|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2021 | Volume
: 8
| Issue : 2 | Page : 114-119 |
|
Knowledge, attitudes, and practices regarding COVID-19 among medical and allied health students in the Kingdom of Saudi Arabia
Eddieson Pasay-an1
 , Ferdinand Gonzales1, Maha Sanat Alreshidi1, Jupiter Cajigal1, Wireen Leila Dator2, Petelyne Pangket1
1 Maternal and Pediatric Department/Medical-Surgical Department, College of Nursing, University of Hail, Hail, Kingdom of Saudi Arabia
2 Postgraduate Studies and Scientific Research Department, Princess Nourah Bint Abdulrahman University, Riyadh, KSA
| Date of Submission | 18-Jul-2020 |
| Date of Decision | 22-Sep-2020 |
| Date of Acceptance | 02-Nov-2020 |
| Date of Web Publication | 04-May-2021 |
Correspondence Address:
Dr. Eddieson Pasay-an
College of Nursing, University of Hail, Hail
Kingdom of Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JNMS.JNMS_92_20
Context: Notwithstanding the recognizable impact on public health, knowledge regarding this virus remains inadequate.
Aims: This study aimed to determine the knowledge, attitudes, and practices of medical and allied health students regarding COVID-19 and its relationship to their demographic information.
Setting and Design: This study was conducted at the University of Hail, Hail region, Kingdom of Saudi Arabia. This study used a quantitative comparative-correlational design.
Materials and Methods: There were 232 students recruited as respondents resulting from convenience sampling. A Google Forms survey was used to collect the data from March 2, 2020, until April 15, 2020.
Statistical Analysis Used: One-way ANOVA, t-test, and Pearson's correlation test were used to analyze the data.
Results: The participants had good knowledge, positive attitudes, and good practices on COVID-19. Of all the variables tested, only gender (P < 0.002) has statistical difference to knowledge. The Pearson's results showed no significant relationship between knowledge and attitudes (P > 0.5), knowledge and practices (P > 0.5), or attitudes and practices (P > 0.5).
Conclusion: With the good knowledge, positive attitudes, and good practices of the participants about COVID-19, it is inferred that they can help to do information dissemination needed by the community. As females found to be more knowledgeable than males, female involvement in prevention and information of COVID-19 in the family dynamics of the Saudi context is worth considering. Moreover, male participants' knowledge should be improved through health education.
Keywords: Allied health students, Attitudes, COVID-19, Knowledge, Medical, Practices
How to cite this article:
Pasay-an E, Gonzales F, Alreshidi MS, Cajigal J, Dator WL, Pangket P. Knowledge, attitudes, and practices regarding COVID-19 among medical and allied health students in the Kingdom of Saudi Arabia. J Nurs Midwifery Sci 2021;8:114-9 |
How to cite this URL:
Pasay-an E, Gonzales F, Alreshidi MS, Cajigal J, Dator WL, Pangket P. Knowledge, attitudes, and practices regarding COVID-19 among medical and allied health students in the Kingdom of Saudi Arabia. J Nurs Midwifery Sci [serial online] 2021 [cited 2023 Jun 6];8:114-9. Available from: https://www.jnmsjournal.org/text.asp?2021/8/2/114/315423 |
| Introduction | |  |
Since its outbreak in late December 2019, coronavirus disease (COVID-19) has become a threat to public health worldwide. On January 21, 2020, the situation report by the World Health Organization stated that the causative agents are still unknown.[1] The disease is believed to be caused by a novel virus originating from the coronavirus (CoV) group, which can spread from one person to another by means of respiratory droplets and contact routes.[2],[3],[4] Current knowledge regarding this disease is that it can affect people of all ages, but its transmission can be prevented through social distancing, isolation, and containment. Bai et al. reported that SARS-CoV-2 could be transmitted by people without symptoms, but people with symptoms are more contagious.[5] Notwithstanding the recognizable impact on public health, knowledge about this virus remains inadequate.[6] Although urgent measures have been taken by governmental authorities to contain the virus, the reported number of cases has increased exponentially. Limiting the worldwide spread of this viral infection is necessary; thus, control measures are urgently required.[7] The public must be educated in a timely manner to advance their knowledge, attitudes, and perceptions. The reinforcement of information on the outbreak of this disease improves the public's understanding of risk behavior and aids in a quick response to the outbreak.[8] However, it is unfortunate to note that gaps in knowledge concerning the disease and its prevention has been exacerbated by media sources providing conflicting information.[9]
