Skip to main content
Journal of the Egyptian Public Health Association
Download PDF

Assessment of attitudes and practices towards COVID-19 pandemic: a survey on a cohort of educated Syrian population

Journal of the Egyptian Public Health Association volume 98, Article number: 17 (2023) Cite this article

Abstract

Background

Coronavirus disease (COVID-19) caused the death of millions of people and affected the lives of hundreds of millions worldwide. The WHO recommendations aimed mainly to reduce transmission, minimize infection, and get people vaccinated. Nevertheless, opinions and attitudes about the disease varied. In this study, we evaluated personal attitudes and practices of a cohort of an educated Syrian population, after several waves of infection with COVID-19 and the release of different types of vaccines.

Methods

A cross-sectional internet-based survey was launched in January 2022.The survey queried the participants’ personal experience, attitudes, practices towards COVID-19, and vaccination.

Results

The study included 408 individuals. The respondents were mainly females (72.6%), 20–29 years old (39.2%), and college graduates (59.3%). A large proportion (89.7%) reported having been infected at least once during the pandemic; a significant association was found with age (p = 0.001). Nearly half of the respondents got vaccinated; the majority were > 40 years old. Opinions differed regarding the effectiveness and safety of the vaccines; only a small percentage of the participants (17.4%) thought all vaccines were effective and safe. Remarkably, the level of education did not significantly dominate the participants’ attitudes or practices towards the COVID-19 pandemic. Approximately half of the respondents (44.9%) stated their lives were affected by the pandemic and over the third were worried (38%). A significant association was detected with gender in favour of females. Most of the participants have taken at least one precautionary measure to limit the infection.

Conclusion

The level of education did not significantly dominate the participants’ attitudes or practices towards the COVID-19 pandemic. Female respondents were more cautious, concerned and committed to taking precautionary measures regardless of their education level. However, their unwillingness to receive the vaccine raises significant concerns. Efforts should be made to emphasize the importance of immunization, the safety and effectiveness of vaccines, and encourage vaccination among individuals.

1 Introduction

The first outbreak of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) occurred on December 31, 2019 in Wuhan City, China [1]. The virus that causes Coronavirus disease 2019 (COVID-19), has spread rapidly and formed a serious health concern worldwide [2]. According to the WHO, by April 29, 2023, the confirmed cases of COVID-19 reached over 764 million, including more than 6.9 million deaths [1]. Intensive studies have been conducted to track the outbreaks of clinically significant mutant viruses, expected to affect disease severity, named variants of interest (VOI). Additional studies investigated variants that increase transmissibility and virulence or reduce effectiveness in prevention, diagnosis, and treatment, which are called variants of concern (VOC) [3].

Scientists working on COVID-19 have faced significant challenges in finding the appropriate treatment and developing effective vaccines, in an effort to minimize symptom severity, hospitalization and mortality rates [4,5,6,7]. Hundreds of vaccines have been rapidly developed, which differed in their efficacy against COVID-19 variants and in their side effects [8]. The Food and Drug Administration (FDA) and/or the WHO approved several vaccines [9]. According to many studies vaccine acceptance differed broadly between countries and between individuals with different sociodemographic backgrounds [10, 11] In addition, different attitudes and practices towards the pandemic have been observed worldwide [12, 13].

In Syria, the first confirmed Coronavirus case was declared in March 2020 [14]. Since then, health authorities have taken various important precautionary measures to limit the spread of the infection. Measures started with educating the public, recommending people to stay at home, and imposing night curfews. Later, the measures expanded to inter-city travel restrictions, closing of schools and universities, and banning public gatherings. Finally, the authorities issued a complete lockdown. Since educated individuals exert influence on their communities, it is highly important to explore their attitudes and practices, especially at the time of pandemic. In this study, we aimed to evaluate the attitudes, practices and the safety measures taken by a cohort of educated Syrian population against the COVID-19 pandemic.

