To understand communities’ knowledge, attitudes, and practices (KAP), along with their information needs on COVID-19, this KAP assessment was conducted by the Turkish Red Crescent Society (TRCS), with support from IFRC, under the Community Based Migration Programme (CBMP) from 12 March to 9 April 2021. This is the third round of the KAP assessment and is a follow up on the first round conducted from 20 July to 12 August 2020 and the second round conducted from 10 to 26 November 2020. This third round of the assessment also provides an understanding of people’s perception and attitude towards a COVID-19 vaccine and their willingness to get vaccinated once a vaccine is available as well as to find out if anyone has already received vaccines under the government’s vaccination plan. The assessment was conducted using the same methodology as before - via phone interviews and online consultations/focus group discussions (FGDs) with refugees and local people in 16 TRCS Community Centre locations. Comprising both qualitative and quantitative data, a total of 3,840 individuals had been interviewed over the phone in 16 Community Centre locations, with a total of 305 refugees and local people participating in 32 FGDs. The findings of the assessment are intended to inform understanding of community perceptions of, and knowledge about, COVID-19 and, in turn, shape risk communication, behaviour change and community engagement activities. At the same time, the results will support TRCS to provide clear and accurate information about vaccination and respond to any misperceptions in the community.
Survey findings show that community members are well aware (93.9%) of the COVID-19 outbreak, including the symptoms of the infection, how it spreads, and how to reduce the risks of becoming infected. Although slightly less than the previous assessment (96.1%), this number indicates communities’ continued exposure to a wide range of information related to this topic.
The most popular sources of information about COVID-19 were TV (66.9%), followed by Ministry of Health (36.3%), family/ neighbours (30.4%), friends (28.3%) and health workers (26.5%). Other sources mentioned included website, government officials and social media channels - including those of TRCS and its website - and TRCS staff and volunteers. There were no significant differences in the responses for TV and Ministry of Health among refugees and host community respondents and both the groups accessed information from these sources. However, family/neighbours (20.0%), friends (17.4%), health workers (13.6%), Facebook (20.8%) and website (17.1%) were reported as channels used more by refugees compared to respondents from the host population.
The majority (95.9%) of the respondents reported that they did not encounter any challenges in receiving information about COVID-19. However, in addition to not knowing the trusted sources of information, which was one of the major challenges among both refugees and host population, not having access to internet and social media channels having limited information in the language of the respondents were other obstacles, more highly reported by the refugees.
Communities’ most trusted sources of information were TV (45.3%), Ministry of Health (37.8%), doctors (32.0%) and health workers (28.3%). Other channels mentioned included government officials, family and friends, websites and TRCS. Like in the previous round, respondents from several locations in this round said key influencers, such as religious leaders or community leaders, were one of the trusted channels to receive information from and should be involved to encourage communities to practise positive behaviour.
A majority of respondents identified older people (83.8%) and people with chronic diseases (74.6%) as being at the highest risk of COVID-19 infection. Also mentioned were doctors and health workers, pregnant women, children, and people who were going out to work or in crowded places, those using public transport and people not following the preventive measures could be at risk of COVID-19 infection. As in the previous round, it was understood that young people may not always show symptoms but can be carriers of the disease.
A majority of survey respondents viewed COVID-19 as ‘’very dangerous’’ (65.7%). This response was much higher in the previous KAP assessment (81.4%). On the other hand, the number of respondents considering COVID-19 as ‘’more or less dangerous’’ has increased in the third round (29.3%) compared to the second (15.6%).
When asked if a person who is infected or has recovered from COVID-19 would face discrimination, 9.6% of the host population answered ‘’Yes’’ compared to 6.5% of the refugee respondents. This suggests that stigmatisation of COVID-19 is higher among the host population than among refugee communities. Stigmatisation was also reported higher among the host population in the previous assessment (14.9%) compared to refugees (5.3%), however, overall, there has been a further decrease during the third round in those saying people would be discriminated against. According to those who said discrimination would occur (908 respondents), the most discriminated groups of people were those who had, or previously had had, COVID -19 (52.8%), as well as those suspected of being infected with the virus (46.9%).
A majority of the survey respondents (59.8%) reported being worried that they might become infected with COVID-19 or that their family members might become infected (57.4%). Fears of losing employment (14.1%), paying rents/bills (14.2%), having losing employment (10.5%) or being unable to afford food for the household (10.5%) were all higher among refugees than local people. Concerns related to employment were also higher for men than women.
