Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 Since the emergence of COVID-19, the number of infected people has risen rapidly, and the fierce pandemic has brought great harm to public health and life. As of now, the weekly case incidence has continued to increase globally, with the following reasons: (1) Treatment measures are mostly symptomatic and supportive treatment Reference Gao2,Reference Xu, Liu and Li3 ; (2) novel coronavirus variant strains appear frequently and have increased transmissibility Reference Yu and Tian4 ; and (3) the global supply of COVID-19 vaccines is insufficient and its distribution is unfair. Reference Yu and Tian4 In China, although currently the pandemic has been effectively controlled, factors such as the spread of mutated strains with a higher infectivity, the large-scale movement of people throughout the country during holidays, and the vaccination rate, which has not yet reached the herd immunity threshold, have increased the risk of COVID-19 transmission, resulting in several provinces/streets across the country becoming medium/high-risk areas. 5,6 Therefore, the majority of the world’s population remains at high risk of infection. This further indicates that vaccination and other epidemic prevention and control measures have a certain relationship with social and economic factors.
Literature Review
It is undeniable that the success of pandemic prevention and control depends on residents’ past or existing social support, as well as their own behavior to a large extent. At present, most countries have formed a relative framework of government-led and diversified social support systems for pandemic prevention and control. Furthermore, globally promoted vaccination is now the routine way to prevent the spread of the pandemic within the framework of social support systems, but it will take time for global vaccination rates to reach collective immunization. According to the R0 value of the basic transmission coefficient of COVID-19, Reference Park, Cook and Lim7–Reference Zhou, Liu and Yang10 47% to 85% of the natural infection rate or vaccination rate is required to achieve the protective effect of herd immunization, Reference Wu11 thus the current global population of about 7.6 billion people needs between 7.1 billion and 12.9 billion doses of COVID-19 vaccine based on 2 doses per person. Reference Yu and Tian4 Meanwhile, the Boao Forum for Asia (BFA) launched “Report on the Global Use of COVID-19 Vaccines,” which pointed out that there is a serious imbalance and fragmentation in the international distribution of vaccines. Among countries with more than 30% of the population fully vaccinated, European and American countries account for the majority. 12 In contrast, vaccination rates in less developed countries and regions are generally low. For example, the vaccination rate of residents on the African continent is less than 2%. 12 Therefore, under the current background, controlling infectious sources and cutting off transmission routes are still important ways to control virus transmission. Continuous implementation of self-prevention and control measures, such as wearing a mask, handwashing, self-isolation, and keeping social distance among public residents, is fundamental to control the pandemic and prevent its recurrence. Reference Yang, Liu and Ma13
During the outbreak of COVID-19, a large number of scholars conducted research on residents’ knowledge, attitude, belief, and practice (KABP) of pandemic prevention and control. A survey of Syrian residents showed that the knowledge, attitude, and practice mean scores toward COVID-19 were 3.54 (SD 1.20, range 0-6), 2.45 (SD 0.81, range 0-4), 5.90 (SD 1.52, range 0-8), respectively, and about 60% of residents had confidence that the COVID-19 pandemic will eventually be controlled. Reference Al Ahdab14 Mohamed et al. found that the respondents had good knowledge (knowledge awareness rate was 91.3%) and attitude toward COVID-19 prevention and control, and the main information sources were official websites of the Ministry of Health and World Health Organization (WHO). Reference Mohamed, Elhassan and Mohamed15 A survey conducted by Naser et al. showed that the knowledge level of COVID-19 among residents in the Middle East was relatively low, with an overall knowledge awareness rate of 66.1%, in particular, an awareness rate of 43.3% regarding the route of transmission. Reference Naser, Dahmash and Alwafi16 Abdelhafiz et al. found that the mean score of Egyptian residents’ knowledge on COVID-19 prevention and control was 16.39 (SD 2.63, range 7-22); residents mainly obtained knowledge through social media (66.9%) and the Internet (58.3%); and the knowledge level of low-education, low-income, older rural residents was significantly lower. Reference Abdelhafiz, Mohammed and Ibrahim17 Zhang et al. found that the total KABP score of rural residents in Henan Province, China, was at a high level, with a mean sore of 100.35 (SD 14.92), in which the mean scores of knowledge, attitude, and practice were 3.97 (SD 0.77), 4.25 (SD 0.63), and 4.29 (SD 0.68), respectively. Reference Zhang, Liu and Chen18 Zhao et al. found that 65% of the residents in Shunyi District, Beijing, China, had a high cognitive level of COVID-19 knowledge, 52.4% had a positive attitude, and 87.3% had good practice level. Reference Zhao, Hu and Zhang19 Chen et al. found that residents in Guangzhou, China, had a relatively high awareness rate of basic knowledge about COVID-19 prevention and control (70.73%–98.92%) and the implementation rate of personal protection practice (88.87%–98.30%). Reference Chen, Luo and He20
