An online population-based survey was conducted from 23 April to 8 June 2020 in 22 provinces of the DRC. This study was part of a series of surveys organised by an International Consortium (International Citizen Project COVID-19 (ICPCovid); http://www.icpcovid.com ) in low-income countries and low/middle-income countries to monitor the degree to which people aged ≥18 years adhere to COVID-19 preventive measures.
A web-based online questionnaire (seeonline supplemental material ), available at https://www.icpcovid.com/fr/country/congo-kinshasa, was used. The questionnaire proposed by the ICPCovid consortium was translated from English to French, adapted and pretested for use in the DRC.13 (link) The link was disseminated via social media platforms such as WhatsApp. On clicking on the link, the potential participant was informed about the study objectives, data confidentiality and consent form. Mindful of the low internet penetration and mobile connections in the country (19% and 40% of the total population, respectively, as of January 202014 ), we anticipated a low number of respondents to the online survey. To increase participation, one to four study assistants were used in each province to assist potential study candidates who had no access to the internet or had difficulties in filling out the form. The study assistants were recruited from among students in medical schools and the Kinshasa School of Public Health, and were trained in data collection procedures and ethics with an emphasis on COVID-19 prevention measures to be respected. Personal protective equipment and mobile internet bundles were provided to the study assistants, who were thereafter deployed to recruit potential participants. Study assistants used WhatsApp to motivate persons in their network to participate in the survey. Moreover, they were asked to interview the first 60 people they met in the street. Study assistants received financial support to cover transportation and mobile internet, but the persons interviewed did not receive any incentive. Participants’ responses were either recorded by the study assistants or entered directly by the participants. Where needed, the study assistants shared their internet access to enable participants to access the online questionnaire. Both convenience sampling (surveyors themselves contacted potential participants in different districts) and snowball sampling (the participants were requested to share the link of the questionnaire with their contacts) methods were used. The required sample size to detect the anticipated frequency of 18% of non-adherence as reported by Reuben et al15 (link) with 80% power and 0.05 significance levels was calculated to be a minimum of 354 participants per province.
The survey tool included questions on demographic characteristics such as age, sex, educational level and occupation. Adherence to preventive measures was assessed using 10 ‘yes/no’ questions based on the WHO and national guidelines on COVID-19 prevention. These included the following: (1) the use of face mask; (2) physical distancing; (3) coughing or sneezing in the crease of the elbow, or covering mouth and nose with a disposable handkerchief; (4) handwashing/disinfecting right after coughing or sneezing; (5) checking body temperature at least twice a week; (6) regular handwashing during the day; (7) using alcohol-based hand sanitiser during the day; (8) avoid touching face (eyes, nose, mouth); (9) disinfecting phone when getting home; and (10) staying at home when having flu-like symptoms.
Each item was scored 1 if the study participant confirmed that he/she adhered to the measure, or 0 otherwise. We computed adherence scores by summing responses to the above-mentioned 10 questions. The score ranged from 0 to 10. The Bloom’s cut-off point was used to classify practices into three levels: inadequate (<6), moderate (6–8) and adequate (>8–10). Subsequently, we grouped moderate and adequate practices into one category tagged adherence, whereas inadequate practices were considered as non-adherence to COVID-19 preventive measures. We also asked questions about the presence or absence of flu-like symptoms during the preceding 14 days, the specific symptom(s) they experienced, whether they had been tested for COVID-19 and the test result.
A web-based online questionnaire (see
The survey tool included questions on demographic characteristics such as age, sex, educational level and occupation. Adherence to preventive measures was assessed using 10 ‘yes/no’ questions based on the WHO and national guidelines on COVID-19 prevention. These included the following: (1) the use of face mask; (2) physical distancing; (3) coughing or sneezing in the crease of the elbow, or covering mouth and nose with a disposable handkerchief; (4) handwashing/disinfecting right after coughing or sneezing; (5) checking body temperature at least twice a week; (6) regular handwashing during the day; (7) using alcohol-based hand sanitiser during the day; (8) avoid touching face (eyes, nose, mouth); (9) disinfecting phone when getting home; and (10) staying at home when having flu-like symptoms.
Each item was scored 1 if the study participant confirmed that he/she adhered to the measure, or 0 otherwise. We computed adherence scores by summing responses to the above-mentioned 10 questions. The score ranged from 0 to 10. The Bloom’s cut-off point was used to classify practices into three levels: inadequate (<6), moderate (6–8) and adequate (>8–10). Subsequently, we grouped moderate and adequate practices into one category tagged adherence, whereas inadequate practices were considered as non-adherence to COVID-19 preventive measures. We also asked questions about the presence or absence of flu-like symptoms during the preceding 14 days, the specific symptom(s) they experienced, whether they had been tested for COVID-19 and the test result.
