{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T08:07:35Z","timestamp":1793606855748,"version":"4.5.0"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,29]],"date-time":"2023-01-29T00:00:00Z","timestamp":1674950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objectives: To assess perceived fear and to evaluate the level of knowledge, attitude, and prevention practices (KAP) regarding COVID-19 infection among patients with diabetes mellitus (DM) attending primary healthcare centers (PHCs) in Kuwait. This will help evaluate gaps and provide appropriate support to limit the spread of COVID-19 infection in high-risk patients. Methods: A descriptive cross-sectional study was carried out using a self-administered questionnaire. All patients aged 18 years or older attending for follow-up or newly diagnosed with type 1 or type 2 diabetes were eligible to participate in the study. Patients waiting for their regular follow-up appointments at the PHCs were invited verbally to take part in the study. The study excluded patients under the age of 18 and those with significant cognitive or physical impairment that might interfere with independent self-care behavior. The questionnaire included 57 items. The data were analyzed using descriptive statistics. Results: A total of 294 questionnaires were distributed to patients at PHCs in three health districts (Hawally, Capital, and Farwaniya) in Kuwait; 251 patients agreed to participate in the study, yielding a response rate of 85.4%. The study showed that most patients had moderate knowledge (71.1%) of COVID-19. The majority of correctly responded questions were about the mode of COVID-19 transmission, the most common clinical presentations, and at-risk people. On the other hand, 83.7% (n = 210) identified common cold symptoms (stuffy nose, runny nose, and sneezing) as COVID-19 symptoms. More than half of the patients (n = 146, 58.2%) were unable to identify uncommon COVID-19 symptoms, such as diarrhea and skin rash or discoloration. Most patients had a positive attitude (90.9%) and good prevention practices (83.6%). The overall fear score of the participating patients was 21.6 \u00b1 6.5 (61.7%). Conclusions: Regardless of the positive attitude and good preventive practices of the patients, they had moderate knowledge levels about COVID-19. This indicates that there are significant knowledge gaps that still need to be filled. Different strategies can be used for this purpose, such as social media and public information campaigns. Supporting psychological well-being is vital for at-risk patients during a pandemic.<\/jats:p>","DOI":"10.3390\/ijerph20032369","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T03:56:27Z","timestamp":1675050987000},"page":"2369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Perceived Knowledge, Attitude, and Practices (KAP) and Fear toward COVID-19 among Patients with Diabetes Attending Primary Healthcare Centers in Kuwait"],"prefix":"10.3390","volume":"20","author":[{"given":"Fatemah M.","family":"Alsaleh","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City 12037, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna","family":"Elzain","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City 12037, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1934-3751","authenticated-orcid":false,"given":"Zahra K.","family":"Alsairafi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City 12037, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8440-7446","authenticated-orcid":false,"given":"Abdallah Y.","family":"Naser","sequence":"additional","affiliation":[{"name":"Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s15010-020-01516-2","article-title":"COVID-19 outbreak: History, mechanism, transmission, structural studies and therapeutics","volume":"49","author":"Yesudhas","year":"2021","journal-title":"Infection"},{"key":"ref_2","unstructured":"WHO (2022, July 15). Rolling Updates on Coronavirus Disease (COVID-19): WHO. Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/events-as-they-happen."},{"key":"ref_3","unstructured":"World Health Organization (WHO) (2022). Coronavirus COVID-19 Dashboard, World Health Organization. Available online: https:\/\/covid19.who.int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"69","DOI":"10.7326\/M20-5008","article-title":"Transmission of SARS-CoV-2: A Review of Viral, Host, and Enviromental Factors","volume":"174","author":"Meyerowitz","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/cid\/ciaa1057","article-title":"Risk of Coronavirus Disease 2019 Transmission in Train Passengers: An Epidemiological and Modeling Study","volume":"72","author":"Hu","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","first-page":"753","article-title":"Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19)","volume":"96","author":"Umakanthan","year":"2020","journal-title":"Postgrad. Med. J."},{"key":"ref_7","unstructured":"National Institutes of Health (2022, April 21). Coronavirus Disease 2019 (COVID-19) Treatment Guidelines, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"m1966","DOI":"10.1136\/bmj.m1966","article-title":"Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study","volume":"369","author":"Petrilli","year":"2020","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"588013","DOI":"10.3389\/fmed.2021.588013","article-title":"Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review with Cumulative Meta-Analysis","volume":"8","author":"Geng","year":"2021","journal-title":"Front. Med."