JMIR Publications

ABSTRACT

Background:

A detailed understanding of the public’s knowledge and perceptions of coronavirus disease 2019 (COVID-19) could inform governments’ public health actions in response to the pandemic.

Objective:

The aim of this study was to determine the knowledge and perceptions of COVID-19 among adults in China, and its variation among provinces and by sociodemographic characteristics.

Methods:

Between 8 May 2020 and 8 June 2020, we conducted a cross-sectional online survey among adults in China who were registered with the private survey company KuRunData. We set a target sample size of 10,000 adults, aiming to sample 300-360 adults from each province in China. Participants were asked 25 questions that tested their knowledge about COVID-19, including measures to prevent infection, common symptoms, and recommended care-seeking behavior. We disaggregated responses by age, sex, education, province, household income, rural-urban residency, patient health questionnaire score (PHQ-9 score), and whether or not a participant had a family member, friend, or acquaintance who they know to have been infected with SARS-CoV-2. All analyses used survey sampling weights.

Results:

5,079 men and 4,921 women completed the questionnaire and were included in the analysis. Out of 25 knowledge questions, participants answered a mean and median of 21.5 (95% CI: 21.4-21.5) and 22 (IQR: 20 – 23) questions correctly, respectively. 84.6% (95% CI: 83.9%-85.3%) of participants answered four-fifths or more of the questions correctly. For at least one of four ineffective prevention measures (using a hand dryer, regular nasal irrigation, gargling mouthwash, and taking antibiotics), 69.0% (95% CI: 68.0%-69.9%) of participants answered that it was an effective method to prevent SARS-CoV-2 infection. While knowledge overall was similar across provinces, the percent of participants who answered the question on recommended care-seeking behavior correctly varied from 36.7% (95% CI: 31.3%-42.2%) in Tibet to 86.6% (95% CI: 86.5%-92.8%) in Beijing. Within provinces, participants who were male, older, residing in urban areas, and had higher household income tended to answer a higher proportion of the knowledge questions correctly.

Conclusions:

This large online study of individuals across China suggests that the majority of the population has good knowledge of COVID-19. However, a significant proportion still holds misconceptions or incorrect beliefs about prevention methods and healthcare-seeking behaviours, especially in rural areas and some less wealthy provinces in Western China. This study can inform the development of tailored public health policies and promotion campaigns by identifying knowledge areas for which misconceptions are comparatively common and provinces and districts that have relatively low knowledge.