Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey
Michael S Wolf, Marina Serper, Lauren Opsasnick, Rachel M O'Conor, Laura Curtis, Julia Yoshino Benavente, Guisselle Wismer, Stephanie Batio, Morgan Eifler, Pauline Zheng, Andrea Russell, Marina Arvanitis, Daniela Ladner, Mary Kwasny, Stephen D Persell, Theresa Rowe, Jeffrey A Linder, Stacy C Bailey, Michael S Wolf, Marina Serper, Lauren Opsasnick, Rachel M O'Conor, Laura Curtis, Julia Yoshino Benavente, Guisselle Wismer, Stephanie Batio, Morgan Eifler, Pauline Zheng, Andrea Russell, Marina Arvanitis, Daniela Ladner, Mary Kwasny, Stephen D Persell, Theresa Rowe, Jeffrey A Linder, Stacy C Bailey
Abstract
Background: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear.
Objective: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions.
Design: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study.
Setting: 5 academic internal medicine practices and 2 federally qualified health centers.
Patients: 630 adults aged 23 to 88 years living with 1 or more chronic conditions.
Measurements: Self-reported knowledge, attitudes, and behaviors related to COVID-19.
Results: A fourth (24.6%) of participants were "very worried" about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response.
Limitation: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak.
Conclusion: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities.
Primary funding source: National Institutes of Health.
References
- Worldometer. COVID-19 coronavirus outbreak. Accessed at . on 24 March 2020.
- Ioannidis JPA. Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest. 2020:e13223. [PMID: 32202659] doi:10.1111/eci.13223.
- Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020. [PMID: 32173574] doi:10.1016/j.ijid.2020.03.017.
- Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005;165:1946-52. [PMID: 16186463]
- Paasche-Orlow MK, Parker RM, Gazmararian JA, et al. The prevalence of limited health literacy. J Gen Intern Med. 2005;20:175-84. [PMID: 15836552]
- Mantwill S, Monestel-Umaña S, Schulz PJ. The relationship between health literacy and health disparities: a systematic review. PLoS One. 2015;10:e0145455. [PMID: 26698310] doi:10.1371/journal.pone.0145455.
- O'Conor R, Arvanitis M, Wismer G, et al. Rationale and design of the Regimen Education and Messaging in Diabetes (REMinD) trial. Contemp Clin Trials. 2019;83:46-52. [PMID: 31260791] doi:10.1016/j.cct.2019.06.016.
- Wolf MS, Curtis LM, Wilson EA, et al. Literacy, cognitive function, and health: results of the LitCog study. J Gen Intern Med. 2012;27:1300-7. [PMID: 22566171]
- Bailey SC, Wismer GA, Parker RM, et al. Development and rationale for a multifactorial, randomized controlled trial to test strategies to promote adherence to complex drug regimens among older adults. Contemp Clin Trials. 2017;62:21-26. [PMID: 28823927] doi:10.1016/j.cct.2017.08.013.
- Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the Newest Vital Sign. Ann Fam Med. 2005;3:514-22. [PMID: 16338915]
- Wolf MS, Smith SG, Pandit AU, et al. Development and validation of the Consumer Health Activation Index. Med Decis Making. 2018;38:334-343. [PMID: 29436308] doi:10.1177/0272989X17753392.
- Kelly B, Squiers L, Bann C, et al. Perceptions and plans for prevention of Ebola: results from a national survey. BMC Public Health. 2015;15:1136. [PMID: 26572610] doi:10.1186/s12889-015-2441-7.
- Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702-6. [PMID: 15033648]
- Lin L, Savoia E, Agboola F, et al. What have we learned about communication inequalities during the H1N1 pandemic: a systematic review of the literature. BMC Public Health. 2014;14:484. [PMID: 24884634] doi:10.1186/1471-2458-14-484.
- Freimuth VS, Jamison A, Hancock G, et al. The role of risk perception in flu vaccine behavior among African-American and white adults in the United States. Risk Anal. 2017;37:2150-2163. [PMID: 28314047] doi:10.1111/risa.12790.
- Crouse Quinn S, Jamison AM, Freimuth VS, et al. Determinants of influenza vaccination among high-risk black and white adults. Vaccine. 2017;35:7154-7159. [PMID: 29126805] doi:10.1016/j.vaccine.2017.10.083.
- Nanna MG, Navar AM, Zakroysky P, et al. Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: insights from the Patient and Provider Assessment of Lipid Management Registry. JAMA Cardiol. 2018;3:739-748. [PMID: 29898219] doi:10.1001/jamacardio.2018.1511.
- Park CL, Cho D, Moore PJ. How does education lead to healthier behaviours? Testing the mediational roles of perceived control, health literacy and social support. Psychol Health. 2018;33:1416-1429. [PMID: 30450977] doi:10.1080/08870446.2018.1510932.
- Ramírez AS, Arellano Carmona K. Beyond fatalism: information overload as a mechanism to understand health disparities. Soc Sci Med. 2018;219:11-18. [PMID: 30342382] doi:10.1016/j.socscimed.2018.10.006.
- Grantz KH, Rane MS, Salje H, et al. Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. Proc Natl Acad Sci U S A. 2016;113:13839-13844. [PMID: 27872284]
- Shoemaker SJ, Wolf MS, Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96:395-403. [PMID: 24973195] doi:10.1016/j.pec.2014.05.027.
Source: PubMed