|Year : 2020 | Volume
| Issue : 3 | Page : 105-112
Knowledge, attitude, and practice toward COVID-19 among health-care professionals, ancillary support staff, family members, and patients in a tertiary care COVID-19 hospital
Harmeet Singh Arora1, Satish Chandra Mishra1, Arun Kumar Yadav2, PL Vidya1, Arijit Kumar Ghosh1, R Ananthakrishnan1, Ajay Joshi1
1 Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
2 Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Submission||19-Aug-2020|
|Date of Decision||18-Sep-2020|
|Date of Acceptance||12-Oct-2020|
|Date of Web Publication||02-Nov-2020|
Dr. P L Vidya
Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Corona virus disease-2019 (COVID-19) is a recently emerged and rapidly growing public health emergency. Adequate knowledge, positive attitude, and good practice among different sections of the society, including health-care workers, are quintessential in prevention and control of this deadly disease. Hence, the present study was undertaken with the objective of determining the knowledge, attitude, and practice among health-care workers (HCWs) including ancillary support staff, their family members, and patients toward COVID-19. Materials and Methods: A cross-sectional 40-item survey was conducted among HCWs, family members, and patients in a dedicated tertiary care COVID-19 hospital during May 2020–June 2020.The responses were tabulated and regression analyses were performed to determine the significance of each parameter among different groups. Results: Of 596 participants, among health-care professionals, ancillary support staff, family members, and patients, most were graduates (72.9%, 74.6%, and 50.6%, respectively), while 50% of the patients were educated up to high school. Social media and Internet was the main source of information for health-care professionals, while it was news media for others. Younger age was significantly associated with knowledge and attitude among HCWs (P = 0.001, P= 0.006) and ancillary support staff (P = 0.01, P < 0.001), while younger age and education were positively associated with knowledge among family members (P = 0.007, P < 0.001). Among patients, only education related to better knowledge (P < 0.001) and younger age with better practice (P = 0.001). Conclusion: Overall, HCWs and ancillary support staff have better knowledge and attitude toward COVID-19. Education was associated with better practice among patients. Health education programs to improve the awareness and encourage appropriate practices toward this global hazard, especially among the general public, are required to conquer this virus and limit the spread of infection.
Keywords: Attitude, COVID-19, health-care workers, knowledge, patients, practice
|How to cite this article:|
Arora HS, Mishra SC, Yadav AK, Vidya P L, Ghosh AK, Ananthakrishnan R, Joshi A. Knowledge, attitude, and practice toward COVID-19 among health-care professionals, ancillary support staff, family members, and patients in a tertiary care COVID-19 hospital. J Mar Med Soc 2020;22, Suppl S1:105-12
|How to cite this URL:|
Arora HS, Mishra SC, Yadav AK, Vidya P L, Ghosh AK, Ananthakrishnan R, Joshi A. Knowledge, attitude, and practice toward COVID-19 among health-care professionals, ancillary support staff, family members, and patients in a tertiary care COVID-19 hospital. J Mar Med Soc [serial online] 2020 [cited 2021 Dec 3];22, Suppl S1:105-12. Available from: https://www.marinemedicalsociety.in/text.asp?2020/22/3/105/299798
| Introduction|| |
The novel severe acute respiratory distress coronavirus 2 (SARS-CoV-2) is the cause of coronavirus disease-2019 (COVID-19), a highly contagious and rapidly emerging infection, which has affected almost every country worldwide in the recent times. The World Health Organization has declared it a global pandemic in March 2020. The community spread of this deadly disease is quite rapid and is mainly through droplets and direct contact, with an incubation period of 2–14 days. Since no specific antiviral treatment or vaccine is available against it, prevention of its spread is the most important component of its containment. Worldwide, various stringent social, administrative, and legal measures are undertaken to achieve this goal in an effective manner. The success of these measures is highly dependent upon the knowledge, attitude, and practice of individuals in the community regarding various basic aspects of the disease. The health-care professionals including the ancillary support staff are at higher risk of acquiring this infection. The understanding of the knowledge, attitude, and practice (KAP) of this subset as well as general population pertaining to COVID-19 is essential to bring forth a sustained change in behaviors of individuals, institution, and community and to improve such practices while designing interventions. This study was conducted to ascertain these parameters in the COVID-19-positive patients and in health-care professionals, ancillary support staff, and their family members in a tertiary care COVID-19 hospital to get an overall view about the perceptions of COVID-19 among different stakeholders.
