Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey

Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey Bao‐Liang Zhong Wei Luo Hai-Mei Li Qian-Qian Zhang Xiao-Ge Liu Wen-Tian Li Yi Li

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Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey 2020 International Journal of Biological Sciences 10.7150/ijbs.45221 zhong2020-knowledge-attitudes-and-practices zhong2020-knowledge-attitudes-and-practices.txt, the project's staged copy 431fe16b87dded1dfe88839f033578339ff6f268 cc-by-nc health-psychology

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0 spans located by searching the stored text for the quote's exact words, allowing any whitespace between them knowledge, attitudes and practices towards COVID-19 among Chinese residents during the rapid-rise period of the outbreak Quotation withheld because this record is not cleared for redistribution. what Chinese residents knew, felt and did about COVID-19 while the epidemic was accelerating, and whether knowledge predicted the other two Quotation withheld because this record is not cleared for redistribution. a 6,910-respondent online KAP survey, reported with the DIRECTION of its own sampling bias on each headline figure Quotation withheld because this record is not cleared for redistribution. existence Quotation withheld because this record is not cleared for redistribution. high self-reported knowledge, optimism and mask-wearing in a self-selected online sample during an accelerating epidemic Quotation withheld because this record is not cleared for redistribution. survey survey Quotation withheld because this record is not cleared for redistribution. the proposed pathway is knowledge -> attitude and practice: a higher COVID-19 knowledge score is associated with a LOWER likelihood of negative attitudes and of poor preventive practices, OR 0.75-0.90, P<0.001 Quotation withheld because this record is not cleared for redistribution. knowledge and attitudes act on transmission indirectly through panic, which the paper says can itself complicate prevention Quotation withheld because this record is not cleared for redistribution. A SIGNED ERROR TERM, NOT A LIMITATIONS PARAGRAPH. The sample is over-representative of women, the well-educated and mental labourers, and the paper states the consequence per figure: `we may have OVERESTIMATED knowledge and rates of preventive practices and UNDERESTIMATED rates of positive attitudes` Quotation withheld because this record is not cleared for redistribution. the population the findings apply to is narrowed explicitly - `strictly speaking, our findings can only be generalized to Chinese populations of a relatively high socioeconomic status, particularly women` Quotation withheld because this record is not cleared for redistribution. THE MEASURE IS DECLARED INADEQUATE BY THE PEOPLE WHO USED IT: the assessment of attitudes and practices is `unstandardized and inadequate` and, for want of time, `both were measured with two simple questions only` Quotation withheld because this record is not cleared for redistribution. and the paper names who is missing and why: vulnerable populations - older adults, rural people - have limited access to internet and online health information, which is the same channel the survey recruited through Quotation withheld because this record is not cleared for redistribution. community-based national sampling was not feasible during the lockdown, so the survey is an online convenience sample and the paper says so Quotation withheld because this record is not cleared for redistribution. recruitment ran through the authors' own social networks and local media reposts, which decides who could see the poster at all Quotation withheld because this record is not cleared for redistribution. attitudes rest on two questions and practices on two behaviours, against twelve for knowledge - the three KAP components are not measured at comparable depth Quotation withheld because this record is not cleared for redistribution. the achieved sample is compared against the most recent NATIONAL POPULATION STATISTICS of China, rather than described on its own terms eliminates: a self-selected sample being read as a population sample - the comparison is what turns 'our respondents' into 'over-representative of women, well-educated people, and people engaging in mental labor' · outcome: failed Quotation withheld because this record is not cleared for redistribution. the DIRECTION of the resulting bias is worked out per outcome, using the associations the study itself measured between the demographic variables and KAP eliminates: a caveat that says only 'may not generalise' - here the reader is told which numbers are too high and which are too low · outcome: held Quotation withheld because this record is not cleared for redistribution. whether attitudes and practices were measured adequately eliminates: nothing - the assessment is called 'unstandardized and inadequate' by the authors, who state that both should have been developed via focus group and interview and built as multi-dimensional measures · outcome: failed Quotation withheld because this record is not cleared for redistribution. whether the populations most likely to score poorly are in the sample at all eliminates: nothing - older adults and rural people have limited internet access, which is the channel the survey recruited through, and the paper says so · outcome: failed Quotation withheld because this record is not cleared for redistribution. excluding the nine respondents who reported having been infected before analysing the sample eliminates: the possibility that people who already had the disease answer knowledge and practice items from experience rather than from public information · outcome: held Quotation withheld because this record is not cleared for redistribution. backward stepwise selection in the regression models rather than entering all variables eliminates: associations that survive only because a correlated demographic is held in the model · outcome: held Quotation withheld because this record is not cleared for redistribution. a yes/no consent item that had to be answered before the questionnaire opened, under ethics approval eliminates: participation without informed consent in a survey distributed by social media reposting · outcome: held Quotation withheld because this record is not cleared for redistribution. knowledge questionnaire knowledge questionnaire Quotation withheld because this record is not cleared for redistribution. attitudes attitudes Quotation withheld because this record is not cleared for redistribution. practices practices Quotation withheld because this record is not cleared for redistribution. socioeconomic status socioeconomic status Quotation withheld because