Coronavirus disease 2019 (COVID-19) is a contagious respiratory disease in humans that causes pneumonia-like infection (1). So far, seven human coronaviruses (HCoVs) have been identified. These include the highly pathogenic severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and the newly identified SARS-CoV-2. They are known to have caused global outbreaks, with SARS-CoV-2 being responsible for the current pandemic (2).

The COVID-19 pandemic emerged in Wuhan, China, in late December 2019 (3). Later, this disease was declared a global public health emergency (4). COVID-19 was declared a pandemic by WHO on March 11, 2020, due to an increase in the number of cases worldwide (5). On March 13, 2020, the first COVID-19 case in Ethiopia was confirmed (6).

Contaminated objects and respiratory droplets were the primary means of transmission for this pandemic (7). Asymptomatic patients serve as carriers of this pandemic (8). Old age and patients with pre-existing chronic illnesses were identified as risk factors for the severe form of the disease and mortality (9). Fever, dry cough, fatigue, respiratory illnesses, diarrhoea, vomiting, and headache were among the clinical manifestations (10).

Non-pharmaceutical interventions (NPIs) are key to controlling the spread of this virus (11), relying on public willingness, which is influenced by knowledge and risk perception (12). However, studies showed inconsistent knowledge about the pandemic. A study in Bangladesh showed that about 45% of participants had poor knowledge (13). A Chinese study showed that droplet infection was mentioned as a mode of transmission by only 66.6% of the participants, while 35.9 and 4.8% of the participants, respectively, mentioned people with ages greater than 65 and smokers as being at high risk of contracting COVID-19 (14).

Because of its high transmission rate, lack of definitive treatment, and high morbidity and mortality rate, this disease is a global concern (15). Controlling its spread was extremely difficult due to the lack of definitive treatments (16). Developed countries are adversely affected, despite their advancement in healthcare systems (17). Ethiopia is an African country with a low-skilled workforce and technological assets (18). Governments all over the world are working hard to keep it under control. However, a large number of people were reluctant to use preventive measures. To be effective, information is crucial to comprehend the relationships between demographic factors, risk perceptions, and prevention practices (19).

Several studies conducted in various countries revealed that the risk perception for this disease was low. A study done in Ghana showed that about 32% of participants had low-risk perceptions (20). A Myanmar study showed that approximately 22% of the participants wrongly perceived spontaneous recovery (14). According to a study conducted in Iraq, only 26.9, 29.7, and 41.7% of respondents, respectively, were concerned about contracting infection, serious illness, or death from this pandemic (21).

The number of COVID-19 cases and deaths in Ethiopia has increased over time. The Ethiopian Ministry of Health reported 102,720 cases as of December 14, 2020 (22). Ethiopia adapts basic intervention measures to reduce the spread of this virus (23). However, people’s adherence to preventive measures is critical, which is influenced primarily by their knowledge and risk perception (3).

Protection practices rely on the perceived risk of contracting a disease and efficacy beliefs for preventive modalities (24). Health models advocate risk perception as a motivator for change in behaviour (25). One of them is the extended parallel process model (EPPM), which advocates protection practice as a result of threat assessment and coping evaluation based on the concept of protection motivation theory (PMT). Threat assessment entails assessing the risk of contracting a disease (perceived vulnerability or susceptibility) and determining the severity of the disease (perceived severity) (26).

Several studies found that protection practices against this disease were not satisfactory. For instance, studies done in Myanmar (14) and Bangladesh (27) revealed that nearly 45.2 and 24.8% of participants, respectively, had poor hand hygiene practices. Studies in the Philippines (28) and Malaysia (29) showed that around 37 and 49% of participants were not avoiding crowded areas, respectively. A Bangladesh (27) study showed that around 30% of participants failed the regular mask-wearing practice. Studies done in Myanmar (14), Bangladesh (27), and Thailand (30) showed that 78, 50, and 83% of respondents had poor protection practices, respectively.

