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International Journal of
Environmental Research
and Public Health
Article
Preparedness and Preventive Behaviors for a
Pandemic Disaster Caused by COVID-19 in Serbia
Vladimir M. Cvetkovi´c 1,* , Neda Nikoli´c 2, Una Radovanovi´c Nenadi´c 3, Adem Öcal 4,
Eric K. Noji 5and Miodrag Zeˇcevi´c 6
1Faculty of Security Studies, University of Belgrade, Gospodara Vuˇci´ca 50, 11040 Belgrade, Serbia
2
Faculty of Tehnical Science in ˇ
Caˇcak, University of Kragujevac, 32000 ˇ
Caˇcak, Serbia; neda.nikolic@ftn.kg.ac.rs
3
Scientific-Professional Society for Disaster Risk Management, Dimitrija Tucovi´ca 121, 11040 Belgrade, Serbia;
una.radovanovic@gmail.com
4Independent Researcher, Ankara 06500, Turkey; ocadem@gmail.com
5King Saud University Hospitals and College of Medicine, Riyadh 11564, Saudi Arabia;
nojie@alumni.stanford.edu
6Faculty of International Engineering Management Belgrade, European University, 11000 Belgrade, Serbia;
misko.zecevic@gmail.com
*Correspondence: vmc@fb.bg.ac.rs; Tel.: +381-6-0373-8606
Received: 30 April 2020; Accepted: 3 June 2020; Published: 9 June 2020
Abstract:
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute
respiratory syndrome coronavirus 2. The disease was first detected in Wuhan, the capital of China’s
Hubei province, in December 2019 and has since spread globally, especially to Europe and North
America, resulting in the ongoing global coronavirus pandemic disaster of 2019–2020. Although most
cases have mild symptoms, there is some progression to viral pneumonia and multi-organ failure
and death. More than 4.6 million cases have been registered across 216 countries and territories
as of 19 April 2020, resulting in more than 311,000 deaths. Risk to communities with continued
widespread disease transmission depends on characteristics of the virus, including how well it
spreads between people; the severity of resulting illness; and the medical or other measures available
to control the impact of the virus (for example, vaccines or medications that can treat the illness)
and the relative success of these. In the absence of vaccines or medications, non-pharmaceutical
interventions were the most important response strategy based on community interventions such as
person-to-person distancing, mask-wearing, isolation and good personal hygiene (hand-washing)—all
of which have been demonstrated can reduce the impact of this seemingly unstoppable globally
spreading natural disaster. This paper presents the results of quantitative research regarding
the level of citizen preparedness for disasters caused by coronavirus disease (COVID-19) in Serbia.
The survey was conducted using a questionnaire that was requested and then collected online
among 975 respondents during disaster in April 2020. The questionnaire examined citizens’ basic
socio-economic and demographic characteristics, their knowledge, preparedness, risk perception
and preventive measures taken individually and as a community to prevent the death and widespread
transmission of novel coronavirus disease 2019 in the Republic of Serbia. Based on the findings that
there are major differences in the public’s perception of risks posed by communicable disease threats
such as presented by COVID-19, emergency management agencies should use these differences
to develop targeted strategies to enhance community and national preparedness by promoting
behavioral change and improving risk management decision-making.
Keywords:
disaster; epidemic risk; pandemic; citizen preparedness; coronavirus; COVID-19; Serbia
Int. J. Environ. Res. Public Health 2020,17, 4124; doi:10.3390/ijerph17114124 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2020,17, 4124 2 of 23
1. Introduction
COVID-19 is a new strain of coronavirus that has not been previously identified in humans.
Coronaviruses are zoonotic and are a large family of viruses that cause illness ranging from the common
colds to more serious diseases, such as MERS and SARS [
1
]. Compared with SARS and MERS, COVID-19
has spread more rapidly, mainly due to increased globalization and the focus of the epidemic [
2
].
COVID-19 may have acted differently from previous coronavirus epidemics. Firstly, the lack of
organized, systematic and scientific knowledge about COVID-19 caused anxieties on the part of
individuals and governments as they were facing an unseen enemy around the world [
3
]. In addition,
the main phenotype of this outbreak is the high rate of spread, age and increased vulnerability of low
immune individuals and the differential rate of recovery [4].
On 7 January 2020, the Chinese CDC isolated a novel coronavirus from the throat swab of a patient
with pneumonia of unknown etiology. The new virus and disease were unknown before the outbreak
began in Wuhan, China, in December 2019, but the novel virus was identified by the World Health
Organization (WHO) as the 2019-novel Coronavirus (nCoV). On 11 February 2020, WHO formally
named the disease caused by SARS-CoV-2 virus as “COVID-19” [
5
]. Two pathogenic coronaviruses
were mainly known before December 2019. One is severe acute respiratory coronavirus syndrome
(SARS-CoV) and the other is Middle East respiratory coronavirus syndrome (MERS-CoV). SARS was
first identified in China in 2002, with 32 countries reporting cases worldwide and 8442 people infected
with SARS, of whom 916 died, for a case–fatality rate (CFT) of 11% worldwide, but the CFT was 27%
in China [
1
]. MERS was identified in the Middle East (Saudi Arabia) region in 2012. By the end of
November 2019, a total of 2494 laboratory-confirmed cases of MERS, including 858 related deaths
(case–fatality rate: 34.4%) were reported in 27 countries; the majority of these cases were reported from
Saudi Arabia [
1
]. Other known coronaviruses (HCoV-OC43, HCoV-229E, HCoV-NL63, HCoV-HKU1)
induce mild or asymptomatic upper respiratory tract disease like the common cold [6].
The outbreak of COVID-19 spread far faster than before around the world. As of 11 February
2020, there have been 43,118 laboratory-confirmed cases of novel coronavirus (2019-nCoV) infected
pneumonia (NCIP) worldwide, with 1,018 deaths [
7
]. Cases have been reported from 14 Asian countries,
nine European countries, two North American countries and one country in Oceania. There have
been 1017 deaths in China and 1 in the Philippines outside of China [
7
]. All reported cases have been
confirmed by real-time reverse transcriptase-polymerase chain reaction [8,9].
The total global number of COVID-19 cases has exceeded 4.6 million, and total number of death is
311,847 [
10
]. Since the declaration of COVID-19 as a public health emergency of international concern,
the number of countries implementing additional health measures that significantly interfere with
international traffic has increased. COVID-19 is a new disease that is distinct from other SARS, MERS,
and influenza diseases. Although coronavirus and influenza infections may have similar symptoms,
the virus responsible for COVID-19 differs in terms of community spread and severity. Much remains
to be discovered about the disease and its impact in different contexts. Preparedness, readiness,
and response actions will continue to be driven by the rapid accumulation of scientific and public
health knowledge.
Every country should urgently take all necessary measures to slow further spread and prevent
its health systems from being overwhelmed by seriously ill patients with COVID-19. Although
the government was convinced that Serbia would not be largely affected by the COVID-19, the state of
emergency was declared on 15 March, not long after the first case had been registered. The first officially
registered case on 6 March is most likely to be imported from Budapest, as the male patient in question
visited his ill sister (with “respiratory problems, fever and other COVID-19 symptoms”), as stated
by the Minister of Health Zlatibor Lonˇcar [
11
]. Subsequently, a significant number of provisions
and orders were made, among the most important ones [
12
]: compulsory 28-day self-isolation was
imposed for anyone entering the country on 14 March 2020 and later.
Social media and networks monitoring and addressing’s of the government representatives
clearly indicated difficulties in complying with the envisaged measures, particularly in the first weeks
Int. J. Environ. Res. Public Health 2020,17, 4124 3 of 23
leading up to the state of emergency. This could probably have been the result of changes of point
of view in this less than a month long period, which could lead to the confusion among the general
public [
12
]. Although Serbian officials followed WHO Guidelines and collaborated with the experts
from the China following the declaration of the state of emergency, and have urged Serbian citizens to do
the same, the public was not prepared for an epidemic. Even though history testifies to a small number
of serious epidemics and researchers have found evidences of poor knowledge and preparedness
of Serbian public about epidemics [
13
,
14
] and infectious agents used as biological weapons [
15
],
little has been done to prevent epidemics and pandemics. Given that Serbia suffered great losses in
the May 2014 floods, the most of the government attention was focused to emergency management in
general. However, the right to education in emergency situations was not affirmed and recognized in
the past [
16
]. The need to conduct a survey on the preparedness of citizens for outbreaks of a major
epidemiological significance (declared on 19 March) on the territory of the Republic of Serbia has
therefore been recognized.
1.1. Literature Review
Understanding individuals’ behavior and their relationship to their perceived risk is important
in terms of effective control of an outbreak of infectious diseases [
17
]. Some studies have examined
risk perceptions and precautionary behaviors during the early stages of the 2009 (H1N1) influenza
pandemic in Hong Kong [
18
,
19
], Australia [
20
], France [
21
,
22
], and the England, Scotland, and Wales [
20
].
These studies found that precautionary behaviors were associated with anxiety about H1N1 influenza,
risk perceptions, perceived efficacy of the precautionary behaviors [19,23].
There are some scientific studies related to perceptions of people about pandemic diseases,
their precautions and preparations. Balicer et al. [
24
] conducted a study to understand local public
health workers’ perceptions of pandemic influenza response. They surveyed 308 staffat three health
departments in Maryland from March–July 2005, about factors that could influence their ability
and willingness to report to duty in this event. The study demonstrated that almost half of the local
health department workers were likely not to report to duty during a pandemic. The perceived risk
among public health workers has been shown to be associated with several factors that are peripheral
to the actual hazard of this event. These changes in the risk perception and the knowledge gaps
identified serve as barriers to the response to a influenza pandemic and must be specifically addressed
to enable effective local public health response to this significant threat. Barr et al. [
25
], investigated
how a population perceives the threat of influenza pandemic, and what was their preparedness to
comply with specific public health behaviours in the event of pandemic influenza.