It is well known that medical and allied health students assist authorities in disseminating information about health. The medical and allied health students in this study were enrolled in medical and health courses such as medicine, nursing, dentistry, public health and informatics, pharmacy, and applied science. These students are key players in mass education campaigns because of the public's assumptions regarding the knowledge and attitudes these students have gained through their education. However, anecdotal reports have shown a lack of knowledge among medical and allied health students, compromising their ability to communicate accurate information to the public and their ability to help prevent the spread of this disease. Research by Koralek et al. showed that precise knowledge of disease characteristics and routes of transmission is essential at the time of an outbreak.[10] A study conducted by Koskan et al. suggested that students lacked knowledge regarding the details of preventative behavior and vaccines for the H1N1 disease.[11] In addition, Kanadiya and Sallar performed a study on swine flu and concluded that there is a gap in knowledge about swine flu, resulting in a lack of risk reduction and a high degree of anxiety, which requires serious attention.[12] Thus, it is paramount to understand the knowledge, attitudes, and practices of medical and allied health students. According to Koskan et al., it is important to identify how to best communicate with these students in the event of a public health emergency.[11] Studies on the knowledge and attitudes toward behavior during pandemics will not only help to guide the development of important messages but also help in creating mitigation strategies for the present situation. These studies can also be used as a basis for a plan to achieve pandemic preparedness.[13] Indeed, an appropriate response at the beginning of an outbreak is dependent on public knowledge about the disease and its mode of transmission.[14]
This study is of paramount importance, as medical and allied health students are expected to help generate good public knowledge and attitudes and to display good practices in their community. This study provides the necessary information regarding the dissemination of information to the public by these students. Understanding the characteristics of the disease, including its symptoms and transmission routes, is important for preventing further spread of the pandemic. This study aims to determine the knowledge, attitudes, and practices of a population of medical and allied health students with regard to COVID-19 and to examine the relationships between the students' knowledge, attitudes, and practices.
| Materials and Methods | | |
Design
This quantitative comparative-correlational study aimed to determine the knowledge, attitudes, and practices of medical and allied health students and their differences in demographic variables. Further, this study assesses whether their knowledge translates into attitudes and practices.
Participants
The participants consisted of 232 medical and allied health students enrolled in the second semester of the 2019–2020 school year at the University of Hail, Kingdom of Saudi Arabia. This population includes students in the colleges of nursing, medicine, dentistry, applied science, and public health and informatics. Medical and allied health students were included, provided that they were enrolled both into theory courses and practice, were willing to participate, and understood English.
Sampling
The researchers utilized snowball sampling using a link (Google Forms survey) that was sent to the identified key persons in the class and colleges. These key persons were requested by the researchers to share the link with their classmates.
Data collection
Due to the enhanced community quarantine and social distancing, the researchers used a Google Forms survey to collect the data. The participants were invited to participate in the study through social platforms such as Messenger, WhatsApp, Twitter, and Snapchat. The participants forwarded a link to a webpage that contained the informed consent form and the study questionnaire. The students were asked to read the informed consent; if they understood the content of the informed consent and decided to participate, they were asked to proceed with the questionnaire. Data collection was conducted from March 2, 2020, until April 15, 2020.
Questionnaire
The questionnaire was adapted from Zhong et al.,[15] with their permission and modified by the researchers. The original questionnaire contained 12 items (four about clinical presentation, three about transmission route, and five about prevention control). In the present study, two items on prevention control with regard to handwashing were added. Scoring of the knowledge items was the same as that for the original questionnaire, with possible responses of “true,” “false,” and “I don't know.” One point was given for every correct answer, and 0 point was awarded for an incorrect answer or “I don't know” answer. The items for attitudes and practice comprised two questions each. Responses to the attitude and practice questions were “yes” and “no.” Each question regarding knowledge, attitudes, and practices was scored based on the subject's response, and higher total scores indicated better knowledge, attitudes, and practices.