Although during the outbreak of the COVID-19 pandemic, the research on residents’ KABP for pandemic prevention and control has promoted a large number of successful prevention and control measures, it is undeniable that in order to prevent the recurrence of the pandemic, the normalized prevention and control period of the pandemic is still particularly important, and there are differences between the normalization period and the outbreak period. Therefore, it is necessary to further explore the prevention and control status of residents in the normalization period, to provide a reference for the improvement of prevention and control measures. Based on this special period, we studied the current situation of residents’ KABP and social support for pandemic prevention and control and explored the relationship between KABP and social support, in order to provide a scientific reference for the successful completion of pandemic prevention and control.
Purpose of the Study
This study aimed to explore the status quo of residents’ knowledge, attitude, belief, and practice (KABP) and social support and the correlation of KABP with social support under normalized COVID-19 pandemic prevention and control, to provide a scientific basis for improving targeted education and action intervention aimed at improving residents’ prevention and control capabilities and practice.
Methods
Design
The study was a cross-sectional electronic survey based on multiple network platforms.
Sample
This survey included 8 basic information items and 7 questionnaire dimensions, resulting in a total of 15 variables. The sample size was calculated according to the Kendall sample estimation method in multivariate analysis, that is, the sample required should be 10-20 times as high as the number of variables. Reference Wang21 Calculated by 15 times, the minimum sample size was 225. The invalid sample size was increased by 20%, so that the sample size required for this study was 270.
Measures
Questionnaire
Based on the KABP model and guidelines or documents for COVID-19 prevention and control issued by the WHO, Reference Gochman22,23 the National Health Commission of the People’s Republic of China (NHC), 24 the Chinese Center for Disease Control and Prevention (China CDC), 25 and the related literature, Reference Wang and Xu26 this questionnaire titled, Residents’ Knowledge, Attitude, Belief, Practice, and Social Support for the COVID-19 Prevention and Control, was designed. The questionnaire covered the following 7 parts:
Informed consent
Includes research introduction, voluntary, anonymous, and confidential nature of participation, guidelines for questionnaire filling, invitation to participate, and informed consent options. Only participants who select “agree to participate” option can continue to fill in the rest of the questionnaire.
Basic information
Includes 8 items: gender, age, nationality, marital status, education level, place of residence, length of work experience, and family economic level.
Knowledge
Includes 10 items: service time, disposal method, and type of mask, and disease-related knowledge (including duration of community quarantine, route of transmission, major symptom, safe social distance, acronym, time of medical observation, and incubation period). The answer option of each item was a single choice, each correct answer scored 1 point, and the total score ranged from 0 to 10 points, with a higher total score indicating a better mastery of knowledge.
Attitude
Includes 7 items: attitude toward the necessity of personal and community prevention for pandemic control, and attitude toward the cooperation for nucleic acid detection, knowledge dissemination, disease attentiveness, self reporting and isolation, and volunteer activities. Each item was rated on a 4-point Likert scale, and the total score ranged from 7-28 points, with a higher total score indicating a more positive attitude.
Belief
Includes 4 items: confidence in national/departmental, regional/community, and individual pandemic prevention andcontrol, and confidence in the recovery of national economy in the severe disaster areas. Each item was rated on a 4-point Likert scale, and the total score ranged from 4-16 points, with a higher total score indicating better belief.