| Materials and Methods|| |
A cross-sectional study was conducted using a 40-item survey instrument to gather responses from COVID-19-positive patients, health-care professionals, ancillary support staff, which included health assistants and housekeepers, and their family members of a dedicated COVID-19 hospital during May 2020–June 2020.
With the help of WHO course materials on emerging respiratory viruses, including SARS-CoV-2, a 40-item survey instrument was prepared that included sections of demographic details, source of information, knowledge, attitude, and practice related to COVID-19. The developed draft was circulated among five randomly selected senior faculty members to determine the content validity and quality of questions prior to pretesting among 30 randomly selected HCW for understandability, acceptability, and relevance. Clarifications and rectifications were made as required to ensure comprehensibility and maintain simplicity before the final questionnaire was handed out to the study population. The Cronbach's alpha was 0.8 from pilot-tested form. These forms were excluded from the final analysis.
The survey instrument consisted of 40 closed-ended questions, divided into four sections, including participant's demographic details, educational qualification, and source of information. The knowledge section had 20 items regarding awareness of COVID-19 infection (6 items), symptoms (3 items), incubation period (2 items), mode of transmission (2 items), treatment (1 item), and preventive measures (6 items). Attitude section included 10 items on perception toward the illness (2 items), seeking medical attention (4 items), and preventive strategies (4 items), while the Practice section comprised 10 items on their adherence to various preventive measures advised by the WHO and Government of India to contain the spread of the infection. Adequate time was provided to the participants to read, understand, and complete the questionnaire.
All HCWs, ancillary support staff, and their family members above 18 years of age were included in the study. Stable COVID-19-positive patients admitted in the general isolation ward, more than 18 years of age, were included in the study. Critically ill patients in the intensive care unit/high dependency unit were excluded from the study. The questionnaire was self-administered. The forms were checked for completeness before data compilation. If there was any blank response, participants were contacted to complete the form. A questionnaire in Hindi was provided when necessary.
The study was approved by the Institutional Ethical Committee and informed consent was obtained from all participants. Confidentiality was maintained and all information and responses of the participants were kept anonymous. There was no monetary benefit provided and participation was voluntary.
Descriptive analysis of the data obtained was done by calculating frequencies and proportions. Chi-square test and regression analyses were done to compare variables among the groups and a P ≤ 0.05 was considered statistically significant. All analyses were done using StataCorp. 2013, Stata Statistical Software: Release 13. College Station, TX, USA: StataCorp LP.
| Results|| |
A total of 596 participants were interviewed. These consisted of 170 health-care professionals which included doctors and nursing officers, 137 ancillary support staff, 179 family members, and 110 patients admitted in the COVID-19 ward. In our setting, ancillary support staff, including health assistants and housekeepers, are all male members, while among patients, 68.18% (75) were female. The demographic characteristics, educational qualifications, and the main source of information about COVID-19 among each group are elaborated in [Table 1].
Knowledge among different groups was checked by responses to 20 questions. The number of correct responses is shown in [Table 2]. Attitude and practice, collected using data from 10 questions each, are shown in [Figure 1] and [Figure 2], respectively.
|Table 2: Knowledge among different groups about coronavirus disease-2019|
Click here to view
The total knowledge score varies from 8 to 20, with a median of 18 (IQR 17-19) and mean of 17.7 ± 1.9 among doctors and nurses. Younger age and higher education were significantly associated with knowledge among health-care professionals. Attitude score ranged from 3 to 10 with a median of 10 (IQR 9-10) and mean 9.5 ± 0.95. In multiple linear regression analysis, the younger age group was associated with a better attitude toward COVID-19. For practice, the median was 9 (IQR 9-10) and mean 9 ± 1.2. In multiple linear regression for practice, none of the variables showed any significant association among health-care workers. The multiple linear regression analyses of all variables among different groups are enumerated in [Table 3], [Table 4], [Table 5].
