Healthcare workers (HCWs) are at the frontline of the coronavirus disease 2019 (COVID-19) pandemic response, yet there is a paucity of literature on their knowledge, attitudes and practices (KAP) in relation to the pandemic. Community Health Workers (CHWs) in Mozambique are known locally as 'agentes polivalentes elementares' (APEs). While technical guidance surrounding COVID-19 is available to support APEs, communicating this information has been challenging due to restrictions on travel, face-to-face group meetings and training, imposed from May to August 2020. A digital health platform, upSCALE, that already supports 1,213 APEs and 299 supervisors across three provinces, is being used to support APEs on effective COVID-19 management by delivering COVID-19 sensitive SMS messages, training modules and a COVID-19 KAP survey. The KAP survey, conducted from June 2020 to August 2020, consisted of 10 questions. Of 1,065 active upSCALE APEs, 28% completed the survey. Results indicate that only a small proportion of APEs listed the correct COVID-19 symptoms, transmission routes and appropriate prevention measures (n=(25%), n=(16%) and n=(39%), respectively) specifically included in national health education materials. Misconceptions were mainly related to transmission routes, high risk individuals and asymptomatic patients. 84% said they followed all government prevention guidelines. The results from the KAP survey were used to support the rapid development and deployment of targeted COVID-19 awareness and education materials for the APEs. A follow-up KAP survey is planned for November 2020.

To better support tailoring and targeting of appropriate messages a COVID-19 KAP survey was developed and delivered to the APEs via upSCALE from 9 June 2020 to 14 August 2020. The KAP was a cross-sectional study that was sent to all 1,400 upSCALE registered APEs and involved those who responded to an invitation via SMS message, asking them to complete the questionnaire on the UPSCALE application. The SMS messages were accompanied by simple videos demonstrating how to install and complete the KAP survey on the application. The KAP survey questionnaire was developed using various references including the WHO survey tools, guidance on COVID-19 insights and previous KAP surveys conducted during the pandemic. The self-reported survey consisted of 9 questions related to COVID-19 symptoms, prevention and transmission, as well as main sources of information. The components of the knowledge section included the causes and modes of COVID-19 transmission, main symptoms, transmissibility from asymptomatic patients, individuals at risk and preventive measures. The attitudes and practices sections were comprised of questions related to COVID-19 preventive measures practiced, adherence to government prevention measures, barriers to following recommended measures and what to do when symptoms occur. The draft survey was pretested with four users before launch to ensure it was accessible and respondent friendly.