2 Methods

2.1 Study design and data collection

An internet-based survey was designed by the authors, using the Google Forms. The survey’s questions were in Arabic and were evaluated by two experts for relevance and clarity. A draft of the survey was piloted on 30 participants to assess the survey’s simplicity, clarity, and ease to understand. The validated survey was uploaded to websites and private groups on social media mainly Facebook and WhatsApp groups. The survey began with a brief introduction and the aim of the study, followed by 22 “close-ended” and “multiple-choice” questions (Supplement 1), as follows:

  • Questions Q1-Q8: gathered general information on the participants and explored participants’ personal experiences with the Coronavirus disease.

  • Questions Q9-Q18: inspected the participants’ behaviour, attitudes and practices regarding personal protective equipment (PPE) and safety measures, towards the Coronavirus disease.

  • Questions Q19-Q 22: explored participants’ opinions and attitudes towards COVID-19 vaccines and getting vaccinated.

The survey was accessible online for 10 weeks (January 3rd -March 16th, 2022). Taking the survey was voluntary; nevertheless, the respondent’s consent of participation was taken at the end of the introduction section. Middle school education level or higher was considered as the inclusion criteria.

2.2 Sample size

The sample size was estimated using the equation: n = z2. [p *q]/d2 [15], z is the Z-score; 1.96 for 5% significance levels, P is the estimated proportion of the studied construct, q = 1-P, and d is the margin of error (5%). The minimum required sample was 384.

2.3 Statistical analysis

The analyses were accomplished using SPSS, Version 25. Descriptive and comparative data were presented as percentages. Nonparametric Kruskal–Wallis, Mann–Whitney and Chi-square tests were used where applicable. For all tests p value < 0.05 was considered statistically significant.

3 Results

3.1 General description of the participants

A total of 408 respondents took part in the study. The majority of the respondents were females (72.6%), 20–29 years old (39.2%) and college graduates (59.3%). The confirmed cases of COVID-19 infection were 192, mostly females (140). Data revealed significant correlation between infection and age groups (p = 0.001), while no significant association with gender nor with education level were found. Furthermore, 20.1% of the participants confirmed being re-infected by COVID-19 and 27.2% suspected being infected more than once. However, the majority of the participants (68.7%) did not confirm their COVID-19 infection by PCR test. Of note, the participants aged > 40 years old sought medical confirmation of the infection more than the other age groups. Nearly half of our respondents (49.3%) got vaccinated against COVID-19, mostly those over 40 years old. More than 20% of the respondents either opposed vaccination or acknowledged not being ready yet to get vaccinated and 8.1% were neutral to the idea. Significant associations were found with age and with education levels (p values < 0.001) (Table 1).

Table 1 The reported occurrence of Corona virus infection, re-infection, and the vaccination status among the sample of educated Syrian participants in relation to their socio-demographic characteristics, 2021
Full size table

The majority of the participants (67.9%) reported that at least one person in their household had caught COVID-19. A significant association was revealed between the infection of the respondents and infection of any of their household members (p < 0.001). Additionally, a significant association was detected between the reinfection of the respondents and infection of their household members (p = 0.012) (Table 2).

Table 2 Association between the participants’ infection with COVID-19 and the infection of household members
Full size table

The highest numbers of COVID-19 infections occurred in late 2020 and mid 2021 (Fig. 1). Overall, general fatigue was the most common symptom experienced by more than three quarters of the respondents (Fig. 2).

Fig. 1
figure 1

Frequency of COVID-19 infection among the educated Syrian participants (2020–2021). The highest COVID-19 infections occurred in late 2020 (95 participants) and mid-2021 (93 participants)

Full size image
Fig. 2
figure 2

The common symptoms experienced by the educated Syrian respondents. General fatigue was the most prevalent symptom

Full size image

3.2 Personal attitudes

Over half of the participants (56.1%) responded positively towards self-isolation. A significant association was found between genders, age and education in favour of females, > 40 years old, and college graduates respectively. Furthermore, for approximately half of the respondents (44.9%), the pandemic has affected their personal lives and relationships with others. A significant association was found with gender in favor of females.

When the participants were asked about their attitude towards wearing face masks, more than half of the respondents confirmed its necessity (51.7%), while over one quarter of them (26.5%) declared not being committed to wearing face masks, despite confirming its importance. A significant association was found with gender in favour of females and with age, in favour of the participants > 40 years old.

