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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
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
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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.
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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
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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
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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%)
709
(14.6%)
9. Ordinary residents can wear face masks to prevent the infection by the
COVID-19 virus.
3719
(76.7%)
813
(16.8%)
318 (6.6%)
10. It is not necessary for children and young adults to take measures to
prevent the infection by the COVID-19 virus.
179 (3.7%) 4630
(95.5%)
41 (0.8%)
11. To prevent the infection by COVID-19, individuals should avoid going
to crowded places and avoid taking public transportations.
4689
(96.7%)
112 (2.3%) 49 (1.0%)
12. Isolation and treatment of people who are infected with the COVID-19
virus are effective ways to reduce the spread of the virus.
4797
(98.9%)
17 (0.4%) 36 (0.7%)
13. People who have contact with someone infected with the COVID-19
virus should be immediately isolated in a proper place. In general, the
isolation period is 14 days.
4807
(99.1%)
18 (0.4%) 25 (0.5%)
Correct answers are indicated in bold.
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scores between those who did and did not avoid crowded places. Those with higher knowledge
scores did not avoid crowded places in the week before the MCO [Table 5].
The second question asked participants if they were wearing face masks when outside the
home during the week before the MCO began. More than half of the participants reported
wearing a face mask when going out in public (51.2%). The remaining participants did not
wear a mask (48.8%).
The wearing of face masks was found to be significantly associated with gender, age group,
region, occupation and income group. Males, people between the ages of 18 and 49, students
and those earning less than RM3,000 per month showed higher percentages in wearing face
masks when leaving the house. People living in the Central region, those above the age of 50
and people with an income over RM12,000 per month were less likely to wear a face mask. The
results also show that there was a significant difference between knowledge scores in terms of
mask-wearing. Those with higher knowledge scores did not wear masks when leaving the
house in the week before the MCO was enforced.
Lastly, when enquired about hand hygiene, a majority of participants reported that they
practised proper hand hygiene by frequently washing their hands and using hand sanitiser
(87.8%). Even so, there was still a percentage of participants who were not practising proper
hand hygiene in the week before the implementation of the MCO (12.2%).
There were significant associations found between proper hand hygiene and gender, age
group, region and occupation. Females, those living in the Central region, people between the
ages 18 to 29 and students were more likely to practise good hand hygiene. Those above 50,
Table 3. Demographic characteristics of participants and knowledge score (N = 4850).
Characteristics No. of participants Knowledge score (SD) t / F P
Gender Male 2042 (42.1%) 10.3 (1.5) -6.878 <0.001
Female 2808 (57.9%) 10.6 (1.3)
Age group 18–29 2065 (42.6%) 10.0 (1.4) 203.717 <0.001
30–49 2233 (46.1%) 10.7 (1.3)
Above 50 544 (11.2%) 11.0 (1.1)
Region Central 1993 (41.1%) 10.7 (1.3) 31.548 <0.001
Northern 1178 (24.3%) 10.1 (1.4)
Southern 638 (13.2%) 10.4 (1.5)
Eastern 662 (13.6%) 10.4 (1.4)
Sabah/Sarawak 379 (7.8%) 10.4 (1.4)
Occupation group Other� 33 (0.7%) 10.5 (1.2) 21.349 <0.001
Student 1125 (23.2%) 10.1 (1.4)
Unemployed 195 (4.0%) 10.7 (1.2)
Retiree 96 (2.0%) 10.9 (1.1)
Private sector 955 (19.7%) 10.7 (1.3)
Public sector 2173 (44.8%) 10.5 (1.4)
Self-employed 267 (5.5%) 10.7 (1.4)
Income category Below RM3k 1540 (31.8%) 10 (1.4) 96.113 <0.001
RM3k – 6k 1289 (26.6%) 10.5 (1.4)
RM6k – 9k 832 (17.2%) 10.7 (1.3)
RM9k – 12k 575 (11.9%) 10.8 (1.3)
RM12k and above 614 (12.7%) 11.0 (1.2)
�“Other” includes occupations such as manual labour and contract/ part-time work
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residents in the Eastern region and retirees were among the highest percentage of participants
who had not practised good hand hygiene in the week before the MCO.
4. Discussion
COVID-19 is a relatively new virus that has had devastating effects within the short time since
it was first detected in December 2019. To date, there has been limited published data on pop-
ulation knowledge, attitudes and practices toward COVID-19, specifically in Malaysia. The
novelty of this disease, along with its uncertainties, make it critical for health authorities to
plan appropriate strategies to prepare and manage the public. It is therefore of utmost impor-
tance that the knowledge, attitudes and practices of the population be studied to guide these
efforts.
