Journal of Datta Meghe Institute of Medical Sciences University

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 17  |  Issue : 3  |  Page : 530--535

Knowledge, attitude, and practices among front-line health-care workers in a COVID hospital: An online questionnaire-based cross-sectional study


Priya Tomar1, Naveen Chauhan2,  
1 Department of Pediatrics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
2 Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India

Correspondence Address:
Dr. Priya Tomar
Department of Pediatrics, 4th Floor, School of Medical Sciences and Research, Sharda University, Knowledge Park 3, Greater Noida - 201 310, Uttar Pradesh
India

Abstract

Background and Objectives: COVID-19 pandemic has currently attacked the health-care system of the whole world. Prevention and collaboration are the key to its management. Our study aims to assess the knowledge, attitude, and practices (KAP) among front-line health-care workers (HCWs) of a COVID dedicated hospital regarding the infection. Materials and Methods: An online questionnaire based study was conducted. Participants were doctors and nursing staff working in a medical college. KAPs were assessed using a 26-item questionnaire with questions pertaining to knowledge (n = 13), attitude (n = 6), and practice (n = 7). Individual scores were generated and stratified as good (>10)/moderate (7–10)/poor knowledge (<7), positive (≥4)/negative (<4), attitude and good (≥4)/poor (<4) practice scores. Percentages of correct and incorrect responses were calculated for each question. Predictors of good overall scores were identified. Results: Response rate was 75%. Participants were interns (n = 45, 28.7%), junior residents (n = 7, 4.5%), postgraduate students (n = 58, 36.9%), clinicians (n = 9, 5.7%), and nursing staff (n = 38, 24%). Mean age was 26.13 ± 3.27 years. 8 (5%), 98 (62%), and 51 (32.5%) participants acquired good, moderate, and poor scores, respectively. Seventy-seven (49%) participants had positive attitude scores. Majority (n = 149, 94.9%) participants had good practice scores. Older age of HCWs was found significantly associated with better knowledge (adjusted odds ratio [aOR] = 3.81, 95% confidence interval [CI] = 1.29–11.22, P = 0.015). Similarly, HCWs who had personal experience of work in COVID area had more positive attitude than those who did not (aOR = 2.58, 95% CI = 1.23–5.42, P = 0.013). Good practices were evenly distributed among all subgroups. Interpretation and Conclusions: Repeated training sessions for correct dissemination of knowledge are essential in the fight against this novel pandemic. Collective efforts should be made regarding management.



How to cite this article:
Tomar P, Chauhan N. Knowledge, attitude, and practices among front-line health-care workers in a COVID hospital: An online questionnaire-based cross-sectional study.J Datta Meghe Inst Med Sci Univ 2022;17:530-535


How to cite this URL:
Tomar P, Chauhan N. Knowledge, attitude, and practices among front-line health-care workers in a COVID hospital: An online questionnaire-based cross-sectional study. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Jan 28 ];17:530-535
Available from: http://www.journaldmims.com/text.asp?2022/17/3/530/360202


Full Text



 Introduction



COVID-19 infection is a highly infectious disease which has been declared as pandemic by the World Health Organization (WHO) in the recent past.[1] Owing to the huge population of our country and varying sociodemographic factors, it has been difficult to manage a rapidly spreading pandemic. India today is witnessing rapidly increasing number of positive cases with no part of the country spared.

It is known that health-care workers (HCWs) have emerged as front line warriors in these difficult times.[2] Owing to the rapid growth in the number of infected cases health care system is already fighting a tough battle against this infection. In the current scenario, the country is witnessing more HCW infections and few deaths of front line warriors. Due to shortage of HCWs, the quarantine period has also been shortened recently and HCWs are facing a serious burnout.[3]

Regarding prevention and management of the infection there is flooding of information from various government portals, media resources and institutional websites. To contain the infection maximally with minimal HCW infection, correct knowledge, attitude, and practices (KAP) values regarding COVID infection are desirable in the HCWs.[4] In order to install effective control measures, having knowledge about universal precautions, special precautions, modes of disease transmission, and preventive measures are of vital importance.[5] Since fighting with this infection is a multidimensional task, we wish to assess the KAP among health-care professionals working at a dedicated COVID center regarding COVID-19 infection and its various aspects.

