The results of this study revealed that the majority of the study sample were aware that no vaccine is readily available against the novel coronavirus, as COVID-19 is a newly emerging pandemic with insufficient data regarding effective treatment protocols, and no vaccine has yet been developed. Bai et al. [37] reported that in the absence of effective vaccines, medical, and pharmacological treatments, the current social distancing and health-protective behaviors are likely to remain necessary for a long time, especially as many individuals infected with COVID-19 are asymptomatic or have only mild symptoms.
The present study found that the majority of participants perceived the COVID-19 pandemic as being serious or very serious, and the mean scores for all items associated with the perception of coronavirus seriousness, in addition to the total score, were the highest among Saudi participants, followed by Egyptian participants and then Jordanian participants. These differences may be due to the low numbers of confirmed COVID-19 cases and deaths reported in Jordan compared with those in Saudi Arabia and Egypt, which may affect the perception of seriousness among participants. In addition, Saudi Arabia has experienced previous outbreaks of epidemic pathogens, such as SARS and Ebola, which may provide a reference point for evaluating the risk perceptions of the current COVID-19 pandemic.
This result was congruent with the results reported by Kyaw et al. [38], who reported that adults in Myanmar reported moderate to high levels of risk perception regarding COVID-19. However, the scores of risk perception for COVID-19 in the present study were lower than those reported in a study conducted in Hong Kong, by Kwok et al. [39], who reported that individuals in the Hong Kong community had high-risk perception toward COVID-19, high perceived susceptibility, and high perceived severity during the initial stages of the outbreak, due to the disease uncertainty (including transmissibility, route of transmission, and pathogenicity).
The present study demonstrated that nearly half of the study sample reported “perhaps yes-perhaps no” for their perception of the risk of contracting COVID-19 during the coming year without taking any preventive measures, whereas one-fifth responded, “most certainly.” The population sample of Saudi Arabia scored significantly higher for their perception of the risk of contracting COVID-19 in the absence of preventive measures compared with the Egypt and Jordan samples. The majority of participants responded “not small, not large” or “large chance” for the items associated with perceived susceptibility to COVID-19 and the extent of anxiety regarding disease contraction. These differences in the perception of susceptibility may be due to a lack of public awareness regarding the COVID-19 pandemic, the delayed application of precautionary measures in Egypt, and ignoring disease onset, which resulted in the underestimation of the pandemic situation in Egypt, compared with the responses in Saudi Arabia and Jordan. Sawaya et al. [40] demonstrated that Egypt faced a rapid surge in the numbers of COVID-19 cases and deaths because public health measures were announced and implemented late. Lewnard and Lo [41] demonstrated that the evidence suggested the underreporting of COVID-19 cases, for various reasons, such as the lack of surveillance and diagnostic capacities and the lack of medications and treatment protocols for managing COVID-19 cases.
The population sample of Egypt scored lower in all items associated with perceptions of efficacy and self-efficacy, with significantly lower mean self-efficacy total scores than the participants from Jordan and Saudi Arabia. The observed difference among these three Arab countries, with regard to the self-efficacy of protective behaviors, may be attributed to differences in education levels, as more than half of the Egyptian sample had only a moderate educational level (diploma) compared with the higher educational levels reported by participants from the other two countries, which may affect the level of knowledge and risk perceptions regarding COVID-19 and, subsequently, alter the sense of self-efficacy toward COVID-19. Financial difficulties may also play a vital role in participants’ feelings of low self-efficacy to deal with the pandemic, as quarantine causes an economic burden for the majority of the population who work for the private sector. Furthermore, the need to purchase precautionary equipment, including alcohol, detergents, soap, gloves, and masks, for the whole family may present an additional monetary burden for participants from Egypt due to the generally worse financial status and low governmental subsidy.