Males, younger age groups, and less educated individuals were less likely to implement preventive measures (31). The clarity of communication influences protection behaviour (32). Risk perception and beliefs about the efficacy of the preventive methods influenced the community’s engagement in realising precautionary measures (33). People with good knowledge and a high-risk perception of the pandemic respond positively to preventive methods (34, 35).

As a result, the purpose of this study was to assess knowledge, risk perceptions, and protection practices in Dessie City, Northeast Ethiopia, as well as investigate factors associated with protection practices.

COVID-19 poses a serious economic as well as public health threat. COVID-19 is effectively controlled by increasing public knowledge, perception, and prevention practices.

In line with the previous study (41), nearly nine out of ten participants believed that the virus caused this pandemic (87.5% vs. 96%). The majority of them reported fever, dry cough, difficulty breathing, and headache as symptoms of this pandemic. These findings agreed with those of Fang et al. (42).

The study found that 63% of the participants had good knowledge about the COVID-19 pandemic. This was comparable to findings from Bangladesh (63% vs. 61.4%) (27) but higher than in Myanmar, where the majority (87%) of the participants had poor knowledge (14), and lower than in India (43), Tanzania (44), China (12), and USA (45), where 80.64, 84.4, 90, and 80% of participants, respectively, had good knowledge. The variation in knowledge levels across studies may be due to differences in study population, timing of study, and access to information, highlighting the need for improved health education in the community.

Regarding the source of information, the majority of participants obtained COVID-19-related information from national TV, social media, and radio, with social media being a significant source, similar to studies in Myanmar (14) and Hong Kong (12), approximately half of participants obtained information about COVID-19 from social media. However, this finding differed from the Chinese study, in which the vast majority of participants (98%) obtained information about COVID-19 via social media (46). This shows a high proclivity for people to use social media in recent years. However, trust in the truthfulness of social media information was low. The most reliable information sources were health professionals, MOH official websites, and mass communication tools such as television or radio. These findings were imperative since they may indicate that more efforts should be made to deliver trustworthy information through the most popular and trusted communication channels.

Approximately two out of five participants thought they were at risk of COVID-19. This finding is lower than that of Thailand (75%) (30), Southwest Ethiopia (53.4%) (39), Ghana (68.3%) (20), and Sierra Leone (75%) (47). Furthermore, the study found a higher risk perception than 7.6% in India (48). This could be due to the differences in the study period, study population, and case count. The perceived severity of the disease was lower than in the Hong Kong (49) and Myanmar (14) studies, where almost all participants perceived the disease to be very severe. In this study only 16.8% of the participants thought COVID-19 was a deadly disease, whereas in Thailand, approximately 70% thought it was a severe and dangerous disease (30). Similarly, studies in China found that the majority of people thought COVID-19 was extremely severe (46, 50). In terms of survivorship, if infected, the communities in this study had a higher (53.5%) response rate than Myanmar (22%) (14) and Hong Kong (18%) (12). This explains why the people in this study setting become more hesitant to take preventive measures and require more convincing of the COVID-19 risk. According to a study conducted in Egypt (3), the majority of participants thought the disease was more dangerous for the older adult and those with chronic diseases. This could be because the risk of death from COVID-19 is higher in the older adult and those with medical conditions (51).

Perceived efficacy toward preventive measures such as hand hygiene, wearing face masks, and avoiding crowded areas was lower than in previous studies conducted in Myanmar and Hong Kong (i.e., 49.1% vs. 80 and 90%, respectively) (12, 14). The belief in the efficacy of preventive methods is important information for improving epidemic control. This indicates that more work is required to ratify belief in efficacy.

Handwashing practices were lower in studies conducted in the Philippines (28), Hong Kong (49), and Bangladesh (52) (58.6% vs. 89.9, 95.8, and 98.6%, respectively), but higher than a study conducted in Myanmar (14) (58.6% vs. 44.9%). Avoiding crowded places was lower in this study than in previous studies from Myanmar (14) and Hong Kong (49) (34.1% vs. 57.9 and 88.1%, respectively). Furthermore, the practice of avoiding crowded areas was lower than in a study conducted in the Philippines (28), Bangladesh (13), Tanzania (44), China (12), Nepal (53), and Malaysia (29), where 62.9, 87.97, 77, 96.4, 94.9, and 51.2% of people avoid social gatherings, respectively.