Furthermore, approximately 75% of the participants stated dealing cautiously with an infected household member. In contrast, a small percentage of them choose either to deal indifferently or avoid dealing at all with infected patients (16.1% and 9.7%, respectively). A significant difference was detected with age (Table 3).

Table 3 Attitude of educated Syrian adults towards COVID-19 pandemic, 2022
Full size table

The anxiety level of the participants was measured on a five-point scale as follows: 1 = very worried, 2 = worried, 3 = neutral, 4 = unworried and 5 = not worried at all. Our data showed that 4.2% of the respondents were very worried, 38% were worried 11.3% were neutral, 27.9% were unworried, and 18.6% were unworried at all. Significant differences were found between genders (p = 0.021) and between age groups (p = 0.01). Male participants were less concerned compared to females; the average anxiety scores were 3.42 ± 1.3 and 3.10 ± 1.2, respectively. Moreover, the participants belonging to the age group 30–40 years old were unworried (3.59 ± 1.3); whereas the participants from the other age groups were neutral (Table 4).

Table 4 Differences in the anxiety level towards COVID-19 pandemic amongst the educated Syrian participants, 2021
Full size table

3.3 Personal practices

Less than half of the participants (46.5%) reported coughing or sneezing in their face masks, while a small number never did this practice (23.7%). The majority of the respondents (62.1%) acknowledged replacing or washing their face masks regularly. No significant differences were detected between participants with regard to gender, age, or education levels. In addition, almost half of the respondents (49.5%) stated that they were accustomed to pursuing good personal hygiene habits before the COVID-19 pandemic, whereas a small number declared that they never did this practice (7.6%). A significant difference was found with gender (Table 5). Our statistical analysis showed significant differences between genders in avoiding close contact with patients or the elderly, in keeping social distances between age groups, and in cleaning high-touched surfaces between genders (Table 5).

Table 5 Precautionary practices done by the educated Syrian participants according to gender, age and education
Full size table

Furthermore, a limited number of the participants (18) did not take any precautionary measures to limit the virus spread and infection while, most of the participants took at least one measure. Avoiding crowded places was a common practice for the majority of the participants (n = 283) (Fig. 3).

Fig. 3
figure 3

The safety practices taken by the participants

Full size image

The majority of the participants avoided crowded places as a common practice.

Additionally, our data showed that less than 40% of the participants did not change their attitudes towards following the precautionary measures after receiving the vaccine. A significant association was found with education levels in favour of college graduates (p = 0.048). Furthermore, the participants’ opinions differed regarding the effectiveness and safety of the vaccines: 37.7% were neutral; 33.1% thought that some vaccines were effective and safe; 17.4% believed all vaccines were effective and safe; and 11.8% thought all vaccines were ineffective and not safe. A significant association with gender in favour females (p = 0.028) was detected. Remarkably, only a small percentage of the participants were still following updates on the pandemic (19.6%) while one-third of the respondents (33.8%) lost interest. A significant association was revealed with age in favour of > 40 years old (p = 0.020).

4 Discussion

The COVID-19 pandemic is not over yet, although its intensity has decreased, new cases are registered daily [16]. In Syria, according to the WHO statistics, the total number of confirmed cases reached 57,423 on 26 April 2023 [17]. Understanding how people behave during pandemics is particularly important, especially in poor countries, as this knowledge can help governments to formulate suitable strategies. In this study, we assessed the personal attitudes and practices towards the COVID-19 pandemic among a group of educated Syrian participants, following several waves of infection, and the release of different types of vaccines. The total number of individuals who volunteered in our survey was 408, generally females, between 20–29 years old, and college graduates.

The majority of the respondents (~ 86%) acknowledged being infected previously with the Coronavirus. The highest infection rates have been observed among females, with a significant association with age. Remarkably, the participants who sought medical confirmation (PCR test) were females and > 40 years old indicating greater concern, particularly amongst this group. The influence of gender on the infection rates of COVID-19 was previously researched. Higher infection risk was observed among females than males especially during peak times, due to their higher number of contacts consequent to their caregiving responsibilities at home and in the workplace, besides gender inequalities in political considerations, financial resources and access to healthcare facilities [18, 19]. This explanation may be supported by the fact that in our study, a close association was found between the infection of a family member and the recurrence of participant infection. However, the education level may have played an effective role in preventing the recurrence of the infection in most cases.