Leppin and Aro [42] suggested that increased risk perceptions may only predict protective behaviors when people believe that effective protective actions are accessible and readily available (response efficacy) and when they are confident that they have the ability to engage in protective actions and tolerate their conditions (self-efficacy). Despite these countries’ wide and exceptional measures, which have been employed to combat the outbreak, the success or failure of these efforts is generally dependent on public behavior. Therefore, encouraging public adherence to preventive measures is of high significance for preventing the spread of the disease. Adherence is, in all likelihood, influenced by the public’s knowledge and attitudes toward COVID-19. Evidence has confirmed that public knowledge and awareness are necessary to appropriately address pandemics [43]. By assessing public awareness of information regarding COVID-19, deeper insights into existing public perceptions and practices can be gained, allowing those attributes that impact the public willingness to adopt healthful practices and responsive behaviors to be determined [44].
Tang and Wong [45], in their study of adult Chinese individuals in Hong Kong, suggested that compliance with health-related guidelines, such as preventive measures, would likely increase if people believed that they had a high probability of being infected or if they perceived the illness to have a significant negative consequence. Similarly, De Zwart et al. [46], in their international survey, reported that efficacy attitudes toward SARS were more positive in Asia, where people felt more capable of dealing with and controlling SARS. Alternatively, the increased direct and closer experience with SARS in Asia and the unique experience of outliving and overcoming the SARS outbreak may have improved people’s self-efficacy and response efficacy beliefs in Asia. Preventive measures in Asia were also more visible, which may have been more reassuring to the public. In the same vein, Zhong et al. [47] reported that the majority of Chinese residents (98%) had good compliance and practiced appropriate measures for the prevention of COVID-19.
Although the vast majority of the study sample reported a positive intention to perform the advised preventive measures against the novel coronavirus, the population sample from Egypt scored significantly lower for this metric than the populations of the other two countries, which reflects a lower intention to comply with precautionary measures and perform preventive actions against the COVID-19 outbreak. This variation may be due to the dire consequences of COVID-19 in Egypt, which has generally been attributed to the terrible state of the health infrastructure, poverty concerns, detrimental living conditions in cities, excessive population densities, and the prevalence of underlying disease conditions. In addition, confirmed cases in Egypt are not diagnosed until they visit healthcare facilities with serious signs and symptoms of COVID-19. The monetary burdens associated with preventive measures negatively influence work and business, particularly among private-sector workers. In contrast to Egypt, the Saudi Arabian and Jordanian governments strictly applied to WHO protocol, to contain the outbreak, implementing an early public curfew, testing all individuals who showed COVID-19 symptoms, ensuring that all cases who test positive are systematically hospitalized and properly treated, regardless of symptoms, ensuring that COVID-19 contact cases are quarantined, and providing free COVID-19-related medical care for all residents and citizens. Abdelhafiz et al. [48], who conducted a study on the Egyptian population, mentioned that Egypt is one of the largest countries in the Arab region, Africa, and the Middle East (with more than one hundred million inhabitants). This extremely high population could be associated with the increased risk of disease spread and mortality, particularly among older individuals and those with chronic diseases. Global efforts have been made to stop and mitigate the spread of the virus, including political efforts made by governments and changes in personal attitudes and behaviors, which rely heavily on the awareness and knowledge of the general public regarding the disease.
The results of the present study agree with the results of the study reported by Branas et al. [49], who suggested that many deaths are not directly caused by coronavirus but can instead be attributed to the reality that hospitals become overwhelmed and patients are not handled properly. Similarly, Shahnazi et al. [50], in their study in Iran, suggested that the perceived benefits associated with the implementation of preventive actions were factors that could predict compliance with precautionary behaviors against the COVID-19 outbreak. Individuals perform better when the perceived benefits increase. Having positive perceptions of the effects of frequent hand washing and the use of personal protective equipment, such as masks and disposable gloves, can lead to higher perceived benefits, which are robust motivations for complying with preventive measures. Moreover, Jordan et al. [51] found that focusing on “your community” had a positive effect on the intention to engage in numerous preventive behaviors, in contrast to the baseline, which may represent a beneficial suggestion and useful recommendation for leaders and policymakers.