The survey was completed on a representative sample of 2081 adults. In the event of a flu
pandemic, the majority of the population was willing to be vaccinated (75.4%), be isolated (70.2%),
and wear a face mask (59.9%). People with higher levels of risk perception are significantly more
likely to be willing to comply with specific public health behaviours. While only 14.9% of the New
South Wales (Australia) population thought that a pandemic influenza was very or extremely likely
to occur, a significantly higher proportion of the population and the family were concerned if a
pandemic actually occurred. Ibuka et al. [
26
] assessed temporal changes and geographical differences
in risk perceptions and precautionary behaviors in response to H1N1 influenza. An online survey
of risk perceptions, interests in pharmaceutical interventions (preventive intervention and curative
intervention), and involvement in precautionary activities (information seeking activities and taking
quarantine measures) in response to H1N1 influenza was conducted in 2009. Geographical differences
in risk perception and precautionary behaviors have been evaluated. Predictors of willingness to take
part in a pharmaceutical intervention were analyzed. The perceived likelihood of influenza infection,
willingness to take drugs, and involvement in information seeking activities was higher for women than
men. The perceived risk of infection and precautionary behavior can be dynamic over time, and differ
by demographic characteristics and geographical locations. These patterns are likely to influence
the effectiveness of disease control measures. Park et al. [
27
] conducted a study to assess the perceptions,
Int. J. Environ. Res. Public Health 2020,17, 4124 4 of 23
motivational factors and behaviors associated with the use of hand washing to prevent H1N1 influenza
transmission during the peak pandemic period in Korea. They reached the point that Korean students
increased their frequency of hand hygiene practices during the pandemic, with significant gender
differences existing in the attitudes and behaviors related to the use of hand hygiene as a means of
disease prevention. The factors that affected hand washing behavior were similar to those identified at
the beginning of the H1N1 or SARS pandemics, suggesting that public education campaigns regarding
hand hygiene are effective in altering individual hand hygiene habits during the peak periods of
influenza transmission.
Kwok et al. [
28
] examined the community’s psychological and behavioral responses during
the early phase of the Hong Kong epidemic of COVID-19. Analysis of 1715 complete responses indicated
high perceived susceptibility (89%) and high perceived severity (97%). Most of the respondents were
worried about COVID-19 (97%), and had their daily routines disrupted (slightly/greatly: 98%). The level
of anxiety, measured by the Hospital Anxiety and Depression Scale, was borderline abnormal (9.01).
Almost all respondents were alert to the disease progression (99.5%). The most reliable sources
of information were doctors (84%), followed by broadcasts (57%) and newspapers (54%), but they
were not common sources of information (doctor: 5%, broadcast: 34%, newspaper: 40%). Only 16%
respondents found official websites to be reliable. Enhanced personal hygiene and travel-avoidance
practices to China have frequently been adopted (>77%) and considered effective (>90%). The adoption
of social-distancing measures was lower (39–88%), and their drivers for increased adoption include:
being female (adjusted odds ratio [aOR]:1.27), living in the New Territories (aOR:1.32–1.55), perceived
as having good understanding of COVID-19 (aOR:1.84) and being more anxious (aOR:1.07).
Gilbert et al. [
29
] assessed the preparedness and vulnerability of African countries to their risk of
importation of COVID-19. The risk of importation from China of cases of COVID-19 to Africa was
estimated on the basis of the origin–destination air travel flows from January 2019; number of cases in
Chinese provinces; and the population in each of the Chinese provinces that reported transmission.
They identified the country’s capacity to detect and respond to cases with two indicators: preparedness,
and vulnerability. Countries were clustered according to the Chinese regions that contributed most to
their risk. The authors identified three clusters of countries (i.e., Egypt, Algeria, and South Africa)
that share the same risk exposure from the provinces of Guangdong, Fujian and Beijing. Countries
at moderate risk (i.e., Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable
capacity and high vulnerability.
As the classic Health Belief Model (HBM) and other models for health psychology indicate, risk
perceptions have been seen as one of key drivers of health behaviors [
30
]. In the HBM, perceived
susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy
(individual beliefs in disaster preparedness) predict individual behavior [31].
1.2. Epidemic Hazard in Serbia
During the Crusades (1096–1291), the territory of the Republic of Serbia was affected by a leprosy
epidemic that claimed several dozen human lives in the Balkans. Then, in the Middle Ages, the plague
occurred on several occasions (1348, 1362, 1428, 1430 and 1438), with the most recent cases being
recorded between 1836 and 1838 [
32
]. Although the borders in Balkans have often been moved
and outbreaks of infectious diseases are not uncommon, over the last century three major outbreaks
have been linked to the geographical area of the Republic of Serbia. Firstly, during the First World War,
the Serbian army and public were greatly affected by typhus. The second was a smallpox epidemic
of in Socialistic Federative Republic of Yugoslavia (SFRY) in 1972, “the biggest post-war outbreak in
Europe”; and, lastly, the tularemia outbreaks during the 1990s [33].
The lack of time and resources to recover from the losses caused by the Balkan wars (1912–1913),
the epidemics of typhoid, recurrent and especially freckled typhus (besides dysentery, measles,
diphtheria, scarlet fever, smallpox, etc.), have consequently spread all over Serbia and caused losses
that no other people and army suffered during the First World War [
34
]. World Health Organization
Int. J. Environ. Res. Public Health 2020,17, 4124 5 of 23
(WHO) developed a major eradication plan for Variola major in 1967, and 10 years later the last case
of smallpox was registered in Somalia. However, the last large outbreak in Europe occurred in 1972
in Yugoslavia, with 175 cases and 35 deaths [
35
,
36
]. Before eradication, the last case of smallpox in
Serbia was recorded in 1930, with the last lethal consequence in 1926. Although 38,963 people lost
their lives in smallpox epidemics between 1896 and 1910 for many years, medical personnel were
not trained, prepared and experienced at the time of the outbreak of smallpox [
33
]. Nevertheless,
despite organizational, technical and other weaknesses, the epidemic was quickly brought under
control within four weeks after the detection of the first case by vaccination of whole SFRY population
(about 18 million citizens) which began on 16 March, surveillance and movement restrictions [33].
Although the first human infection in SFRY was reported in 1947 and the disease occurred
sporadically in Serbia, the first outbreak of tularemia in Serbia was recorded in late 1998 in the Sokobanja
region. The epidemic lasted until 1999 and 2000, with oropharyngeal tularemia as the dominant
form of the disease. Subsequently, minor tularemia outbreaks occurred in the district of Pˇcinja in
2010, Gazdin Han in 2014 and in 2015 in the natural foci of the disease—Stara planina, Suva planina,
and Rtanj and Kopaonik mountains [
33
]. The recent history of the Republic of Serbia also records the flu
epidemic in 2009/2010, at the time of pandemic. The population surveillance reported 190,563 (2.5%) of
patients with clinically manifest flu symptoms between 26th week of 2009 and the 13th week of 2010.
6021 patients were hospitalized for influenza-like illnesses, among which influenza was laboratory
confirmed at 553. Among those hospitalized, 137 deaths were reported (mortality rate—2.3%), 122 of
which had influenza as the cause of death, and 15 died as a result of complications of chronic illness
following influenza [
37
]. Although Ristanovi´c [
33
] argued that smallpox epidemics, as well as other
epidemics mentioned above, should have provided sufficient warning and improved preparedness
for response, and rare studies have shown that this is not the case. In the context of general publics’
preparedness for epidemics, Cvetkovi´c et al. [
13
] have shown that “less than half of respondents know
what epidemics are and how to protect themselves against epidemics”. Another interesting testimony
about Serbia’s poor public knowledge of infectious diseases was found.
The aim of this paper was to establish the level and impact of certain demographic characteristics
of preparedness and preventive behavior in the event of a pandemic disaster caused by COVID-19
in Serbia.
2. Methods
The research was designed to identify adults’ preparedness behaviours during the epidemic of
COVID-19 in Serbia, with the result that all participants were Serbian residents over 18 years of age.
Due to the extraordinary circumstances of the COVID-19 pandemic, in particular the restriction of
movement and the need for social distance, the data collection for this study had to be conducted via
the on-line survey platform (google.doc). Namely, the study was conducted in April, 2020, only two
weeks after the state of emergency was declared, ensuring that the researchers complied with movement
restrictions and the need for social distancing. The participants were invited to complete the on-line
questionnaire in their native language by using the snowball sampling method.
2.1. Study Area
The Republic of Serbia is located at the crossroads of Central and South-Eastern Europe in
the Southern Pannonian Plain and the central Balkans and covers an area of 88.499 km
2
. It borders
Hungary to the north, Romania to the northeast, Bulgaria to the southeast, North Macedonia to the south,
Montenegro to the southwest and Croatia and Bosnia and Herzegovina to the west. Also, the disputed
territory of Kosovo in the south of the country, borders with Albania to the south-southwest. According
to the 2011 census, there were 7,186,862 inhabitants in the Republic of Serbia, of whom 3,499,176
were male and 3,687,686 were female. Almost one third of population is concentrated in just 5% of
the territory (the metropolitan area of Belgrade and regional centers as Novi Sad, Niš and Kragujevac),
while more than 35% of the territory is well below the average population density (up to 50
Int. J. Environ. Res. Public Health 2020,17, 4124 6 of 23
inhabitants/km
2
). Over 1.7 million of Serbian residents were retired, 1.2 million were 65 years
of age or older, more than 800,000 were officially unemployed, and more than 570,000 people had some
kind of disability [
38
]. It is also important to note that Serbia is a country in transition, with the official
position of the government being to become part of the European Union.
