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 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 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.
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.
SSn = 100 × SQ­n − Smin/ [Smax − Smin]
Where SSn is scaled score of question n, SQn is the obtained score of question n and Smax and Smin 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 <.05 was considered to indicate statistical significance.