Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Central Pennsylvania Adults Early in the Pandemic: A Mixed Methods Cross-Sectional Survey

Lauren Jodi Van Scoy; Erin L. Miller; Bethany Snyder; Emily Wasserman; Vernon M. Chinchilli; Aleksandra E. Zgierska; David Rabago; Courtney L. Lennon; Daniella Lipnick; Olubukola Toyobo; Mack T. Ruffin; Robert P. Lennon

doi:10.1370/afm.2674

Article Figures & Data

Tables

Additional Files

View popup

Table 1.

Participant Demographics (n = 5,948)

	No. (%)
Age, y
Mean (SD)	56.27 (15.20)
Missing, No.	28
Sex
Male	1,883 (31.66)
Female	4,006 (67.35)
Non-binary	11 (0.18)
Prefer not to answer	31 (0.52)
Missing	17 (0.29)
Race/Ethnicity
American Indian or Alaska Native	19 (0.32)
Asian	57 (0.96)
Black or African American	99 (1.66)
Hispanic or Latino	93 (1.56)
Native Hawaiian or other Pacific Islander	3 (0.05)
White	5,473 (92.01)
Prefer not to answer	188 (3.16)
Missing	16 (0.27)
Household and relations
Live with children aged <18 years
Yes	1,468 (24.68)
No	4,449 (74.80)
Missing	31 (0.52)
Live with adults in home aged >70 years
Yes	1,266 (21.28)
No	4,654 (78.24)
Missing	28 (0.47)
Have, or live with, someone that has impaired immunity^{^a}
Yes	2,885 (48.50)
No	3,044 (51.18)
Missing	19 (0.32)
Have, or someone known has, been tested for or diagnosed with COVID-19
Yes	691 (11.62)
No	5,216 (87.69)
Prefer not to answer	26 (0.44)
Missing	15 (0.25)
Highest level of educational attainment
Did not finish high school	37 (0.62)
High school	740 (12.44)
Some college	977 (16.43)
Associate’s degree	659 (11.08)
Bachelor’s degree	1,677 (28.19)
Graduate degree	1,846 (31.04)
Missing	12 (0.20)
Vaccinations
Received a flu vaccine since Sept 1, 2019
Yes	4,562 (76.70)
No	1,301 (21.87)
Would like to, but unable for medical reasons	76 (1.28)
Missing	9 (0.15)
For those living with children aged < 18 years (n = 1,468), best description of the vaccination status of children in the home
Received most or all recommended vaccines	1,403 (95.57)
Would have received most or all recommended vaccinations, but unable to for medical reasons	19 (1.29)
Received some recommended vaccinations	21 (1.43)
Received only the vaccinations required to attend school	8 (0.54)
Received none of the recommended vaccinations	6 (0.41)
Missing	11 (0.75)
Nicotine use and exposure
I use nicotine products	460 (7.73)
I do not use nicotine products, but someone who lives in my home uses them	533 (8.96)
No person in my home uses nicotine products	4,932 (82.92)
Missing	23 (0.39)
Employment
Best description of current employment status
Full-time employment (Employed)	2,384 (40.08)
Part-time employment (Employed)	600 (10.09)
Not employed, seeking employment	78 (1.31)
Not employed, not seeking employment	362 (6.09)
Not employed, full-time student	73 (1.23)
Retired	2,288 (38.47)
Prefer not to answer	150 (2.52)
Missing	13 (0.22)
For those employed (n = 2,984), best description of work status related to COVID-19
I have missed work, but will still be paid	581 (19.47)
I have missed work, and will not be paid for my lost time	429 (14.38)
I have not missed work	1,876 (62.87)
Unsure	87 (2.92)
Missing	11 (0.37)
For those employed (n = 2,984), best description of work location related to COVID-19
I still go to my regular place of work	910 (30.50)
I now work remotely for part of my time	226 (7.57)
I now work remotely for most or all of my time	1,442 (48.32)
Unsure	342 (11.46)
Missing	64 (2.14)
For those employed (n = 2,984), how many days of work did you miss in calendar year 2019?
Mean (SD)	5.59 (15.19)
Missing, N	237
For those employed (n = 2,984), how many days of work do you think you will miss in calendar year 2020, including days missed between the beginning of the year and now?
Mean (SD)	12.63 (25.01)
Missing, N	331
Primary language spoken in the home
English	5,858 (98.49)
Spanish	22 (0.37)
Other	28 (0.47)
Prefer to not answer	28 (0.47)
Missing	12 (0.20)
Do you work in the medical profession?
Yes	946 (15.90)
No	4,966 (83.49)
Missing	36 (0.61)
Risk status
Age, y
<60	3,057 (51.40)
≥60	2,863 (48.13)
Missing	28 (0.47)
Diagnoses and conditions
Ever diagnosed with heart disease
Yes	946 (15.90)
No	4,970 (83.56)
Missing	32 (0.54)
Ever diagnosed with diabetes
Yes	912 (15.33)
No	5,012 (84.26)
Missing	24 (0.40)
Ever diagnosed with lung disease
Yes	835 (14.04)
No	5,075 (85.32)
Missing	38 (0.64)
Immunosuppression
Yes	1,296 (21.79)
No	4,619 (77.66)
Missing	33 (0.55)
COVID-19 risk strata^{^b}
Low	1,926 (32.38)
High	3,981 (66.93)
Missing	41 (0.69)