 Materials and Methods



Study design

An online questionnaire-based cross-sectional study was conducted in a medical college of Uttar Pradesh in the month of May, 2020. This medical college is a dedicated COVID center and has been managing COVID-19 cases from the month of March 2020. The total bed capacity of this hospital is 1000. The COVID center has a capacity of 400 beds including intensive care unit. The participants were junior residents, postgraduate residents, physicians, interns and nursing staff under guidance of senior specialists. Doctors from both clinical and pre/para-clinical departments of the teaching hospital were included. HCWs unwilling to participate were excluded.

Due to national lockdown persisting at the time of this study, an online study was planned. The study protocol was submitted online to Institutional Ethical Committee and approval was acquired. Questions in the present study were prepared by referring to the WHO, Centre for Disease Control, Ministry of Health and Family Welfare, and Indian Council of Medical Research material available. The questionnaire was designed using Google form. It was pretested in a small group of specialists and recommended changes were made in the questions after discussion. The questionnaire was circulated in WhatsApp groups of medical professionals and some were contacted via e-mails. After pretesting the questionnaire among 15 participants, the final version was made. The time taken for collection of responses was 1 week.

First section of the questionnaire introduced the study as a KAP study. Participants were assured that the information collected would remain anonymous. Informed consent was taken and participants were given a chance to opt-out of enrollment in the study. In the second section, personal information was taken in the form of age, gender, marital status, department, designation, years of experience, and area of duty.

Third section was designed for knowledge questions. Knowledge section comprised of 13 items. It covered various aspects of the disease such as epidemiology (2 items), transmission (2 items), clinical features (4 items), risk group (1-item), prevention/precaution (3 items), and management (1 item). These questions were either in the form of a multiple choice answer or in the form of true, false, or no opinion. The correct answer was marked as 1 while incorrect answer/not sure was marked as 0. Total score ranges from 0 to 13. Scores were stratified as-good knowledge (score >10), moderate (score = 7–10), and poor (score <7).

Attitude section was designed to have 6 questions related to general attitude of HCWs toward this pandemic and its management. The answering and scoring systems were similar to the knowledge section (correct response = 1, incorrect/not sure = 0). Total score ranged from 0 to 6. Scores were grouped as positive (score ≥4) and negative (score <4).

Practices were assessed using 7 questions in the last section. Each item was responded as yes (1-point), no (0-point). Practice items total score ranged from 0 to 7. Scores were grouped as good (score ≥4) and poor (score <4).

Statistical analysis

Data collected was transported to an excel sheet for cleaning and coding. SPSS v.20 software (IBM SPSS software (v.20)) was used for data analysis. Categorical variables were described using frequency and percentages. Continuous variables were depicted using mean and standard deviation (SD). Chi-square test was used for comparing proportions. Student's t-test/ANOVA was used for comparing means. Statistical significance was set at <0.05 and a confidence interval (CI) of 95%. Mean knowledge score, mean attitude score, and practice score with SD were calculated.

The association of various demographic variables with good KAP scores was determined. Finally, multivariate logistic regression was applied. Authors declare that they have not received any financial support for this study. There are no competing interests among authors.

 Results



Out of 210 HCWs approached, 157 submitted their responses (response rate = 75%). Majority of study participants were female (n = 86, 54.8%). Age of study participants ranged from 23 to 38 with mean of 26.13 ± 3.27 years. Of the 157 HCWs, interns were 45 (28.7%), junior residents were 7 (4.5%), postgraduate students were 58 (36.9%), clinicians were 9 (5.7%), and nursing staff were 38 (24%) in number. Forty-eight (30.6%) of the participants were staying with their families routinely. Majority of the participants had work experience after graduation of <5 years (n = 141, 89%). [Table 1] summarizes the demographic distribution of study participants. [Figure 1] and [Table 2] show a summary of responses to the KAP questions of our survey.{Figure 1}{Table 1}{Table 2}

Mean knowledge score of our study participants was 7.57 ± 2.15 SD (maximum = 13, minimum = 3). Eight (5%) participants acquired good knowledge score, 98 (62%) had moderate scores and 51 (32.5%) got poor scores. Factors associated significantly with knowledge scores were age (P = 0.000), gender (P = 0.014), “living with family” status (P = 0.014), personal work experience in COVID area (P = 0.008). Clinicians and postgraduate students had better knowledge scores than interns and nursing staff (P = 0.000). HCWs with more years of experience acquired better scores (0.004) [Figure 1].

