Knowledge, beliefs/attitudes and practices of rural residents in the prevention and control of COVID-19: An online questionnaire survey
Authors: Lihua Ma , Ma Lihua , Liu Hui , Jiang Ning , Wang Song , Jiang Xiaolian 
Published: April 2020

Background: The outbreak of COVID-19 in Wuhan quickly spread to 34 provinces, municipalities and autonomous regions in the country and 184 countries and regions around the world. It has drawn great attention from the International Health Organization and was declared an international public health emergency on January 31, 2020. Because the population is generally susceptible to the virus, there are no effective drugs and vaccines, and active participation of the entire population in self-protection and self-isolation has become the key to cutting off transmission routes and effectively controlling the epidemic. China has vast land and a vast area with a large population. Although the agricultural population has decreased this year with the acceleration of urbanization, according to national demographics, 40% of China's rural population is still living in remote areas. This population is relatively lacking in material and economic conditions and has limited access to medical services and education. Influencing factors such as traditional health habits and consciousness should not be underestimated in rural areas. In addition, the COVID-19 outbreak coincided with the Chinese New Year, and people’s return and post-holiday resumption of work greatly increased the chance of transmission of the virus. Rural residents accounted for 60% of the people returning to the Spring Festival. They are the most mobile and susceptible group and are at high risk of viral transmission. The knowledge, consciousness, attitude and behavior of rural residents with regard to COVID-19 control are related to the success or failure of epidemic prevention and control. To investigate the knowledge, attitudes and behaviors related to the prevention and control of COVID-19 among rural residents, to analyze the influencing factors, difficulties and challenges of prevention and control in this population, and to develop a plan to improve rural residents' awareness of COVID-19 prevention and control. Targeted interventions for prevention and control capabilities provide scientific evidence.Methods: A self-designed questionnaire to assess residents’ knowledge, attitudes and behaviors related to COVID-19 prevention and control was borrowed from the Questionnaire Star service platform, and snowball sampling was used to invite rural residents to complete the questionnaire on WeChat. Data analysis was performed with SPSS 22.0 statistical software.Results: A total of 554 valid questionnaires were collected. Rural residents’ average score of knowledge about the prevention and control of new coronary pneumonia was 39.75 ± 6.703, the average score of prevention and control attitude was 45.40 ± 3.341, and the average score of prevention and control behavior was 104.69 ± 12.167. Multiple linear regression analysis showed that male residents’ scores for knowledge, attitudes and behaviors related to SARS were significantly higher than those of women who had not experienced SARS (P <0.01); the scores of attitudes and behaviors of rural residents aged 30 and under were significantly higher than those of other age groups (P <0.01) 0.01); residents with an education level of junior high school or below and those who worked as farmers had significantly lower scores in knowledge, attitude, and behavior than those with other education levels (P <0.05); the knowledge and behavior scores of respondents with poor family economic conditions were significantly lower than those with good and moderate family economic conditions (P <0.05); and residents with chronic diseases and those living in areas with confirmed cases had significantly higher knowledge and behavior scores than those without chronic diseases and no or unknown living cases (P <0.05). Rural residents’ scores for knowledge and attitudes, attitudes and behaviors, and knowledge and behavior were positively correlated with new coronary pneumonia control (P <0.05). The difficulties and challenges they perceived during the epidemic were a lack of protective equipment and travel difficulties (lack of transportation) and weak awareness of prevention and control.Conclusions: Rural residents have a good grasp of COVID-19 and a positive attitude toward the need for prevention and control by individuals, communities, and the government during the epidemic. They use common chopsticks or split meals and take Chinese herbal medicines that nourish yin, invigorate the spleen, and nourish the lungs. Protective measures such as cleaning furniture with alcohol or chlorine disinfectant, returning home, and handwashing with soap before and after meals and after contact with pollutants need to be further strengthened. A lack of protective materials and weak awareness of prevention and control are the greatest difficulties and challenges experienced by rural residents during the epidemic.Trial registration:“Not applicable” in this section