The average knowledge score of Malaysians in regards to COVID-19 was moderate at 10.5
±1.4 with an overall correct rate of 80.5%. Even so, correct rates of COVID-19 knowledge ran-
ged widely indicating that while some participants had high levels of knowledge on the disease,
others did not. Malaysians above the age of 50 held higher knowledge scores, possibly due to a
higher risk perception of contraction and complications from the disease [16]. On the other
hand, those with low monthly income scored among the lowest knowledge scores. This may
indicate limited access to credible and timely information about the virus. This variation in
levels of knowledge may be reflective of the current COVID-19 information landscape in the
country. Although health authorities have been consistently disseminating COVID-19 infor-
mation since the disease was first detected in Malaysia, there has also been a surge in false and
inaccurate information [17,18]. The overload of information may have caused confusion and
difficulty ascertaining correct information.
Fig 1. Attitudes of participants on COVID-19 (N = 4850).
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Several studies conducted in other Asian countries have indicated high levels of COVID-19
knowledge among the general population [13] and healthcare workers [19]. Differences in
measurement and scoring systems do not make it possible for accurate comparisons of knowl-
edge levels across these studies.
The present study found that a large majority of participants held positive attitudes toward
overcoming COVID-19. Roughly eight out of ten participants agreed that COVID-19 would
be successfully controlled. Similarly, approximately nine out of ten participants were confident
that Malaysia would be able to win its battle against the virus and that the Malaysian govern-
ment was handling the health crisis very well. High levels of positive attitudes were also
detected in the KAP study conducted in China [13]. The authors attributed the positive atti-
tudes to the drastic measures taken by the Chinese government in mitigating the spread of the
virus. In Malaysia, the swift action taken by the Malaysian government in enforcing the MCO
may have also contributed to these positive attitudes.
Although the percentage of participants reporting uncertainty toward success in fighting
against COVID-19 was low (14%), this was significantly associated with lower knowledge
Table 4. Demographic characteristics of participants and attitudes toward COVID-19 (N = 4850).
Do you agree that COVID-19 will be
successfully controlled?
Do you have confidence that
Malaysia can win the battle
against the COVID-19 virus?
The government of Malaysia is handling
the COVID-19 health crisis very well.
Characteristics Agree Disagree I’m not sure Yes No Agree Disagree I’m not sure
Gender Male 1724 (85.0%) 44 (2.2%) 259 (12.8%) 1954 (96.4%) 74 (3.6%) 1836 (90.5%) 94 (4.6%) 98 (4.8%)
Female 2304 (82.9%) 56 (2.0%) 419 (15.1%) 2695 (97.0%) 84 (3.0%) 2526 (90.9%) 88 (3.2%) 165 (5.9%)�
Age group 18–29 1674 (81.6%) 51 (2.5%) 326 (15.9%) 1967 (95.9%) 84 (4.1%) 1839 (89.7%) 82 (4.0%) 130 (6.3%)
30–49 1889 (85.3%) 41 (1.9%) 284 (12.8%) 2160 (97.6%) 54 (2.4%) 2053 (92.7%) 66 (3.0%) 95 (4.3%)
Above 50 459 (86%) 8 (1.5%) 67 (12.5%)�� 516 (96.6%) 18 (3.4%)�� 464 (86.9%) 34 (6.4%) 36 (6.7%)���
Region Central 1594 (80.8%) 50 (2.5%) 329 (16.7%) 1899 (96.2%) 74 (3.8%) 1740 (88.2%) 105 (5.3%) 128 (6.5%)
Northern 975 (83.8%) 21 (1.8%) 167 (14.4%) 1124 (96.6%) 39 (3.4%) 1066 (91.7%) 33 (2.8%) 64 (5.5%)