Practice
Includes 9 items: wearing a mask, preparing protective supplies, washing hands, enhancing ventilation, avoidance of parties/gatherings, observing social distancing measures, cleaning/disinfection frequency, using disposable tissues, frequency of receiving information. Each item was rated on a 4-point Likert scale, and the total score ranged from 9-36 points, with a higher total score indicating better practice.
Social support
Includes 10 items: The Social Support Rating Scale (SSRS) is a rating instrument for social support, with good reliability and validity, compiled by Xiao in 1986. Reference Xiao27 A modified and validated Chinese version of the SSRS with a Cronbach’s α of 0.885 was used. Reference Zhang, Cui and Zhu28 The scale consists of 10 items and includes objective support, subjective support, and availability of social support sub-dimensions. The answer options of items were a single choice or multiple choice, and after assignment, the total score of the scale ranged from 12 to 66 points and was interpreted as follows: low (total score ≤ 22), medium (total score = 23-44), and high (total score ≥ 45).
Validity and reliability
Six experts reviewed the online questionnaire (2 preventive medicine experts, 2 sociologists, and 2 nursing professors). The questionnaire had a good content validity index (CVI = 0.926). Before the formal survey, a pilot study among 30 residents was conducted to check the questionnaire’s reliability. The internal consistency Cronbach’s α coefficient for the questionnaire was 0.815.
Data collection
First, we uploaded the questionnaire to Wenjuanxing (https://www.wjx.cn), an online questionnaire system widely used in academic study in China. Then, our research team shared the questionnaire link generated by Wenjuanxing to their WeChat (https://weixin.qq.com), the largest Chinese social media platform, and invited people in their WeChat to fill in the questionnaire. The link was subsequently forwarded by these contacts to more people in their WeChat to fill in the questionnaire, and so on. We also posted the questionnaire link on other widely used social media platforms, including Sina Weibo (https://weibo.com) and QQ (https://www.qq.com) to reach as many residents as possible. IP address restriction technology was adopted to ensure users with the same IP address could complete the questionnaire only once. Finally, 2 independent researchers were downloaded and checked the questionnaire data, eliminated the unqualified questionnaires with invalid filling parts accounting for more than 20% of the whole questionnaire page. Any disagreements between 2 researchers were settled by reaching a consensus with a third researcher.
Analytic Strategy
The SPSS software (version 25.0; SPSS Inc., Chicago, IL, USA) was used for statistical analysis in this study. Continuous variables were described as means with standard deviations (SD), whereas categorical variables were presented as frequencies with percentages (%). The item scoring rate and the total scoring rate for KABP were calculated by dividing the actual score of an item or total items by the total item/items score and then multiplying by 100%. Two independent sample t-tests or one-way analysis of variance (ANOVA) was conducted to evaluate differences among respondents with different sociodemographic characteristics. Statistically significant variables identified in univariate analysis and those professionally considered as significant factors were screened as independent variables, which were then incorporated into the multivariate linear regression equation to further clarify factors influencing KABP and social support. Pearson’s correlation analysis was carried out to examine relationships among KABP and social support. Two-tailed P values < 0.05 were considered statistically significant.
Ethical Standards
Permission for the study was granted by Chengdu University, Sichuan Province, China. Informed consent was obtained from each participant online who was assured of anonymity and confidentiality, their rights to withdraw from the study at any time, and that the data were collected for academic use only.
Results
Characteristics of Respondents
A total of 360 questionnaires were collected, in which 44 were invalid, as a result, and 326 valid questionnaires were finally obtained for data analysis (effective response rate was 90.6%). The main characteristics of respondents were female (190 [58.3%]), ages 21-25 years (183 [56.1%]), Han Chinese (312 [95.7%]), being unmarried (266 [81.6%]), having an undergraduate degree or higher (172 [52.8%]), living in urban locality (177 [54.3%]), having less than 2 years of working seniority (196 [60.1%]), and having a per capital monthly income of less than 2000 yuan (149 [45.7%]; see Table 3).