Many factors may influence vaccine acceptance [20, 21] and this may differ from one country to another and from one particular phase to another, [22, 23]. In our study, approximately half of the participants reported being vaccinated; the majority were college graduates and > 40 years old, indicating age influence on vaccine acceptance amongst this group of participants. This result is in agreement with a previous nationwide study conducted on the Syrian population where individuals between 45–65 years old expressed their desire to receive the vaccine more than others [24]. Interestingly, in our study the percentage of male participants who received vaccination was higher than that of their female counterparts. This shows that even though females were more concerned and their lives were more influenced by the pandemic, they seemed more unwilling to get vaccinated. Our results were in line with previous studies in which a significant distinction was found between males and females in their intentions to get the vaccine [24, 25].

Remarkably, a comparative study between Jordanians, Palestinians and Syrians showed that Syrians were the least interested in vaccination among other nations [26]. Furthermore, the latest statistics show that about 27% only of the Syrian population has received the vaccine [17]. This figure raises a great concern, since it is far away from reaching the accepted percentage for the herd immunity [27]. The participants differentiated between the different types of vaccines from the effectiveness and safety standpoints; only 17.4% thought that all vaccines were effective and safe, while 11.8% thought that all vaccines were ineffective. The discrepancy concerning COVID-19 vaccines in public opinion was notably observed in many studies worldwide and the rates of vaccine acceptance have changed over time, as new vaccines are developed and sides effects are reported. For example, in a comprehensive survey among physiotherapy students in the United Arab Emirates, the majority of the students believed that vaccines are safe, while nearly thirty percent did not believe in the effectiveness of the vaccine [28].

In addition, a Korean widespread analysis revealed a notable difference in public opinion for each vaccine brand [29]. Furthermore, a slight difference in opinions towards locally produced and foreign vaccines was found, among Iranian people [30].

Adherence to precautionary behaviour after vaccination differed between studies. In our study, 38.7% of the participants maintained precautionary measures after vaccination. A significant association with education in favour of college graduates was found. Our result indicates a high degree of commitment to WHO instructions among this particular group. A decline in precautionary behaviour after vaccination was also observed amongst vaccinated people in Jazan, Saudi Arabia. However, older age and females were associated with higher adherence levels [31]. By contrast, in a test on a British cohort, no decrease in precautionary behaviour among vaccinated individuals was observed [32].

Although some studies showed that education has a major influence in shaping attitudes, and practices towards COVID-19 [33, 34], in the present study, the level of education did not significantly dominate the participants’ attitudes or practices towards the COVID-19 pandemic.

Evidence from previous studies showed that the COVID-19 pandemic has impacted the lives of people worldwide. Social, physiological, economic and psychological effects were more noticed among females, as they are more vulnerable and emotional [35,36,37,38]. Our survey revealed that female participants were more worried, and the pandemic greatly affected their lives and their relationships with others. These results may be attributed to the nature of the Syrian society in which females are the caretakers of the family, besides their fears of who takes care of them and their family if they develop the infection. This explanation was supported by our other results which showed that female participants and participants > 40 years old were more committed and had positive attitudes towards self-isolation and wearing face masks when feeling sick. These results accord with a previous study conducted on a different Syrian cohort [39] and also with a study from the United States [40].

Furthermore, the impact of COVID-19 pandemic on mental health and the quality of life was observed. Stress, anxiety, and depression were common impacts in different studies [41,42,43,44]. In our study, significant differences between genders and between the age groups were detected in the anxiety level towards COVID-19. This finding accords with previous studies, in which anxiety levels were significantly affected by the female gender [45, 46]. Remarkably, only one fifth of the participants were still closely following updates on the pandemic, which may show that the pandemic is not anymore viewed as a hot topic by the general population. This data corresponds with the results from Turkey where over half of the respondents recounted not needing any additional information on COVID-19 and not being interested in a continuous update on the disease [47].

