The COSMO-Spain Survey: Three First Rounds of the WHO Behavioral Insights Tool

Objective: To describe changes in knowledge, attitudes and preventive practices (KAP), risk perception, and psychological variables of Spanish population toward the COVID-19 pandemic from July to November 2020. Methods: Three samples, each of one composed by 1,000+ persons aged 18 years or older, were interviewed online in three rounds, every 2 months, from July to November 2020. Results: The level of knowledge on COVID-19 was high in the three rounds, with percentages above 95% of correct answers related to ways of contagion and correct use of face masks. The most accepted measure was the mandatory use of face masks (80-86% of agreement in the three rounds, p = 0.001), followed by the night curfew (63% of agreement). Most participants (>80%) consistently reported using face masks, ventilating spaces, and washing or disinfecting hands. However, risk perception and self-efficacy were low. Worry about losing a loved one, the health system overload and people who do not wear face masks was high (>85% of the samples). The percentage of respondents who felt depressed due to COVID-19 increased from round 1 to round 3 (p = 0.044). Conclusions: Spanish population has a high degree of KAP, but a relatively low risk perception and self-efficacy. These findings can help health authorities to guide containment measures and campaigns addressed to improve preventive practices.This work was funded by Carlos III Health Institute.S

Compliance with the main preventive measures of COVID-19 in Spain: The role of knowledge, attitudes, practices, and risk perception

In epidemics such as COVID-19, major changes need to be made to the population's behavior to prevent infection and stop disease transmission. The three most recommended preventive measures are wearing a mask, washing hands with soap or hydroalcoholic gel, and watching an interpersonal distance of at least two meters (3W) from other people. This study aimed to assess adherence to these COVID-19-related three preventive measures and its association with knowledge, attitudes, risk perception, and practices in Spain. The COSMO-Spain survey, based on the WHO Behavioral Insights questionnaire on COVID-19, was conducted in the general Spanish population using an online questionnaire (n = 1,033). Sociodemographic, knowledge, attitudes, practices, and risk perception variables were included. A multivariable logistic regression model was carried out to evaluate the factors associated with compliance with the three preventive measures. Half of the respondents (49.8%) were women with a median age of 45 (Inter-quartile Range, IR = 21) years. In the logistic regression, the factors associated with 3W compliance were being over 45 years; knowing about how COVID-19 spreads and wearing masks properly; appropriate attitudes towards COVID-19 (greater agreement with mandatory mask use); high risk perception (feeling that the coronavirus is spreading rapidly, being concerned about non-mask wearers), and adherence to other preventive measures against COVID-19, such as staying at home. Adequate knowledge, attitudes and risk perception are determinants of 3W compliance. Developing effective health education programs and frequent communication strategies are necessary, particularly for those who adhere less to preventive measures.S

Measuring COVID-19 health literacy: validation of the COVID-19 HL questionnaire in Spain

Background: The COVID-19 pandemic has highlighted the importance of health literacy to make informed preventive decisions. A specifc COVID-19 health literacy questionnaire (CHL-Q) is included in the COVID-19 Snapshot Monitoring WHO initiative to conduct behavioral insights studies related to COVID-19. The objective was to assess the psychometric properties of a Spanish version of the COVID-19 Health Literacy Questionnaire (CHL-Q). Methods: Data quality, acceptability, internal consistency, and construct and structural validity were analyzed. A Rasch analysis was also performed. This cross-sectional, observational study was conducted on the Spanish general population after the frst wave of the pandemic and after the end of the general lockdown by an online survey agency. 1033 participants (inclusion criteria were being 18 years or older and living in Spain), was extracted from a panel of approximately 982,000 participants. The sampling was stratifed matching the Spanish general population in terms of age, gender, and area of residence. The CHL-Q includes 9 items and assesses people’s knowledge, motivation and competencies to access, understand, evaluate, and apply information about COVID-19 in order to make informed decisions. Results: CHL-Q index presented a mean of 33.89 (SD=9.4), and good ft to the Rasch model (χ2(32)=34.672, p=0.342, person separation index=0.77), with ordered thresholds, unidimensionality, item local independence, and no item bias by sex, age or education level. The CHL-Q showed signifcant diferent scores by level of education, experience of infection, confusion related to COVID-19 information and adherence to preventive measures. We found a statistically signifcant correlation between the CHL-Q index and the total number of preventive measures adopted, COVID-19 knowledge, and information seeking behaviour. The Cronbach´s alpha was 0.87 and the item total corrected correlation, 0.49–0.68. Conclusions: The Spanish version of CHL-Q is a short, adequate, and reliable instrument to measure COVID-19 related health literacy in the Spanish general population. Measuring the CHL in the population can be useful to evaluate whether public authorities, media and the medical and scientifc community have been able to reach the population to ofer the information in the terms they need it.This work was supported by Carlos III Health Institute.S

Evolution of the concerns, perceptions and attitudes of the Spanish population during the COVID-19 pandemic

