Background: The behavior of the general public will probably have an important bearing on the course of the coronavirus disease 2019 (COVID-19) epidemic. Human behavior is influenced by people's knowledge and perceptions (1).

Objective: To assess knowledge and perceptions about COVID-19 among a convenience sample of the general public in the United States and United Kingdom.

Methods and Findings: This study is a cross-sectional survey conducted on an online platform managed by Prolific Academic Ltd. The platform's pool of participants numbers approximately 80 000 individuals, of whom approximately 43% reside in the United Kingdom and 33% in the United States (2). For this study, Prolific selected a convenience sample of 3000 participants residing in the United States and 3000 participants residing in the United Kingdom who were chosen to have approximately the same distribution of age, sex, and ethnicity (and each combination thereof) as the U.S. and U.K. general population (by using numbers from the last census in each country). Specifically, Prolific established population strata (Table 1) with a predetermined number of open slots into which eligible participants in the online pool could enroll on a first-come, first-served basis.

Table 1. Sample Characteristics

Participants, who had to have indicated that they were fluent in English, received US$1.50 for completing the survey. They completed the online questionnaire between 23 February and 2 March 2020. The questionnaire (Supplement, available at Annals.org) consisted of 22 questions on knowledge and perceptions of COVID-19, including specific questions about “myths” or falsehoods listed on the World Health Organization's “myth busters” Web site (3).

To summarize the survey findings, I dichotomized categorical variables and computed the median and interquartile range for continuous variables. For binomial proportions, I used a score interval (Wilson score interval without continuity correction [4]) to construct a 95% CI. No sampling weights were used given that this was not a probabilistic sample.

In total, 2986 and 2988 adults residing in the United States and United Kingdom, respectively, completed the questionnaire. Participants' sociodemographic characteristics are shown in Table 1. Although participants generally had good knowledge of the main mode of disease transmission and common symptoms, the survey identified several important misconceptions on how to prevent acquisition of COVID-19, including beliefs in falsehoods that have circulated on social media (Table 2). A substantial proportion of participants also expressed an intent to discriminate against individuals of East Asian ethnicity for fear of acquiring COVID-19. A more detailed analysis and visualization of all survey responses are available (5).

Table 2. Summary of Survey Findings

Discussion: The findings of this study could be used to set priorities in information campaigns on COVID-19 by public health authorities and the media. Such information provision could, for instance, emphasize the comparatively low case-fatality rate, the recommended care-seeking behavior, the low risk posed by individuals of East Asian ethnicity living in the United States and United Kingdom, and that children appear to be at a lower risk for a fatal disease course than adults. In addition, to ensure that individuals focus their attention on those prevention measures that are most effective, this study suggests that it will be important to inform the public about the comparative effectiveness of common surgical masks versus frequent and thorough handwashing and avoiding close contact with people who are sick.

This study has several limitations. First and foremost, given that participants had to have both chosen to register with Prolific and to take the survey at the time it was published, this convenience sample of adults is unlikely to be representative of the general U.S. and U.K. population. The generalizability of the findings is, therefore, limited. Second, it is possible that some participants may have randomly selected responses to spend the least amount of time to earn the $1.50 reward. I believe this is unlikely to be an important source of bias because only 2 participants (who were excluded from the analysis) completed the survey in under 2 minutes (while it was physically possible to complete it in well under 90 seconds), there was no bimodal distribution in the time taken to complete the survey, and $1.50 is a relatively small monetary incentive. Third, it is possible that participants looked up the answers to some of the questions online before answering. Participants were asked at the end of the survey (while being reassured that their payment is not influenced by their response) for which, if any, questions they searched for an answer online. These responses were set to missing in the analysis.

In conclusion, the general public in the United States and United Kingdom appears to have important misconceptions about COVID-19. Correcting these misconceptions should be targeted in information campaigns organized by government agencies, information provision by clinicians to their patients, and media coverage.

References

• Janz NK, Becker MH. Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11:1-47. [PMID: 6392204] Google Scholar
• Prolific Academic Ltd. Prolific Academic Ltd. Explore our participant pool demographics. Accessed at www.prolific.co/demographics on 4 March 2020. Google Scholar
• World Health Organization. World Health Organization. Coronavirus disease (COVID-19) advice for the public: myth busters. January 2020. Accessed at www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters on 5 March 2020. Google Scholar
• Newcombe RG. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857-72. [PMID: 9595616] Google Scholar
• Geldsetzer P. Geldsetzer P. Knowledge and perceptions of coronavirus disease 2019 among the general public in the United States and the United Kingdom: a cross-sectional online survey. medRxiv. 2020. https://doi.org/10.1101/2020.03.13.20035568. Accessed at https://medrxiv.org/cgi/content/short/2020.03.13.20035568v1 on 17 March 2020. Google Scholar

This article was published at Annals.org on 20 March 2020.

