Knowledge, Attitudes, and Practice towards COVID-19 among Multi-Ethnic Elderly Asian Residents in Singapore: A Mixed Methods Study

Amudha Aravindhan, Tau Liang Alfred Gan, Ester Pei Xuan Lee, Preeti Gupta, Ryan E.K. Man, Kam Chun Ho, Sharon Cohan Sung, Ching Yu Cheng, Moi Lin Ling, Hiang Khoon Tan, Tien Yin Wong, Eva K. Fenwick, Ecosse L. Lamoureux

Research output: Contribution to journalArticlepeer-review


Introduction: We investigated knowledge, attitudes, and practice (KAP) about COVID-19 and related preventive measures in Singaporeans aged ≥ 60 years.

Methods: This was a population-based, cross-sectional, mixed-methods study (13 May 2020-9 June 2020) of participants aged ≥60 years. Self-reported KAP about ten COVID-19 symptoms and six government-endorsed preventive measures were evaluated. Multivariable regression models identified sociodemographic and health-related factors associated with knowledge, attitudes and practices in our sample. Associations between knowledge/attitude scores, and practice categories were determined using logistic regression. 78 participants were interviewed qualitatively about practice of additional preventive measures and data were analysed thematically.

Results: Mean awareness score of the symptoms was 7.2/10. Fever (93.0%) and diarrhoea (33.5%) were the most- and least-known symptoms, respectively. Most knew all six preventive measures (90.4%), perceived them as effective (78.7%), and practiced 'wear a mask' (97.2%). Indians, Malays, and those in smaller housing had poorer mean knowledge of COVID-19 symptoms scores. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practicing 3/6 recommendations. A one-point increase in knowledge of and attitudes towards preventive measures score had higher odds of always practicing 3/6 and 2/6 measures, respectively. Qualitative interviews revealed use of other preventive measures, e.g. maintaining a healthy lifestyle.

Conclusion: Elderly Singaporeans displayed high levels of KAP about COVID-19 and related preventive measures, with a positive association between levels of knowledge/attitude, and practice. However, important ethnic and socioeconomic disparities were evident, suggesting key vulnerabilities remain, requiring immediate attention.

Keywords: COVID-19; attitude; elderly; knowledge; practice.
Original languageEnglish
Pages (from-to)1-42
Number of pages42
JournalSingapore Medical Journal
Publication statusPublished - 11 Oct 2021
Externally publishedYes


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