Southern 549 (86.5%) 13 (2.0%) 73 (11.5%) 616 (97.0%) 19 (3.0%) 586 (92.3%) 21 (3.3%) 28 (4.4%)
Eastern 586 (88.9%) 7 (1.1%) 66 (10.0%) 647 (98.2%) 12 (1.8%) 630 (95.6%) 11 (1.7%) 18 (2.7%)
Sabah/Sarawak 324 (85.9%) 10 (2.7%) 43 (11.4%)��� 363 (96.3%) 14 (3.7%) 340 (90.2%) 12 (3.2%) 25 (6.6%)���
Occupation group Other# 25 (78.1%) 0 (0%) 7 (21.9%) 30 (93.8%) 2 (6.3%) 26 (81.3%) 2 (6.3%) 4 (12.5%)
Student 879 (78.6%) 37 (3.3%) 202 (18.1%) 1061 (94.9%) 57 (5.1%) 974 (87.1%) 59 (5.3%) 85 (7.6%)
Unemployed 164 (85%) 2 (1.0%) 27 (14.0%) 188 (97.4%) 5 (2.6%) 180 (93.3%) 8 (4.1%) 5 (2.6%)
Retiree 77 (81.9%) 1 (1.1%) 16 (17.0%) 91 (96.8%) 3 (3.2%) 75 (79.8%) 10 (10.6%) 9 (9.6%)
Private sector 761 (80.3%) 32 (3.4%) 155 (16.4%) 905 (95.5%) 43 (4.5%) 833 (87.9%) 45 (4.7%) 70 (7.4%)
Public sector 1889 (87.8%) 28 (1.3%) 234 (10.9%) 2112 (98.2%) 39 (1.8%) 2042 (94.9%) 44 (2.0%) 65 (3.0%)
Self-employed 226 (85.6%) 1 (0.4%) 37 (14%)��� 255 (96.6%) 9 (3.4%)��� 226 (85.6%) 14 (5.3%) 24 (9.1%)���
Income category Below RM3k 1290 (84.3%) 29 (1.9%) 212 (13.8%) 1486 (97.1%) 45 (2.9%) 1399 (91.4%) 56 (3.7%) 76 (5.0%)
RM3k – 6k 1093 (85.4%) 26 (2.0%) 161 (12.6%) 1236 (96.6%) 4 (3.4%) 1154 (90.2%) 41 (3.2%) 85 (6.6%)
RM6k – 9k 698 (84.6%) 14 (1.7%) 113 (13.7%) 795 (96.4%) 30 (3.6%) 749 (90.8%) 37 (4.5%) 39 (4.7%)
RM9k – 12k 456 (81.0%) 12 (2.1%) 95 (16.9%) 545 (96.8%) 18 (3.2%) 519 (92.2%) 19 (3.4%) 25 (4.4%)
RM12k and above 491 (80.8%) 20 (3.3%) 97 (16.0%) 587 (96.5%) 21 (3.5%) 541 (89.0%) 29 (4.8%) 38 (6.3%)
Knowledge score 10.5 (1.4) 10.4 (1.4) 10.2 (1.5)��� 10.5 (1.4) 10.3 (1.4) 10.5 (1.4) 10.3 (1.4) 10.2 (1.5)���
#“Other” includes occupations such as manual labour and contract/ part-time work
�P<0.05
��P<0.01
���P<0.001
https://doi.org/10.1371/journal.pone.0233668.t004
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scores. These results reinforce conclusions from previous studies associating higher levels of
knowledge with higher confidence and positive attitudes in health crises [20].
Positive attitudes were higher among those working in the public sector. This group showed
the highest confidence that COVID-19 would be successfully controlled, that Malaysia would
win the battle against the disease and that the Malaysian government were handling the health
crisis well. This may be due to work duties or affiliations directly related to government efforts
toward the containment of the virus.
In the current study, most participants reported taking precautions such as avoiding
crowded places and practising proper hand hygiene in the week before the MCO was imple-
mented. This indicates a general willingness for participants to make behavioural changes in
the face of the COVID-19 pandemic. Even so, people above the age of 50 and people who
earned more than RM12,000 per month were among those who did not avoid crowded places
in the week before the MCO. The week before the implementation of the MCO coincided with
the school holidays in Malaysia, a common season for family holidays and gatherings such as
weddings. Those above the age of 50 were also more likely to attend daily religious congrega-
tions like praying at the mosque. Cultural norms may have been influential in the decision to
attend these gatherings despite the health risks, especially among the older generation. Previ-
ous research has also shown that those with higher income were less willing to comply with
health recommendations [21] perceived less fear and more control in pandemic situations
[22].