The questionnaire was subjected to a content validity index (CVI). It obtained overall CVI scores of 0.81 for relevance and 0.80 for clarity, indicating a high level of content validity. Thereafter, pilot testing was conducted using 13 students from different allied health colleges to determine the reliability of the questionnaire. The questionnaire yielded a reliability coefficient of 0.74.
Ethical consideration
Ethical approval was obtained from the Ethical Review Board of the University of Hail (H-2020-097). The researchers observed the ethical principles of the World Medical Association Declaration of Helsinki in conducting research involving humans. Written informed consent was obtained from all participants.
Statistical analysis
Frequency and percentage values were calculated to describe the demographic data and the knowledge, attitude, and practice data. One-way ANOVA was used to determine differences in age, while the t-test was used for gender and availability of home/mobile Internet. Pearson's correlation coefficient was used to identify significant relationships between knowledge, attitudes, and practices. All statistical analyses were performed using (SPSS v. 22, IBM Software Group, Chicago, IL, USA) 25 at a 0.05 level of significance.
| Results | | |
The majority of the respondents (83.2%) were 21–30 years old, and the next largest group was 20 years old and below. The respondents were predominantly male (51.3%). Most of the respondents had an access of home or mobile Internet connection (77.6%) [Table 1].
The knowledge displayed by the medical and allied health students was high, with an average of 87.29% correct responses. The correct response rate was high for nearly all knowledge items. A 100% correct response rate was obtained for items 1 and 11, which pertained to the main clinical symptoms of COVID-19 and the isolation and treatment of people who are infected with COVID-19, respectively. The item with the lowest correct response rate of 60.8% pertained to children and young adults taking measures to prevent infection by the COVID-19 virus. Conversely, the correct response rates of the medical and allied health students for the attitudes and practice items were not as high with results of 73.2% and 58.4%, respectively [Table 2]. | Table 2: Knowledge, attitudes, and practices of medical and allied health students regarding COVID-19
Click here to view |
Age (P > 0.34) and home/mobile Internet (P > 0.62) were found not to be significant; however, there was a statistically significant difference between the level of knowledge and gender (P < 0.002).
Concerning attitude, there was no significant differences on age (P > 0.66), gender (P > 0.73), and home/mobile Internet (P > 0.64).
On practices, there were no significant differences found in age (P > 0.24), gender (P > 0.99), and home/mobile Internet (P > 0.86) [Table 3]. | Table 3: Differences in age, sex, Internet/mobile at home on knowledge, attitudes, and practices
Click here to view |
Pearson's correlation coefficient shows no significant relationship between respondents' knowledge and attitudes (P > 0.5).
Pearson's correlation coefficient shows no significant relationship between the knowledge and practices of the respondents (P > 0.5).
Pearson's correlation coefficient shows no significant relationship between the attitudes and practices of the respondents (P > 0.5) [Table 4]. | Table 4: Relationships between knowledge, attitudes, and practices (n=232)
Click here to view |
| Discussion | | |
This study aimed to determine the knowledge, attitudes, and practices of medical and allied health students and the differences in demographic variables. It also aimed to predict relationships between the students' knowledge, attitudes, and practices. The findings of this study suggest that medical and allied health students have good knowledge, positive attitudes, and good practices concerning COVID-19. The findings regarding good knowledge, positive attitudes, and good practices among medical and allied health students were expected because these students' courses explain the mechanisms and characteristics of diseases, disease prevention, and health promotion. In general, these results are similar to those of Erfani et al., whose respondents showed good knowledge, positive attitudes, and reasonable practices.[16] The results pertaining to good knowledge from the current study are also similar to the findings of Zhong et al. and Erfani et al. whose respondents had overall correct response rates of 90% and 85%, respectively.[15],[16] It is worth mentioning that the respondents showed a full understanding of the main clinical symptoms of the disease and the need for isolating and treating people who are infected with COVID-19, as those items had 100% correct response rates. Furthermore, the positive attitudes and good practices of the medical and allied health students were similar to the findings of a previous study.[15] In addition, the students had a positive attitude concerning MERS-CoV.[16] The results of this study indicate that medical and allied health students can contribute to the dissemination of accurate information to help decrease the anxiety and stress in their communities. Moreover, the good knowledge, positive attitudes, and practices of medical and allied health students can help slow the rates of “infodemics” concerning COVID-19.
