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RESEARCH ARTICLE

Public knowledge, attitudes and practices

towards COVID-19: A cross-sectional study in

Malaysia

Arina Anis Azlan1, Mohammad Rezal Hamzah2, Tham Jen SernID 3, Suffian Hadi AyubID

4,

Emma MohamadID 1*

1 Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti

Kebangsaan Malaysia, Bangi, Selangor, Malaysia, 2 School of Human Development and

Technocommunication, Universiti Malaysia Perlis, Arau, Perlis, Malaysia, 3 Department of Communication,

Faculty of Modern Languages and Communication, Universiti Putra Malaysia, Seri Kembangan, Selangor,

Malaysia, 4 Department of Communication, School of Arts, Sunway University, Petaling Jaya, Selangor,

Malaysia

* [email protected]

Abstract

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic

lockdown, movement control or shelter in place orders on their residents. The effectiveness

of these mitigation measures is highly dependent on cooperation and compliance of all

members of society. The knowledge, attitudes and practices people hold toward the disease

play an integral role in determining a society’s readiness to accept behavioural change mea-

sures from health authorities. The aim of this study was to determine the knowledge levels,

attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional

online survey of 4,850 Malaysian residents was conducted between 27th March and 3rd April

2020. The survey instrument consisted of demographic characteristics, 13 items on knowl-

edge, 3 items on attitudes and 3 items on practices, modified from a previously published

questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way

analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge

questionnaire was 80.5%. Most participants held positive attitudes toward the successful

control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the

way the Malaysian government was handling the crisis (89.9%). Most participants were also

taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene

(87.8%) in the week before the movement control order started. However, the wearing of

face masks was less common (51.2%). This survey is among the first to assess knowledge,

attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results high-

light the importance of consistent messaging from health authorities and the government as

well as the need for tailored health education programs to improve levels of knowledge, atti-

tudes and practices.

PLOS ONE

PLOS ONE | https://doi.org/10.1371/journal.pone.0233668 May 21, 2020 1 / 15

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OPEN ACCESS

Citation: Azlan AA, Hamzah MR, Sern TJ, Ayub SH,

Mohamad E (2020) Public knowledge, attitudes

and practices towards COVID-19: A cross-sectional

study in Malaysia. PLoS ONE 15(5): e0233668.

https://doi.org/10.1371/journal.pone.0233668

Editor: Wen-Jun Tu, Chinese Academy of Medical

Sciences and Peking Union Medical College,

CHINA

Received: April 21, 2020

Accepted: May 11, 2020

Published: May 21, 2020

Peer Review History: PLOS recognizes the

benefits of transparency in the peer review

process; therefore, we enable the publication of

all of the content of peer review and author

responses alongside final, published articles. The

editorial history of this article is available here:

https://doi.org/10.1371/journal.pone.0233668

Copyright: © 2020 Azlan et al. This is an open

access article distributed under the terms of the

Creative Commons Attribution License, which

permits unrestricted use, distribution, and

reproduction in any medium, provided the original

author and source are credited.

Data Availability Statement: All relevant data are

within the manuscript and its Supporting

Information files.

1. Introduction

The coronavirus disease 2019 (COVID-19) emerged in Wuhan, China at the end of 2019.

Since then, it has spread to 200 countries and has been declared a global pandemic by the

World Health Organisation (WHO). To date, there are more than 2.3 million positive

COVID-19 cases recorded with at least 150,000 deaths globally [1].

The first case of COVID-19 in Malaysia was detected on 25th January 2020 involving three

tourists from China [2]. The number of cases steadily increased before the nation’s first two

deaths were recorded on 17th March [3]. As of 20th April 2020, Malaysia has recorded more

than 5300 positive cases involving 89 deaths. A majority of these cases were traced back to a

religious gathering which has now reached its fifth-generation infections [4]. The Malaysian

Prime Minister enforced a movement control order (MCO) on 18th March 2020 as a mitiga-

tion effort to reduce community spread and the overburdening of the country’s health system.

Similar to lockdowns in China and Italy, the MCO restricted most non-essential activity out-

side the home. Malaysians were only permitted to leave the house for basic activities such as

buying groceries and seeking medical treatment. The MCO also restricted Malaysians from

leaving the country and all foreigners from entry. Non-essential sectors were ordered to close

operations or allow employees to work from home.

Lockdown measures were perceived as necessary to curb the spread of the virus as rapid

human-to-human transmission occurred and much about the virus remained unknown [5].