Interestingly, enquiry into the wearing of face masks garnered a mixed response. Almost
half of the participants indicated that they did not wear a face mask when leaving the home in
the week before the MCO. There are two possible explanations for this behaviour in the
Fig 2. Practices of participants on COVID-19 (N = 4850).
https://doi.org/10.1371/journal.pone.0233668.g002
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 10 / 15
Malaysian context. Firstly, the use of face masks is not a norm in Malaysian society. It is
uncommon for the typical Malaysian to wear a face mask when ill. The emergence of COVID-
19 caused an increase in demand for medical face masks (and hand sanitiser) in the country
and supplies were short [23]. The scarcity of face masks meant that many regular members of
the public were unable to obtain them. The shortage of personal protective equipment was not
limited to Malaysia. It had become a global problem due to increased demand in response to
COVID-19 [24]. Secondly, the Ministry of Health Malaysia has been adamant that medical
face masks should only be worn by those who are showing symptoms of COVID-19 or similar
illnesses. This was to ensure ample supplies of personal protective equipment for medical
workers on the frontline. Even so, mixed messages had been communicated to the public by
different authoritative bodies on the use of face masks. It is possible that the lack of supply and
the confusion caused by the mixed messages led to the divided response on the wearing of face
masks when out in public.
Admittedly, COVID-19 has been a teething public health problem around the world. Scien-
tists are working diligently to explore different vaccines and treatment options. Social
Table 5. Demographic characteristics of participants and practices toward COVID-19 (N = 4850).
In the week before the MCO, did
you avoid going to crowded places
such as weddings?
In the week before the MCO, did
you wear a face mask when leaving
the home?
In the week before the MCO, did
you practice proper hand hygiene
by frequently washing your hands
and using hand sanitizer?
Characteristics Yes No Yes No Yes No
Gender Male 1701 (83.9%) 327 (16.1%) 1092 (53.8%) 936 (46.2%) 1701 (83.9%) 327 (16.1%)
Female 2309 (83.1%) 470 (16.9%) 1369 (49.3%) 1410 (50.7%)�� 2520 (90.7%) 259 (9.3%)���
Age group 18–29 1742 (84.9%) 309 (15.5%) 1271 (62.0%) 780 (38.0%) 1849 (90.2%) 202 (9.8%)
30–49 1853 (83.7%) 361 (16.3%) 972 (43.9%) 1242 (56.1%) 1932 (87.3%) 282 (12.7%)
Above 50 407 (76.2%) 127 (23.8%)��� 212 (39.7%) 322 (60.3%)��� 433 (81.1%) 101(18.9%)���
Region Central 1634 (82.8%) 339 (17.2%) 919 (46.6%) 1054 (53.4%) 1775 (90.0%) 198 (10.0%)
Northern 984 (84.6%) 179 (15.4%) 695 (59.8%) 468 (40.2%) 1027 (88.3%) 136 (11.7%)
Southern 533 (83.9%) 102 (16.6%) 318 (50.1%) 317 (49.9%) 546 (86.0%) 89 (14.0%)
Eastern 535 (81.2%) 124 (18.8%) 323 (49.0%) 336 (51.0%) 553 (83.9%) 106 (16.1%)
Sabah/Sarawak 324 (85.9%) 53 (14.1%) 206 (54.6%) 171 (45.4%)��� 320 (84.9%) 57 (15.1%)���
Occupation group Other# 26 (81.3%) 6 (18.8%) 12 (37.5%) 20 (62.5%) 24 (75.0%) 8 (25.0%)
Student 927 (82.9%) 191 (17.1%) 697 (62.6%) 421 (37.7%) 1015 (90.8%) 103 (9.2%)
Unemployed 161 (83.4%) 32 (16.6%) 81 (42.0%) 112 (58.0%) 168 (87.0%) 25 (13.0%)
Retiree 73 (77.7%) 21 (22.3%) 34 (36.2%) 60 (63.8%) 71 (75.5%) 23 (24.5%)
Private sector 780 (82.3%) 168 (17.7%) 429 (45.3%) 519 (54.7%) 851 (89.8%) 97 (10.2%)
Public sector 1827 (84.9%) 324 (15.1%) 1086 (50.5%) 1065 (49.5%) 1858 (86.4%) 293 (13.6%)
Self-employed 210 (79.5%) 54 (20.5%) 119 (45.1%) 145 (54.9%)��� 227 (86.0%) 37 (14.0%)���
Income category Below RM3k 1321 (86.3%) 210 (13.7%) 941 (61.5%) 590 (38.5%) 1368 (89.4%) 163 (10.6%)
RM3k – 6k 1075 (84.0%) 205 (16.0%) 676 (52.8%) 604 (47.2%) 1115 (87.1%) 165 (12.9%)
RM6k – 9k 682 (82.7%) 143 (17.3%) 351 (42.5%) 474 (57.5%) 718 (87.0%) 107 (13.0%)
RM9k – 12k 455 (80.8%) 108 (19.2%) 243 (43.2%) 320 (56.8%) 482 (85.6%) 81 (14.4%)
RM12k and above 477 (78.5%) 131 (21.5%)��� 250 (41.1%) 358 (58.9%)��� 538 (88.5%) 70 (11.5%)
Knowledge score (t-test) 10.4 (1.4) 10.6 (1.4)�� 10.3 (1.4) 10.6 (1.4)��� 10.5 (1.4) 10.5 (1.4)
#“Other” includes occupations such as manual labour and contract/ part-time work
�P<0.05
��P<0.01
���P<0.001
https://doi.org/10.1371/journal.pone.0233668.t005
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scientists, especially those in public health and health communication, are working to identify