2.2. Socio-Economic and Demographic Characteristics
As an initial invitation to participate in an online questionnaire was posted on social media
and sent to the authors’ contacts and their contacts, the sample was convenient and not necessarily
representative of the Serbian population. Of 975 respondents total, 76.6% were women and 23.4%
men (women 51.3% and men 48.7% of the total country population). The average age of respondents
was 27 years old and the most represented category was 18–28 years old (708; 72.6%) while the least
elderly were 49–58 (51; 5.2%) (average age of the population 42.6 years (men 41.2 and women 43.9).
From the sample, it appears that the majority (57.2%) had undergraduate educational degrees, and very
few only completed primary school (0.3%) (with primary sch. 20.76%, high sch. 48.93%, junior college
4.51%, and undergraduate 10.59% of the population). In the household sample in a relationship people
account for 39.4%, widow/widower 0.9%, and married rate of 13.8%. The interviewees selected also
reflected different status of disability, with 7.7% of the individuals reporting some type of disability or
chronically illness and 92.3% reporting lack of disability. In addition, the majority (44%) of respondents
had monthly household income of more than 741$ (Table 1).
Table 1. Basic socio-economic and demographic information of respondents (n =975).
Variable Category Frequency (%) Variable Category Frequency (%)
Gender Male 228 (23.4) Disability Yes 75 (7.7)
Female 747 (76.6) No 900 (92.3)
Age
18–28 708 (72.6)
Monthly
income
Up to 275$ 96 (9.8)
29–38 126 (12.9) 275 to 465$ 210 (21.5)
39–48 90 (9.2) 466 to 740$ 240 (24.6)
49–58 51 (5.2) Over 741$ 429 (44)
Marital status
Single 423 (43.4)
Education
Primary sch. 3 (0.3)
In a relationship 384 (39.4) High-school 240 (24.6)
Married 135 (13.8) Junior college 63 (6.5)
Divorced 21 (2.2) Undergraduate 558 (57.2)
Widow 9 (0.9)
Master/doctorate
108 (11.0)
TOTAL 975 (100)
2.3. Questionnaire Design
The structured questionnaire was developed using close-ended and 5-point Likert scale
questions (1 strongly disagree to 5 strongly agree). The first part of the questionnaire included
the socio-demographic characteristics of the interviewees in order to assess the social background
and gender of the respondents. Subsequent sections included issues questions related to knowledge,
preparedness, risk perception and information sources, and preventive measures for coronavirus disease
(Appendix A). Several published survey approaches were consulted [
13
,
14
,
17
,
19
,
27
,
28
,
39
] and adapted
according to the circumstances of the COVID-19 pandemics in Serbia. A pilot pre-test of
the questionnaire was conducted in Belgrade (central Serbia) in April 2020 with 45 people to test
the comprehensibility and performance of the questionnaire via online systems. Our research
was consistent with the Helsinki Declaration outlining the principles for socio-medical research
involving human subjects. Participants provided informed consent to participate in the study.
The research protocol was approved by the committees of scientific research group review board of
Scientific-Professional Society for Disaster Risk Management, ID-04052020.
Int. J. Environ. Res. Public Health 2020,17, 4124 7 of 23
2.4. Analyses
Descriptive statistics were calculated for the demographic characteristics of the participants
in this study. The analysis of variance (one-way ANOVA with Post hoc Tests-Supplementary),
Chi-square test and the regression analysis were used to examine the relationship between the variables
and preparedness scores of the participants. All tests were two-tailed, with a significance level of
p<0.05. Statistical analysis was performed using SPSS Statistics 17.0 (IBM SPSS Statistics, New York,
NY, USA). The internal consistency of Likert scales for Preparedness Subscale (24 items) is good with a
Cronbach’s alpha of 0.89, for Preventive Measurement Subscale (20) 0.87, Risk Perception Subscale
(13 items) 0.83.
3. Results
The results were based on knowledge, preparedness, risk perception and preventive measures for
coronavirus disease. Starting from the abovementioned methodological framework, the results were
handled into four categories:
Firstly, we tested the central hypothesis that gender, educational level and age were predictive
variables of citizen preparedness for a pandemic disaster. Multivariate regression analysis was used to
determine the extent to which four scores of the subscales (knowledge, preparedness, risk perception,
preventive measures) were associated with six socio-economic variables: gender, age, marital status,
education level, disability, and monthly income. Analyses showed that the assumptions of normality,
linearity, multicollinearity and homogeneity of variance had not been violated.
The results of the multivariate regressions of preparedness subscale showed that the most important
predictor is disability (
β
=0.091), and explains 9.1% variance in preparedness [
40
]. The remaining
variables (e.g., gender, age, marital status, income level) were not significantly affected by preparedness.
This model (R
2
=0.17, Adj. R
2
=0.11, F=2.73, t=4.95, p<0.01) with all mentioned independent
variables explains the 11% variance of preparation (Table 2).
Table 2.
Results of a multivariate regression analysis concerning subscales (preparedness, knowledge,
risk perception, preventive measures) for coronavirus disease (n =975).
Predictor
Variable
Preparedness Knowledge Risk Perception Preventive Measures
B SE βB SE βB SE βB SE β
Gender 1.35 0.71 0.063 0.136 0.128 0.035 0.260 0.397 0.022 4.88 0.949 0.167 **
Age 0.434 0.707 0.021 −
0.297
0.127 −0.081 * 1.52 0.395 0.134 ** 5.46 0.944 0.196 **
Marital status −
0.706
0.622 −0.039 −
0.200
0.112 −0.061 −
0.032
0.348 −0.003 0.507 0.830 0.020
Education level −
0.728
0.674 −0.035 −
0.405
0.121 −0.107 ** −
0.705
0.377 −0.060 * 1.15 0.899 0.040
Disability 14.9 5.29 0.091 * −
0.543
0.953 −0.018 −1.69 2.95 −0.018 −6.13 7.05 −0.027
Monthly income 1.26 0.990 0.042 0.212 0.178 0.039 0.886 0.553 0.052 2.74 1.32 0.066
Adjusted R20.11 0.21 0.19 0.63
*p
≤
0.05; ** p
≤
0.01; B: unstandardized (B) coefficients; SE: std. error;
β
: standardized (
β
) coefficients. Note: males,
young, single-headed households, secondary-school respondents, low income and disabled people have been coded
as 0; 1 has been assigned otherwise.
Further analyses showed that the most important predictor of knowledge subscale was the level of
education (
β
=
−
0.107), explaining 10.7% of the variance, followed by age (
β
=
−
0.081, 8.1%) (R
2
=0.27,
Adj. R
2
=0.21, F=4.43, t=10.37, p<0.01). This model (with all mentioned independent variables)
explains the 21% variance of knowledge. The remaining variables did not have a significant impact on
knowledge (Table 2).
The analyses showed that the most important predictor of risk perception was age (
β
=0.134)
with 13.4% of variance followed by education level (
β
=
−
0.060, 6%). This model with all of the defined
independent variables explains the 19% variance of risk perception (R
2
=0.25, Adj. R
2
=0.19, F=4.16,
t=16.47, p<0.01). The remaining variables did not have significant effects on the perception of risk
(Table 2).
The most important predictor in preventive measures was age (
β
=0.196) which explains 19.6%
of variance followed by the gender (
β
=0.167, 16.7%). This model with all independent variables
Int. J. Environ. Res. Public Health 2020,17, 4124 8 of 23
mentioned explains the 63% variance of preventive measures (R
2
=0.69, Adj. R
2
=0.63, F=11.9,
t=10.07, p<0.01). The remaining variables did not have significant effects on knowledge (Table 2).
3.1. Knowledge of Coronavirus Disease
In terms of basic knowledge, the respondents were offered statements and the possibility to
“agree” or “disagree” (yes or no), when required, coded as 1 or 2, respectively. According to the results,
84.6% of respondents indicated that they had knowledge of epidemics, although 65.8% of them, when
it comes to assessing their knowledge, confirmed zoonotic nature of coronavirus, which means that
virus was transferred from animals to humans. Then, 71.4% of respondents said that at the end of 2019,
COVID-19 virus occurred for the first time in human population in China. Most of the respondents
(95.4%) thought coronavirus-related disease was infectious and 16.3% of the respondents stated that
symptoms occur only after 14 days, while 91.7% of the respondents stated that symptoms occur within
0 to 28 days of infection/exposure to virus. When asked about symptoms occurring in infected persons,
the majority of the respondents (98.2%) noted that common symptoms include fever, severe fatigue
and dry cough. On the other hand, 68.3% of respondents believe that other symptoms include difficulty
breathing, pain, diarrhoea, nausea and runny nose.