Note: Categorical measures are reported as frequency (percent). Continuous measures are summarized as mean (SD).
↵a For example, chronic lung disease, renal disease, chronic hypertension, diabetes, or active cancer.
↵b High risk defined as age ≥60 years or any “Yes” response to any of the 4 diagnoses and/or conditions (heart disease, diabetes, lung disease, or immunocompromised). To be classified as high risk, the union of any of these definition components could be missing responses as long as at least one of the specified criteria were met. Low risk defined as age <60 years and responded “No” to all 4 diagnoses and conditions (heart disease, diabetes, lung disease, and immunocompromised). To be classified as low risk, all definition components must be nonmissing with all responses meeting the intersection of all low-risk criteria.

View popup

Table 2.

Knowledge Assessment Summary, Unweighted and Weighted by Confidence in Response (n = 5,948)

Question	Correct^{^a}	Missing Knowledge Response and Confidence Weight (N)^{^b}	Unweighted^{^c}Item Level	Weighted^{^d}Item Level
Treatments for the symptoms of COVID-19 are available without a prescription.^{^e}	T	19	0.44 (0.43, 0.45)	0.41 (0.40, 0.43)
Most hospitalized patients with COVID-19 should be treated in an ICU.^{^e}	F	25	0.64 (0.62, 0.65)	0.65 (0.63, 0.66)
The CDC recommends using corticosteroids for COVID-19 patients with acute respiratory distress syndrome (ARDS).	F	176	0.56 (0.54, 0.57)	0.57 (0.55, 0.60)
COVID-19 is the first coronavirus to cause disease in humans.	F	27	0.92 (0.91, 0.92)	0.95 (0.94, 0.95)
Patients with shortness of breath, fever, and cough should call the emergency department before arrival.^{^e}	T	21	0.87 (0.86, 0.88)	0.89 (0.88, 0.90)
Patients whose first (early) symptoms are severe are more likely to die from COVID-19 than those whose first (early) symptoms are less severe.	F	47	0.75 (0.74, 0.76)	0.77 (0.75, 0.79)
Children ages 5 and under are at higher risk of death from COVID-19.^{^e}	F	33	0.85 (0.84, 0.86)	0.88 (0.87, 0.89)
In someone who has not received the measles vaccine, measles is more contagious than COVID-19.	T	62	0.40 (0.39, 0.41)	0.43 (0.41, 0.45)
The incubation period for the coronavirus that causes COVID-19 is up to 21 days.	F	39	0.48 (0.47, 0.49)	0.47 (0.46, 0.49)
Healthy people should wear facemasks to help prevent the spread of COVID-19.^{^e}	F	20	0.83 (0.82, 0.84)	0.85 (0.84, 0.86)
A vaccine for COVID-19 should be available within approximately 3 months.^{^e}	F	26	0.87 (0.86, 0.88)	0.91 (0.90, 0.92)
CDC recommends the use of alcohol-based hand sanitizers with greater than 60% ethanol or 70% isopropanol.	T	34	0.91 (0.91, 0.92)	0.93 (0.92, 0.94)
Currently, the CDC recommends that everyone with COVID-19 symptoms should get tested.	F	28	0.51 (0.49, 0.52)	0.53 (0.51, 0.54)
Everyone who tests positive for COVID-19 should be treated with hydroxychloroquine (Plaquenil) or chloroquine.^{^e}	F	39	0.91 (0.91, 0.92)	0.94 (0.93, 0.95)
COVID-19 testing is not recommended for individuals with no symptoms, even if they were exposed to someone with confirmed COVID-19 within the past 2 weeks.^{^e}	T	20	0.68 (0.67, 0.69)	0.71 (0.69, 0.73)
Total Score (15-Item)		616	0.71 (0.70, 0.71)	0.75 (0.74, 0.75)
Total Score (8-Item)		616	0.76 (0.76, 0.76)	0.79 (0.79, 0.80)