Similarly, Al-Hanawi et al. [13] mentioned that following the WHO declaration of COVID-19 as a worldwide pandemic, countries around the globe, including the Kingdom of Saudi Arabia, began to enact strategic plans that were tailored to mitigate the pandemic spread, reduce daily reported infected cases, increase daily recovered cases, and contain the virus. Following the confirmation of its first case of COVID-19, on 2 March 2020, the Saudi Arabian government enacted effective measures, which were applied throughout the country, under the threat of penal law, to control and prevent the spread of the disease, combined with the registration of new COVID-19 cases and daily follow-up reporting, in accordance with the instructions provided by the WHO for handling this pandemic. Upon confirming the first case in Jordan, however, countrywide measures were scaled-up, to limit and tackle the spread of COVID-19 during the early stages [52].
The Saudi Arabian Ministry of Health (MOH) has enacted an intensive awareness campaign, communicated through its website, television, and social media platforms. The MOH has produced a guide to COVID-19, to offer residents necessary information and precautionary messages, available in more than 10 languages. The MOH has also communicated with the public and the media, through social media platforms. These early intervention efforts to inform the public of prevention and mitigation measures, as well as extensive efforts to counter rumors and misinformation, have been significantly increased as the pandemic continues [53]. The KSA is in a unique position of having dealt effectively with two outbreaks of viral origin, associated with similar viruses [54]. This unique experience has helped the government enact an instant response and implement precautionary measures against COVID-19, to control the disease spread.
The results of the current study revealed a positive significant correlation between the mean scores for the “seriousness perception” of COVID-19 and the mean “self-efficacy” scores, among the entire population sample. Among the study participants, higher seriousness perception mean scores were significantly associated with higher self-efficacy mean scores. Although the COVID-19 epidemic can be perceived as a threatening situation, individuals that confront this hazard in a manner that restores the experience of control may alleviate stress reactions, which, ultimately, can have a positive effect on emotional health and well-being. According to social cognitive theory, Bandura [55] reported that perceived coping efficacy (e.g., the perception that one is capable of managing or coping with a threat) plays a key role in effective adaptation.
Brewer et al. [56] described public health authorities as being dependent on the willingness and capacity of the general public to adhere to disease prevention recommendations, including those associated with personal hygiene, vaccination and/or prophylaxis, quarantine, transportation restrictions, and the closing down of public institutions, such as schools and universities; however, one factor that can affect the willingness and motivation of the public to integrate and adopt precautionary behaviors is risk perception. Qian et al. [57] and Wang et al. [58], in studies performed in China, reported that higher perceived risk regarding coronavirus dangers was positively linked with favorable behavioral responses and substantially higher anxiety levels among the general population.
The results of the current study revealed that the population sample aged 35 to 39 years had significantly higher mean self-efficacy scores than all other age categories, whereas the lowest mean self-efficacy scores were identified among the oldest population (50 years or older), which may be associated with increased worries regarding potential complications associated with COVID-19 and higher mortality rates, especially among those with chronic diseases.
Similarly, the current study revealed that females scored significantly higher for mean self-efficacy scores compared with males, and those with bachelor’s degrees had significantly higher self-efficacy mean scores than all other educational levels, which may be due to their abilities to obtain more information and gain more insight into COVID-19. Similarly, Lau et al. [59], who studied the hemagglutinin type 1 and neuraminidase type 1 swine flu (H1N1) pandemic in Hong Kong, found that females had better overall performance than men for disease prevention. Furthermore, Guo et al. [60] reported that older individuals and patients with comorbidities are more likely to become infected with COVID-19 and are more prone to developing serious complications, such as acute respiratory distress syndrome and cytokine storm, placing them under greater psychological stress.
Similarly, El-Zoghby et al. [61], in their study in Egypt, reported that higher educational levels were associated with higher awareness, which can increase participation in preventive measures and precautionary practices in cases of suspected infection, limiting their feelings of stress. Abdelhafiz et al. [48] demonstrated that individuals with university-level or higher educations had drastically greater awareness mean scores regarding COVID-19 compared with participants with lower levels of education.
Studies in Hong Kong revealed that those with higher levels of education were more likely to undertake precautionary behaviors to defend against SARS [62] and avian influenza [63], including frequent handwashing, respiratory hygiene, mask-wearing, the proper use of utensils, and hand washing after touching contaminated surfaces. More educated individuals in Australia also reported a higher intention to wear face masks during pandemic influenza events [64].