中文翻译：

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美国和英国公众对COVID-19的了解和看法：在线横截面调查。

背景：普通民众的行为可能对2019年冠状病毒病（COVID-19）的流行过程有重要影响。人的行为受人的知识和知觉的影响（1）。

目的：在美国和英国的普通公众中，评估有关COVID-19的知识和看法。

方法和发现：这项研究是在Prolific Academic Ltd管理的在线平台上进行的一项横断面调查。该平台的参与者总数约为80 000，其中约43％居住在英国，33％居住在美国（2） 。在这项研究中，Prolific选择了一个便利样本，样本中有3000名美国居民和3000名英国居民，他们的年龄，性别和种族分布（及其组合）与美国大致相同和英国总人口（使用每个国家最近一次人口普查的数字）。具体而言，具有预定数量的开放位置的多产已建立的人口阶层（表1），在线池中的合格参与者可以按照先到先得的方式注册。

表1.样本特征

与会人员必须表明自己能说流利的英语，但由于完成调查而获得了1.50美元的奖励。他们在2020年2月23日至3月2日期间完成了在线问卷。该问卷（Annals.org上的补编）包含22个有关COVID-19知识和看法的问题，包括有关世界上列出的“神话”或虚假性的具体问题卫生组织的“神话破坏者”网站（3）。

为了总结调查结果，我将分类变量一分为二，并计算了连续变量的中位数和四分位数范围。对于二项式比例，我使用得分间隔（Wilson得分间隔，不进行连续性校正[4]）来构建95％CI。考虑到这不是概率样本，因此不使用抽样权重。

总共有2986名和2988名分别居住在美国和英国的成年人填写了问卷。参加者的社会人口统计学特征如表1所示。尽管参加者通常对疾病的主要传播方式和常见症状有很好的了解，但调查发现了一些关于如何预防获得COVID-19的重要误解，包括对流传虚假的信念的认识。在社交媒体上（表2）。很大一部分参与者还表示有意歧视东亚种族的个人，因为他们害怕获得COVID-19。可以对所有调查答复进行更详细的分析和可视化（5）。

表2.调查结果摘要

讨论：这项研究的结果可用于确定公共卫生当局和媒体在COVID-19信息运动中的优先级。例如，这种信息提供可以强调相对较低的病死率，建议的就诊行为，居住在美国和英国的东亚种族个人构成的低风险，以及儿童似乎处于致命疾病的风险要比成人低。此外，为了确保人们将注意力集中在最有效的预防措施上，这项研究表明，重要的是要告知公众常见的口罩与经常彻底洗手以及避免与人紧密接触的比较效果。谁生病了

这项研究有几个局限性。首先，考虑到参与者必须选择在Prolific进行注册并在调查发布时进行调查，这种方便的成年人样本不太可能代表美国和英国的总体人口。因此，研究结果的普遍性受到限制。其次，可能有一些参与者可能会随机选择响应，以花费最少的时间来获得$ 1.50的奖励。我认为这不太可能成为偏见的重要来源，因为只有2名参与者（被排除在分析之外）在2分钟内完成了调查（虽然实际上可以在90秒内完成调查），但没有完成调查所需的时间中的双峰分布，以及$ 1。50是相对较小的货币激励。第三，参与者有可能在回答之前先在线查询一些问题的答案。在调查结束时向参与者提问（同时确保他们的付款不受他们的回答影响），如果有的话，他们会在网上搜索答案。这些响应在分析中被设置为丢失。

总之，美国和英国的公众似乎对COVID-19有严重的误解。政府机构组织的宣传运动，临床医生向患者提供的信息以及媒体报道应针对纠正这些误解。

参考文献

• Janz NK，贝克尔MH。 Janz NK，贝克尔MH。健康信念模型：十年后。Health Educ Q.1984; 11：1-47。[PMID：6392204] Google学术搜索
• Prolific Academic Ltd. Prolific Academic Ltd.探索我们的参与者人数统计。于2020年3月4日访问www.prolific.co/demographics。Google学术搜索
• 世界卫生组织。 世界卫生组织。面向公众的冠状病毒病（COVID-19）建议：神话破坏者。2020年1月。于2020年3月5日访问www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters。Google学术搜索
• 纽科姆RG。 纽科姆RG。单一比例的双面置信区间：七个方法的比较。Stat Med。1998; 17：857-72。[PMID：9595616] Google学术搜索
• Geldsetzer P.Geldsetzer P.2019年美国和英国公众对冠状病毒病的认识和看法：在线横断面调查。medRxiv。2020。https：//doi.org/10.1101/2020.03.13.20035568。2020年3月17日访问https://medrxiv.org/cgi/content/short/2020.03.13.20035568v1。Google学术搜索

该文章于2020年3月20日在Annals.org上发布。