The results of Chi-square test showed that there was no relationship between self-perceived
knowledge of COVID-19 and the variables examined. Contrarily, the relationship between COVID-19
was found to be zoonotic disease and educational level. Specifically, the respondents with
completed masters/doctoral studies (75.7%) were more likely to have the above assertion compared to
the respondents who graduated from junior college (37%). In addition, in relation to the argument that
the coronavirus appeared first in China, a statistically significant association with education was found
in such a way that university level respondents (75.8%) agreed with the above-mention statement,
mainly in relation to high-school level respondents (56.6%). A significant statistical correlation was
found between this belief that COVID-19 was contagious and gender that women (96.4%) were more
likely to agree with this statement than men (89.7%). A statistically significant correlation was observed
between the opinion that the symptoms of COVID-19 would occur only after 14 days and the majority
of respondents aged 49 to 58 years of age (50%) support this statement. On the other hand, the statement
that symptoms may occur between 0 and 28 days after exposure to COVID-19 showed significant
statistical association with the level of education and age of respondents. Elderly (55%) and high-school
respondents (18.3%) agree to a greater extent than younger respondents (16%) and university graduates
(15%). Finally, it was also found that agreement with the statement that other symptoms include
difficulty breathing, pain, diarrhoea, nausea and runny nose were associated with educational level
and age. Respondents with a university degree (83.8%) and elderly respondents (73.3%) support this
statement to greater extent than those with high-school degree (71.4%) and younger respondents (65%)
(Table 3).
Table 3.
Chi-square test results between gender, education level, age variables and knowledge
of COVID-19.
Variable Gender Education Level Age
Sig.(2-Tailed) X2Sig. (2-Tailed) X2Sig. (2-Tailed) X2
1. Self-perceived knowledge 0.169 0.287 2.62 0.134 2.59 0.065
2. The corona is zoonotic 2.01 0.157 17.28 0.002 * 5.32 0.256
3. First time in China 0.396 0.529 26.16 0.000 ** 9.01 0.064
4. The disease is contagious 7.27 0.007 * 6.33 0.176 8.02 0.054
5. Symp. manifest after 14 days 0.733 0.392 8.62 0.071 13.57 0.009 *
6. Symp. manifest up to 28 days 3.62 0.067 38.05 0.000 ** 25.40 0.000 **
7. Symp.: fever,fatigue and etc. 1.01 0.314 5.85 0.210 4.71 0.318
8. Other symptoms 3.97 0.054 18.01 0.001 ** 29.33 0.000 **
*p≤0.05; ** p≤0.01.
Int. J. Environ. Res. Public Health 2020,17, 4124 9 of 23
3.2. Preparedness for Coronavirus Disease
Considering the importance of citizens’ preparedness for responding to epidemic-induced
disasters, the respondents were asked to rate the level of preparedness for the coronavirus epidemic
on a scale of 1 to 5. On this occasion, the following descriptive results were obtained: individual
preparedness (X =3.56); household preparedness (X =3.58); local government preparedness (X =2.76);
state preparedness (X =3.12); individual knowledge for responding (X =3.41); enough training for
responding (X =3.11); food supplies (X =3.42); protective equipment (X =3.09); response plans
(X =3.14); household knowledge (X =3.49), training (X =3.26), plans (X =2.56); local community
knowledge (X =2.72), plans (X =2.56), training (X =3.34) and supplies (X =2.79); state knowledge
(X =3.28), trainings (X =3.27), supplies (X =3.58), plans (X =3.18); first responders preparedness
(X =3.79); healthcare institutions—knowledge (X =3.54) and their supplies for responding (X =2.53)
(Table 4).
Table 4.
One-way ANOVA results between gender, education level, and age variables and preparedness
for coronavirus disease.
Variable Mean Std. Deviation Gender Education Level Age
F p F p F p
9. Individual preparedness 3.56 0.89 0.179 0.673 6.64 0.000 ** 6.89 0.000 **
10. Household preparedness 3.58 0.93 1.31 0.252 3.44 0.008 * 2.14 0.094
11. Community preparedness 2.76 1.03 16.87 0.000 ** 5.11 0.000 ** 4.73 0.003 *
12. State preparedness 3.12 1.04 12.78 0.000 ** 4.60 0.001 ** 2.62 0.049 *
13. Enough personal knowledge 3.41 0.96 1.31 0.252 7.64 0.000 ** 10.651 0.000 **
14. Enough personal training 3.11 1.07 3.98 0.047 * 6.98 0.000 ** 10.66 0.000 **
15. Enough food supplies 3.42 1.13 7.06 0.008 * 8.95 0.000 ** 14. 663 0.000 **
16. Enough of req. prot. equipment 3.09 1.24 2.70 0.100 3.69 0.005 * 1.87 0.132
17. Personal response plans 3.14 1.07 0.716 0.398 10.95 0.000 ** 5.66 0.001 **
18. Enough household knowledge 3.49 0.96 0.971 0.325 8.22 0.000 ** 5.96 0.001 **
30. First responders preparedness 3.79 1.02 3.41 0.065 4.87 0.001 ** 9.22 0.000 **
*p≤0.05; ** p≤0.01.
When the association between gender and different variables of preparedness to respond to
disasters caused by COVID-19 was analyzed, it was found that women rate local communities
and states at a higher level of preparedness, while level of training and food supply is ranked
lower. Significant statistical association was found between the educational level and different
variables of preparedness, with respondents who received a high-school degree noting highest scores
for household, local community, members of the emergency services preparedness. Furthermore,
respondents with completed masters or doctoral studies expressed the highest rates of self-assesed
individual preparedness, training for adequate response, household-level plans. Besides that, junior
college respondents noted the highest scores for state preparedness and the possession of sufficient
food supplies. Finally, it was confirmed that university-level respondents reported the highest level of
knowledge for adequate response and the possession of sufficient protective equipment (Table 4).
On the other hand, when the age of respondents was analyzed, it was determined that respondents
aged 29 to 38 years have reported the highest rates of ownership of sufficient food supplies.
Also, it is found that respondents aged 39 to 48 report highest scores for individual preparedness,
the level of knowledge required for adequate response, and the level of household response knowledge.
Preparedness of first responders was the best evaluated by the respondents aged 18 to 29. On the other
hand, respondents aged 58 or older years assessed the level of disaster response training in question
and having plans (Table 4).
3.3. Risk Perception and Informing of Coronavirus Disease
Starting with the importance of informing citizens on a timely basis of current risks regarding
the coronavirus epidemic, respondents were asked to rate between 1 and 5 different ways of informing
on a Likert scale from. The results of the survey showed that citizens get the most information online
(X =4.23), then TV (X =3.88), family members (X =3.19), friends (X =3.10), members of first respondent
Int. J. Environ. Res. Public Health 2020,17, 4124 10 of 23
services (X =2.45), scientific journals (X =2.33), local community (X =2.22), newspapers (X =2.02),
chosen physician (X =1.98), government organizations (X =1.86), radio (X =1.74). As a result,
in order to obtain needed information about the current status of the coronavirus epidemic, citizens
the most frequently use the internet and radio were the least used. In relation to the source of
information, the most reliable information was obtained by experts (epidemiologists, other physicians
and experts in the field of disaster risk management) (X =4.35), websites of international health
organizations (WHO, Centers for Disease Control and Prevention, etc.) (X =3.48), addresses of official
state governance structures (X =3.87), social networks (X =3.10), communications from educational
institutions (X =2.74), national Institute of Public Health website (X =2.70), websites of local medical
institutions (X =2.47) (Table 5).
Table 5.
One-way ANOVA results of information sources of citizens and gender, education level,
and age the variables on the risk perception of coronavirus disease.
Variable Mean Std. Deviation Gender Education Level Age
F p F p F p
33. Television 3.88 1.17 39.09 0.000 ** 3.76 0.005 * 8.93 0.000 **
34. Radio 1.74 1.08 0.055 0.814 7.31 0.000 ** 6.46 0.000 **
35. Newspaper 2.02 1.31 2.07 0.064 6.69 0.000 ** 1.13 0.045
36. Internet 4.23 0.98 0.090 0.764 1.34 0.251 7.68 0.000 **
37. Scientific journal 2.33 1.44 0.036 0.849 4.18 0.002 * 5.11 0.001 **
38. Local medical website 2.47 1.37 23.26 0.000 ** 7.55 0.000 ** 5.25 0.001 **
41. Addressing of a statesman 3.87 1.23 103.23 0.000 ** 5.04 0.011 * 17.20 0.000 **
42. Addressing of an expert 4.35 0.84 53.10 0.000 ** 1.83 0.052 3.49 0.015
43. The social network 3.10 1.41 2.45 0.118 1.55 0.185 1.57 0.195
44. Family members 3.19 1.24 0.249 0.618 7.46 0.000 ** 2.26 0.079
45. Friends 3.10 1.22 1.20 0.272 5.72 0.000 ** 11.23 0.000 **
46. Local community 2.22 1.23 0.560 0.454 4.65 0.001 ** 0.218 0.884
47. Chosen physician 1.98 1.30 814 0.314 8.27 0.000 ** 2.61 0.050
48. First responders 2.45 1.38 0.184 668 6.37 0.000 ** 14.75 0.000 **
49. Non-government org. 1.86 1.10 0.853 0.356 8.96 0.000 ** 3.43 0.017
50. Educational institutions 2.74 1.39 6.47 0.11 * 14.33 0.000 ** 19.00 0.000 **
*p≤0.05; ** p≤0.01.
By examining the relationship between gender and various variables of information sources, it was
found that men are mostly informed via television. On the other hand, women are mostly informed
through the websites of local medical institutions, and most believe the information provided through
the addresses of the officials and experts and educational institutions (Table 5). In addition, it was
found that the majority of men reported that infected individuals develop mild to moderate respiratory
symptoms, from which they will recover quickly without special treatment. Women, on the other hand,
were mostly afraid of the health of family members and fear of the major economic consequences of
the disaster (Table 5).