Participants’ willingness to perform preventive measures against COVID-19, in the current study, was primarily driven by a feeling of responsibility toward their own health, followed by the desire to prevent coronavirus transmission to other people, and the feeling that coronavirus can be serious. The perception of personal infection risk and the perceived seriousness of the health-related consequences have both been linked to engagement with disease-preventive behaviors. Because COVID-19 is spread relatively rapidly by direct human-to-human contact, fighting this disease has been more challenging and has required governments to inform the public of the risks and necessary precautions for protecting themselves and others. However, the feeling of personal responsibility was evidenced in the Arab culture.
This result was congruent with the results of Bish and Michie [65] who reported that higher perceived personal risk predicts an individual's engagement with disease-preventive behaviors, such as hand washing and social distancing, as reflected by studies of prior pandemics. Similarly, Abdelhafiz et al. [48] reported that most of their study participants believed that COVID-19 represents a life-threatening hazard and have been worried about the possible risk of COVID-19 infections among members of their families.
When asked why they may not be willing to undertake preventive measures, in the current study, almost two-fifths of participant reported that the situation does not apply to them, and slightly more than one-quarter answered that the measures require too much effort (cost, time, etc.) and that the people in their environment would also not perform these measures. These responses reflect the public desire to obtain accurate and adequate information regarding the nature of the novel coronavirus disease pandemic and the necessity of orienting and educating the public regarding the importance of utilizing and abiding by the suggested preventive measures to control COVID-19 transmission. Similarly, van der Weerd et al. [66], in a study performed in the Netherlands, reported that receiving information from a variety of sources during the course of the new influenza H1N1 pandemic, such as public health professionals, the government, and the media, could expand people’s awareness of risks and, consequently, increase their adoption of the recommended preventive measures.
The current findings suggested that most of the study sample reported their desire to receive information regarding COVID-19 treatment, methods of preventing disease contraction, the incubation period of the novel coronavirus, and how COVID-19 is transmitted. Because COVID-19 is a newly emerging disease, with no understood natural history and no definite treatment or vaccine, the community required knowledge regarding the etiological agents, epidemiological parameters, such as the virus incubation period, transmission modes, signs and symptoms, and preventive measures. Alzoubi et al. [67] and Huang et al. [68], who conducted studies in Jordan and Wuhan, respectively, reported that no specific antiviral drugs or vaccines have yet been identified to treat COVID-19. Al-Hanawi et al. [13] reported that approximately half of their study respondents were unaware that SARS-CoV-2 could transmit person-to-person in close proximity. Therefore, the general population of that study had a low level of awareness of when protective masks were necessary and who must use them to prevent disease transmission.
The results of the current study demonstrated that the vast majority of participants reported that they prefer to receive COVID-19 updates from national authorities of their respective countries, such as the Ministry of Health. More than two-thirds of the respondents declared that they prefer to receive COVID-19 updates through the reports published by national authorities and letters sent by local authorities, indicating that people actively choose which resources they trust for information. Providing information through various sources can play an important role in managing threats by influencing the public’s judgments of risks and related benefits, which may indirectly impact the adoption of recommended measures. However, trust is a core component for the public to listen to, understand, and react to public health messages.
Several studies have mentioned that during an epidemic, understanding how important information regarding health hazards is disseminated and how the public accesses, processes, understands, and uses this information is crucial [69, 70]. The threats and uncertainties associated with emerging infectious diseases may additionally arouse public emotions and alter behaviors in constructive (e.g., engaging in personal hand hygiene and averting mass gatherings) or disruptive manners (e.g., inflated public fear, useless anxiety, and socioeconomic unease) [71]. Xiao et al. [72] reported that during quarantine, the separation and restriction of movement among the population fall within the mandate of the government and public health authorities. Therefore, having confidence in the judgments of government and public health authorities can have remarkable effects on the intellectual health and well-being of individuals under quarantine. Individuals who self-isolated during the COVID-19 virus epidemic in central China who had more family support and higher social trust reported lower levels of anxiety and stress. Sawaya et al. [40] also mentioned that governments and the WHO have resorted to TV, social media outlets, and cellular operators to disseminate information to increase public awareness about COVID-19 and promote safe physical distancing while combatting the disease outbreak in the Middle East.