[ES] En la pandemia de COVID-19, tanto el comportamiento individual como el colectivo son determinantes en el control de la propagación de la enfermedad, pero las restricciones adoptadas para atajar esta crisis de salud pública han afectado al bienestar físico y mental de la población. Conocer las percepciones y actitudes de los ciudadanos ayuda a identificar las necesidades de la población y adoptar medidas de respuesta a la pandemia más efectivas y participativas. El estudio COSMO-Spain analiza las preocupaciones, percepciones y actitudes de la población en relación a la pandemia, el grado de adherencia a las medidas preventivas y otras variables relacionadas, como la percepción de riesgo. Este estudio, impulsado por la OMS, se ha realizado desde julio de 2020 cada dos meses, a través de un cuestionario online a muestras representativas de la población española. Los resultados muestran que las actitudes de la población han ido cambiando en el tiempo influenciadas por factores individuales y contextuales. Debido la naturaleza evolutiva de esta pandemia, las campañas de educación y sensibilización deben ser dinámicas y actualizarse continuamente en función de los datos. [EN] Both individual and population behavior are determining factors in controlling the spread of the COVID-19 pandemic. However, the restrictions have impacted the mental and physical well-being of citizens, the social cohesion, the economic stability, as well as the community resilience. In this complex scenario, understanding the feelings and attitudes of the population helps us to identify their needs and adopt response measures to control the pandemic in a more consensual and effective way. The COSMO-Spain study explores the concerns, perceptions, and attitudes of the population about the pandemic to find out the acceptance and adherence to behavioral prevention measures, as well as to analyze the citizens’ risk perception, well-being and trust in information sources and institutions. The COSMO-Spain study has been carried out every two months since July 2020, through an online questionnaire to representative cross-sectional samples of the Spanish population, composed by 1000 people each. The results up to December 2021 show that the attitudes of the population are dynamic and evolve over time, influenced not only by individual factors, but also by contextual ones. Due to the changing nature of this pandemic, education and awareness campaigns need to be dynamic and continually updated based on real data.El estudio COSMO-Spain ha sido financiado por el Instituto de Salud Carlos III.S

Association Between Pandemic Fatigue and Disease Knowledge, Attitudes, Concerns, and Vaccination Intention at Two Key Moments of the COVID-19 Pandemic

Objective: This study aimed to describe the change in knowledge, attitudes, concerns, perceptions, preventive practices, and vaccination intention at two key time points of the COVID-19 pandemic and to assess whether these changes varied by level of pandemic fatigue. Methods: Data included in this study came from the third and the ninth round of the COSMO-Spain cross-sectional study. A general linear model was used to investigate the interaction terms between rounds and levels of pandemic fatigue. Results: Changes between rounds were observed in knowledge, attitudes, concerns, perceptions, behaviours, and vaccination intention. Significant interactions between rounds indicated that those with low levels of pandemic fatigue had a greater increase in knowledge, lower decrease in concerns, greater decrease in agreement with the decisions made, and lower increase in vaccination intention compared with those with high pandemic fatigue. Conclusion: As a pandemic evolves, it becomes necessary to consider the level of pandemic fatigue of the population and how this affects knowledge, concerns, and agreement with the measures adopted, as they influence the population's adherence to public health recommendations aimed at controlling infections and protecting the most vulnerable.The research was funded by the Carlos III Health Institute. The funder had no role in the study design, the collection, analysis, and interpretation of data, writing of the paper, and/or decision to submit for publication.S

COVID-19 vaccine hesitancy in Spain and associated factors

Introduction: The present study explores the reasons of those who have not been vaccinated in the later stage of the vaccine rollout in Spain and its associated determinants. Methods: Cluster and logistic regression analyses were used to assess differences in claimed reasons for vaccine hesitancy in Spain using two samples of unvaccinated people (18-40 years old) gathered by an online cross-sectional survey from social networks (n = 910) and from a representative panel (n = 963) in October-November 2021. Results: The main reasons for not being vaccinated were believing that the COVID-19 vaccines had been developed too fast, they were experimental, and they were not safe, endorsed by 68.7% participants in the social network sample and 55.4% in the panel sample. The cluster analysis classified the participants into two groups. Logistic regression showed that Cluster 2 (individuals who reported structural constraints and health-related reasons such as pregnancy or medical recommendation) presented a lower trust in information from health professionals, had a lower willingness to get vaccinated in the future, and avoided less social/family events than those in Cluster 1 (reasons centered in distrust on COVID-19 vaccines, conspiracy thoughts and complacency). Conclusions: It is important to promote information campaigns that provide reliable information and fight fake news and myths. Future vaccination intention differs in both clusters, so these results are important for developing strategies target to increase vaccination uptake for those who do not reject the COVID-19 vaccine completely.The research was funded by Carlos III Health Institute. This study was also partially funded by RICAPPS (Carlos III Health Institute, ref: RD21CIII/0003/0002). The funder had no role in the study design; collection, analysis, and interpretation of data; writing of the paper; and/or decision to submit for publication.S

How patients with COVID-19 managed the disease at home during the first wave in Spain: a cross-sectional study.