There is no doubt that taking precautionary measures and using personal protective equipment is one of the most important practices to prevent infection with the Coronavirus. This survey revealed that approximately 96% of the participants showed a high commitment to preventive measures against COVID-19 infection. Similar findings were observed in a previous study [48]. Age and female gender correlated significantly with some precautionary measures. This finding agrees with a previous study from Iran, which found that some particular practices were associated significantly with higher age, and with female gender [49].

4.1 Strengths and limitations

This survey explored personal experiences and practices amongst educated Syrian participants, after several waves of infection and a decrease in the number of deaths and infected cases. In particular, this study is helpful in identifying the perceptions and level of COVID-19 vaccines acceptance. Future studies are required on a country-level to allow better exploration of potential factors of vaccine hesitancy and how society deals with the pandemic in different phases. However, being a cross-sectional study, some limitations may occur including the relatively small number of the participants due to low response rate and the limited number of socio-demographics beside recall biases should be considered.

5 Conclusions

In the present study, the level of education did not significantly dominate the participants’ attitudes or practices towards the COVID-19 pandemic. Females especially those over the age of 40 years old were more cautious, anxious and more committed to taking the precautionary measures. However, their unwillingness to receive the vaccine raises significant concerns. Efforts should be made to emphasize the importance of immunization, the safety and efficacy of vaccines, and to promote immunization among individuals.

Availability of data and materials

All data generated or analysed during this study are included in this article. Also, data are available from the corresponding author on reasonable request.

Abbreviations

WHO:

World Health Organization

COVID-19:

Coronavirus disease of 2019

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

PPE:

Personal protective equipment

PCR:

Polymerase Chain Reaction

References

  1. World Health Organization. WHO Coronavirus disease (COVID-19) dashboard. Who.int.; 2020. Available from: https://covid19.who.int. Accessed 29 Apr 2023.

  2. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. World Health Organization; 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020. Accessed 29 Apr 2023.

  3. World Health Organization. Tracking SARS-CoV-2 variants. www.who.int ; 2022. Available from: https://www.who.int/activities/tracking-SARS-CoV-2-variants. Accessed 29 Apr 2023.

  4. Kumari M, Lu RM, Li MC, Huang JL, Hsu FF, Ko SH, et al. A critical overview of current progress for COVID-19: development of vaccines, antiviral drugs, and therapeutic antibodies. J Biomed Sci. 2022;29(1):68. https://doi.org/10.1186/s12929-022-00852-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ghasemiyeh P, Mohammadi-Samani S. COVID-19 outbreak: Challenges in pharmacotherapy based on pharmacokinetic and pharmacodynamic aspects of drug therapy in patients with moderate to severe infection. Heart Lung. 2020;49:763–73. https://doi.org/10.1016/j.hrtlng.2020.08.025.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zarkesh K, Entezar-Almahdi E, Ghasemiyeh P, Akbarian M, Bahmani M, Roudaki S, et al. Drug-based therapeutic strategies for COVID-19-infected patients and their challenges. Future Microbiol. 2021;16(18):1415–51. https://doi.org/10.2217/fmb-2021-0116.

    Article  CAS  PubMed  Google Scholar 

  7. WHO Solidarity Trial Consortium. Repurposed antiviral drugs for COVID-19 — interim WHO solidarity trial results. N Engl J Med. 2021;384:497–511. https://doi.org/10.1056/NEJMoa2023184.

  8. Hadj Hassine I. COVID‐19 vaccines and variants of concern: a review. Rev Med Virol. 2021;32(4). https://doi.org/10.1002/rmv.2313.

  9. Haghpanah F, Lin G, Levin SA, Klein E. Analysis of the potential impact of durability, timing, and transmission blocking of COVID-19 vaccine on morbidity and mortality. EClinicalMedicine. 2021;35:100863. https://doi.org/10.1016/j.eclinm.2021.100863.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mengistu DA, Demmu YM, Asefa YA. Global COVID-19 vaccine acceptance rate: systematic review and meta-analysis. Front Public Health. 2022;10:1044193. https://doi.org/10.3389/fpubh.2022.1044193.

