Safety at
SBMU.

\textbf{ETHICAL STATEMENT}

The study was approved by the Ethics Committee in Research of the School
of Public Health and Safety, SBMU. Also consent of participants was
taken prior to the response.

\textbf{CONFLICT OF INTERES}

The authors declare no conflict of interest.

\textbf{DATA AVAILABILITY STATEMENT}

The analyzed data in the original language are available on
https://survey.porsline.ir/r/5rQukYZ. Additional data are available on
request from the corresponding author.

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\textbf{Table 1-} Questions/Items used in each section of the
questionnaire\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
Sections of questionnaire/ question ID & Questions or
items\tabularnewline
\midrule
\endhead
\textbf{Knowledge section} &\tabularnewline
KQ1 & Clinical symptoms of COVID-19\tabularnewline
KQ2 & Treatment of COVID-19\tabularnewline
KQ3 & Severity of clinical symptoms\tabularnewline
KQ4 & Possibility of transmission by asymptomatic\tabularnewline
KQ5 & Transmission of the disease through respiratory
droplets\tabularnewline
KQ6 & Using masks\tabularnewline
KQ7 & Preventive measures for children and adolescents\tabularnewline
KQ8 & Going to crowded places\tabularnewline
KQ9 & Using chlorine-based disinfectants\tabularnewline
KQ10 & Isolation of COVID-19 patients\tabularnewline
KQ11 & Quarantine of patients with suspected COVID-19\tabularnewline
KQ12 & Unnecessary trips\tabularnewline
KQ13 & Using alcohol-based disinfectants\tabularnewline
\textbf{Attitude section} &\tabularnewline
AQ1 & The country's success in controlling COVID-19\tabularnewline
AQ2 & Proper informing and public education and training by
authorities\tabularnewline
AQ3 & Public compliance with preventive regulations\tabularnewline
AQ4 & Having adequate information by respondent\tabularnewline
\textbf{Practice section} &\tabularnewline
PQ1 & I have gone to crowded places during the outbreak\tabularnewline
PQ2 & I have visited my relatives during New Year
holidays\tabularnewline
PQ3 & I have observed physical distancing during the
outbreak\tabularnewline
PQ4 & I regularly wash my hands with soap and water\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
Characteristics of respondents & & Number of respondents (\%) &
Knowledge score (mean\selectlanguage{ngerman}±SD) & \emph{p} value & Attitude score (mean\selectlanguage{ngerman}±SD) &
\emph{p} value & Practice score (mean\selectlanguage{ngerman}±SD) & \emph{p}
value\tabularnewline
\midrule
\endhead
Gender & Female & 711(43.7) & 89.09\selectlanguage{ngerman}±10.94 & <\selectlanguage{english}0.001 & 59.81\selectlanguage{ngerman}±17.14 & 0.25
& 91.73\selectlanguage{ngerman}±9.96 & <\selectlanguage{english}0.001\tabularnewline
& Male & 917(56.3) & 86.78\selectlanguage{ngerman}±13.25 & & 58.81\selectlanguage{ngerman}±17.61 & & 88.08\selectlanguage{ngerman}±11.54
&\tabularnewline
Age group (year) & 18-25 & 207(12.7) & 85.19\selectlanguage{ngerman}±13.44 & <\selectlanguage{english}0.001 &
55.02\selectlanguage{ngerman}±16.93 & <\selectlanguage{english}0.001 & 86.34\selectlanguage{ngerman}±13.24 & <\selectlanguage{english}0.001\tabularnewline
& 26-35 & 549(33.7) & 87.65\selectlanguage{ngerman}±12.68 & & 58.32\selectlanguage{ngerman}±17.57 & & 89.49\selectlanguage{ngerman}±11.02
&\tabularnewline
& 36-45 & 542(33.3) & 89.16\selectlanguage{ngerman}±11.39 & & 60.43\selectlanguage{ngerman}±17.12 & & 90.27\selectlanguage{ngerman}±10.82
&\tabularnewline
