Older age, lower education tied to poor COVID-19 knowledge among kidney donors in SG

Knowledge levels about COVID-19 are high among kidney transplant recipients and low among donors, particularly those who are older, with lower education, and patients with financial concerns or feelings of social isolation, according to a Singapore study.

“Our findings identified vulnerable individuals among kidney transplant recipients and donors and suggested that intensified patient education may be beneficial for this vulnerable group,” said the researchers, who conducted a cross-sectional survey among 325 kidney transplant recipients and 172 donors between 1 May 2020 and 30 June 2020.

Survey questionnaires were used to assess COVID-19 knowledge levels, sociodemographic data, health status, psychosocial impact of COVID-19, and precautionary behaviours during the pandemic.

The study population had a mean COVID-19 knowledge score of 7.5 out of 10, with the mean score being significantly higher among kidney recipients than kidney donors (7.9 vs 6.7; p<0.001). [Singapore J Med 2025;66:81-90]

Younger age (21–49 years vs ≥50 years) and higher education (diploma and higher vs secondary and lower) significantly correlated with higher scores in COVID-19 knowledge among donors, but not among recipients (p≤0.01 for interaction). 

“[W]e postulate that intensified education had mitigated these differences in the recipient population,” the researchers said.

Interestingly, financial concerns and social isolation both showed significant associations with lower knowledge levels in both kidney donors and recipients. This finding supported that of previous studies conducted among general populations. [PLoS One 2020;15:e0239646; J Community Health 2020;45:881-890]

Information dissemination

An association was also noted between residence in government housing and higher COVID-19 knowledge levels. Researchers suggested that the high density of people living in these areas may have allowed mass transmission of information in common areas.

“Similar to previous studies that reported a positive correlation between better knowledge levels and higher compliance with adopting precautionary measures during the COVID-19 pandemic, we also observed that donors with higher knowledge scores were more likely to keep following social distancing,” they said. [J Community Health 2020;45:1263-1269; Work 2020;66:767-775]

In the current study, kidney recipients also reported higher rates of adopting precautionary measures than kidney donors, which correlated with their better knowledge levels.

Psychological impact

Furthermore, the psychological impact of COVID-19 was low overall. The reported prevalence of anxiety, depression, or stress among kidney recipients and kidney donors was lower than that seen in a previous meta-analysis (14.3 percent and 13.7 percent vs 30 percent to 55 percent). [Singapore Transplantation Direct 2020;6:e554]

“This may be due to the lower infection rates and mortality in Singapore compared to contemporaneous global data,” according to the researchers.

Social media

The use of social media among kidney recipients to gather information about COVID-19 was also associated with a higher knowledge score. Nearly 67.3 percent of these recipients reported using social media to obtain information. This finding was consistent with a published review. [Public Underst Sci 2020;29:777-799]

"The drawbacks of social media are its potential for misconceptions and its association with anxiety and depression with prolonged use in a pandemic,” the researchers said. [Psychiatry Res 2020;291:113190]