Awareness, Attitudes, and Actions Related to COVID-19 among Adults with Chronic Conditions at the Onset of the U.S. Outbreak ; A Cross-sectional Survey

Michael S. Wolf*, Marina Serper, Lauren Opsasnick, Rachel M. O'Conor, Laura Curtis, Julia Yoshino Benavente, Guisselle Wismer, Stephanie Batio, Morgan Eifler, Pauline Zheng, Andrea Russell, Marina Arvanitis, Daniela Ladner, Mary Kwasny, Stephen D. Persell, Theresa Anne Rowe, Jeffrey A. Linder, Stacy C. Bailey

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

374 Scopus citations


Background: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. Objective: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. Design: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study. Setting: 5 academic internal medicine practices and 2 federally qualified health centers. Patients: 630 adults aged 23 to 88 years living with 1 or more chronic conditions. Measurements: Self-reported knowledge, attitudes, and behaviors related to COVID-19. Results: A fourth (24.6%) of participants were "very worried"about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely"to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response. Limitation: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak. Conclusion: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities.

Original languageEnglish (US)
Pages (from-to)100-109
Number of pages10
JournalAnnals of internal medicine
Issue number2
StatePublished - Jul 21 2020

ASJC Scopus subject areas

  • Internal Medicine


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