As regards the association between education and various information variables, it was found that
respondents with high school graduation are mostly informed by television, radio, websites of local
health institutions, addresses of officials, friends, local communities, chosen physicians, members of
first-time respondents services (Table 5). Respondents with a university degree were found to be mostly
informed through non-governmental organizations, educational institutions. Then, respondents with
a masters/doctoral degree are mostly informed through the newspaper, scientific journals, family
members (Table 5).
In the context of respondents age, those aged 18 to 29 are more informed through television
to the greater extent, have the highest level of trust in information obtained through addressing of
the officials. Additionally, respondents aged 29 to 38 are mostly be informed by friends. On the contrary,
respondents aged 39 to 48 are mostly informed through the internet, scientific journals, websites of
local health institutions, members of first responders services, educational institutions. In addition,
respondents aged 58 years and older are most frequently informed via the radio and state that they are
in the higher risk of epidemics due to their place of residence (Table 5).
In the following, examining of the different dimensions of risk perception we obtained the following
attitude ratings: (a) The likelihood that I will be infected with the virus is low (X =3.00); (b) The majority
Int. J. Environ. Res. Public Health 2020,17, 4124 11 of 23
of people who become infected will develop mild to moderate respiratory symptoms, from which
they will recover without the need for special treatment (X =3.43); (c) Elderly people and those with
chronic illnesses (e.g., respiratory, cardiovascular, diabetes, immunity, etc.) are at the highest risk of
developing severely treatable diseases and are at high risk of death (X =4.52); (d) I believe that even if
I do get infected I will not develop serious health problems (X =3.66); (e) Although they are not at
risk of developing severe illnesses, I find it good that children do not go to kindergartens and schools
(X =4.71); (f) I think that I am in a higher risk of being infected with the virus because of where I
live (X =2.90); (g) I believe that because of the epidemic and the state of emergency declared, I am at
risk of losing my job and source of income (X =2.72); (h) I believe that through my behavior (taking
preventive measures) I can prevent the spread of virus (X =4.51); (i) I feel that I have a responsibility to
do what I can to protect people at risk (X =4.58); (j) we will not be able to stop the spread of the virus by
following the introduced measures (X =2.30); (k) I think I have all the information I need to critically
review the situation in our country caused by epidemic and decide what to do (X =3.60); (l) I fear for
the health of family members (X =4.11); (m) I fear that the economic consequences of the epidemic will
be great for society (X =4.28); (n) I’m afraid the restriction on movement will prevent me from meeting
my needs (take medication, taking money, buy groceries) (X =2.62).
In relation to the association between education and various risk assessment factors, respondents
with a high school diploma rate the highest statement that protective actions will avoid the spread of
the virus, statement of obligations for taking measures to protect people at-risk, and the statement
that they are afraid of limitations. Respondents with a university degree were found to have mostly
assessed the level of risk of being unemployed, and stated that they needed information for critical
evaluation of the situation (Table 6).
Table 6.
One-way ANOVA results of psychological behaviours of citizens and the variables of gender,
education level, and age on the risk perception of coronavirus disease.
Variable Mean Std. Dev. Gender Education Level Age
F p F p F p
51. The likelihood of infect. 3.00 1.12 0.024 0.877 2.52 0.055 6.32 0.000 **
52. Respiratory problems 3.43 1.09 13.01 0.000 ** 5.59 0.068 5.23 0.001 **
53. Most severe symptoms 4.52 0.73 3.08 0.079 1.63 0.164 2.44 0.062
54. Serious health 3.66 1.03 4.79 0.029 5.06 0.000 ** 1.86 0.134
55. Kindergarten or school 4.71 0.73 0.004 0.947 2.31 0.056 2.13 0.057
56. A place of greater risk 2.90 1.49 0.518 0.475 2.84 0.051 37.2 0.000 **
57. Losing my job 2.72 1.48 2.10 0.147 2.78 0.026 * 1.86 0.067
58. Prevent behavior 4.51 0.77 0.121 0.728 4.24 0.002 * 9.41 0.000 **
59. The responsibility 4.58 0.75 1.05 0.305 4.34 0.002 * 7.33 0.000 **
60. Respecting measures 2.30 1.33 0.484 0.487 9.02 0.000 ** 1.43 0.231
61. Information critically 3.60 1.03 0.925 0.336 2.71 0.029 * 1.53 0.205
62. I’m afraid of health 4.11 1.02 20.24 0.000 ** 2.21 0.065 1.51 0.208
63. Econ. consequences 4.28 0.94 24.05 0.000 ** 1.80 0.127 1.90 0.064
64. Fear of restrictions 2.62 1.31 0.147 0.701 3.17 0.013 * 2.28 0.078
*p≤0.05; ** p≤0.01.
In the context of respondents’ age, those aged 18 to 29 stated that their behaviour, which was
taking preventive measures, could stop spreading of the COVID-19, and that even if they were infected,
they wouldn’t develop serious health problems. Respondents aged 18 to 29 showed the highest scores
for assessment of first respondents services preparedness, stated that the majority of infected persons
would develop mild to moderate respiratory symptoms and had a responsibility to do what they could
to protect others (Table 6).
3.4. Preventive Measures for Coronavirus Disease
Despite the high importance of preventive measures to prevent the further spread of the epidemic,
different claims on the Likert scale were made to the respondents, and the following results were
obtained. Wash hands with soap and water for 20 s (X =4.78), use disinfectants to maintain the hygiene
of the room (X =4.47), wear protective mask (X =3.25), wear protective gloves (X =3.16), do not
touch the face (eyes, nose, mouth) (X =3.95), do not shake hands with acquaintances (X =4.65), do not
Int. J. Environ. Res. Public Health 2020,17, 4124 12 of 23
hug with family members, friends, acquaintances (X =4.29), do not kiss on the cheek with family
members, friends, acquaintances (X =4.31), keep a recommended distance of 2 m from other people
(X =4.15), respect restrictions of movement in public places (X =4.88); avoid contacts with people
over 65 (X =4.63), do not see family members with whom they do not live in the same household,
friends, acquaintances (X =4.23), using a disinfectant to clean my shoes and clothes in which I went
to make my purchases, to the workplace (X =3.66), disinfect the pet’s paws upon returning from
the walk (X =3.30), move pets out of the living space and no longer have contact with them (X =2.71),
to make a plan with the members of my household about the modes of isolation if necessary (X =2.85),
Preparing a diet plan and necessary food with household members (X =3.36), having supplies of
groceries needed for 3 days of isolation (X =3.36), having supplies of groceries needed for 3–7 days
of isolation (X =4.27), having supplies of groceries for a month and longer (X =3.63). Respondents
were also asked whether they had been engaged in any form of assistance prior to the epidemic of
the coronavirus, and it was found that 68.6% of respondents were not engaged before the epidemic,
while 29.2% of respondents were involved during the epidemic before or at the time of research.
Examining the relationship between gender and different preventive measures variables, it was
found that women use soaps to a greater extent, disinfect clothing and footwear, wear protective mask,
do not touch their face, do not shake hand with acquaintances, avoid contact with the elderly, do not see
family members, disinfect pet’s paws. On the other hand, males only use disinfectants more (Table 7).
Table 7.
One-way ANOVA results of different groups of independent variables and variables on the
preventive measures for coronavirus diseases.
Variable Mean SD Gender Educ. Level Age
F p F p F p
64. I wash my hands with soap 4.78 0.54 40.14 0.000 ** 0.31 0.868 1.00 0.392
65. I’m disinfecting my hands 4.47 0.87 39.95 0.000 ** 2.41 0.057 0.416 0.742
66. I wear a protective mask 3.25 1.6 13.92 0.000 ** 1.97 0.097 1.00 0.389
67. I wear protective gloves 3.16 1.67 18.16 0.000 ** 1.72 0.142 2.25 0.081
68. I don’t touch my face 3.95 1.17 26.58 0.000 ** 2.16 0.071 1.29 0.275
69. I don’t shake hands with acquaintances 4.65 0.85 14.78 0.000 ** 4.44 0.001 * 7.13 0.000 **
70. I’m not hugging others 4.29 1.17 1.97 0.160 6.07 0.000 ** 4.40 0.004 *
71. I do not kiss others 4.31 1.22 2.86 0.091 7.83 0.000 ** 8.06 0.000 **
72. Maintaining recommended distance 4.15 1.12 0.009 0.926 7.92 0.000 ** 18.57 0.000 **
73. I respect movement restrictions 4.88 0.44 0.107 0.743 2.08 0.081 4.31 0.005 *
74. I avoid contacts with the elderly 4.63 0.84 12.33 0.000 ** 2.06 0.084 15.46 0.000 **
75. I don’t meet with family members 4.23 1.21 37.97 0.000 ** 1.44 0.227 2.27 0.078
76. I use disinfectants for clothes and shoes 3.66 1.41 10.48 0.001 ** 2.21 0.066 4.97 0.002 *
77. Disinfection of pets paws 3.30 1.78 28.79 0.000 ** 4.08 0.003 * 5.29 0.001 **
78. I have no contacts with pets 2.71 1.79 2.37 0.123 5.07 0.000 ** 17.63 0.000 **
79. Plan isolation household members 2.85 1.53 0.013 0.909 4.70 0.001 ** 5.73 0.001 **
80. Household nutrition plan 3.36 1.46 2.70 0.057 1.80 0.126 15.64 0.000 **
81. I have groceries 4.27 1.20 1.97 0.161 8.88 0.000 ** 3.88 0.000 **
82. I have enough supplies 3.63 1.48 0.012 0.915 11.00 0.000 ** 3.90 0.009 *
*p≤0.05; ** p≤0.01.
