JMIR Publications

ABSTRACT

Background:

Long COVID affects millions worldwide, straining health systems and workforce stability; among civil servants, prolonged illness threatens essential services. This first nationwide survey among French civil servants combines epidemiological assessment with a Knowledge, Attitudes, and Behaviors approach. Long COVID remains a diagnostic and epidemiological challenge in the general population with evolving symptoms and uncertain categorization, particularly among self-suspected cases. Beyond prevalence and risk factors, understanding behavioral dimensions is essential to develop prevention strategies and maintain the workforce resilience.

Objective:

This study aimed to estimate the prevalence of long COVID among a large French civil servant population, identify associated sociodemographic, occupational, and health-related factors, and assess disease-related knowledge of long COVID, as well as vaccination attitudes and behaviors.

Methods:

This cross-sectional, anonymous survey based on a convenience sample was conducted in 2024 among active or retired civil servants in France. A KAB-validated questionnaire, based on WHO guidelines, was designed. Responses were compared across four COVID-19 status groups (No COVID, COVID-19 without long COVID, Diagnosed long COVID, Suspected long COVID). Statistical analyses included univariate tests and multivariable logistic regressions to identify factors associated with diagnosed or suspected long COVID.

Results:

Among 3,962 eligible respondents, 61 (1.54% [1.20-1.97]) reported a formal diagnosis of long COVID and 241 (6.08% [5.38-6.87]) without diagnosis. Diagnosed long COVID was significantly associated with long-term sick leave (OR=1.15[95% CI: 1.03–6.28]; p=0.044) and long-term illness coverage (OR=0.72[0.27–0.92]; p=0.027). Suspected long COVID was associated with being in a couple (OR=1.65[1.08–2.52]; p=0.021), widowed (OR=2.25[1.18–4.31]; p=0.014), and uncertain (OR=1.90[1.32–2.74]; p<0.001) or incomplete COVID-19 vaccination status (OR=1.67[1.16–2.42]; p=0.006). Knowledge scores differed significantly across groups (ANOVA F=24.31, p<0.00001; Chi²=54.92, p<0.00001), with diagnosed cases showing the highest proportion of high knowledge (21.3%) compared to 12.4% in the non-COVID group. Among 61 diagnosed cases, 36 (59.0%, [46.4–70.5]) were vaccinated, 13 (21.3%[12.9–33.2]) intended to get vaccinated, and 12 (19.7%, [11.6–31.3]) remained unvaccinated; among suspected cases, these proportions were 173 (71.8%[65.9–77.1], 30 (12.4%[8.8–17.3], and 38 (15.8%[11.6–21.0], respectively.

Conclusions:

Unlike previous studies examined clinical or behavioral factors separately, this nationwide analysis integrates both dimensions, linking epidemiological data with knowledge and vaccination behaviors among French civil servants. Long COVID remains underdiagnosed in this population, where absenteeism and sick leave threaten essential services. The study highlights disparities in disease-related knowledge, vaccination attitudes and behaviors, underlining the importance of workplace health education and systematic screening. Vaccination is associated with lower odds of long COVID, reinforcing its preventive value. Although based on a convenience sample, which may limit generalizability, the findings reveal organizational implications, including reduced workforce availability and delayed return-to-work. They support workplace-based prevention strategies integrating vaccination promotion, early detection, and health literacy to sustain the resilience of public services.