This study found a significant difference in the knowledge between genders. This study suggests that females have higher scores than males. Previous studies explored the reasons why females perform far better than males and found that females display a better perception of educating themselves and self-control.[17],[18] This finding is similar to that of Asaad et al., who noted a significant difference in knowledge between genders, where females scored higher than their male counterparts.[19] The findings of this study contribute to the identification of educational strategies that aim to improve the knowledge of COVID-19 in both males and females. Having proper knowledge, such as knowing precautionary measures, can be used to protect oneself, regardless of gender. Conversely, the participants' age and those with home/mobile Internet were found to be insignificant to the level of knowledge. Moreover, age, gender, and home/mobile Internet were not significantly associated with attitudes and practices. Overall, these specific findings suggest that these variables were not determinants of knowledge (apart from gender), attitudes, and practices. It is important to note, however, that educational needs, regardless of the demographic variables, must be considered to create educational strategies. This can improve the understanding of the medical and allied health students on their roles in the challenges presented by COVID-19.
The present study found no significant relationships between knowledge, attitudes, and practices with regard to COVID-19. This finding suggests that knowledge does not translate to attitudes or practices and that attitudes do not translate to practices. In contrast to the current findings, Erfani et al. found that higher knowledge of COVID-19 was significantly related to positive attitudes and good practices; thus, they proposed that good knowledge translates to positive attitudes and good practices.[16] On the other hand, insignificant or weak associations between knowledge, attitudes, and practices were explored in earlier studies with regard to different topics.[20],[21],[22] In the present study, the respondents showed good knowledge (98.3%) about the prevention of COVID-19 with respect to avoiding crowded places; however, 30.6% of the respondents had recently gone to a crowded place. As such, medical and allied health students have good knowledge of COVID-19, but this is not reflected in their practices. Sadeghi and Hakimi have similar views regarding the gap between theory and practice.[23] This finding is important to aid educators in developing strategies that can help students put their knowledge into action and practice. Indeed, this is a way educators can contribute to the formation of the skills necessary for allied health students to become responsible health professionals who cater to the health needs of society.
The study findings highlight the good knowledge, attitudes, and practices of medical and allied health students; however, this does not translate to practice. Therefore, it is recommended that part of the curriculum is revised to ensure that the theory-practice gap is filled. This can be achieved by strategizing evident learning outcomes, reinforcement, and the alignment of theory and practice.
Limitations of the study
One of the limitations of the study was that the researchers did not include the year level of the medical and health allied students, which can be significant to the knowledge, attitudes, and practices on COVID-19. Moreover, since the questionnaire was in English, there was an exclusion of students that have difficulty with English. As such, these factors require examination in future studies as they directly identify the educational needs of these students regarding COVID-19.
| Conclusion | | |
Medical and allied health students have good knowledge, positive attitudes, and good practices with regard to COVID-19. There were no significant relationships between knowledge, attitudes, and practices. Therefore, knowledge of COVID-19 in this context does not translate to attitudes or practices.
Conflicts of interest
There are no conflicts of interest.
Authors' contribution
EP, FG, and MSA were responsible for the study conception and design, while JC, WLD, and PP were responsible for the acquisition of data. EP, WLD, PP analyzed and interpreted the data. All of the authors drafted the manuscript and critically revised it. Further, all authors give final approval of the version submitted in this journal.
Financial support and sponsorship
Nil.
