Background So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. Objective This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. Methods An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. Results Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; P<.001). Conclusions We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs.

Background: So far, there has been no published population study on the relationship between COVID-19 infection and public risk perception, information source, knowledge, attitude and four non-pharmaceutical interventions(NPI: hand washing, proper coughing habits, social distancing and mask wearing) during the COVID-19 outbreak in China. Methods: An online survey of 8158 Chinese adults between 22 February to 5 March 2020 was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. Results: Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (99.2%), positive risk perception (99.9%) and high knowledge levels that were among the strongest predictors of four highly adopted NPIs (hand washing:96.8%; proper coughing: 93.1%; social distancing:87.1%; mask wearing:97.9%). There was an increased risk of COVID-19 infection for those who not washing hands (2.28% vs 0.65%; RR=3.53: 95%CI: 1.53-8.15; P<0.009); not practicing proper coughing (1.79% vs 0.73%; RR=2.44: 95%CI: 1.15-5.15;P=0.026); not practicing social distancing (1.52% vs 0.58%; RR=2.63:95%CI:1.48-4.67; P=0.002); and not wearing a mask (7.41% vs 0.6%; RR=12.38:95%CI:5.81-26.36; P<0.001). For those who did practice all other three NPIs, wearing mask was associated with significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; p=0.035). Similarly, for those who did not practice all or part of the other three NPIs, wearing mask was also associated with significantly reduced risk of infection. In a penalised logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among four NPIs (OR=7.20; 95%CI:2.24-23.11; p<0.001). Conclusions: We found high levels of risk perception, positive attitude, desirable knowledge as well as a high level of adopting four NPIs. The relevant knowledge, risk perception and attitude were strong predictors of adapting the four NPIs. Mask wearing, among four personal NPIs, was the most effective protective measure against COVID-19 infection with added preventive effect among those who practised all or part of the other three NPIs.

Background: The strategies adopted to prevent spreading of COVID-19 are quarantine, social distancing and isolation of infected cases. This study investigates perceptions and behavioral adoptions of COVID-19 prevention strategies among the Chinese public and identified factors predicting individual health behavior.Methods: We conducted a cross-sectional online survey between 22 February and 5 March, 2020. We approached to urban residents aged over 18 years through snowball sampling method using the Chinese social media. The Health Belief Model was adopted to guide the analysis. Bivariate and multivariate logistic regressions were used to examine impacts of modifying factors (including demographic and socio-economic characteristics) and individual beliefs on individual health behavior.Results: of 5675 valid questionnaires, 95.8% of the respondents well understood the preventive measures from COVID-19 transmission, while 79.9% of the respondents adopted the behavior advised. 45.7% of the respondents perceived severity of the disease, 75.6% of the respondents perceived benefits of social constraints measures and 62.7% reported anxiety during the epidemic. After adjusting for modifying factors and individual beliefs, those who were female, had better income and good knowledge on preventive measures, perceived benefits on social constraint measures and did not feel anxiety were more likely to adopt behaviors advised.Conclusions: The Chinese public highly accepted and adopted behaviors advised to slow down the COVID-19 epidemic. People with low income or feeling anxiety were less likely to adopt the behavior advised. The policy support should target on the social vulnerable groups. The psychological support should be disseminated through different means, and the consultation should be provided to those who are in need.

BACKGROUND So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. OBJECTIVE This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. METHODS An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. RESULTS Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; <i>P</i>=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; <i>P</i>=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; <i>P</i>=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; <i>P</i>&lt;.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; <i>P</i>=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; <i>P</i>&lt;.001). CONCLUSIONS We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs.

Background: The strategies adopted to prevent spreading of COVID-19 are quarantine, social distancing and isolation of infected cases. This study investigates perceptions and behavioral adoptions of COVID-19 prevention strategies among the Chinese public and identified factors predicting individual health behavior.Methods: We conducted a cross-sectional online survey between 22 February and 5 March, 2020. We approached to urban residents aged over 18 years through snowball sampling method using the Chinese social media. The Health Belief Model was adopted to guide the analysis. Bivariate and multivariate logistic regressions were used to examine impacts of modifying factors (including demographic and socio-economic characteristics) and individual beliefs on individual health behavior.Results: of 5675 valid questionnaires, 95.8% of the respondents well understood the preventive measures from COVID-19 transmission, while 79.9% of the respondents adopted the behavior advised. 45.7% of the respondents perceived severity of the disease, 75.6% of the respondents perceived benefits of social constraints measures and 62.7% reported anxiety during the epidemic. After adjusting for modifying factors and individual beliefs, those who were female, had better income and good knowledge on preventive measures, perceived benefits on social constraint measures and did not feel anxiety were more likely to adopt behaviors advised.Conclusions: The Chinese public highly accepted and adopted behaviors advised to slow down the COVID-19 epidemic. People with low income or feeling anxiety were less likely to adopt the behavior advised. The policy support should target on the social vulnerable groups. The psychological support should be disseminated through different means, and the consultation should be provided to those who are in need.