& 46-55 & 208(12.8) & 88.72\selectlanguage{ngerman}±11.79 & & 63.29\selectlanguage{ngerman}±16.79 & & 91.09\selectlanguage{ngerman}±8.99
&\tabularnewline
& \textgreater{}55 & 122(7.5) & 85.21\selectlanguage{ngerman}±13.02 & & 58.39\selectlanguage{ngerman}±18.09 & &
91.04\selectlanguage{ngerman}±9.89 &\tabularnewline
Marital status & Married & 1122(68.9) & 88.22\selectlanguage{ngerman}±12.11 & 0.035 &
60.73\selectlanguage{ngerman}±17.14 & <\selectlanguage{english}0.001 & 89.99\selectlanguage{ngerman}±10.51 & 0.097\tabularnewline
& Single & 506(31.1) & 86.83\selectlanguage{ngerman}±12.80 & & 55.95\selectlanguage{ngerman}±17.56 & & 88.96\selectlanguage{ngerman}±12.06
&\tabularnewline
Education level & Under Diploma & 96(5.9) & 78.66\selectlanguage{ngerman}±17.64 & <\selectlanguage{english}0.001 &
62.04\selectlanguage{ngerman}±18.93 & 0.334 & 87.64\selectlanguage{ngerman}±12.17 & 0.256\tabularnewline
& Diploma and Associate's degree & 407(25) & 85.04\selectlanguage{ngerman}±14.70 & & 59.64\selectlanguage{ngerman}±17.91
& & 89.45\selectlanguage{ngerman}±11.12 &\tabularnewline
& Bachelor and master's degree & 1030(63.3) & 89.34\selectlanguage{ngerman}±10.21 & &
58.93\selectlanguage{ngerman}±17.23 & & 89.91\selectlanguage{ngerman}±10.96 &\tabularnewline
& Doctorate and PhD & 95(5.8) & 92.02\selectlanguage{ngerman}±9.44 & & 58.15\selectlanguage{ngerman}±15.37 & &
90.09\selectlanguage{ngerman}±9.95 &\tabularnewline
Relation of education to health & Relevant & 431(26.4) & 91.59\selectlanguage{ngerman}±8.41 &
<\selectlanguage{english}0.001 & 62.27\selectlanguage{ngerman}±16.55 & 0.002 & 90.97\selectlanguage{ngerman}±9.89 & 0.002\tabularnewline
& Irrelevant & 1197(73.6) & 86.42\selectlanguage{ngerman}±13.22 & & 58.16\selectlanguage{ngerman}±17.59 & & 89.20\selectlanguage{ngerman}±11.37
&\tabularnewline
Occupation & Related to healthcare & 153(9.4) & 93.46\selectlanguage{ngerman}±7.29 & <\selectlanguage{english}0.001 &
64.44\selectlanguage{ngerman}±14.95 & <\selectlanguage{english}0.001 & 92.10\selectlanguage{ngerman}±8.94 & <\selectlanguage{english}0.001\tabularnewline
& Employee & 598(36.7) & 88.38\selectlanguage{ngerman}±11.94 & & 59.55\selectlanguage{ngerman}±17.99 & & 89.63\selectlanguage{ngerman}±10.45
&\tabularnewline
& Worker & 91(5.6) & 83.50\selectlanguage{ngerman}±13.53 & & 57.84\selectlanguage{ngerman}±18.44 & & 84.80\selectlanguage{ngerman}±12.67
&\tabularnewline
& Retired & 96(5.9) & 87.08\selectlanguage{ngerman}±13.66 & & 61.20\selectlanguage{ngerman}±19.26 & & 91.67\selectlanguage{ngerman}±9.22
&\tabularnewline
& Salesman and businessman & 153(9.4) & 84.69\selectlanguage{ngerman}±14.03 & & 55.85\selectlanguage{ngerman}±19.30 & &
87.88\selectlanguage{ngerman}±11.92 &\tabularnewline
& Student & 164(10.1) & 87.15\selectlanguage{ngerman}±11.39 & & 54.11\selectlanguage{ngerman}±15.65 & & 87.41\selectlanguage{ngerman}±13.46
&\tabularnewline
& Others & 373(22.9) & 87.30\selectlanguage{ngerman}±12.82 & & 60.12\selectlanguage{ngerman}±15.76 & & 91.14\selectlanguage{ngerman}±10.52
&\tabularnewline
Place of residence & City/Town & 1566(96.2) & 87.81\selectlanguage{ngerman}±12.42 & 0.75 &
59.25\selectlanguage{ngerman}±17.39 & 0.916 & 89.70\selectlanguage{ngerman}±11.03 & 0.608\tabularnewline
& Village & 62(3.8) & 87.32\selectlanguage{ngerman}±10.24 & & 59.02\selectlanguage{ngerman}±18.06 & & 88.97\selectlanguage{ngerman}±10.92
&\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2-} Demographic characteristics of respondents and KAP
scores by demographic variables