In relation to the association between educational level and various variables of risk perception,
it was found that respondents with high school respondents were most likely commonly made isolation
plans for their households. Furthermore, respondents with junior college degrees avoid hugging,
and kissing with family members, friends and acquaintances and use disinfectants for clothes and shoes
to the highest extent. Respondents with a university degree avoid contacts with pets to the highest
degree. Finally, respondents with completed masters/doctoral studies to the highest degree avoid
shaking hands, maintaining recommended distance, having food supplies for months or more (Table 7).
When age of respondents was analyzed, it is found that respondents aged 29 to 38 years to
the highest extent respect movement restrictions, have food supplies for a month or more, and avoid
contact with the elderly. Respondents aged 39 to 48, on the other hand, most commonly avoid hugging,
and kissing with family members, friends and acquaintances, then carry out disinfection, and avoid
contacts in general. Additionally, respondents aged 49 to 58 to the highest degree, avoid shaking hands,
they maintain recommended distance, disinfect their pets’ paws and make dietary plans (Table 7).
Int. J. Environ. Res. Public Health 2020,17, 4124 13 of 23
4. Discussion
The results of this study showed that the respondents had knowledge gaps three weeks after
the state of emergency was declared. It was not expected that 84.6% of respondents would state
that they had knowledge of epidemics and how to prevent them, since 43.1% of respondents agreed,
26.6% were not sure and 24.7% disagreed with the same statement in 2015 [
13
]. This finding is even
more confusing when we look at the results of perceived sufficient knowledge and training to respond
properly to epidemic emergencies. Respondents expressed the highest degree of understanding that
COVID-19 is a contagious disease and that most commonly manifests symptoms such as fever, fatigue
and dry cough. In addition, most of them even recognized that symptoms could manifest within
28 days of exposure to virus at a time when the possibility of incubation period longer than 14 days
was newly introduced to the public. In contrast to health information, respondents were less receptive
to “technical” information on the novel coronavirus, its nature and first occurrence. These findings
could be the result of greater monitoring of health experts broadcasted on television and online every
day, focusing on health information. Additionally, at the time of this research respondents could find
many “conspiracy theories” online, even in national media and social networks, which could led to
theirs suspicion and lower level of agreement with these statements. Nevertheless, this general publics’
more responsiveness to health information in the event of an epidemic should be considered when
informational campaigns are launched, since this finding is congruent with some of identified publics’
need for information in the case of bioterrorism—infection, transmission prevention and exposure
detection [41].
The strongest predictor of knowledge was education level, that is, the more educated a person was,
the more knowledge they have of effective measures to prevent infection and disease with COVID-19.
Previous studies in Serbia have also shown that the educational level (university and high school
graduated) is correlated with higher level of epidemiological knowledge and a proper respond [
13
].
It is interesting to note that respondents with high school degree and younger respondents have
been more likely to recognize that COVID-19 symptoms could occur within 28 days period and other
symptoms possible symptoms. These categories have reported that they mostly inform trough
television broadcasts and experts’ addressing’s, thus leading to the conclusion that informing of
the Serbian public about the novel coronavirus had its strengths.
Gender has also been found to be predictive of knowledge, with women being more likely to
agree with the fact that COVID-19 is a contagious disease. Bearing in mind that women in Serbia
have already demonstrated a higher level of knowledge about epidemics [
13
,
42
] the question arises
as to whether this finding is biased due to the sampling method. However, previous studies have
found conflicting results. Some of them discovered males [
39
,
43
] and elderly respondents to be more
knowledgeable [43] while others found females to be more knowledgeable [44].
Our respondents consider household and individual preparedness to be higher than the state
and local community preparedness. This is not surprising since social, economic, functional,
institutional and political factors have had an impact on successful emergency management [
45
]
and Serbian citizens have been protesting for months before epidemic claiming that they had enough of
problems in affected areas. The fact that government has changed its opinion about epidemic severity
for its population, as well as for other officials, dealing with catastrophic scenarios and equipment
shortages (of respirators especially), has most certainly reduced the perception of preparedness.
Additionally, the perceived knowledge of healthcare institutions and response supplies are consistent
with the idea that coronaviruses are not new, although COVID-19 is, to our healthcare professionals
and lack of protective equipment and disinfectants in the country at the time of research.
Multivariate regression results demonstrated that some type of disability (invalidity and/or
chronically disease) is the most important predictor of individual preparedness, although those
with higher educational levels and between 38 and 49 years of age were most certain of their
preparedness. In previous epidemic preparedness study in Serbia, males with higher educational
level and non-disability perceived their individual preparedness higher than other respondents [
13
].
Int. J. Environ. Res. Public Health 2020,17, 4124 14 of 23
On the other hand, both male and younger respondents had higher scores on household and community
preparedness for earthquakes in Serbia [
46
]. In the case of floods and fires, males in Serbia were more
confident in their ability to cope and perceived greater individual and household preparedness [
42
,
47
].
Males from Belgrade were most confident in individual, household and community preparedness for
terrorist attacks, and respondents with high school degree in household and community preparedness.
Various age categories demonstrated different terrorism preparedness perception: younger respondents
perceived household preparedness greatly, middle aged individual, while elderly believed most in
community preparedness [
48
,
49
]. Given that perception of preparedness is significantly different
in the event of various disasters, this study finding could be explained by proactive approach of
more educated and middle aged respondents towards information gathering, since they have mostly
reported internet, websites of medical institutions, scientific journals, etc. as sources of information
and believed that they have information needed to critically evaluate the situation they are in. The higher
preparedness level of local community and state was perceived by those with high school and junior
college degrees, respectively, and women for both. These findings could be the result of frequent
television monitoring for respondents with high school degree and higher levels of trust among women
towards experts which were addressing to the public on a daily basis.
Although television and continuous broadcasting of experts’ addresses were among the most
frequently selected information sources, the results of our study demonstrated that most citizens
received most of their information about novel coronavirus online via the internet and used radio
only infrequently. Women were more engaged in information seeking activities than men, as was also
found in the case of the A (H1N1) epidemic [
26
]. The internet preference over television as information
source was previously identified in the research on Serbian publics’ opinion about bioterrorism [
15
].
Obtained results could be explained by the fact that since all respondents were recruited online, they
represent preselected internet users. Nevertheless, Serbian public expressed an increasing tendency to
turn away from television and, especially, from radio, and to the internet and social networks with
only 9.4% of participants, with media confidence on average ranging from 23.3% among the elderly
to 5.3% among the youngest participants [
50
]. Another one research showed that 61% of Serbian
citizens do not trust the media [
51
] and that 65% of Serbian citizen use the internet in 2015 [
52
].
This explanation should be extended to the context of Serbian media environment, which was found to
be neglect progress in the area of freedom of expression, threats, intimidation, and to show violence
against journalists, nonexistent transparency of media ownership, partial implementation of media
regulations and insufficient European Commission Regulatory Body for Electronic Media (REM), 2016.
Additionally, the public broadcaster Radio Television of Serbia (RTS) tends to be a service of the ruling
political party [
53
], N1 television lost its national frequency prior the epidemics since they were one of
few who opposed the ruling party, and while a few remaining national broadcasters are predominately
turned towards entertainment and lifestyle programming. It is important to note that the independent
journalist Ana Lali´c was arrested on the night of 1 April 2020 for releasing the story about significant
shortage of equipment in the Vojvodina Clinical Center [
54
] that continues to claim to have originated
from reliable sources and in line with the principles of investigative journalism.
In relation to the source of information, the most trusted information was obtained from experts
such as epidemiologists, other physicians and experts in the field of disaster risk management),
websites of international health organizations, internet links to official state governance structures,
communications from educational institutions, websites of the Institute of Public Health and local
medical institutions such as schools of medicine. These results are further consistent with Serbian
publics’ trust in institutions, with educational (61%) and healthcare (57%) institution viewed as
trustworthy [
51
]. Kwok et al. [
28
] also reported that doctors (84%), thus the experts, are the most
trusted sources of information, followed by television (57%) and newspapers (54%). Hong Kong
citizens reported social platforms (94%) and official or non-official websites (90%) as the most common
sources of information, although they were considered as “only 16–23% of the respondents to be
reliable or very reliable”.
Int. J. Environ. Res. Public Health 2020,17, 4124 15 of 23
Respondents were worried about the health of their family members and thought that kindergartens
and schools should be closed even if children are not at-risk. Although they have not recognized
their personal risk as high, they have understood that elderly citizens and those with chronic diseases
are in great risk and that they have the responsibility to take actions in their power to protect them.
The fact that males expressed a lower perception of their personal risk for becoming ill is consistent
with understanding that females in Serbia are the ones most likely to fear because they have been
taught that they should be protected [
49
]. In case of H1N1 influenza epidemic, females were also
identified as having higher personal susceptibility higher [26,27].
Younger respondents were aware that probably they likely to develop serious health problems
but that their behavior could stop spreading of the virus. This was the focal thesis of all the officials
and experts addressed by the broadcasted, thus our results without a doubt testify to their effectiveness.
Even the lowest level of agreement among elderly respondents that they are at-risk because of their
place of residence is consistent with this claim. Place of residence, in terms of higher number of
cases was found to be significant during A (H1N1) epidemic in the US [
26
]. Citizens of Hong Kong,
on the other hand, perceived their susceptibility (89%) and severity (97%) as high and 97% of survey
respondents were worried about COVID-19. Namely, most of the respondents thought that were
very likely to likely to get infected (89%) and that symptoms of COVID-19 are very serious or serious
(97%), while only 15% of them thought that they are likely to be cured in infected and 18% that they
would survive. Since the respondents in this sample were mostly young (80% of them were between
18 and 44 years of age [
28
] it could be concluded that Serbian sample had better understanding of
COVID-19 health implications.