Most patients with mild COVID-19 had to stay at home trying to implement an optimal quarantine. The aim of this study was to describe the COVID-19 cases during the first wave of the pandemic in Spain, how they managed the disease at home, focusing on differences by age, as well as differences in knowledge, attitudes and preventive practices, compared with the uninfected population. An online survey was used to conduct a cross-sectional study of individuals who were 14 years or older living in Spain during the COVID-19 lockdown. The main variable was a COVID-19 case. Logistic regression models for COVID-19 cases were obtained using a backward stepwise procedure to assess the association between social variables, disease knowledge, attitudes, prevention practices and emotional impact. 3398 people completed the survey. Participants' mean age was 49.6 (SD=14.3). COVID-19 was significantly more prevalent among married people (5.3%) and those currently doing an on-site work (8.7%). Most of the COVID-19 cases stayed at home (84.0%) during the episode. There were significant age-based differences with regard to self-isolation conditions at home during the disease. COVID-19 cases showed better attitudes, practices and knowledge about disease symptoms and transmission than the uninfected population. COVID-19 cases also felt more depressed (adjusted OR: 3.46, 95% CI 1.45 to 8.26) and had better preventive behaviour than the uninfected population, such as always wearing a mask outside the home (adjusted OR 1.58, 95% CI 1.06 to 2.30). COVID-19 cases found it difficult to comply with recommended home self-isolation conditions, with differences by age group. COVID-19 had an important impact on care dependency in non-hospitalised patients, who were mostly dependent on their families for care. It is necessary to reinforce social and health services and to be ready to meet the care needs of populations during the different waves or in future epidemics.This work was supported by Instituto de Salud Carlos III through the National Tropical Diseases Research Network (RD16CIII/003/001RICET). The funders had no role in study design or in the collection, analysis and interpretation of data, or the decision to submit the article for publication.S

Review of hepatitis C screening programs for immigrants in Spain from endemic countries.

hepatitis C virus (HCV) screening strategies in European countries do not usually include the migrant population from endemic countries as a target group for screening. The aim of this study is to describe and to evaluate HCV screening strategies for the migrant population residing in Spain and to compare the differences at a regional level. on-line research on every Health Public Department's website of each autonomous community was carried out during 2017 and 2019. Aragon, Cantabria, Catalunya, Canary Islands and Madrid have HCV screening programmes and include migrants from high-endemic countries as a high-risk group that should be targeted in the screening programme. The Valencian Community and the Basque Country have an HCV programme although migrants for high endemic countries are not included as a high-risk group. Finally, the other autonomic communities have no specific programme for HCV in place. Few of them have a screening control system and/or evaluation. there is heterogeneity on the different HCV autonomic programs concerning the risk groups that should be targeted. A homogenization of such criteria would be recommended. HCV screening in migrant populations from endemic countries should be extended to the rest of autonomic communities. More measures for control and evaluation should be implemented in autonomic strategies with specific indicators for migrant populations.S

Factors associated with Chagas screening among immigrants from an endemic country in Madrid, Spain.

INTRODUCTION:Approximately 120,000 people live with Chagas disease in Europe, 43% of whom are living in Spain. Early diagnosis and treatment are critical to improve outcomes for those living with Chagas, and also for the prevention of ongoing transmission. The decision to be tested for Chagas is affected by a range of factors. Studies have highlighted the need to consider the wider social determinants of healthcare seeking behaviour related to Chagas. In Madrid, 44% of Bolivians undergo Chagas screening, which is a higher rate than other European regions, but studies concerning the factors which determine testing have not been performed. This study aimed to assess, for a first time, the factors associated with screening for Chagas among Bolivians living in Madrid trying to help in developing strategies and health recommendations. METHODS:This was a cross-sectional survey about knowledge of Chagas and practices of Bolivians living in Madrid, Spain. A structured questionnaire was administered to 376 participants regarding Chagas health-seeking behaviour. Determinants were assessed by multiple logistic regressions adjusted by sex. RESULTS:After adjusting for others variables and sex, the factors shown to be associated with Chagas screening were to have between 35 and 54 years of age; coming from a department with high prevalence of Chagas (OR 2.17 95% CI 0.99-4.76); received information about Chagas in Spain (OR 2.44 95% CI 1.32-4.51); and received any advice to do the test, especially if the advice came from a professional. CONCLUSIONS:Health authorities should coordinate and promote strategies addressed to diagnose and treat Chagas taking into account all factors associated with screening. Our study suggests that professional advice appears to be the cornerstone to encourage Bolivians to undergo Chagas screening in Madrid. It is time to change the burden of the decision of being screened from the patient to the doctor. Being diagnosed for Chagas needs to become an institutional strategy