Scores of KABP and Social Support
The mean score of knowledge was 6.49 (SD 1.863, range 2-10), the total scoring rate was 68.1%, and the highest (service time of mask) and lowest (incubation period) item scoring rates were 95.7% and 12.9%, respectively. The mean score of attitudes was 25.40 (SD 3.501, range 14-28), the total scoring rate was 92.2%, and the highest (necessity of personal prevention for pandemic control) and lowest (willingness to engage in volunteer activities to combat the pandemic) item scoring rates were 95.0% and 89.6%, respectively. The mean score of belief was 13.44 (SD 3.011, range 6-16), the total scoring rate was 89.3%, and the highest (confidence in national/departmental pandemic prevention and control) and the lowest (confidence in regional/community pandemic prevention and control) item scoring rates were 92.7% and 88.7%, respectively. The mean score of practice was 24.19 (SD 5.256, range 17-36), the total scoring rate was 75.3%, and the highest (wearing a mask when going out) and the lowest (frequency of staying informed about pandemic-related information) item scoring rates were 93.3% and 63.3%, respectively. The results are shown in Table 1.
Table 1. Scores of residents’ KABP on prevention and control of COVID-19 (N = 326)
KABP, knowledge, attitude, belief, and practice; SD, standard deviation.
The mean score of social support was 34.15 (SD 6.463, range 12-50), the total scoring rate was 62.6%, and the highest (“the way I live in the past year”) and the lowest (“the source of financial support or help when I have an emergency”) item scoring rates were 84.7% and 41.6%, respectively. The mean scores of objective support, subjective support, and availability of social support sub-dimensions were 7.81 (SD 3.269, range 1-17), 18.90 (SD 4.240, range 8-30), and 7.44 (SD 2.154, range 3-12), respectively. The total scoring rates of those 3 sub-dimensions were 51.1%, 74.1%, and 78.5%, respectively. The results are depicted in Table 2.
Table 2. Scores of residents’ social support on prevention and control of COVID-19 (N = 326)
SD, standard deviation.
Table 3. Univariate and multivariate analyses of factors associated with residents’ KABP and social support on prevention and control of COVID-19 (N = 326)
KABP, knowledge, attitude, belief, and practice; SD, standard deviation; β, standardized coefficient.
† Reference group; *P < 0.05; **P < 0.01; ***P < 0.001.
Univariate and Multivariate Analyses of Factors Related to KABP and Social Support Scores
According to the results of 2 independent sample t-tests or one-way ANOVA, in terms of knowledge, differences in the mean scores between residents of different gender, nationality, education level, and family economic level were statistically significant (ie, female vs male: 7.93 vs 6.88, P < 0.001; Han Chinese vs other nationalities: 7.55 vs 6.14, P < 0.01; undergraduate degree or higher vs junior college vs high school and below: 7.69 vs 7.34 vs 7.12, P < 0.001; < 2000 yuan vs 2000-5000 yuan vs > 5000 yuan of family per capita monthly income: 6.95 vs 7.24 vs 7.38, P < 0.05). Regarding belief, significant difference was identified in the mean scores between residents of different place of residence (ie, urban vs rural: 13.54 vs 11.34, P < 0.05). As for social support, significant differences were identified in the mean scores between residents of different marital status and place of residence (ie, unmarried vs married: 20.73 vs 23.00, P < 0.01; urban vs rural: 22.69 vs 20.85, P < 0.01). Moreover, the results of attitude and practice showed that there were no significant differences in the mean scores between residents of different sociodemographic characteristics.
Based on the results of multivariate linear regression analysis, gender (P = 0.006), nationality (P = 0.002), education level (P = 0.046), practice (P = 0.000), and social support (P = 0.000) were the significant influencing factors of knowledge; belief (P = 0.000) and practice (P = 0.000) were significant positive predictors for attitude; place of residence (P = 0.040), attitude (P = 0.000), and practice (P = 0.000) were the significant influencing factors of belief; knowledge (P = 0.000), attitude (P = 0.000), belief (P = 0.000), and social support (P = 0.012) were significant positive predictors for practice; and marital status (P = 0.006), place of residence (P = 0.021), knowledge (P = 0.000), and practice (P = 0.012) were the significant influencing factors of social support. The results are depicted in Table 3.