Ancillary support staff
The median and mean score of knowledge, attitude, and practice among family members was 16 (IQR: 15–17) and 15.8 ± 2.3, 9 (IQR: 8–9) and 8.4 ± 1.6, and 9.5 (IQR: 9–10) and 8.8 ± 1.9, respectively. In multiple linear regression for KAP among ancillary worker, age was positively associated with knowledge and attitude, and none of the variables were significantly associated with practice.
The median and mean score of KAP among family members was 16 (IQR: 15–18) and 15.9 ± 2.4, 9 (IQR: 8–10) and 8.4 ± 1.4, and 9 (IQR: 8–10) and 8.7 ± 1.6, respectively. In multiple linear regression for knowledge among family members, younger age and higher educational were found to be significantly associated. Multiple regression for attitude and practice did not show any association.
The median and mean score of KAP among patients was 14 (IQR 11–16) and 13.5 ± 3.3, 8 (IQR 7–9) and 8.4 ± 1.4, and 8 (IQR 7–9) and 7.7 ± 2.1, respectively. In multiple regression for knowledge and practice among patients, only education showed significant association with respect to knowledge and attitude. Younger age group was also associated with statistically significant value with better practice.
| Discussion|| |
Our country has shown a steady increase in the number of cases and is currently in the top five countries with a maximum incidence of infection. Assessing the level of information about COVID-19 can be an essential step in the control of the disease.
This study showed that awareness of the study population regarding COVID-19 infection was overall good. These results are similar to the knowledge and positive attitude among HCW during the MERS epidemic and another study by Alqahtani et al. among medical students. The finding of an increased correct percentage of knowledge among the public was unexpected, as this study was conducted in the early stages of pandemic in our country. This probably can be attributed to the global dissemination of information regarding this public health emergency much earlier in other countries which has enabled our population to be aware of the situation.
Our study showed that majority of our participants have a high level of knowledge about COVID-19 and positive attitude, while perceptions of prevention and practice were relatively less among the family members and patients. While news media was the major source of information for patients (69.5%), family members (71.2%) and ancillary support staff (51.8%), surprisingly half of health-care workers reported social media and Internet as the main source. This is similar to several studies that reported social media (Facebook, Twitter, WhatsApp, YouTube, and Instagram) and news media (television, radio, newspapers, and magazines) to be the primary source of information and awareness,, while during MERS pandemic, seminars and workshops accounted for 48% of information. This indicates that with advances in technology, the COVID-19-related information from authentic websites, news channels, and social media play an important role and would enhance the knowledge of HCW and general population. However, it is important to consider that heterogeneity in information available through Internet, including unverified content, can mislead both HCW and general public leading to dire consequences. Globally, health institutes and medical professionals have warned that misguidance about COVID-19 is a genuine concern causing panic and xenophobia.,
Our study has shown certain gaps in the knowledge among ancillary support staff, family members, and patients regarding COVID-19, particularly about the management and prevention. Altthough majority were aware of term :Social distancing”, the role played by all practices of wearing face mask, frequent hand hygiene, and social distancing in prevention of infection transmission was answered correctly only by 32.1%, 25%, and 14%, respectively. However, there was no statistical difference among age, gender, or education in the knowledge category among health-care professionals, ancillary support, and family members. Majority of patients had insufficient knowledge regarding the incubation period (58% answered correctly) and the most common mode of transmission (60% answered droplets) as well as the age group most severely affected (67% answered >60 years, only 38% knew middle age was least dangerous). This is in contrast to the study among Chinese residents wherein more than 70% had sufficient knowledge. This could possibly be attributed to the educational status of our patient population wherein graduates and postgraduates had significantly better knowledge scores compared to those who received up to high school education (graduate: β = 2 [P = 0.002] and postgraduate: β = 4.7 [P< 0.0001]). Targeting this population, especially those from rural and suburban areas with inadequate access to information, regular health education programs by the government and private may prove beneficial to reduce the spread of infection.