Due to the obscurity of this novel virus, there has been a lot of confusion and misunderstand-

ing about the virus itself, how it can spread and the necessary precautions that should be taken

to prevent infection. This becomes increasingly challenging with the vast amount of misinfor-

mation and disinformation shared on social media that is clouding people’s understanding of

COVID-19 [6]. When the initial MCO announcement was made, Malaysians reacted in panic

and confusion. Aside from panic buying, people crowded public transportation hubs to travel

back to their hometowns, potentially increasing the risk of infection to other parts of the coun-

try. While this reaction to the MCO was not unexpected, it raises questions regarding the level

of understanding and attitudes toward COVID-19 among Malaysians.

The knowledge, attitudes and practices (KAP) toward COVID-19 play an integral role in

determining a society’s readiness to accept behavioural change measures from health authori-

ties. KAP studies provide baseline information to determine the type of intervention that may

be required to change misconceptions about the virus. Assessing the KAP related to COVID-

19 among the general public would be helpful to provide better insight to address poor knowl-

edge about the disease and the development of preventive strategies and health promotion pro-

grams. Among the lessons learned from the SARS outbreak is that knowledge and attitudes are

associated with levels of panic and emotion which could further complicate measures to con-

tain the spread of the disease [7,8]. The survey also gives a general picture of Malaysians

COVID-19 prevention practices before the MCO and this can better prepare the government

to address future health crises involving infectious diseases. The results of this study are impor-

tant to inform future efforts focusing on societal readiness to comply with pandemic control

measures.

2. Methods

Study design

A quantitative approach was utilised to achieve the objectives of this study. A survey is most

appropriate as it allows large populations to be assessed with relative ease [9]. In this study, a

cross-sectional survey was deemed most appropriate to gather information on COVID-19 for

PLOS ONE Public knowledge, attitudes and practices towards COVID-19 in Malaysia

PLOS ONE | https://doi.org/10.1371/journal.pone.0233668 May 21, 2020 2 / 15

Funding: This research was supported by a grant

from Universiti Kebangsaan Malaysia (Grant code:

SK-2020-007) to EM. The funder had no role in the

study design, data collection and analysis, decision

to publish, or preparation of the manuscript.

Competing interests: The authors have declared

that no competing interests exist.

the Malaysian context. Data collection was performed online using the Survey Monkey plat-

form. The call for participation was made on social media.

Ethical approval

The Ethics Committee of Universiti Kebangsaan Malaysia approved our study protocol, proce-

dures, information sheet and consent statement (JEP-2020-276). Participants who gave con-

sent to willingly participate in the survey would click the ‘Continue’ button and would then be

directed to complete the self-administered questionnaire.

Recruitment procedure

This cross-sectional survey was conducted in the second week of the MCO, between 27th

March 2020 to 3rd April 2020. The target sample size was 3,640, determined by identifying the

smallest acceptable size of a demographic subgroup with a ±5% margin of error and a confi-

dence level of 95% [10,11]. As it was not feasible to conduct a systematic nationwide sampling

procedure during this period, the researchers opted to use an online survey using Survey Mon-

key Advantage Annual. Members of the Malaysian public above the age of 18 and currently

residing in the country were eligible to participate in the survey. We utilised several strategies

to reach as many respondents as possible all over the country within the one-week data collec-

tion period. This includes relying on professional and personal networks of the researchers,

reaching out to community leaders and social media influencers to broadcast and share the

survey. Two main platforms used in disseminating this survey were social media (Facebook,

Twitter and Instagram) and WhatsApp. Facebook and Whatsapp were selected as two of the

most popular communication and social platforms in Malaysia [12]. While Facebook is gener-

ally preferred by older Malaysians, Twitter and Instagram are more popular among the youn-

ger generation. A standardised general description about the survey was given in the

WhatsApp message/social media postings before the link was provided to both English and

Malay language versions of the questionnaire. A total of 4,850 participants took part in the

survey.

Study instrument

The survey instrument is an adaptation of the measures developed in a study on Chinese resi-

dents’ knowledge, attitudes and practices (KAP) towards COVID-19 in China [13]. The ques-

tionnaire consisted of four main themes: 1) demographics, which surveyed participants’ socio-

demographic information, including gender, age, state of residence, occupation, and house-

hold income; 2) knowledge about COVID-19; 3) attitudes toward COVID-19; and 4) practices

relevant to COVID-19. The survey was offered in the English and Malay languages. A back-

ward-translation approach was used in translating the items between English and Bahasa

Malaysia, so as to ensure linguistic and conceptual equivalence [14]. Discrepancies between

the two versions were rectified, and equivalence of measuring on all items was ensured

through consultation with bilingual researchers.