Among respondents, fear about economic impact of the epidemic was common, although they
were not as much worried about losing their jobs. This finding is somewhat contrasting until we
consider that most of the respondents were younger citizens and students, and that fear of job losses
was the highest among university-level respondents, thus employed subsample. It also points out
the fact that younger respondents are aware of the potential impact of the epidemic on society, especially
since the unemployment and economic problems were identified as the biggest problems (41%) of
Serbian youth [55].
Respondents reported significant behavioral changes in hand hygiene, social distancing
(recommended distance, movement restriction, avoiding elderly and family members). On the other
hand, significant lack of protective masks and gloves, as well as disinfectants, could be considered as a
cause of poorer adherence to these measures. This conclusion is further supported by the respondents’
perception of having enough of required protective equipment since lack of it could have an impact on
their usage. Additionally, the efficacy of protective masks for healthy people was advocated to be low by
WHO and national health experts at the time of this research. However, the respondents have perceived
that preventive measures were effective. Hong Kong citizens also reported significant behavioral
changes when it comes to hygiene practices, but lower adoption of social distancing measures, although
they have considered them useful in preventing COVID-19 [
28
]. The H1N1 [
19
,
23
] and SARS [
17
]
epidemic in Hong Kong were also seen prevalent adoption of hygiene practices. On the other hand,
UK residents have reported low levels of precautionary measures during H1N1 epidemic, with 62% of
respondents reporting no change in the frequency of hand washing (72%), cleaning or disinfecting
(83%) or discussing plans with people who should take care of them if they get ill (83%) [
17
]. Finally,
all countries should urgently take all necessary measures to slow further spread and prevent their health
systems from becoming overwhelmed by seriously ill patients with COVID-19. Also, respondents
have reported significant attention to nutrition plans and food supplies, despite frequent assurances
from officials that food supplies are not a problem, or because of them? Respondents with masters or
doctoral degree were most likely to report stockpiling more than a month’s worth of food supplies in
their homes even though it has previously been shown that educational levels indicate a wider range
of information sources and perceived individual and household preparedness. Until the declaration of
the state of emergency, it should be remembered that the products were “disappearing” from the raffles,
Int. J. Environ. Res. Public Health 2020,17, 4124 16 of 23
in particular wheat, yeast, oil and toilet paper. While this may be a legacy of the past (inflation, civil war
and NATO bombing), it should be further examined whether more educated citizens acted on the basis
of information they’ve gathered (and critical evaluation of them) or on general distrust of statements
made by officials.
Additionally, age was demonstrated to be the most important predictor of preventive measures,
although gender and educational level were also significantly predictive to adopting precautionary
measures. It is interesting that younger respondents reported the highest level of restriction on
movement, since it could be the result of high reception of messages from television and experts,
but could also be the result of the penalties imposed. In the sense of Serbian economy, it is important
to note that the average net salary in February 2020 was 58,132.00 RSD ($535.26) while the amount
of the misdemeanor sentence for non-compliance with the travel ban was set at 50,000.00 to
150,000.00 dinars or between $460.38 and $1381.15 [
38
]. Thus, perception of risk shouldn’t be
seen as motivator for the adoption of respect for the prohibition of movement among respondents,
given that personal risk was not perceived as high and that the penalties mentioned were determined
after the motion restriction recommendation was not followed. Additionally, for the past few weeks
political opposition to ruling party and civil activist movements accused the government of dictatorship
and contempt of the Constitution of the Republic of Serbia.
Gender differences in adoption of preventive measures could be explained by their traditional
roles in Serbia, with women more concentrated on family and/or household care, as can be seen
in the study of earthquake preparedness study [
46
]. Females in our sample are the most likely to
disinfect their home, clothing, and adopt social distancing to a greater extent than men, who only
used disinfectants more for hand hygiene. Household care and behaviours were also demonstrated in
the flood preparedness study in Serbia, as well as willingness to help flood victims [
55
]. Female gender
was also found to be predictive of better adoption of precautionary measures in Hong Kong during
COVID-19 epidemic as a public health emergency of international concern [
28
] and Korean study of
influenza epidemic [
27
]. This was the case with females in Hong Kong during the SARS epidemic,
but old age and higher levels of education were also more likely to take comprehensive precautionary
measures to prevent infection [
17
]. On the other hand, being male and of old age was predictive of
better preventive practice in the case of Dengue epidemic study in Wah Cantt [43].
As regards the association between educational level and various variables of preventive measures,
it was found that high school respondents most commonly planned for their homes to be insulated,
respondents with a junior college education avoided gestures of affection such as hugging and kissing
family members, friends and acquaintances and were more likely to use disinfectants when cleaning
their clothes. It should also be remembered that for weeks prior the epidemics Serbian citizens bought
a large quantity of Asepsol (0.1%, 1% and/or 5% solution of ADBAC/BKC (C
12
–C
16
) and gel-based
hand sanitizers only to be told during the state of emergency that only products containing 70% alcohol
and those based on chlorine had a protective effect. Respondents with a university degree were
most likely to avoid contacts with pets. Finally, respondents with masters or doctoral degrees were
most likely to avoid shaking hands, maintain recommended social distances, and store more than
a month’s worth of food supplies in their homes. On the other hand, Ramzan et al. [
42
] have
found that the level of educational had no association with preventive behavior of their respondents.
The proportion of volunteers in the survey sample is slightly higher than the findings of previous
research on youth volunteerism (2007—20%; 2009—15%; 2011—20%; and 2012: 21%) with the most
significant motivational factor helping those in need [55].
The limitations of our study include: (1) potential bias in selecting study subjects to complete
questionnaires, (2) no study participants had any experience with a “real life” global pandemic
emergencies, (3) insufficiently representative sample of respondents, (4) the timing of the study
(the research was conducted in first phase, but the COVID-19 pandemic is still ongoing, and this
may also have an impact on the study), (5) in particular the mental state of the respondents due to
the overall situation etc.
Int. J. Environ. Res. Public Health 2020,17, 4124 17 of 23
5. Conclusions
The risk to communities with continued widespread transmission depends on the characteristics of
the virus, including how well it spreads among people; the severity of resulting illness; and the medical
or other measures available to control the impact of the virus (for example, vaccines or drugs that
can treat the illness) and the relative success of these. In the absence of vaccines or medications,
non-pharmaceutical interventions become the most important response strategy based on citizen
preparedness measures such as person-to-person distancing, mask-wearing, isolation and good
personal hygiene (hand-washing)—all of which have been demonstrated to reduce the impact of this
seemingly unstoppable globally spreading natural disaster. The possibility that the COVID-19 virus
could behave differently from previous coronavirus outbreaks in 2003 and 2015 requires new research
studies, assessments, and plans to address a novel virus with high transmission in the community
and severe morbidity and mortality.
The study described in this paper deals with the critical initial steps in the process of preparing for
a pandemic disease disaster, i.e., determining the general knowledge of citizens in Serbia regarding their
level of knowledge regarding the general threat that novel coronavirus 2019 poses to both themselves
and the wider community, risk perception, risk management and the recommended preventive
approach. The results of this study demonstrated the importance of knowledge, preparedness,
risk perception and preventive measures to effectively respond to a COVID-19 outbreak. We tested
the central hypothesis that gender, educational level and age are predictive variables for stronger
citizen preparedness for a pandemic disaster.
Results of our survey indicate that there are major differences in the Serbian public’s perception of
risks presented by pandemic Novel Coronavirus 2019 particularly their general knowledge vis-
à
-vis
the general threat that novel coronavirus 2019 presents to both themselves and the community at
large, risk perception, risk management and recommended preventive measures to take to decrease
the possibility of becoming ill or dying from COVID-19. The study described in this paper addresses
critical initial steps in the process of local and national preparation for a pandemic disease disaster.
We encourage emergency management agencies in Serbia to use the differences in public perception
of risks identified in our study to develop enhanced anti-pandemic disease preparedness measures
by promotion of behavioural changes that go hand in hand with the of adoption of improved risk
management decision-making procedures.
All cities and towns in Serbia need to have disaster plans that are tailored to specific scenarios
and locations, not preconceived generalized plans. Airport plane crashes, stadium catastrophes,
and remote mass transit accidents are all very different from those caused by deadly infectious
microorganisms such as COVID-19 and require different responses. Communications need to be
standardized and supported. Triage needs to be thought through more clearly. Future research
would benefit from a more epidemiological approach (e.g., case-control and cohort studies) to identify
risk factors for poor community responses to communicable disease disasters such as epidemics,
“before and after” studies looking at a population in Serbia that has been affected by infectious
disease disasters such as coronavirus pandemics, and studies using currently validated modelling
and simulation methods.
Supplementary Materials:
The following are available online at http://www.mdpi.com/1660-4601/17/11/4124/s1,
Data: Anova results with Post hoc Tests with gender, age and education variables.
Author Contributions:
V.M.C. had the original idea for this study and developed the study design
and questionnaire with U.R.N., V.M.C., N.N., U.R.N. and M.Z. contributed to questionnaire dissemination,
while V.M.C. and N.N. analyzed and interpreted the data. U.R.N. and A.Ö. made special contribution by drafting
the introduction; U.R.N. and E.K.N. have drafted the discussion and E.K.N. the conclusions. V.M.C., N.N.,
U.R.N., A.Ö., E.K.N. and M.Z. critically reviewed the data analysis and contributed to the content for revising
and finalizing the manuscript. All authors have read and agreed to the published version of the manuscript.