Attitude and practice did not differ significantly with age, sex, or education. More than three-fourth of the study population regarded COVID-19 as a serious illness and more than 85% of them showed a positive attitude in disclosing correct information regarding travel history, contact history, and symptom onset to the physician. More than 88% in each group claimed to follow the lockdown measures enforced by the government strictly in their respective areas. An impressive number of participants among HCW, ancillary staff, family members, and patients reported meticulous following of hand hygiene at home (85.9%, 82.4%, 84.9%, and 78.2%, respectively), avoiding handshake (97.6%, 97.8%, 91.1%, and 92.7%, respectively), avoiding touching one's face frequently (90.6%, 80.3%, 82.7%, and 80%, respectively), wearing the mask (95.3%, 97.8%, 84.9%, and 81.8%, respectively), and taking a bath after returning home from outside (89.4%, 84.7%, 87.2%, and 61.8%, respectively). These practices are similar to the recent survey on ongoing pandemic conducted among the general population in northern India. These simple measures are prudent in preventing the transmission of the virus from one person to another at home and outside.
As compared to other similar studies, ours included a more elaborate questionnaire and also involved COVID-19-positive patients. However, there were limitations too. Due to the prevailing circumstances during the initial phases of pandemic and lockdown, only male ancillary support staff were recruited for the study which may have given rise to gender bias in the findings. The mean age being younger in all the groups may have led to selection of more informed and digitally savvy population and hence may bias the findings toward better KAP. As pandemic is evolving at a rapid pace and this being a single-center study, the generalizability of the results may be limited.
| Conclusion|| |
HCWs and ancillary support staff had better knowledge and attitude, while education of patients was associated with better practices toward COVID-19. Sufficient knowledge and optimistic attitude are highly essential in the battle against this deadly disease, which can only be achieved with periodic health education programs besides regular surveillance. Adequate dissemination of accurate, verified information from one central body through proper sources such as newspapers, media, and Internet to penetrate different sections of the society is the need of the hour.
We sincerely thank all the staff members of our hospital for extending their support in carrying out this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020;91:157-60.
Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al
. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: Estimation and application. Ann Intern Med 2020;172:577-82.
Khan MU, Shah S, Ahmad A, Fatokun O. Knowledge and attitude of healthcare workers about Middle East Respiratory Syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC Public Health 2014;14:1281.
Alqahtani AS. Knowledge and attitude toward Middle East respiratory syndrome coronavirus among heath colleges' students in Najran, Saudi Arabia. Int J Community Med Public Health 2017;4:2641-7.
Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and perceptions of COVID-19 among health care workers: Cross-sectional study. JMIR Public Health Surveill 2020;6:e19160. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193987/
. [Last accessed on 2020 Jun 15].
Huynh G, Nguyen TN, Tran VK, Vo KN, Vo VT, Pham LA. Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pac J Trop Med 2020;13:260. [Full text]
Albarrak AI, Mohammed R, Al Elayan A, Al Fawaz F, Al Masry M, Al Shammari M, et al
. Middle East Respiratory Syndrome (MERS): Comparing the knowledge, attitude and practices of different health care workers. J Infect Public Health. 2019:S1876-0341:30239-4. doi: 10.1016/j.jiph.2019.06.029.
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020;55:105924.
Shimizu K. 2019-nCoV, fake news, and racism. Lancet 2020;395:685-6.
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al
. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.
Dkhar SA, Quansar R, Saleem SM, Khan SM. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020;64:S205-0.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]