The mean attitude score was 3.44 ± 1 SD (maximum = 5, minimum = 1). Seventy-seven (49%) participants had positive attitude scores while 80 (51%) had negative scores. The factors associated with positive attitude were “living with family” status (P = 0.025), personal experience of work in COVID area (P = 0.001) and designation (P = 0.005) [Table 3]. Sixty-nine (43.9%) participants were of the opinion that installing a COVID 19 app could be a serious breach in their privacy, 51 (32.5%) were comfortable with it and 37 (23.5%) were not sure of this aspect [Table 2].{Table 3}

Mean practice score of our study participants was 5.53 ± 1 SD (maximum = 7, minimum = 2). Majority (n = 149, 94.9%) participants had positive practice scores. One hundred and thirty-eight HCWs (87.8%) had already installed COVID 19 tracking app in their mobile phones. Practice was found to be same among all designation and age groups [Table 2]. None of the demographic variables were found to be significantly associated with good or bad practices [Table 3].

On multivariate analysis, it was seen that older age of HCWs was found significantly associated with better knowledge (adjusted odds ratio [aOR] = 3.81, 95% CI = 1.29–11.22, P = 0.015). Similarly, HCWs who had personal experience of work in COVID area inside the hospital had more positive attitude scores than those who did not (aOR = 2.58, 95% CI = 1.23–5.42, P = 0.013).

 Discussion



COVID-19 is an emerging and rapidly evolving global emergency situation. Although in our country, the spread of COVID 19 was halted at onset due to early lockdown imposition the situation is now getting complex. HCWs have been handling the pandemic efficiently in spite of the prevailing fear and stigma associated with the infection. To reduce their chances of self-infection and at the same time to ensure quality care of COVID patients, healthy KAP values need to be followed.[2],[6] Healthy practices and good knowledge among HCWs creates awareness in their patients as well as the society. Various population-based studies have been conducted across the globe assessing current knowledge, attitude of people related to COVID 19 infection.[7],[8],[9] To the best of our knowledge, our study is first in the country that depicts KAP values of HCWs directly at the frontline.

In our study, 5% and 62% participants had good and moderate knowledge regarding this infection. In a study from China, 88% participants had sufficient knowledge.[10] This difference can be explained by difference in age of participants and years of experience in the two studies. Notable finding was that 89% participants answered that most common route of infection spread was through aerosol which is not true. The main route of spread is via droplet infection. As per the WHO, aerosol spread is possible only during procedures such as endotracheal intubation, bronchoscopy, and nebulization.[11] Despite availability of ample amount of literature from various government and international authorities this lack of information calls for stringent implementation of guidelines at local and hospital level.[6] Such shortcomings can be overcome by appropriate usage of scientific terminology and referrals to updated literature.

It has been observed in our study that doctors had better knowledge than nursing staff. Similar results were found by Bhagavathula et al. and in a study from Thailand.[4],[11] Social distancing guidelines vary across different countries; it is 1.8–2 m in the UK, Europe, and the US.[12] In India and China and as per the WHO recommendations, the distance advocated is 1 meter. However, most of our participants agreed on following social distancing, there is an evident lack of knowledge about the absolute number regarding the same in our country. We saw that still a good number of participants (32.5%) had not undergone any online training related to COVID 19 This information calls for organization of more webinars and training sessions in near future. The WHO advocates that till date active COVID-19 virus has not been detected in breast milk hence all efforts should be made for exclusive breast feeding while following respiratory hygiene.[13] Only 43% of our participants were aware of this guideline.

Half of our HCWs held a positive attitude toward the steps required for COVID 19 management and prevention. Good knowledge leads to positive attitude and a hope that we will win over this situation in the near future. Similar results have been supported by various studies among HCWs across the globe.[10],[14] However, in a study from Uganda, it is shown that majority of HCWs were pessimistic about the COVID infection and its effects.[15]

Nine-three percent of study participants had fear of self-infection. Similar anxiety and disturbances in sleep and appetite of HCWs has been observed in other studies.[16],[17] This can be linked to more number of HCWs therefore following rules of social distancing, hand hygiene and PPE use themselves. Interesting revelation of study was agreement to use of technology for tracing of contacts and abiding to Government guidelines as majority HCWs had already installed COVID tracking app in their mobile phones. More encouragement from institution and authorities is required for complete coverage and tracing. Ninety-three percent HCWs agreed that they will use universal precautions in a better way in future. This comes as a promising sign even in stressful situation and can be considered a learning lesson from this pandemic.