  11. de Figueiredo A, Simas C, Larson HJ. COVID-19 vaccine acceptance and its socio-demographic and emotional determinants: a multi-country cross-sectional study. Vaccine. 2023;41(2):354–64. https://doi.org/10.1016/j.vaccine.2022.10.051.

    Article  PubMed  Google Scholar 

  12. Li L, Wang F, Shui X, Liang Q, He J. Knowledge, attitudes, and practices towards COVID-19 among college students in China: a systematic review and meta-analysis. PLoS One. 2022;17(6):e0270038. https://doi.org/10.1371/journal.pone.0270038.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Raquib A, Raquib R, Jamil S, Hossain A, al-Mamun F, Mamun MA. Knowledge, attitudes, and practices toward the prevention of COVID-19 in Bangladesh: a systematic review and meta-analysis. Front Med. 2022;9:856156. https://doi.org/10.3389/fmed.2022.856156.

  14. Syrian Arab Republic: COVID-19 update no. 03 - 25 March 2020 - Syrian Arab Republic. reliefweb.int. 2020. Available from: https://reliefweb.int/report/syrian-arab-republic/syrian-arab-republic-COVID-19-update-no-03-25-march-2020?fbclid=IwAR3YrN5_q-N0ku9HCkduGiPIMMs6ClLaENzryjkL-3YQPVzrL_L2oMwldGA. Accessed 10 Apr 2023.

  15. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–6. https://doi.org/10.4103/0253-7176.116232.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Real Time World Statistics. Available from: https://www.worldometers.info/. Accessed 29 Apr 2023.

  17. Syrian Arab Republic: WHO Coronavirus Disease (COVID-19) Dashboard. covid19.who.int. Available from: https://covid19.who.int/region/emro/country/sy. Accessed 29 Apr 2023.

  18. Doerre A, Doblhammer G. The influence of gender on COVID-19 infections and mortality in Germany: insights from age- and gender-specific modeling of contact rates, infections, and deaths in the early phase of the pandemic. PLoS One. 2022;17(5):e0268119. https://doi.org/10.1371/journal.pone.0268119.

  19. Wu C, Qian Y. The gender peak effect: women are most vulnerable to infections during COVID-19 peaks. Front Public Health. 2022;10:937179. https://doi.org/10.3389/fpubh.2022.937179.

  20. Siddiqui A, Priya, Adnan A, Abbas S, Qamar K, Islam Z, et al. COVID-19 vaccine hesitancy in conflict zones: a review of current literature. Front Public Health. 2022;10:1006271. https://doi.org/10.3389/fpubh.2022.1006271.

  21. Biswas MDR, Alzubaidi MS, Shah U, Abd-Alrazaq AA, Shah Z. A scoping review to find out worldwide COVID-19 vaccine hesitancy and its underlying determinants. Vaccines. 2021;9(11):1243. https://doi.org/10.3390/vaccines9111243.

  22. Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux-Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine. 2020;38(45):7002–6. https://doi.org/10.1016/j.vaccine.2020.09.041.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Salali GD, Uysal MS. COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychol Med. 2020;52(15):3750–2. https://doi.org/10.1017/s0033291720004067.

  24. Shibani M, Alzabibi MA, Mouhandes AE-F, Alsuliman T, Mouki A, Ismail H, et al. COVID-19 vaccination acceptance among Syrian population: a nationwide cross-sectional study. BMC Public Health. 2021;21(1):2117. https://doi.org/10.1186/s12889-021-12186-6.

  25. Mohamad O, Zamlout A, AlKhoury N, Mazloum AA, Alsalkini M, Shaaban R. Factors associated with the intention of Syrian adult population to accept COVID-19 vaccination: a cross-sectional study. BMC Public Health. 2021;21(1):1310. https://doi.org/10.1186/s12889-021-11361-z.