},{"key":"ref_11","first-page":"E008","article-title":"Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19","volume":"48","author":"Chen","year":"2020","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Alkandari, A., Alarouj, M., Elkum, N., Sharma, P., Devarajan, S., Abu-Farha, M., Al-Mulla, F., Tuomilehto, J., and Bennakhi, A. (2020). Adult Diabetes and Prediabetes Prevalence in Kuwait: Data from the Cross-Sectional Kuwait Diabetes Epidemiology Program. J. Clin. Med., 9.","DOI":"10.3390\/jcm9113420"},{"key":"ref_15","unstructured":"WHO (2022, April 21). COVID-19 Transmission and Protective Measures: WHO. Available online: https:\/\/www.who.int\/westernpacific\/emergencies\/covid-19\/information\/transmission-protective-measures."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2307\/1965090","article-title":"KOREA: Trends in Four National KAP Surveys, 1964\u20131967","volume":"1","author":"Kim","year":"1969","journal-title":"Stud. Fam. Plan."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/inr.12085","article-title":"Knowledge, attitudes, and practices towards prevention and early detection of chronic kidney disease","volume":"61","author":"Khalil","year":"2014","journal-title":"Int. Nurs. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Matsumoto-Takahashi, E.L.A., Tongol-Rivera, P., Villacorte, E.A., Angluben, R.U., Jimba, M., and Kano, S. (2015). Patient Knowledge on Malaria Symptoms Is a Key to Promoting Universal Access of Patients to Effective Malaria Treatment in Palawan, the Philippines. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0127858"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ricardo, T., Bergero, L.C., Bulgarella, E.P., and Previtali, M.A. (2018). Knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside settlements of Santa Fe, Argentina. PLoS Neglected Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006470"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.2310\/7060.2004.13587","article-title":"Travelers\u2019 knowledge, attitudes and practices on the prevention of infectious diseases: Results from a study at Johannesburg International Airport","volume":"11","author":"Toovey","year":"2004","journal-title":"J. Travel Med."},{"key":"ref_21","first-page":"e00054020","article-title":"Stress, anxiety, and de-pression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain","volume":"36","year":"2020","journal-title":"Cad. Saude Publica"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.psyneuen.2016.04.019","article-title":"Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis","volume":"70","author":"Buchberger","year":"2016","journal-title":"Psychoneuroendocrinology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"856156","DOI":"10.3389\/fmed.2022.856156","article-title":"Knowledge, Attitudes, and Practices Toward the Prevention of COVID-19 in Bangladesh: A Systematic Review and Meta-Analysis","volume":"9","author":"Raquib","year":"2022","journal-title":"Front. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3855\/jidc.14388","article-title":"Knowledge, Attitude and Practices (KAP) towards COVID-19 pandemic in America: A preliminary systematic review","volume":"15","author":"Fusaro","year":"2021","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Li, L., Wang, F., Shui, X., Liang, Q., and He, J. (2022). Knowledge, attitudes, and practices towards COVID-19 among college students in China: A systematic review and meta-analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270038"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Li, F., Liang, W., Rhodes, R.E., Duan, Y., Wang, X., Shang, B., Yang, Y., Jiao, J., Yang, M., and Supriya, R. (2022). A systematic review and meta-analysis on the preventive behaviors in response to the COVID-19 pandemic among children and adolescents. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13585-z"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.puhe.2021.03.005","article-title":"Knowledge, attitudes, and practices of the general population about Coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis with policy recommendations","volume":"194","author":"Saadatjoo","year":"2021","journal-title":"Public Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"108344","DOI":"10.1016\/j.diabres.2020.108344","article-title":"Knowledge, attitudes and practices towards COVID-19 among young adults with Type 1 Diabetes Mellitus amid the nationwide lockdown in India: A cross-sectional survey","volume":"166","author":"Pal","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"225","DOI":"10.25122\/jml-2020-0184","article-title":"Knowledge, attitude and practice towards COVID-19 among individuals with associated comorbidities","volume":"14","author":"Saeed","year":"2021","journal-title":"J. Med. Life"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4203","DOI":"10.2147\/IDR.S283999","article-title":"COVID-19 Knowledge, Attitudes, and Pre-vention Practices Among People with Hypertension and Diabetes Mellitus Attending Public Health Facilities in Ambo, Ethiopia","volume":"13","author":"Taye","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.dsx.2021.03.033","article-title":"Knowledge, attitude and practice of patients with chronic diseases towards COVID-19 pandemic in Dessie town hospitals, Northeast Ethiopia","volume":"15","author":"Addis","year":"2021","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s13340-021-00511-8","article-title":"Evaluation of perceived fears of COVID-19 virus infection and its rela-tionship to health-related quality of life among patients with diabetes mellitus in Egypt during pandemic: A developing country single-center study","volume":"13","author":"Abdelghani","year":"2021","journal-title":"Diabetol. Int."},{"key":"ref_33","first-page":"e13899","article-title":"Fear of COVID-19 and stigmatization towards infected people among Jordanian people","volume":"75","author":"Abuhammad","year":"2020","journal-title":"Int. J. Clin. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.2147\/OPTH.S300239","article-title":"Fear Associated with COVID-19 in Patients with Neovascular Age-Related Macular Degeneration","volume":"15","author":"Rozon","year":"2021","journal-title":"Clin. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3389\/fpubh.2020.00217","article-title":"Knowledge, Attitude and Practice Toward COVID-19 Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study","volume":"8","author":"Angawi","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Azlan, A.A., Hamzah, M.R., Sern, T.J., Ayub, S.H., and Mohamad, E. (2020). Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS ONE, 15.","DOI":"10.1101\/2020.04.29.20085563"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.7150\/ijbs.45221","article-title":"Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey","volume":"16","author":"Zhong","year":"2020","journal-title":"Int. J. Biol. Sci."},{"key":"ref_38","unstructured":"World Health Organization (2022, April 21). Coronavirus Disease (COVID-19) Advice for the Public. Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/advice-for-public."},{"key":"ref_39","unstructured":"Kuwait Ministry of Health (2021, March 03). Q&A on Coronaviruses (COVID-19), Available online: https:\/\/corona.e.gov.kw\/en\/Home\/NovelCoronavirus."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s11469-020-00270-8","article-title":"The Fear of COVID-19 Scale: Development and Initial Validation","volume":"20","author":"Ahorsu","year":"2020","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"American diabetes Association (2021). Standards of Medical Care in Diabetes\u20142021. J. Clin. Appl. Res. Educ., 44, S1\u2013S232.","DOI":"10.2337\/dc21-Sint"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Naser, A.Y., Dahmash, E.Z., Alsairafi, Z.K., Alwafi, H., Alyami, H., Jalal, Z., Al Rajeh, A.M., Paudyal, V., Alhartani, Y.J., and Turkistani, F.M. (2021). Knowledge and Practices during the COVID-19 Outbreak in the Middle East: A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094699"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Al Ahdab, S. (2021). A cross-sectional survey of knowledge, attitude and practice (KAP) towards COVID-19 pandemic among the Syrian residents. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10353-3"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Gao, H., Hu, R., Yin, L., Yuan, X., Tang, H., Luo, L., Chen, M., Huang, D., Wang, Y., and Yu, A. (2020). Knowledge, attitudes and practices of the Chinese public with respect to coronavirus disease (COVID-19): An online cross-sectional survey. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09961-2"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1111\/jan.14718","article-title":"Knowledge, attitude and practice of residents in the prevention and control of COVID-19: An online questionnaire survey","volume":"77","author":"Yang","year":"2021","journal-title":"J. Adv. Nurs."},{"key":"ref_46","unstructured":"Mitchell, A. (2022, April 21). Can SARS-CoV-2, the Virus that Causes COVID-19 Disease, Be Spread by Blood? National Institute of Environmental Health Sciences, Available online: https:\/\/tools.niehs.nih.gov\/wetp\/public\/hasl_get_blob.cfm?ID=11981#:~:text=It%20isn't%20that%20SARS,hemoglobin)%20ability%20to%20work%20effectively."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Qutob, N., and Awartani, F. (2021). Knowledge, attitudes and practices (KAP) towards COVID-19 among Palestinians during the COVID-19 outbreak: A cross-sectional survey. PLoS ONE, 16.","DOI":"10.1101\/2020.08.12.20170852"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.4103\/ijo.IJO_2522_20","article-title":"Knowledge, attitude and practise toward COVID-19 among patients presenting to five tertiary eye care hospitals in South India\u2014A multicentre questionnaire-based survey","volume":"68","author":"Venkatesh","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_49","first-page":"371","article-title":"Knowledge, attitudes, and practices towards COVID-19 among residents of Bosnia and Herzegovina during the first stage of COVID-19 outbreak","volume":"33","year":"2021","journal-title":"Ann. Ig."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Bazaid, A.S., Aldarhami, A., Binsaleh, N.K., Sherwani, S., and Althomali, O.W. (2020). Knowledge and practice of personal protective measures during the COVID-19 pandemic: A cross-sectional study in Saudi Arabia. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243695"},{"key":"ref_51","first-page":"e15817","article-title":"Fear of COVID-19 and Stress-Relieving Practices Among Social Media Users, Makkah Region, Saudi Arabia","volume":"13","author":"Mousa","year":"2021","journal-title":"Cureus"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1136\/bmj.333.7570.674-a","article-title":"Two thirds of doctors in UK say the NHS could not cope with bird flu epidemic","volume":"333","author":"Cole","year":"2006","journal-title":"BMJ"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Khan, M.U., Shah, S., Ahmad, A., and Fatokun, O. (2014). Knowledge and attitude of healthcare workers about middle east respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1281"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1007\/s11469-020-00332-x","article-title":"Assessing Coronavirus fear in Indian population using the fear of COVID-19 scale","volume":"19","author":"Doshi","year":"2021","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Alsairafi, Z., Naser, A., Alsaleh, F., Awad, A., and Jalal, Z. (2021). Mental Health Status of Healthcare Professionals and Students of Health Sciences Faculties in Kuwait during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18042203"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:18:49Z","timestamp":1760120329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,29]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032369"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032369","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,29]]}}}