the levels of knowledge, attitudes and practices on COVID-19 among the public as to design
cost-effective public health campaigns and education programmes. The current survey, in fact,
exposes the need for more comprehensive education programmes with focus on consistency
of information from the government and related authorities. COVID-19 education efforts
should take a proactive approach and focus on dispelling misinformation in the form of con-
flicting opinions, old wives’ tales and incorrect information. Due to the levels of media and
telecommunication usage in Malaysian society [25–27] and evidence from prior research [28],
authorities would benefit from utilising both mainstream and social media in disseminating
these messages.
5. Limitations
Sampling for the study was conducted via a convenience sample through the networks of the
researchers and disseminated through different social media platforms (Whatsapp, Facebook,
Twitter etc.). As a result, there is a possibility of bias as underprivileged populations may not
have been able to participate in the study. Additionally, when compared to current population
statistics in Malaysia [29], the sample of the study were over-representative of women, people
below the age of 50, and those employed in the public sector. Therefore, there are limitations
to the representativeness of the findings. A more systematic, inclusive sampling method is war-
ranted to improve representativeness and generalisability of the findings.
The second limitation is related to the KAP instrument used in this study. The instrument
was adapted from a survey that had been previously tested and utilised in China [13]. Even so,
a more thorough assessment of instrument validity and reliability would have produced a
more robust instrument. Due to the limited time and urgency of the survey, attitudes and prac-
tices were measured with only one item each. In addition to this, possible factors contributing
to knowledge, attitude and practice such as risk perceptions and health literacy [30,31] were
not measured in this study. These would have been a useful addition in understanding the
knowledge, attitudes and practices of COVID-19 in Malaysia.
A further limitation of the present study is the possibility of participants giving socially
desirable responses. As this study used self-reported data, it is possible that participants may
have answered attitude and practice questions positively based on what they perceive to be
expected of them [32].
6. Conclusions
In summary, the present study was able to provide a comprehensive examination of the knowl-
edge, attitudes and practices of Malaysians toward COVID-19. The findings suggest that
Malaysians have an acceptable level of knowledge on COVID-19 and are generally positive in
their outlook on overcoming the pandemic. Even so, consistent messaging from the govern-
ment and/ or health authorities are key to aid public knowledge and understanding of
COVID-19. Additionally, some categories of the population may benefit from specific health
education programs to raise COVID-19 knowledge and improve practices.
Supporting information
S1 Data.
(SAV)
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 12 / 15
Acknowledgments
We would like to express our appreciation to the Faculty of Social Sciences and Humanities,
Universiti Kebangsaan Malaysia, particularly to Associate Professor Dr. Kadaruddin Aiyub
and Noraznita Anor Basri for their assistance and a sincere thank you to all members of the
Malaysian public who participated in the survey.
Author Contributions
Conceptualization: Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern, Suffian
Hadi Ayub, Emma Mohamad.
Data curation: Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern.
Formal analysis: Arina Anis Azlan.
Funding acquisition: Arina Anis Azlan, Emma Mohamad.
Investigation: Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern, Suffian Hadi
Ayub, Emma Mohamad.
Methodology: Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern, Suffian Hadi
Ayub, Emma Mohamad.
Project administration: Emma Mohamad.
Resources: Emma Mohamad.
Supervision: Emma Mohamad.
Validation: Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern, Suffian Hadi
Ayub, Emma Mohamad.
Visualization: Arina Anis Azlan.
Writing – original draft: Arina Anis Azlan, Mohammad Rezal Hamzah, Tham Jen Sern, Suf-
fian Hadi Ayub, Emma Mohamad.
Writing – review & editing: Arina Anis Azlan, Emma Mohamad.
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