The COVID-19 pandemic is not over yet, although its intensity has decreased, new cases are registered daily [16]. In Syria, according to the WHO statistics, the total number of confirmed cases reached 57,423 on 26 April 2023 [17]. Understanding how people behave during pandemics is particularly important, especially in poor countries, as this knowledge can help governments to formulate suitable strategies. In this study, we assessed the personal attitudes and practices towards the COVID-19 pandemic among a group of educated Syrian participants, following several waves of infection, and the release of different types of vaccines. The total number of individuals who volunteered in our survey was 408, generally females, between 20–29 years old, and college graduates.

The majority of the respondents (~ 86%) acknowledged being infected previously with the Coronavirus. The highest infection rates have been observed among females, with a significant association with age. Remarkably, the participants who sought medical confirmation (PCR test) were females and > 40 years old indicating greater concern, particularly amongst this group. The influence of gender on the infection rates of COVID-19 was previously researched. Higher infection risk was observed among females than males especially during peak times, due to their higher number of contacts consequent to their caregiving responsibilities at home and in the workplace, besides gender inequalities in political considerations, financial resources and access to healthcare facilities [18, 19]. This explanation may be supported by the fact that in our study, a close association was found between the infection of a family member and the recurrence of participant infection. However, the education level may have played an effective role in preventing the recurrence of the infection in most cases.

Many factors may influence vaccine acceptance [20, 21] and this may differ from one country to another and from one particular phase to another, [22, 23]. In our study, approximately half of the participants reported being vaccinated; the majority were college graduates and > 40 years old, indicating age influence on vaccine acceptance amongst this group of participants. This result is in agreement with a previous nationwide study conducted on the Syrian population where individuals between 45–65 years old expressed their desire to receive the vaccine more than others [24]. Interestingly, in our study the percentage of male participants who received vaccination was higher than that of their female counterparts. This shows that even though females were more concerned and their lives were more influenced by the pandemic, they seemed more unwilling to get vaccinated. Our results were in line with previous studies in which a significant distinction was found between males and females in their intentions to get the vaccine [24, 25].

Remarkably, a comparative study between Jordanians, Palestinians and Syrians showed that Syrians were the least interested in vaccination among other nations [26]. Furthermore, the latest statistics show that about 27% only of the Syrian population has received the vaccine [17]. This figure raises a great concern, since it is far away from reaching the accepted percentage for the herd immunity [27]. The participants differentiated between the different types of vaccines from the effectiveness and safety standpoints; only 17.4% thought that all vaccines were effective and safe, while 11.8% thought that all vaccines were ineffective. The discrepancy concerning COVID-19 vaccines in public opinion was notably observed in many studies worldwide and the rates of vaccine acceptance have changed over time, as new vaccines are developed and sides effects are reported. For example, in a comprehensive survey among physiotherapy students in the United Arab Emirates, the majority of the students believed that vaccines are safe, while nearly thirty percent did not believe in the effectiveness of the vaccine [28].

In addition, a Korean widespread analysis revealed a notable difference in public opinion for each vaccine brand [29]. Furthermore, a slight difference in opinions towards locally produced and foreign vaccines was found, among Iranian people [30].

Adherence to precautionary behaviour after vaccination differed between studies. In our study, 38.7% of the participants maintained precautionary measures after vaccination. A significant association with education in favour of college graduates was found. Our result indicates a high degree of commitment to WHO instructions among this particular group. A decline in precautionary behaviour after vaccination was also observed amongst vaccinated people in Jazan, Saudi Arabia. However, older age and females were associated with higher adherence levels [31]. By contrast, in a test on a British cohort, no decrease in precautionary behaviour among vaccinated individuals was observed [32].

Although some studies showed that education has a major influence in shaping attitudes, and practices towards COVID-19 [33, 34], in the present study, the level of education did not significantly dominate the participants’ attitudes or practices towards the COVID-19 pandemic.

Evidence from previous studies showed that the COVID-19 pandemic has impacted the lives of people worldwide. Social, physiological, economic and psychological effects were more noticed among females, as they are more vulnerable and emotional [35,36,37,38]. Our survey revealed that female participants were more worried, and the pandemic greatly affected their lives and their relationships with others. These results may be attributed to the nature of the Syrian society in which females are the caretakers of the family, besides their fears of who takes care of them and their family if they develop the infection. This explanation was supported by our other results which showed that female participants and participants > 40 years old were more committed and had positive attitudes towards self-isolation and wearing face masks when feeling sick. These results accord with a previous study conducted on a different Syrian cohort [39] and also with a study from the United States [40].

Furthermore, the impact of COVID-19 pandemic on mental health and the quality of life was observed. Stress, anxiety, and depression were common impacts in different studies [41,42,43,44]. In our study, significant differences between genders and between the age groups were detected in the anxiety level towards COVID-19. This finding accords with previous studies, in which anxiety levels were significantly affected by the female gender [45, 46]. Remarkably, only one fifth of the participants were still closely following updates on the pandemic, which may show that the pandemic is not anymore viewed as a hot topic by the general population. This data corresponds with the results from Turkey where over half of the respondents recounted not needing any additional information on COVID-19 and not being interested in a continuous update on the disease [47].

There is no doubt that taking precautionary measures and using personal protective equipment is one of the most important practices to prevent infection with the Coronavirus. This survey revealed that approximately 96% of the participants showed a high commitment to preventive measures against COVID-19 infection. Similar findings were observed in a previous study [48]. Age and female gender correlated significantly with some precautionary measures. This finding agrees with a previous study from Iran, which found that some particular practices were associated significantly with higher age, and with female gender [49].

This survey explored personal experiences and practices amongst educated Syrian participants, after several waves of infection and a decrease in the number of deaths and infected cases. In particular, this study is helpful in identifying the perceptions and level of COVID-19 vaccines acceptance. Future studies are required on a country-level to allow better exploration of potential factors of vaccine hesitancy and how society deals with the pandemic in different phases. However, being a cross-sectional study, some limitations may occur including the relatively small number of the participants due to low response rate and the limited number of socio-demographics beside recall biases should be considered.