Only 26.7% of participants followed the principles of staying at home. This was much lower than in the Bangladesh study (52), where the majority (93.2%) of respondents followed the stay-at-home principle. Cough etiquette practice was markedly lower than in a Hong Kong study (49) (56.2% vs. 97.1%), but higher than in a Myanmar study (14) (56.2% vs. 47.3%). Only 27.3% of participants put on a face mask when leaving their home. It was much lower than in studies conducted in Bangladesh (13), Malaysia (29), Tanzania (44), China (12), and Nepal (53), where nearly 75, 83.4, 80, 98, and 88.2% of the participants used a face mask. This disparity was attributed to socioeconomic factors, culture, case count, beliefs in the efficacy of preventive measures, and perceptions of COVID-19 risk.

The practice of COVID-19 prevention measures in this study was 38.6%, which was much lower than the study conducted in Iran (54), 71%, and Bangladesh (27), 51.6% of participants had good COVID-19 prevention practices, but higher than the study conducted in Myanmar, 22% (14). The disparities could be explained by differences in information-seeking behaviour, case counts, death rates, misconceptions, and study time.

In line with the study done in Lebanon (41), Iran (55), India (43), Hong Kong (49), and Malaysia (56), education was a strong predictor of protection practices. Behavioural models advocate education is an influential determining factor of healthy behaviour (57). Education leads to better information-gathering habits and efficient use of health inputs (58). This may explain why more educated respondents engaged in precautionary behaviours. This underlines the importance of education in an attempt to raise protection.

In line with the study done in China (12), high income was associated with good practices. Economic status is the primary determinant of actions for maintaining one’s health (57). It has been demonstrated that the low-income households do not use preventive methods (59). In addition, income determines the likelihood of purchasing personal protective equipment, such as a face mask and hand sanitiser. Individuals with low income fail to observe preventive methods; instead, they prefer to continue their daily activities to satisfy their basic needs during the transmission period. This may explain why high-income groups had good preventive practices. Therefore, the government should recognise income discrepancies and provide targeted support to decline the transmission rate across the income spectrum.

Protective practices were predicted by knowledge, aligning with findings from other studies (12, 60). Knowledge enhances awareness, dispels misconceptions, and supports informed decision-making. However, its effectiveness can be shaped by cultural beliefs to the pandemic, socioeconomic conditions, and trust in health systems. Traditional practices, resources limitation, and distrust may hinder the adoption of scientific protective behaviours. In line with other studies (61), risk perception also strongly predicts protective behaviour. People with a low perception of risk should be a prime target for public health education. Additionally, belief in the effectiveness of preventive methods was the strongest predictor of adherence to protective behaviours during the pandemic.

These findings showed that protective behaviour implementation largely depends on community engagement in the prevention pathway. Public health education should focus on enhancing knowledge while addressing key barriers, particularly among individuals with low risk perception and limited belief in the effectiveness of preventive measures, to ensure effective control over the spread of this virus.

The study found that two-thirds of the participants had good knowledge. However, there was a low perception of the risk and poor practices for preventing COVID-19. There is an urgent need to fill the risk perception and knowledge gap to control the expansion of the COVID-19 outbreak.

This study revealed that COVID-19 knowledge, efficacy beliefs, and risk perception significantly predicted precautionary behaviour. Older people, people with a high income, a high level of education, and a large family size readily showed a high propensity toward protection practices. As a result, the young population, as well as lower-income and education groups, would be challenging to the control efforts and will require special attention. Risk communication and community engagement efforts should be considered in fighting against this pandemic.

The results of this study indicate the focus areas that need to be addressed and disclose the need for continued monitoring. The media should make it easier to get reliable health information. Moreover, future research would identify the possible barriers to adopting protective behaviours in fighting the pandemic disease and their solutions.