\textbf{Table 3-} Main categories of knowledge questions and average
responses to each option\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
Main category & \% & \% & \%\tabularnewline
\midrule
\endhead
& Correct response & Wrong response & I don't know\tabularnewline
Preventive measures & 87.40 & 9.0 & 3.60\tabularnewline
Disease control & 95.25 & 1.7 & 3.05\tabularnewline
Treatment of COVID-19 & 95.60 & 1.4 & 3.10\tabularnewline
Clinical symptoms of the disease & 83.50 & 11.0 & 5.45\tabularnewline
Transmission routes & 82.25 & 7.8 & 10.05\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure 1-} Knowledge level of participants regarding preventive
measures questions

\textbf{Table 4} -Attitude of respondents toward prevention and control
of COVID-19\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
Attitude questions & \% & \% & \%\tabularnewline
\midrule
\endhead
& Positive attitude & Negative attitude & No idea\tabularnewline
Country will finally control the outbreak & 47.1 & 20.9 &
31.9\tabularnewline
Public training is good enough & 63.7 & 20.9 & 15.4\tabularnewline
Public follow the principles of prevention & 17.2 & 63.7 &
19.1\tabularnewline
I have enough information about the principles of prevention & 85.6 & 3
& 11.4\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 5} - Practice of respondents regarding COVID-19 control
and prevention\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
Practice questions & \% & \% & \% & \% & \%\tabularnewline
\midrule
\endhead
& Always & Often & Occasionally & Seldom & Never\tabularnewline
I have gone to crowded places during the outbreak & 0.6 & 2.2 & 9.5 &
30.8 & 56.9\tabularnewline
I have visited my relatives during New Year holidays & 0.1 & 0.2 & 2.6 &
15.5 & 81.5\tabularnewline
I have observed physical distancing during the outbreak & 55.6 & 30.8 &
6.9 & 5.3 & 1.4\tabularnewline
I regularly wash my hands with soap and water & 82.2 & 15.7 & 1.4 & 0.4
& 0.3\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 6} -The results of Pearson correlation test\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
& & Scaled score of knowledge & Scaled score of attitude & Scaled score
of Practice\tabularnewline
Scaled score of knowledge & Pearson Correlation & 1 &
.145\textsuperscript{**} & .179\textsuperscript{**}\tabularnewline
& Sig. (2-tailed) & & .000 & .000\tabularnewline
& N & 1628 & 1628 & 1628\tabularnewline
Scaled score of attitude & Pearson Correlation &
.145\textsuperscript{**} & 1 & .092\textsuperscript{**}\tabularnewline
& Sig. (2-tailed) & .000 & & .000\tabularnewline
& N & 1628 & 1628 & 1628\tabularnewline
Scaled score of Practice & Pearson Correlation &
.179\textsuperscript{**} & .092\textsuperscript{**} & 1\tabularnewline
& Sig. (2-tailed) & .000 & .000 &\tabularnewline
& N & 1628 & 1628 & 1628\tabularnewline
*. Correlation is significant at the 0.01 level (2-tailed). & **.
Correlation is significant at the 0.01 level (2-tailed). & **.
Correlation is significant at the 0.01 level (2-tailed). &
&\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{english}
\FloatBarrier
\end{document}