Funding:
This research was funded by Scientific-Professional Society for Disaster Risk Management, Belgrade,
Serbia (http://upravljanje-rizicima.com/).
Int. J. Environ. Res. Public Health 2020,17, 4124 18 of 23
Conflicts of Interest: The authors declare no conflict of interest.
Appendix A
1. Gender: (a) Male; (b) Female
2. I’m _________ (insert number) years old.
3. Educational level:
a. Primary school;
b. High-school;
c. Junior college;
d. Undergraduate/University;
e. Masters/doctoral studies.
4. Average monthly income for household per month:
a. Up to $275;
b. $275 to $465;
c. $466 to $740;
d. Over $741.
5. Marital status:
a. Single;
b. In a relationship;
c. Married;
d. Divorced;
e. Widow.
6. Do you have any invalidity or chronical illness? (a) Yes; (b) No.
Appendix A.1 Knowledge about Coronavirus Caused Emergency
Please note if you “agree” (Yes) or “disagree” (No) with following statements.
No. Statements Yes No
1. I know what epidemic is.
2. Coronavirus is zoonotic, which means it was transferred from animals to humans.
3. The first COVID-19 outbreak in human population was in China at the end of 2019.
4. The disease novel coronavirus causes is contagious.
5. Symptoms manifest exclusively after 14 days.
6.
Symptoms could manifest in the period between 0 and 28 day after the exposure to virus.
7. Common symptoms are fever, fatigue and dry cough.
8. Other symptoms include difficulty breathing, pain, diarrhea, nausea and runny nose.
Appendix A.2 Preparedness for Coronavirus Caused Emergency
Please indicate the degree of agreement with the statements made, where 1 stands for “I strongly
disagree” and 5 for “I strongly agree”.
No. Statements 1 2 3 4 5
9. I find myself individually prepared to respond to emergencies caused by novel coronavirus epidemic. 1 2 3 4 5
10. I find that my household is prepared for emergency response caused by novel coronavirus epidemic. 1 2 3 4 5
11. I consider my local government prepared to respond to emergencies caused by novel coronavirus epidemic. 1 2 3 4 5
12. I consider that my country is prepared to respond to emergencies caused by novel coronavirus epidemic. 1 2 3 4 5
13. I find that I have sufficient knowledge to respond properly to emergencies caused by epidemics. 1 2 3 4 5
14. I find that I am trained enough to respond properly to emergencies caused by epidemics. 1 2 3 4 5
15. I find that I have enough supplies of food, medicine, etc. 1 2 3 4 5
Int. J. Environ. Res. Public Health 2020,17, 4124 19 of 23
16. I find that I have the necessary protective equipment. 1 2 3 4 5
17. I consider that I have prepared adequate response plans during the outbreak. 1 2 3 4 5
18. I think we have enough knowledge within the household to respond during an epidemic. 1 2 3 4 5
19. I think we have enough training within the household to respond during an epidemic. 1 2 3 4 5
20. I think we have enough supplies within the household to respond during an epidemic. 1 2 3 4 5
21. I think we have effective plans within the household to respond during an epidemic. 1 2 3 4 5
22. I believe that my local community has enough knowledge to respond during an epidemic. 1 2 3 4 5
23. I believe that my local community has enough training to respond during an epidemic. 1 2 3 4 5
24. I believe that my local community has enough supplies to respond during an epidemic. 1 2 3 4 5
25. I believe that my local community has effective plans to respond during an epidemic. 1 2 3 4 5
26. I believe that my state has enough knowledge within the household to respond during an epidemic. 1 2 3 4 5
27. I believe that my state has enough training within the household to respond during an epidemic. 1 2 3 4 5
28. I believe that my state has enough supplies within the household to respond during an epidemic. 1 2 3 4 5
29. I believe that my state has effective plans within the household to respond during an epidemic. 1 2 3 4 5
30.
I believe that first responders (police, fire and rescue units, ambulance) are ready to respond to emergencies caused
by epidemics. 1 2 3 4 5
31. I believe that health care institutions have enough knowledge to respond to epidemic of novel coronavirus. 1 2 3 4 5
32. I believe that health care institutions have enough supplies to respond to epidemic of novel coronavirus. 1 2 3 4 5
Appendix A.3 Risk Perception and Information Sources
What are the sources of information about novel coronavirus epidemic and pandemic?
Please indicate the degree of agreement with the statements made, where 1 stands for “I strongly
disagree” and 5 for “I strongly agree”.
No. Statements 1 2 3 4 5
33. Television 1 2 3 4 5
34. Radio 1 2 3 4 5
35. Newspapers 1 2 3 4 5
36. Internet 1 2 3 4 5
37. Websites of international medical organizations 1 2 3 4 5
38. Website of the Institute for Public Health „Dr Milan Jovanovi´c Batut“ * 1 2 3 4 5
39. Scientific journals 1 2 3 4 5
40. Website of local medical institutions 1 2 3 4 5
41. Addressing of statesmen and, in general, governing structures 1 2 3 4 5
42. Addressing of experts (epidemiologists, medical doctors of other specialties, experts in civil protection, etc.) 1 2 3 4 5
43. Social networks 1 2 3 4 5
44. Family members 1 2 3 4 5
45. Friends 1 2 3 4 5
46. Local community 1 2 3 4 5
47. Selected doctors 1 2 3 4 5
48. First responders (police, fire and rescue, army units etc.) 1 2 3 4 5
49. Non-governmental organizations 1 2 3 4 5
50. Educational institutions 1 2 3 4 5
Please indicate the degree of agreement with the statements made, where 1 stands for “I strongly
disagree” and 5 for “I strongly agree”.
No. Statements 1 2 3 4 5
51. The likelihood that I will be infected with the virus is low. 1 2 3 4 5
52. Most people who become infected will develop mild to moderate respiratory symptoms, from which they will
recover without the need for special treatment. 1 2 3 4 5
53. The elderly and those with chronic illnesses (e.g., respiratory, cardiovascular, diabetes, immunity, etc.) are at the
highest risk of developing severely treatable illnesses and putting them at great risk of death. 1 2 3 4 5
54. I believe that even if I do get infected I will not develop serious health problems. 1 2 3 4 5
55.
Although they are not at risk of developing severe illnesses, I find it good that children do not go to kindergartens
and schools. 1 2 3 4 5
56. I think that I am in a higher risk of being infected with the virus because of the place where I live. 1 2 3 4 5
57.
I believe that because of the epidemic and the declared state of emergency, I am at risk of losing my job and source
of income. 1 2 3 4 5
58. I believe that through my behavior (taking preventative measures) I can prevent the virus from spreading. 1 2 3 4 5
59. I feel that I have a responsibility to do what I can to protect people at risk. 1 2 3 4 5
60. We will not be able to stop the spread of the virus by following the introduced measures. 1 2 3 4 5
61. I think I have all the information I need to critically review the situation in our country caused by epidemic
and decide what to do. 1 2 3 4 5
62. I fear that the economic consequences of the epidemic will be great for society. 1 2 3 4 5
63. I’m afraid the restriction on movement will prevent me from fulfilling my needs (take medication, make money
withdrawal, buy groceries). 1 2 3 4 5
Int. J. Environ. Res. Public Health 2020,17, 4124 20 of 23
Appendix A.4 Preventive Measures for Coronavirus Disease
Please indicate the degree of agreement with the statements made, where 1 stands for “I strongly
disagree” and 5 for “I strongly agree”.
No. Statements 1 2 3 4 5
64. I’m washing my hands with soap and water for 20 s. 1 2 3 4 5
65. I’m using disinfectants to maintain the hygiene of the room. 1 2 3 4 5
66. I’m wearing protective mask. 1 2 3 4 5
67. I’m wearing protective gloves. 1 2 3 4 5
68. I do not touch my face (eyes, nose, mouth). 1 2 3 4 5
69. I do not shake hands with acquaintances. 1 2 3 4 5
70. I do not hug with family members, friends, acquaintances. 1 2 3 4 5
71. I do not kiss in cheek with family members, friends, acquaintances. 1 2 3 4 5
72. I maintain a recommended distance of 2 m in relation to the people. 1 2 3 4 5
73. I respect the restriction of movement in public places. 1 2 3 4 5
74. I avoid contacts with people over 65. 1 2 3 4 5
75. I do not meet with family members with who do not live in the same household, friends, acquaintances. 1 2 3 4 5
76.
I use a disinfectant to clean my shoes and clothing in which I went to make my purchases, to the workplace.
1 2 3 4 5
77. I am disinfecting the paws of pet upon returning from the walk. 1 2 3 4 5
78. I’ve moved pets out of the living place and no longer have contact with them. 1 2 3 4 5
79. I’ve made a plan with the members of my household about the modes of isolation if needed. 1 2 3 4 5
80. I’ve made a plan for the diet and necessary food with household members. 1 2 3 4 5
81. I have enough supplies of groceries needed for 3 days of isolation. 1 2 3 4 5
82. I have enough supplies of groceries needed for 3–7 days of isolation. 1 2 3 4 5
83. I have enough supplies of groceries for a month and longer. 1 2 3 4 5
84. Have you been engaged in any form of assistance?
1. Before epidemic: (a) Yes; (b) No.
2. During epidemic: (a) Yes; (b) No.
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