Correlation Analysis Between KABP and Social Support
According to the results of correlation analysis, knowledge, attitude, belief, and practice were positively correlated with each other (r = 0.212-0.649; P < 0.001), and social support was positively correlated with knowledge (r = 0.227; P < 0.01) and practice (r = 0.138; P < 0.05). The results are shown in Table 4.
Table 4. Correlation analysis of residents’ KABP with social support on prevention and control of COVID-19 (N = 326)
KABP, knowledge, attitude, belief, and practice.
*P < 0.05; **P < 0.01; ***P < 0.001.
Discussion
KABP
Knowledge
The total scoring rate of knowledge was 68.1%. Among 10 investigated items of knowledge, 5 had an item scoring rate of over 85.0%, indicating that most residents had a better mastering of COVID-19 knowledge in the period of normalized prevention and control. The highest scoring rate of “service time of mask” item was 95.7%, indicating that masks have been popularized during the period of normalized prevention and control of COVID-19. The lowest scoring rate of “incubation period” item was 12.9%, which is much lower than the rate reported by Nie et al. Reference Nie, Cao, Tuo and Zheng29 The reasons for the difference might be that the incubation period of COVID-19 varies with the variation of SARS-CoV-2; besides, compared with the COVID-19 outbreak period, the reduction of residents’ awareness of prevention and control during the normalized prevention and control period may lead to the reduction of active acquisition of the latest prevention and control knowledge. Moreover, compared with attitude, belief, and practice, the total scoring rate of knowledge was the lowest, suggesting that some residents had insufficient knowledge during this special period. On the one hand, Yang et al. found that mass media (such as WeChat and network news) was the primary source for residents to acquire knowledge, nevertheless, affected by age, social economy, residence, disability and other factors, Reference Yang, Liu and Ma13 so the residents’ network utilization rate may be limited. Reference O’Sullivan and Phillips30 On the other hand, with the progress of disease, the relevant prevention and control knowledge on the network is constantly updated, but some residents are not timely and sensitive to the acquisition of knowledge, suggesting that relevant departments should continue to strengthen knowledge publicity and guidance.
Regarding influencing factors, regression analysis found that gender, nationality, education level, practice, and social support were significant positive predictors for knowledge. The finding of significantly higher knowledge scores among females are in line with a previous study conducted by Li and Chen. Reference Li and Chen31 Studies have shown that females’ cognitive ability is higher than that of males, which may be because females are more likely to engage in life and health conscious behaviors. Reference Sun, Jia and Liu32 Compared with ethnic minority residents, the Han Chinese had a significantly higher knowledge score, which is similar to the findings of another study conducted by Kang. Reference Kang33 Moreover, similar to the results of a study conducted by Chang et al., this study showed that the higher the education level of residents, the higher the knowledge score. Reference Chang, Liu, Sun and He34 Therefore, it is essential for health educators to attach great importance to ethnic minorities and residents with low education level, and carry out multi-form and easy-to-understand popularization activities about COVID-19 prevention and control knowledge for them.
Attitude
The total scoring rate of attitude was 92.2% and all items were scored above 85%, revealing a positive attitude toward COVID-19 prevention and control, which was an important factor for controlling the pandemic. The scoring rates of items “necessity of personal prevention for pandemic control” and “necessity of community prevention for pandemic control” were highest, both of which were 95.0%, indicating that residents were aware of the equal importance of individual and community intervention in pandemic prevention and control. A study on COVID-19 and global governance reforms emphasized the importance of individual prevention and control. Reference Sun35 In addition, some studies believed that the community is not only the front line on prevention and control of COVID-19 in a normalization period, Reference Meng36 but also the most effective defense line for external defense input and internal defense rebound, which is essential for strictly controlling the increase of the pandemic. 37 Therefore, the complementarity of individual and community prevention and control can be conducive to the implementation of prevention and control measures and promote the continuous improvement of pandemic prevention and control situation. Although the scoring rate of “willingness to engage in volunteer activities to combat the pandemic” was the lowest among all items, it still achieved 89.6%, revealing that most residents were highly motivated to participate in pandemic prevention and control, which was inseparable from the strong responsibility and dedication of most residents. Reference Sun35
Belief
The total scoring rate of belief was 89.3%, all items were scored above 85%, and the highest scoring rate of item “confidence in national/departmental pandemic prevention and control” was 92.7%. Overall, residents in our study had a higher belief on COVID-19 prevention and control and had high confidence in overcoming the pandemic. The results also showed that residents had confidence not only in the prevention and control effect at the national/departmental level, but also in the individual and regional/community levels. Previous studies have shown that, according to the health belief model, the smooth progress of standardized prevention and control of COVID-19 requires not only strong and specific measures taken by the state, but also individual prevention awareness and community cooperation. Reference Carvalho Alves, Lima Mendonça and Xavier Soares38–Reference Syed, Meraya and Yasmeen40 Based on the regression analysis results, only place of residence, attitude, and practice were the significant predictive factors for belief. Urban residents often have better social resources than rural residents, which contributes to the timeliness and effectiveness of pandemic prevention and control. Reference Gao, Hu and Yin41 Therefore, it is inevitable to cause different changes in the belief level of urban and rural residents. The results of this study suggested that the interventions for COVID-19 preventive belief among rural residents should be strengthened.