Our study included all three aspects regarding this new pandemic and not just knowledge. It is a real time data collected online during the time of lockdown. In order to improve response rate the number of questions was kept minimum. The attitude questions cater to realistic problems faced by HCWs. We have also tried to assess HCWs approach to COVID 19 tracking apps launched by Government and its direct use. Limitation of study could be its short sample size and absence of a standard KAP tool.

 Conclusions



It can be concluded that to win over this war-like situation HCWs need to strengthen themselves with the best of their knowledge, positive attitude, and good practices. Guidelines should be followed stringently and institutions do have a role in quality care of its patients by empowering their HCWs through periodic education and training sessions.

Acknowledgment

We would like to thank Prof (Dr) V. Bhatnagar for prompt help in the process of IEC approval during the time of national lockdown and Prof (Dr) S. Aneja for her valuable inputs at each step in the study. We would also thank all study participants who took out time in their busy schedule to fill the questionnaire.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1COVID-19 Situation Reports. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. [Last accessed on 2020 May 20].
2Zhou M, Tang F, Wang Y, Nie H, Zhang L, You G, et al. Knowledge, attitude and practice regarding COVID-19 among health care workers in Henan, China. Hosp Infect 2020;105:183-7.
3Advisory for Managing Healthcare Workers Working in COVID and Non COVID Areas of the Hospital. Available from: https://www.mohfw.gov.in/pdf/advisoryformanaging healthcare workers working incovidandnoncovidareasofthehospital.pdf. [Last accessed on 2020 May 20].
4Bhagavathula 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.
5Ağalar C, Öztürk Engin D. Protective measures for COVID-19 for healthcare providers and laboratory personnel. Turk J Med Sci 2020;50:578-84.
6Kotian RP, Faujdar D, Kotian SP, D'souza B. Knowledge and understanding among medical imaging professionals in India during the rapid rise of the covid-19 pandemic. Health Technol (Berl) 2020:1-6. doi: 10.1007/s12553-020-00437-2. Epub ahead of print. PMID: 32837806; PMCID: PMC7247775.
7Erfani A, Shahriarirad R, Ranjbar K, Mirahmadizadeh A, Moghadami M. Knowledge, Attitude and Practice toward the Novel Coronavirus (COVID-19) Outbreak: A opulation-Based Survey in Iran. [Preprint]. Bull World Health Organ. E-pub: 30 March 2020. doi: http://dx.doi.org/10.2471/BLT.20.256651.
8Zhong 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.
9Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One 2020;15:e0233668.
10Huynh 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;13:260-5.
11Apaijitt P, Wiwanitkit V. Knowledge of coronavirus disease 2019 (COVID-19) by medical personnel in a rural area of Thailand. Infect Control Hosp Epidemiol 2020;41:1243-4.
12Should the 2 m Social Distancing Rule Be Relaxed? Hospital Healthcare Europe; 2020. Available from: https://hospitalhealthcare.com/covid-19/should-the-2 m-social-distancing-rule-be-relaxed/. [Last accessed on 2020 Jun 21].
13WHO EMRO,Breastfeeding Advice during the COVID-19 Outbreak,Nutrition-Infocus,Nutrition. Available from: http://www.emro.who.int/nutrition/nutrition-infocus/breastfeeding-advice-during-covid-19-outbreak.html. [Last accessed on 2020 Jun 21].
14Saqlain M, Munir MM, Rehman SU, Gulzar A, Naz S, Ahmed Z, et al. Knowledge, attitude, practice and perceived barriers among healthcare professionals regarding COVID-19: A cross-sectional survey from Pakistan. J Hosp Infec 2020;105:419-23.
15Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus disease-2019: Knowledge, attitude, and practices of health care workers at Makerere University Teaching Hospitals, Uganda. Front Public Health 2020;8:181.
16Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the Fear of COVID-19 Scale: Its Association with Psychological Distress and Life Satisfaction in Turkey. Int J Ment Health Addict 2020:1-9. doi: 0.1007/s11469-020-00294-0. Epub ahead of print. PMID: 32395095; PMCID: PMC7207987.
17Grover S, Dua D, Sahoo S, Mehra A, Nehra R, Chakrabarti S. Why all COVID-19 hospitals should have mental health professionals: The importance of mental health in a worldwide crisis! Asian J Psychiatr 2020;51:102147. doi: 10.1016/j.ajp.2020.102147. Epub 2020 May 5. PMID: 32473537; PMCID: PMC7199675.