  26. Zein S, Abdallah SB, Al-Smadi A, Gammoh O, Al-Awaida WJ, Al-Zein HJ. Factors associated with the unwillingness of Jordanians, Palestinians and Syrians to be vaccinated against COVID-19. PLoS Negl Trop Dis. 2021;15(12):e0009957. https://doi.org/10.1371/journal.pntd.0009957.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Anderson RM, Vegvari C, Truscott J, Collyer BS. Challenges in creating herd immunity to SARS-COV-2 infection by mass vaccination. Lancet. 2020;396(10263):1614–6. https://doi.org/10.1016/s0140-6736(20)32318-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Almheiri S, Hazari A, Kumar P, Kumar S, Girish S. A comprehensive survey on the beliefs, perceptions, and clinical manifestations of pre and post COVID-19 vaccinations among physiotherapy students in the United Arab Emirates. PLoS One. 2023;18(4):e0282385. https://doi.org/10.1371/journal.pone.0282385.

  29. Park S, Suh Y-K. A comprehensive analysis of COVID-19 vaccine discourse by vaccine brand on Twitter in Korea: topic and sentiment analysis. J Med Internet Res. 2023;25:e42623. https://doi.org/10.2196/42623.

  30. BokaeeNezhad Z, Deihimi MA. Twitter sentiment analysis from Iran about COVID-19 vaccine. Diabetes Metab Syndr. 2022;16(1):102367. https://doi.org/10.1016/j.dsx.2021.102367.

  31. Alameer A, Maslamani Y, Gosadi IM, Elamin MY, Muaddi MA, Alqassim AY, et al. Assessing continuity of adherence to precautionary measures for COVID-19 among vaccinated people in Jazan, Saudi Arabia. Microorganisms. 2023;11(3):800. https://doi.org/10.3390/microorganisms11030800.

  32. Desrichard O, Moussaoui L, Ofosu N. Reduction of precautionary behaviour following vaccination against COVID-19: a test on a British cohort. Vaccines. 2022;10(6):936. https://doi.org/10.3390/vaccines10060936.

  33. Padmanaban S, Rajendran P, Davis P, Velayutham P. Knowledge, attitude and practices towards COVID-19 among higher education students in India: a cross sectional study. J Public Health. 2021;30(7):1661–73. https://doi.org/10.1007/s10389-021-01561-7.

  34. Getawa S, Aynalem M, Bayleyegn B, Adane T. Knowledge, attitude and practice towards COVID-19 among secondary school students in Gondar town, Northwest Ethiopia. PLoS One. 2022;17(5):e0268084. https://doi.org/10.1371/journal.pone.0268084.

  35. Bu F, Steptoe A, Fancourt D. Depressive and anxiety symptoms in adults during the COVID-19 pandemic in England: a panel data analysis over 2 years. PLoS Med. 2023;20(4):e1004144. https://doi.org/10.1371/journal.pmed.1004144.

  36. Demartini B, Nisticò V, D’Agostino A, Priori A, Gambini O. Early psychiatric impact of COVID-19 pandemic on the general population and healthcare workers in Italy: a preliminary study. Front Psychiatry. 2020;11:561345. https://doi.org/10.3389/fpsyt.2020.561345.

  37. Qudsieh S, Mahfouz IA, Qudsieh H, Barbarawi LA, Asali F, Al-Zubi M, et al. The impact of the coronavirus pandemic curfew on the psychosocial lives of pregnant women in Jordan. Midwifery. 2022;109:103317. https://doi.org/10.1016/j.midw.2022.103317.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Benjamin LS, Dewi YS, Aurizki GE, Sanad AA, Shanmugam SR, Santhanasamy PJ. Psychological effects of COVID-19 lockdown among Aseer residents, Saudi Arabia. JPMA. 2023;73(02). https://doi.org/10.47391/jpma.ind-s2-1.

  39. Bakkar B, Mohsen F, Armashi H, Marrawi M, Aldaher N. A cross-sectional survey of COVID-19: attitude and prevention practice among Syrians. Heliyon. 2022;8(3):e09124. https://doi.org/10.1016/j.heliyon.2022.e09124.