Acknowledgment
The authors acknowledge the guidance of the mentors of mentor-mentee program of the Nurse Educators and Practitioners Guild (NEPraGuild, Inc) in this research output.
| References | | |
| 1. | |
| 2. | |
| 3. | Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.  |
| 4. | Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. |
| 5. | Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020;323:1406-7. |
| 6. | Lai C, Shih T, Ko W, Tang H, Hsueh P. 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. |
| 7. | Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020;295:210-7. |
| 8. | Balkhy HH, Abolfotouh MA, Al-Hathlool RH, Al-Jumah MA. Awareness, attitudes, and practices related to the swine influenza pandemic among the Saudi public. BMC Infect Dis 2010;10:42. |
| 9. | Kouassi DP, Coulibaly D, Foster L, Kadjo H, N'Zussuouo T, Traoré Y, et al. Vulnerable groups within a vulnerable population: Awareness of the A(H1N1) pdm09 pandemic and willingness to be vaccinated among pregnant women in Ivory Coast. J Infect Dis 2012;206 Suppl 1:S114-20. |
| 10. | Koralek T, Runnerstrom MG, Brown BJ, Uchegbu C, Basta TB. Lessons from Ebola: Sources of Outbreak Information and the Associated Impact on UC Irvine and Ohio University College Students. PLoS Curr. 2016 Aug 25;8:ecurrents.outbreaks. |
| 11. | Koskan A, Foster C, Karlis J, Rose I, Tanner A. Characteristics and influences of H1N1 communication on college students. Dis Prevent Manage 2012;21:418-32. |
| 12. | Kanadiya MK, Sallar AM. Preventive behaviors, beliefs, and anxieties in relation to the swine flu outbreak among college students aged 18-24 years. Z Gesundh Wiss 2011;19:139-45. |
| 13. | Walter D, Bohmer M, Reiter S, Krause G, Wichmann O. Risk perception and information-seeking behaviour during the 2009/10 influenza A(H1N1)pdm09 pandemic in Germany. Euro Surveill. 2012 Mar 29;17(13):20131. PMID: 22490383. |
| 14. | Rubin GJ, Amlot R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: Cross sectional telephone survey. BMJ 2009;339:B2651. |
| 15. | Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, Li Y. 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. |
| 16. | Erfani A, Shahriarirad R, Ranjbar K, Mirahmadizadeh A, Moghadami M. Knowledge, Attitude and Practice toward the Novel Coronavirus (COVID-19) Outbreak: A Population-Based Survey in Iran. [Preprint]. Bull World Health Organ. E-pub: 30 March 2020. http://dx.doi.org/10.2471/BLT.20.256651. |
| 17. | Cornwell C, Mustard DB, Van Parys J. Noncognitive skills and the gender disparities in test scores and teacher assessments: Evidence from primary school. J Hum Resour 2013;48:236-64. |
| 18. | Duckworth AL, Seligman ME. Self-discipline gives girls the edge: Gender in self-discipline, grades, and achievement test scores. J Educ Psychol 2006;98:198-208. |
| 19. | Asaad AM, El-Sokkary RH, Alzamanan MA, El-Shafei M. Knowledge and attitudes towards Middle East respiratory syndrome-coronavirus (MERS-CoV) among health care workers in south-western Saudi Arabia. East Mediterr Health J 2019;25:435-42. |
| 20. | Afroz N, Ilham, Z. Assessment of knowledge, attitude and practice of University Students towards Sustainable Development Goals (SDGs). JISDeP 2020; 1: 31-34. |
| 21. | Ahmad J, Noor S, Ismail N. Investigating students' environmental knowledge, attitude, practice and communication. Asian Soc Sci 2015;11:284-93. |
| 22. | Dauda Goni M, Hasan H, Naing NN, Wan-Arfah N, Zeiny Deris Z, Nor Arifin W, Abubakar Baaba A. Assessment of Knowledge, Attitude and Practice towards Prevention of Respiratory Tract Infections among Hajj and Umrah Pilgrims from Malaysia in 2018. Int J Environ Res Public Health. 2019;16(22):4569. |
| 23. | Sadeghi M, Hakimi H. Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. J Dent Educ 2009;73:740-5. |
[Table 1], [Table 2], [Table 3], [Table 4]
|
Search Pubmed for