Knowledge, attitude, practice and fear of COVID-19: A cross-cultural study

Abstract Background: Knowledge, Attitude and Practice (KAP), and Fear toward COVID-19 are an important issue when designing public health approaches to control the spread of this highly contagious disease like COVID-19 during the global pandemic period. Studies with KAP and fear measures are limited only regional or country level, not yet with global or cross-cultural populations. The study is aimed to measure KAP and fear level towards COVID-19 and explore its cross-cultural variances in knowledge by socio-demographic factors among the general population of 8 different countries over 5 continents. Method: A cross-sectional online survey was conducted in April 2020 among 1296 participants using the Google form platform. Considering the social distancing formula and pandemic situation, we collect data using popular social media networks. Univariate and bivariate analyses were used to explore the collected data on KAP, fear, and sociodemographic factors. Result: Overall knowledge score was 9.7 (out of 12) and gender differences (female vs male: 9.8 vs 9.5) were significant (p=0.008) in the bivariate analysis. Knowledge score variances found significant in some regions by gender, marital status and education qualification. The highest and lowest mean knowledge scores were recorded in the Middle East (10.0) and Europe (9.3). Despite having a high fear score (22.5 out of 35), 78.35% of respondents were in a positive attitude and 81.7% in good practice level. Fear score rankings: Middle East (1st; 23.8), Europe (2nd; 23.2); Africa (3rd; 22.7); South Asia (4th; 22.1); Oceania (5th; 21.9); and North America (6th; 21.7). We did not find a correlation between fear and knowledge. Limitation: Due to the nature of the online survey, aged and rural populations are under-representing (e.g. more than half of the responders are 16-29 age group). Conclusion: KAP and fear variation exist among geographical regions. Gender, marital status and education qualification are factors in knowledge variances for some regions. KAP and fear measures can assist health education programs considering some sociodemographic factors and regions during an outbreak of highly contagious disease and, which can uplift a positive attitude and good practice. Keywords: COVID-19, knowledge; attitude; practice; fear; cross-cultural study; online survey