  40. Pflugeisen BM, Mou J. Gender discrepancies in SARS-COV-2 pandemic related beliefs, attitudes, and practices. Front Public Health. 2021;9:711460. https://doi.org/10.3389/fpubh.2021.711460.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Aslanidis V, Tsolaki V, Papadonta ME, Amanatidis T, Parisi K, Makris D, et al. The impact of the Covid-19 pandemic on mental health and quality of life in COVID-19 department healthcare workers in Central Greece. J Pers Med. 2023;13(2):250. https://doi.org/10.3390/jpm13020250.

  42. Sultan S, Abu Bashar MD, Tabassum A, Iqbal MS, Nomani I, Almasoudi NM, et al. Prevalence of depression, anxiety, stress and its relationship with knowledge about COVID-19 in medical and laboratory medicine students of Umm-Al-Qura University: a cross-sectional survey. Egypt J Neurol Psychiatr Neurosurg. 2022;58(1):160. https://doi.org/10.1186/s41983-022-00590-7.

  43. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun. 2020;87:49–50. https://doi.org/10.1016/j.bbi.2020.04.031.

  44. Glowacz F, Schmits E. Psychological distress during the COVID-19 lockdown: the young adults most at risk. Psychiatry Res. 2020;293:113486. https://doi.org/10.1016/j.psychres.2020.113486.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Abid A, Shahzad H, Khan HA, Piryani S, Khan AR, Rabbani F. Perceived risk and distress related to COVID-19 in healthcare versus non-healthcare workers of Pakistan: a cross-sectional study. Hum Resour Health. 2022;20(1):11. https://doi.org/10.1186/s12960-022-00705-4.

  46. Al-Shannaq Y, Mohammad AA. Psychological impacts during the COVID-19 outbreak among adult population in Jordan: a cross-sectional study. Heliyon. 2021;7(8):e07826. https://doi.org/10.1016/j.heliyon.2021.e07826.

  47. Gölemerz T, Akdaş M, Paslı S, Farhana S, Jankowska K. Knowledge, attitudes and practices (KAP) assessment on COVID-19 (round 2). Community based migration programme Turkey. 2021. Available from: https://data.unhcr.org/en/documents/download/85209.

  48. Shibani M, Alzabibi MA, Mohandes AF, Armashi H, Alsuliman T, Mouki A, et al. Commitment to protective measures during the COVID-19 pandemic in Syria: a nationwide cross-sectional study. PLoS One. 2022;17(10):e0275669. https://doi.org/10.1371/journal.pone.0275669.

  49. Erfani A, Shahriarirad R, Ranjbar K, Mirahmadizadeh A, Moghadami M. Knowledge, attitude and practice toward the novel coronavirus (COVID-19) outbreak: a population-based survey in Iran. Bull World Health Organ. 2020. https://doi.org/10.2471/blt.20.256651.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all respondents for taking part in this study. We also acknowledge Imad A. Almasri for assistance with statistical analysis and Dr Rasheed Abdul Hadi for proofreading.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Pharmaceutics, Faculty of Pharmacy, Arab International University, Damascus, Syria

    Lina Albitar

  2. Department of Biology, Faculty of Science, Damascus University, Damascus, Syria

    Ghalia Aboualchamat

  3. Centre for Epidemiological and Biological Studies, Damascus University, Damascus, Syria

    Ghalia Aboualchamat

Authors
  1. Lina Albitar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ghalia Aboualchamat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

L.B and G.C contributed equally to the literature review, study design, collecting and analysing data, writing and revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ghalia Aboualchamat.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the ethics committees of Damascus University and Arab International University, Damascus, Syria. All methods were carried out in accordance with the Declaration of Helsinki. All participants were fully informed about the study, and informed consent was obtained from them before participation in the survey. The Google form included informed consent about the study where participants have to accept or deny participation in the study before proceeding to the questions.

Consent for publication

Not applicable.

Competing interests

No conflict of interest is associated with this publication.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albitar, L., Aboualchamat, G. Assessment of attitudes and practices towards COVID-19 pandemic: a survey on a cohort of educated Syrian population. J. Egypt. Public. Health. Assoc. 98, 17 (2023). https://doi.org/10.1186/s42506-023-00142-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s42506-023-00142-8

Keywords