To measure knowledge about COVID-19, 13 items were adapted from previous research

[13]. These items include the participant knowledge about clinical presentations (items 1–4),

transmission routes (items 5–8) and prevention and control (items 9–13) of COVID-19. Par-

ticipants were given “true,” “false,” or “not sure” response options to these items. A correct

response to an item was assigned 1 point, while an incorrect/not sure response was assigned 0

points. The maximum total score ranged from 0–13, with a higher score indicating better

knowledge about COVID-19.

PLOS ONE Public knowledge, attitudes and practices towards COVID-19 in Malaysia

PLOS ONE | https://doi.org/10.1371/journal.pone.0233668 May 21, 2020 3 / 15

To measure attitudes towards COVID-19, surveyed participants were asked whether they

agreed, disagreed or were not sure that the pandemic would be successfully controlled. They

were also asked about their confidence towards the government in winning the battle against

COVID-19 (yes or no) and about the ability of the government in handling the COVID-19 cri-

sis (agree, disagree, or not sure). To measure practices, participants were asked yes/no ques-

tions on whether they had avoided going to crowded places such as weddings; wore a face

mask when leaving home; and whether they practiced proper hand hygiene in the week before

the movement control order (MCO).

Statistical analysis

For this study, the collected data were analysed using the Statistical Package for the Social Sci-

ences (SPSS), version 26. Descriptive analysis focused on frequencies, and percentages while

chi-square tests, independent samples t-tests and one-way analysis of variance (ANOVA) were

utilised to determine the differences between groups for selected demographic variables. The

statistical significance level was set at p< 0.05. Internal consistency of the knowledge measures

was tested using a reliability test where the Cronbach alpha coefficient aided in determining

the reliability of the variables. The results showed that the Cronbach alpha for knowledge (13

items) was 0.655. The result added credence where according to Griethuijsen, the range of

Cronbach alpha within 0.6 to 07 is considered adequate and reliable [15]. It is attested that the

items used to measure knowledge on COVID-19 are therefore acceptable.

3. Results

Demographic characteristics

A total of 4850 participants participated in the study. Out of the total, the average age was 34

years (SD = 11.2, range = 18–73), 2808 (57.9%) were women, 1993 (41.1%) resided in Central

Malaysia and 2173 (44.8%) were employed in the public sector. Other demographic character-

istics are detailed in Table 1.

Assessment of knowledge

A total of thirteen questions were used to measure knowledge on the COVID-19 virus. The

average knowledge score for participants was 10.5 (SD = 1.4, range 0–13). The overall correct

answer rate of the knowledge questionnaire was 80.5% (10.5/13�100) while the range of correct

answer rates for all participants were between 46.2 to 100%. About 77.2% of participants were

able to obtain scores above 10, representing an acceptable level of knowledge on COVID-19.

Most participants knew that people who had contact with an infected person should be

immediately isolated for a period of 14 days (99.1%) and that this is an effective way to reduce

the spread of the virus (98.9%). Even so, there was noticeable confusion among participants

regarding transmission of the virus. Only 43.3% of participants answered correctly when asked

if the virus was airborne and just 35.7% answered correctly when asked if eating and touching

wild animals could result in infection [Table 2].

Differences in knowledge scores among different demographic characteristics were assessed

using t-tests and ANOVA. The results show that knowledge scores were significantly different

across genders, age groups, regions, occupation groups and income categories. Higher knowl-

edge scores were obtained among female participants, those above the age of 50, people resid-

ing in Central Malaysia and in the higher income category.

The results of the ANOVA analyses show that the knowledge scores of people living in the

Central region were significantly higher than other regions. Additionally, the average

PLOS ONE Public knowledge, attitudes and practices towards COVID-19 in Malaysia

PLOS ONE | https://doi.org/10.1371/journal.pone.0233668 May 21, 2020 4 / 15

knowledge score of students were significantly lower than those of other occupation categories

and those earning below RM3,000 per month showed significantly lower knowledge scores

[Table 3].

Assessment of attitudes

Participants were asked three questions in assessment of attitudes. The first question asked

whether or not they agreed that the COVID-19 situation would be successfully controlled; sec-

ond, whether they thought Malaysia would be able to win its battle against the virus; and third,

whether they thought the Malaysian government was handling the health crisis well [Fig 1].

