Knowledge, attitudes and practices towards COVID-19 among Pakistani residents: information access and low literacy vulnerabilities.

Fatmi, Zafar; Mahmood, Shafaq; Hameed, Waqas; Qazi, Ibtisam; Siddiqui, Muhammad; Dhanwani, Anny; Siddiqi, Sameen

Background Coronavirus disease (COVID-19) has accentuated the need for speedy access to information. Digital divide and socio-demographic disparity create an information hiatus and therefore unhealthy practices with regard to dealing with COVID-19, particularly in low- and middle-income countries. Aims We assessed knowledge, attitudes, practices and their determinants regarding COVID-19 in Pakistan during March-April 2020. Methods 905 adults ≥18 years (males and females) participated: 403 from a web-based survey; 365 from an urban survey; and 137 from a rural survey. Frequency of adequate knowledge, attitudes and practices for the three populations was determined based on available global guidelines. Multivariable logistic regression analysis determined factors of adequacy of knowledge, attitudes, practices, and association of knowledge with attitudes and practices. Results Mean age of the participants was 33.5 (+ SD 11.1) years, 51% were females. More females and young adults (18-30 years) participated in the web-based survey. The urban survey and web-based survey participants had significantly higher adequate knowledge (2-7 times) and practices (4-5 times) towards COVID-19. Adequate knowledge had a significant influence on healthy attitudes and practices for COVID-19, after adjustment for covariates. Overall, two-thirds of the population had high levels of fear about COVID-19, which was highest among the rural survey population. Conclusion Substantial gaps exist in adequate knowledge, attitudes and practices, particularly among rural populations, and underscores the variation in access to information according to level of education and access to the internet. Thus, a comprehensive, contextually congruent awareness raising strategy is urgently needed to confront COVID-19 among these populations.