CDC = Centers for Disease Prevention and Control; ICU = intensive care unit; F = false; T = true.
↵a Correct response according to information publicly available from the Centers for Disease Prevention and Control website as of the date the survey was distributed (03/25/2020).
↵b Simple imputation was used for confidence items where respondents answered the knowledge component, but skipped the corresponding confidence component (n = 170 imputed confidence level values). After imputing confidence levels, any item missing a knowledge response was also missing a confidence level, and vice versa.
↵c The statistical model used to calculate unweighted predicted probabilities of correct responses (and corresponding 95% confidence limits) excluded n = 616 missing knowledge response questions. Note that n = 616 reflects the number of response items, not the number of patient respondents. All n = 5,948 patient respondents were included in the analysis.
↵d The statistical model used to calculate weighted predicted probabilities of correct responses (and corresponding 95% confidence limits) while accounting for the corresponding confidence in the response excluded n = 616 missing knowledge response questions and n = 616 missing weight values. Note that n = 616 reflects the number of items, not the number of patient respondents. All n = 5,948 patient respondents were included in the analysis.
↵e Item belongs to selected 8-item subset.

View popup

Table 3.

Beliefs Regarding Efficacy of, and Willingness to Follow, CDC Recommendations

	Social Isolation Belief vs Follow
n = 5,943 ICC (95% CI) 0.68 (0.65, 0.71)	Will You Follow Social Isolation, Even if You Have No Symptoms (Avoiding Large Crowds)?
		Missing	Certainly Not	Probably Not	Maybe	Probably Yes	Most Certainly	Total
	Do you think that social isolation, even if you have no symptoms (avoiding large crowds), will decrease the spread of COVID-19 in your community?	Missing	Certainly Not	Probably Not	Missing	Probably Yes	Most Certainly	Total	5 (0.1)	1 (0.0)	1 (0.0)	0 (0.0)	8 (0.1)	58 (1.0)	73 (1.2)
Certainly not		0 (0.0)	7 (0.1)	3 (0.1)	2 (0.0)	2 (0.0)	4 (0.1)	18 (0.3)
Probably not		0 (0.0)	8 (0.1)	12 (0.2)	21 (0.4)	15 (0.3)	9 (0.2)	65 (1.1)
Maybe		4 (0.1)	7 (0.1)	18 (0.3)	54 (0.9)	121 (2.0)	83 (1.4)	287 (4.8)
Probably yes		11 (0.2)	6 (0.1)	4 (0.1)	45 (0.8)	478 (8.0)	773 (13.0)	1,317 (22.1)
Most certainly		35 (0.6)	10 (0.2)	7 (0.1)	21 (0.4)	238 (4.0)	3,877 (65.2)	4,188 (70.4)
	Total	55 (0.9)	39 (0.7)	45 (0.8)	143 (2.4)	862 (14.5)	4,804 (80.8)	5,948
Related Qualitative Themes & Quotes
Theme 1. There are minimal or no barriers to following CDC recommendations.
“There is nothing that prevents me from following CDC recommendations.”
“I am being very compliant with social distancing. I am not allowing my kids to ‘hang out’ with friends. I am listening to CDC and local authorities.”
Theme 2. Life or medical obligations require occasional disregard for CDC recommendations.
“I must work to provide for my family.”
“I have a family of 5 and unfortunately do need to go to the grocery store at least once a week because I can’t keep more than a week’s worth of food stored properly at my house.”
“The only time I have left my house is for OBGYN appointments.”
“I’m not socially isolating because I’m also concerned about the long-term mental health effects of loneliness.”

CDC = Centers for Disease Prevention and Control; ICC = intraclass correlation coefficient; OBGYN = obstetrician-gynecologist.
Note: Reported frequency (percent). The sample size reported for the ICC excludes only those respondents missing values for both measures.

Additional Files

Tables

Supplemental tables

PDF file

Lennon_Supp_Tables_1-8.pdf -
PDF File
The Article in Brief

Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Central Pennsylvania Adults Early in the Pandemic: A Mixed Methods Cross-Sectional Survey

Robert P. Lennon, and colleagues

Background Penn State University researchers conducted a survey in late March 2020, which was completed by almost 6,000 adults enrolled in a central Pennsylvania health care system.

What This Study Found The survey suggests that knowledge about COVID-19 and adherence to behavioral recommendations was generally high among those surveyed. Early concern for COVID-19 outmatched concern for influenza, though researchers believe respondents may have been less focused on their perceived likelihood of contracting COVID-19 and more concerned with its severe impact on their health. Additionally, they found that when the Centers for Disease Control and Prevention began advising social distancing recommendations in the early months of the pandemic, a majority of surveyed adults believed in the effectiveness of social distancing and intended to follow CDC guidelines. Health agency websites like the CDC were most frequently identified as “trusted sources” for COVID-19 information, as opposed to the substantial distrust in COVID-19 information from mass media and politicians.

Implications

These findings highlight the importance of consistent messaging from trusted sources that reaches diverse groups.