Vast majority - 88.7% - of survey respondents were taking some measures in their daily life to prevent the risk of COVID-19 infection, including frequently washing hands with soap, practicing personal hygiene, avoiding going out unless necessary, wearing masks, and maintaining physical distance whenever outside. This finding is slightly lower than the previous assessment (95.8%). The few who said they were not taking any measures (76 respondents) highlighted various reasons, for example, not knowing how to take preventive measures (65.8%), not believing these practices would be effective in preventing the risk (23.7%) and family members needing to go out for work (15.8%).
As in the previous round, it was reported that people in many locations were still less inclined to follow the preventive measures due to reduced fear and fatigue. People felt uncomfortable and were tired out wearing face masks. Some people in the communities believed that COVID-19 did not exist or had fatalistic perceptions about the disease. In addition, misinformation and rumours in social media were causing people to further undermine health information.
Various rumours were reported being spread in the community with several relating to COVID-19 vaccines, denial of COVID-19 and actions to prevent COVID-19. These rumours spread mostly via word of mouth and social media, especially through Facebook, WhatsApp, and Twitter. Misperceptions and rumours can create social tension in a community or lead to practising harmful behaviour and therefore should be responded by providing communities with the right information.
While around two-fifth, 43.6%, of respondents said they do not need any more information about COVID-19, more than half, 56.4%, of the respondents have asked for additional information on COVID-19 on various topics. Participants in this round emphasized the need for accurate and detail information on COVID-19 vaccine in Turkey including vaccination plans and priority groups, procedures to get the vaccine, risks and side effects, effectiveness of vaccines against COVID-19 as well as the new variants. They suggested targeted messages for different groups of people, such as children, young and older people, were important to motivate everyone to practice healthy behaviours.
Over three-fifths of survey respondents said they preferred to receive information on COVID-19 from TRCS by phone (64.7%), but other channels that would also be welcomed were SMS (31.1%), TRCS Facebook (20.3%) and TV (17.3%).
Refugees showed a stronger preference for phone, TRCS Facebook, TV and WhatsApp than respondents from the host population. Turkish (58.4%) and Arabic (57.1%) were the main preferred languages with English, Farsi and Kurdish also reported, but in much lower numbers.
Like the previous round, refugees were significantly more likely to follow TRCS social media channels or visit the TRCS website and recognise these as a source of COVID-19 information, than respondents drawn from the local host community, many of whom said they were unaware of these TRCS platforms. Compared to the previous assessment (where 43.8% of respondents responded positively), less people are now following the TRCS social media and website (41.6%). A greater proportion of refugees visit the TRCS Facebook and Instagram pages, both general and Community Centre accounts, while TRCS Twitter accounts were more popular among people from host communities.
Almost three-quarters of survey respondents said they would prefer to contact TRCS over the phone (73.3%) to ask questions or share feedback. Respondents in several locations also preferred face-to-face interaction by visiting TRCS Community Centres or meeting its staff or volunteers during their outreach activities. Face-to-face or online meetings via Zoom or Skype were also useful to ask questions and share key concerns of their community, they said.
With the pandemic still ongoing, respondents said there were still many people who have been affected and lost employment and they suggested TRCS provide relevant assistance, such as cash or in-kind support, to those who are in need and vulnerable. They also suggested TRCS to organise online information sessions and meetings on COVID-19 vaccines and continue to raise awareness among communities about COVID-19 and the preventive measures. The need for masks, hygiene kits and psychosocial support in the community was still quite high and suggestions were made to distribute hygiene parcels as well as food on a regular basis.
Regarding COVID-19 vaccine, a majority – 94.9% - of survey respondents reported not having received the vaccine and more than half of these respondents (52.1%) did not receive any information about it. The remaining (47.9%) have received information on various topics including on priority groups, people who could get the vaccine and vaccination plans. Popular sources of information on vaccine for the respondents were Ministry of Health, TV, health workers and family and friends.
Among those (3,646), who did not receive COVID-19 vaccine, more than half of the respondents (58.4%) said they wanted to get vaccinated when it was available for them. The remaining (41.6%) were either unsure or did not want to get the vaccine due to beliefs that the vaccine will not be safe or that people could experience serious side effects after getting vaccinated.
Respondents asked several questions on COVID-19 vaccine during the assessment, particularly about its safety and side effects. They also mentioned about misperceptions on vaccines in their communities that should be responded with the right information.