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Knowledge, Concerns, and Behaviors of Individuals During the First Week of the Coronavirus Disease 2019 Pandemic in Italy

Educational Objective
To understand how to assess the knowledge level, concerns, and behaviors of individuals during the first week of COVID-19 in Italy
1 Credit CME
Key Points

Question  What were the worries and perceptions experienced by residents of different exposure areas during the first week of outbreak of the coronavirus disease 2019 (COVID-19) in Italy?

Findings  This survey study including 2886 participants found that people were well informed about COVID-19 and its implications. Higher scores for cognitive rigidity and emotional instability were associated with more worries and concerns regarding the COVID-19 outbreak regardless of exposure region.

Meaning  These findings suggest that at the beginning of the COVID-19 outbreak, people who were cognitively flexible and emotionally stable were more likely to be more resilient to worries and concerns relating to COVID-19.


Importance  At the beginning of a public health crisis, such as the coronavirus disease 2019 (COVID-19) pandemic, it is important to collect information about people’s knowledge, worries, and behaviors to examine their influence on quality of life and to understand individual characteristics associated with these reactions. Such information could help to guide health authorities in providing informed interventions and clear communications.

Objectives  To document the initial knowledge about COVID-19 and recommended health behaviors; to assess worries (ie, one’s perception of the influence of the worries of others on oneself), social appraisal, and preventive behaviors, comparing respondents from areas under different movement restrictions during the first week after the outbreak; and to understand how worries, perceived risk, and preventive behaviors were associated with quality of life and individual characteristics among Italian adults.

Design, Setting, and Participants  This convenience sample, nonprobablistic survey study recruited adult participants with a snowballing sampling method in any Italian region during the first week of the COVID-19 outbreak in Italy from February 26, 2020, to March 4, 2020. Data were analyzed from March 5 to 12, 2020.

Exposures  Information was collected from citizens living in the quarantine zone (ie, red zone), area with restricted movements (ie, yellow zone), and COVID-19–free regions (ie, green zone).

Main Outcomes and Measures  Levels of knowledge on the virus, contagion-related worries, social appraisal, and preventive behaviors were assessed with ratings of quality of life (measured using the Short Form Health Survey). Additionally, some individual characteristics that may be associated with worries and behaviors were assessed, including demographic characteristics, personality traits (measured using Big Five Inventory-10), perceived health control (measured using the internal control measure in the Health Locus of Control scale), optimism (measured using the Revised Life Orientation Test), and the need for cognitive closure (measured using the Need for Closure Scale).

Results  A total of 3109 individuals accessed the online questionnaire, and 2886 individuals responded to the questionnaire at least partially (mean [SD] age, 30.7 [13.2] years; 2203 [76.3%] women). Most participants were well informed about the virus characteristics and suggested behaviors, with a mean (SD) score of 77.4% (17.3%) correct answers. Quality of life was similar across the 3 zones (effect size = 0.02), but mental health was negatively associated with contagion-related worries (β = –0.066), social appraisal (β = –0.221), and preventive behaviors (β = –0.066) in the yellow zone (R2 = 0.108). Social appraisal was also associated with reduced psychological well-being in the green zone (β = –0.205; R2 = 0.121). In the yellow zone, higher worries were negatively correlated with emotional stability (β = –0.165; R2 = 0.047). Emotional stability was also negatively associated with perceived susceptibility in the yellow (β = –0.108; R2 = 0.040) and green (β = –0.170; R2 = 0.087) zones. Preventative behaviors and social appraisal were also associated with the need for cognitive closure in both yellow (preventive behavior: β = 0.110; R2 = 0.023; social appraisal β = 0.115; R2 = 0.104) and green (preventive behavior: β = 0.174; R2 = 0.022; social appraisal: 0.261; R2 = 0.137) zones.

Conclusions and Relevance  These findings suggest that during the first week of the COVID-19 outbreak in Italy, people were well informed and had a relatively stable level of worries. Quality of life did not vary across the areas, although mental well-being was challenged by the social appraisal and worries related to the contagion. Increased scores for worries and concerns were associated with more cognitive rigidity and emotional instability.

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Article Information

Accepted for Publication: June 23, 2020.

Published: July 24, 2020. doi:10.1001/jamanetworkopen.2020.15821

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Pagnini F et al. JAMA Network Open.

Corresponding Author: Francesco Pagnini, PsyD, PhD, Department of Psychology, Università Cattolica del Sacro Cuore, Via Nirone, 15, 20123 Milano, Italy (francesco.pagnini@unicatt.it).

Author Contributions: Dr Pagnini had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Pagnini, Bonanomi, Tagliabue, Bertolotti, Confalonieri, Di Dio, Regalia, Saita, Villani.

Acquisition, analysis, or interpretation of data: Pagnini, Bonanomi, Tagliabue, Balconi, Bertolotti, Gilli, Graffigna, Villani.

Drafting of the manuscript: Pagnini, Bonanomi, Tagliabue, Bertolotti, Confalonieri, Di Dio, Villani.

Critical revision of the manuscript for important intellectual content: Pagnini, Bonanomi, Tagliabue, Balconi, Gilli, Graffigna, Regalia, Saita, Villani.

Statistical analysis: Bonanomi, Tagliabue.

Obtained funding: Di Dio.

Administrative, technical, or material support: Pagnini.

Supervision: Bonanomi, Tagliabue, Balconi, Bertolotti, Confalonieri, Gilli, Graffigna, Saita, Villani.

Conflict of Interest Disclosures: Dr Graffigna reported receiving grants from Merck Serono, Roche Diabetes Care, and Kedrion outside the submitted work. No other disclosures were reported.

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