Practice
The total scoring rate of practice was 75.3%, and among the 9 knowledge items, 33.3% (3 items) scored more than 80% and 66.7% (6 items) scored more than 70%. The highest scoring rate of item “wearing a mask when going out” was 93.3%. Similar results were found in the study of Wang et al. Reference Wang, Li and Cai42 The reason might be that the state/community continued to vigorously publicize and implement prevention and control measures to remind residents to pay attention to the use of masks during the normalization period, so that most residents formed good basic prevention and control behavior. On May 20, 2021, the chief epidemiologist of China CDC emphasized the importance of wearing a mask when going out and in places where people gather. 43 The lowest scoring rate of item “frequency of staying informed about pandemic-related information” was 63.3%, which might be attributed to the weakening of residents’ awareness of prevention and control during the normalization period. Reference Ding44 In addition, the scoring rate of practice was lower than that of attitude and belief, indicating that there is still a gap between attitude/belief formation and practice transformation, and more efforts are warranted to explore the mechanism between them and other possible factors affecting residents’ practice transformation. Reference Yang, Liu and Ma13
Social Support
The total scoring rate of social support was 62.6%, and among 3 sub-dimensions, the objective support sub-dimension had the lowest scoring rate (51.1%). In the objective support sub-dimension, the item “living with classmates, colleagues or friends in the past year” had the highest scoring rate. The respondents in this survey were relatively young, most of whom had short working years and a weak economic foundation. Therefore, in order to reduce the cost of living, they often choose to live with classmates, colleagues, or friends. In the period of normalized pandemic prevention and control, shared renting can alleviate some economic pressure. It is worth mentioning that the item “the source of financial support or help when I have an emergency” had the lowest scoring rate of 41.6%. In this item, we found that residents had relatively few sources of help, of which 68.1% had 1 to 3 sources of help, whereas only 21.8% received more than 3 sources, and even 10.1% had no sources. Similar results were found in studies conducted by Guo et al. Reference Li45,Reference Guo, Sun and Li46 This might be because most of our respondents were in the initial stage of personal development, were currently unmarried, and lacked social resources or the ability to use social resources. The results suggested that residents’ work units, official or non-official organizations, should provide practical help in economic and other resources for residents in the special period of COVID-19 normalization prevention and control.
