Comparative analysis of associations between facility structure and air quality managers’ knowledge, attitudes, and practices by COVID-19 outbreak status in welfare facilities for persons with disabilities: a cross-sectional survey study in South Kor

Objectives: This study investigated associations between building structure and managers' knowledge, attitudes, and practices (KAP) regarding indoor air quality in welfare facilities for persons with disabilities, comparing facilities with and without coronavirus disease 2019 (COVID-19) cluster outbreaks. Methods: A web-based survey was conducted among managers of 242 welfare facilities for persons with disabilities in the Republic of Korea. Facilities were recruited from a national sampling frame of approximately 3,000 facilities, yielding a response rate of 8.1%. The 80-item questionnaire assessed building characteristics and air quality-related KAP scores. Logistic regression was used to identify factors associated with cluster outbreaks. Results: Of the 242 facilities, 50.8% had experienced cluster outbreaks. Facilities in complex/multi-use buildings had higher odds of outbreaks than those in detached buildings did (adjusted odds ratio, 2.21; 95% confidence interval, 1.25-3.91; p=0.006). For managerial factors, facilities with outbreaks tended to have lower attitude scores (p=0.02); however, this association did not remain statistically significant after Bonferroni correction (adjusted α=0.0083). No significant differences were observed in knowledge or practice scores. Conclusion: Building structure, particularly complex/multi-use configuration, was associated with COVID-19 cluster outbreaks. Managerial KAP scores were not definitively associated with outbreaks under the conservative significance threshold, but the observed trends suggest that institutional support, ventilation guidance, and practical training for facility managers may help strengthen future infection-prevention efforts.