this record is not cleared for redistribution. KAP theory KAP theory Quotation withheld because this record is not cleared for redistribution. panic emotion panic emotion Quotation withheld because this record is not cleared for redistribution. case fatality rate case fatality rate Quotation withheld because this record is not cleared for redistribution. KAP - AS OPERATIONALISED HERE, AND THE THREE ARE NOT EQUAL. Knowledge is 12 items with a correct answer. Attitudes and practices are ONE QUESTION EACH: confidence that China can win, and whether a mask was worn recently. A three-part construct measured 12 : 1 : 1 Quotation withheld because this record is not cleared for redistribution. the sample - `recruited via the authors' networks with residents and popular media in Hubei`. THE RECRUITMENT CHANNEL IS ALSO THE EXCLUSION CRITERION: it reaches people with internet access, and the paper says the populations most at risk are the ones without it Quotation withheld because this record is not cleared for redistribution. `most Chinese residents` in the conclusion, WITH ITS QUALIFIER ATTACHED IN THE SAME sentence - `of a relatively high socioeconomic status, in particular women`. The qualifier is inside the claim rather than in a caveat afterwards, which is what makes it survive being quoted Quotation withheld because this record is not cleared for redistribution. supports → health education programmes as a lever on attitudes and behaviour, on the strength of the knowledge-score association Quotation withheld because this record is not cleared for redistribution. critiques → generalising KAP findings from an online sample to the Chinese population, which the paper refuses to do for its own results Quotation withheld because this record is not cleared for redistribution. A SIGNED ERROR TERM: the paper states that it MAY HAVE OVERESTIMATED knowledge and preventive practices and UNDERESTIMATED positive attitudes, deriving the direction from its own measured associations A SIGNED ERROR TERM: the paper states that it MAY HAVE OVERESTIMATED knowledge and preventive practices and UNDERESTIMATED positive attitudes, deriving the direction from its own measured associations Quotation withheld because this record is not cleared for redistribution. THE MEASURE IS DECLARED INADEQUATE BY THE PEOPLE WHO USED IT - attitudes and practices were each measured with TWO SIMPLE QUESTIONS ONLY, for want of time THE MEASURE IS DECLARED INADEQUATE BY THE PEOPLE WHO USED IT - attitudes and practices were each measured with TWO SIMPLE QUESTIONS ONLY, for want of time Quotation withheld because this record is not cleared for redistribution. the overall correct rate on the knowledge questionnaire was 90%, 97.1% had confidence China would win, and 98.0% wore masks when going out the overall correct rate on the knowledge questionnaire was 90%, 97.1% had confidence China would win, and 98.0% wore masks when going out Quotation withheld because this record is not cleared for redistribution. a higher knowledge score is associated with a LOWER likelihood of negative attitudes and poor practices, OR 0.75-0.90, P<0.001 a higher knowledge score is associated with a LOWER likelihood of negative attitudes and poor practices, OR 0.75-0.90, P<0.001 Quotation withheld because this record is not cleared for redistribution. the sample is over-representative of women, the well-educated and mental labourers against national population statistics the sample is over-representative of women, the well-educated and mental labourers against national population statistics Quotation withheld because this record is not cleared for redistribution. with limited internet access, vulnerable groups such as older adults and rural people are more likely to have poor knowledge, negative attitudes and inappropriate practices with limited internet access, vulnerable groups such as older adults and rural people are more likely to have poor knowledge, negative attitudes and inappropriate practices Quotation withheld because this record is not cleared for redistribution. COVID-19's case fatality rate in China was far below SARS, MERS and H7N9, which is the comparison the paper opens with Quotation withheld because this record is not cleared for redistribution. the final sample was 65.7% women, 63.5% held a bachelor's degree or above, and 56.2% did mental labour Quotation withheld because this record is not cleared for redistribution. the knowledge instrument reached acceptable internal consistency, which the paper states with the coefficient Quotation withheld because this record is not cleared for redistribution. 12 questions regarding the clinical characteristics and prevention of COVID-19 knowledge questionnaire Quotation withheld because this record is not cleared for redistribution. the knowledge instrument's construction - twelve items split across clinical presentation, transmission, and prevention, scored 0 to 12 knowledge questionnaire Quotation withheld because this record is not cleared for redistribution. survey completers, of whom 65.7% women, 63.5% with a bachelor degree or above, 56.2% in mental labour 6910 Quotation withheld because this record is not cleared for redistribution. items in the knowledge questionnaire - against one question each for attitudes and for practices 12 Quotation withheld because this record is not cleared for redistribution. per cent overall correct rate on the knowledge questionnaire 90 Quotation withheld because this record is not cleared for redistribution. case fatality of COVID-19 against SARS, MERS and H7N9 Quotation withheld because this record is not cleared for redistribution. the share of Chinese COVID-19 patients progressing to the severe stage Quotation withheld because this record is not cleared for redistribution. the analysed sample and its demographic composition Quotation withheld because this record is not cleared for redistribution. logistic regression logistic regression Quotation withheld because this record is not cleared for redistribution. OR OR Quotation withheld because this record is not cleared for redistribution. the modelling strategy: linear regression for knowledge score, logistic for attitudes and practices, reported as beta and odds ratios with confidence intervals Quotation withheld because this record is not cleared for redistribution. socioeconomic status socioeconomic status Quotation withheld because this record is not cleared for redistribution. knowledge score knowledge score Quotation withheld because this record is not cleared for redistribution. the demographic variables entered as predictors, including place of residence as Hubei against other provinces demographic variables Quotation withheld because this record is not cleared for redistribution.

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