The total scoring rate of subjective support sub-dimension was 74.1%, and the item “the number of close friends who can support and help me” scored the highest (82.6%), indicating that most residents had more opportunities to get along with their friends and received social support from them. Among the 3 sub-dimensions of social support, the availability of social support dimension had the highest scoring rate (78.5%). In this sub-dimension, the item “the way I ask for help when I’m in trouble” had the highest scoring rate (83.2%); specifically, 71% of residents chose “not to seek help, or rarely/occasionally seek help.” Relevant studies have shown that during the normalization period, most areas have resumed normal work and production, and the economy is gradually recovering. Reference Liang, Yao and Wu47,Reference Xu, Wang and Dong48 Therefore, compared with the pandemic outbreak period, residents’ economic difficulties and psychological pressure have been alleviated, and their self-support ability has been improved. In the availability of social support sub-dimension, the item “the frequency with which I participate in group activities” had the lowest scoring rate (60.9%). Specifically, 72% of residents chose “never or occasionally participate in group activities.” The reason might be that due to the needs of pandemic prevention and control, the government and pandemic prevention departments advocate that residents should minimize public gatherings. 49
Regression analysis revealed that the social support level of residents living in rural areas and unmarried residents was lower than those living in urban areas and married residents, which was similar to the findings of previous studies. Reference Gao and Ma50,Reference Sherbourne and Stewart51 For unmarried residents, they may receive less social support due to the lack of social support supply sources, the absence of family functions, and the lack of functional support services such as consultation. Reference Foong, Hamid and Ibrahim52,Reference Zhong53 In addition, because the rural security system and health education system were not perfect, and the overall education level of rural residents was not high, Reference Yue, Zhang, Cao and Knowledge54 these residents’ cognition and behavior tendency of the pandemic situation were in a relatively initial stage, which may lead to the very weak social support they can obtain. Thus, it is suggested to strengthen social support for unmarried residents and rural residents during the normalization period.
Correlation Between KABP and Social Support
The correlation analysis of KABP sub-dimensions showed that practice was the positive predictor for knowledge; belief and practice were the positive predictors for attitude; attitude and practice were the positive predictors for belief; and knowledge, attitude, and belief were the positive predictors for practice. The above results were in line with the KABP model. Reference Gochman22 Moreover, the results showed that social support was positively correlated with knowledge and practice. It might be that residents with high social support and often in a warm and harmonious environment could seek help from the society and could be more positive and optimistic in the face of the pandemic and take appropriate prevention and control measures. Reference Meng55 Moreover, COVID-19 is a serious global public health event, which is easy to cause a series of adverse emotions among residents in the process of prevention and control. Reference Li, Chen and Emotion56 It is far from enough to rely on individuals to fight the pandemic. We need the help of all aspects of society to provide relevant knowledge and emotional support, and guide residents to change their bad behaviors. The results suggested that seeking social support can increase residents’ prevention and control knowledge and improve their self-management behavior, to achieve the purpose of effective pandemic control.
Limitations
This study had certain limitations. First, in order to ensure the effectiveness of the survey, we conducted a preliminary verification of the survey tool through expert review. Although its CVI coefficient was acceptable, further standard verification measures are required. Second, the study was carried out in China, which may limit the generalization of our findings to other countries. Third, this study was carried out at the normalized prevention and control stage of the pandemic, which may only reflect the KABP and social support of our participants on COVID-19 prevention and control during the questionnaire collection period.
Conclusions
This study preliminarily explored the current situation, influencing factors, and correlation of KABP and social support of residents on the normalized prevention and control of COVID-19. The results showed that residents had a positive attitude and belief in prevention and control, but there were certain deviations in the understanding of some important prevention and control knowledge and gaps in the transformation of knowledge into practice. At the same time, our research also showed that social support was also an important factor affecting residents’ KABP, especially knowledge and practice. The findings of our study can provide scientific reference for decision makers in pandemic management and decision making and COVID-19 prevention and publicity in the normalized prevention and control period, especially for health educators to carry out demand-oriented and individualized targeted education programs for specific groups such as males, non-Han Chinese, rural residents, unmarried residents, and those with low education level or social support level.
Data availability statement
All study instruments used on this analysis are available to researchers upon reasonable request.
Acknowledgments
Our thanks to all respondents in this survey for their time and for sharing their experience.
Author contributions
KY conceived and designed the study and wrote the manuscript; KY and YP helped collect data; KY, YP, and JL performed the statistical analysis and wrote the initial draft of the manuscript; KY and YX confirmed the eligibility of the participants for the study; KY, YP, JL, YX, and FZ made a substantial contribution during drafting the manuscript, in data analysis, and during revisions of the manuscript. The final version of the manuscript was approved by all coauthors.
Funding statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Competing interests
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this paper.
Ethical standards
Permission for the study was granted by Chengdu University, Sichuan Province, China. Informed consent was obtained from each participant online who was assured of anonymity and confidentiality, their rights to withdraw from the study at any time, and that the data were collected for academic use only.