For the first question, a majority of participants agreed that COVID-19 would successfully

be controlled (83.1%). Even so, 14% of participants were unsure whether the virus would be

controlled and a smaller number of participants disagreed that it would be successfully con-

trolled (2.1%). The attitude of successfully controlling COVID-19 was significantly associated

with age group, region and occupation. Knowledge scores of those who were unsure were also

significantly lower than those who agreed that the virus would be successfully controlled

[Table 4].

For the second attitude question, the majority of participants had confidence that Malaysia

would be able to win the battle against COVID-19 (95.9%), while a small percentage did not

have that confidence (3.3%). The confidence that Malaysia would be able to win the battle

against COVID-19 was associated with age group and occupation. No significant difference

was found between the two confidence groups in terms of knowledge score.

Table 1. Demographic characteristics of participants (N = 4850).

Characteristic Number Percentage (%)

Gender Male 2042 42.1

Female 2808 57.9

Age 18–29 2065 42.6

30–49 2233 46.1

Above 50 544 11.2

Region Central 1993 41.1

Northern 1178 24.3

Southern 638 13.2

Eastern 662 13.6

Sabah/Sarawak 379 7.8

Occupation Public sector 2173 44.8

Student 1125 23.2

Private sector 955 19.7

Self-employed 267 5.5

Not employed 195 4.0

Retiree 96 2.0

Other� 32 0.7

Income category Under RM 3,000 per month 1540 31.8

RM3,001 –RM6,000 per month 1289 26.6

RM6,001 –RM9,000 per month 832 17.2

RM9,001 –RM12,000 per month 575 11.9

RM12,001 and above per month 614 12.7

� “Other” includes occupations such as manual labour and contract/ part-time work

https://doi.org/10.1371/journal.pone.0233668.t001

PLOS ONE Public knowledge, attitudes and practices towards COVID-19 in Malaysia

PLOS ONE | https://doi.org/10.1371/journal.pone.0233668 May 21, 2020 5 / 15

The third attitude question asked whether the participant agreed that the Malaysian govern-

ment was handling the COVID-19 health crisis well. A large percentage of participants agreed

with this statement (89.9%). Rates of disagreement and uncertainty were at 3.8% and 5.4%

respectively. Agreement that the Malaysian government was performing well in handling the

COVID-19 crisis was significantly associated with gender, age group, region and occupation.

Knowledge scores were also significantly different between those who agreed that the govern-

ment was doing a good job at handling the crisis and those who were unsure.

Assessment of practices

Practices toward COVID-19 were measured using three questions enquiring on: 1) avoidance

of crowded places, 2) wearing of face masks; and 3) practising proper hand hygiene in the

week before the Movement Control Order (MCO) was implemented in Malaysia [Fig 2].

For the first question, 83.4% of participants reported that they were avoiding crowded

places in the week before the MCO was implemented. The other 16.6% did not avoid crowded

places.

In examining the differences between demographic groups, it was found that there were

significant associations between age group, income category and avoidance of crowded places.

Younger people and those earning below RM3,000 monthly were more avoidant of crowded

places in the week before the MCO. There were also significant differences in knowledge

Table 2. Participant knowledge of COVID-19 (N = 4850).

Question True False I’m not

sure

1. The main clinical symptoms of COVID-19 are fever, fatigue, dry cough,

and body aches.

4207

(86.7%)

490

(10.1%)

153 (3.2%)

2. Unlike the common cold, stuffy nose, runny nose, and sneezing are less

common in persons infected with the COVID-19 virus.

3152

(65.0%)

862

(17.8%)

836

(17.2%)

3. There currently is no effective cure for COVID-19, but early symptomatic

and supportive treatment can help most patients recover from the infection.

4562

(94.1%)

66 (1.4%) 222 (4.6%)

4. Not all persons with COVID-2019 will develop to severe cases. Only those

who are elderly and have chronic illnesses are more likely to be severe cases.

4347

(89.6%)

277 (5.7%) 226 (4.7%)

5. Eating or touching wild animals would result in the infection by the

COVID-19 virus.

1705

(35.2%)

1731

(35.7%)

1414

(29.2%)

6. Persons with COVID-19 cannot infect the virus to others if they do not

have a fever.

281 (5.8%) 4038

(83.2%)

535

(11.0%)

7. The COVID-19 virus spreads via respiratory droplets of infected

individuals.

3971

(81.9%)

359 (7.4%) 520

(10.7%)

8. The COVID-19 virus is airborne. 2042

(42.1%)

2099

(43.3%)

7