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BRIEF REPORT
Year : 2023  |  Volume : 21  |  Issue : 1  |  Page : 57-61

Knowledge, attitudes, and practice to COVID 19 infection among outpatients attending a general medicine department


1 Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Biostastistics, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission25-Jul-2022
Date of Decision01-Oct-2022
Date of Acceptance01-Nov-2022
Date of Web Publication17-Jan-2023

Correspondence Address:
Dr. Amita Jacob
Medicine 5 Office, CMC Hospital, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_79_22

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  Abstract 

Background and Objectives: We aimed to assess the knowledge, attitudes, and practices regarding COVID-19 among general medicine outpatients. Materials and Methods: We recruited people attending a general medicine outpatient department of a tertiary hospital. We assessed knowledge, attitudes, and practices toward COVID-19 using a specially designed questionnaire. Results: Two hundred and sixty-eight participants were recruited. The study documented high knowledge, positive attitude, and good practice among patients and their relatives. Knowledge was significantly associated with higher education (odds ratio [OR] = 2.87; 95% confidence interval [CI] = 1.127.36; P = 0.029) and the use of the Internet as a source of information about COVID-19 (OR = 5.17; 95% CI = 2.2611.85; P = 0.000). However, Internet use (OR = 0.23; 95% CI = 0.100.54; P = 0.001) was associated with a more negative attitude. Good practice was associated with high levels of knowledge (OR = 2.20; 95% CI = 1.223.96; P = 0.009), a positive attitude (OR = 2.31; 95% CI = 1.134.71; P = 0.022), and a professional or semi-professional occupation (OR = 2.80; 95% CI = 1.077.32; P = 0.036). Residence outside of the district (OR = 2.79; 95% CI = 1.077.32; P = 0.036) was associated with better practice related to COVID-19 suggesting people who travel greater distances for health care may be more motivated at maintaining better practice. Conclusion: The study found that good practice in relation to COVID-19 was associated with higher levels of knowledge, a positive attitude, professional occupation, and distance traveled to reach hospital.

Keywords: Attitude, COVID-19, knowledge, practice


How to cite this article:
Jacob A, Rebekah J G, Carey RA. Knowledge, attitudes, and practice to COVID 19 infection among outpatients attending a general medicine department. Curr Med Issues 2023;21:57-61

How to cite this URL:
Jacob A, Rebekah J G, Carey RA. Knowledge, attitudes, and practice to COVID 19 infection among outpatients attending a general medicine department. Curr Med Issues [serial online] 2023 [cited 2023 Feb 1];21:57-61. Available from: https://www.cmijournal.org/text.asp?2023/21/1/57/367864


  Introduction Top


During the COVID-19 pandemic, many simple practices played a role in reducing the spread of infection and could be lifesaving for populations at risk of severe disease.[1] The rapid generation and dissemination of information, incorrect interpretation of scientific data, political interests, and public panic contributed significantly to the spread of misinformation regarding COVID-19 in the community.[2],[3]

We assessed knowledge levels, attitudes, and preventive practices regarding COVID-19 and examined factors associated with high knowledge, positive attitudes, and good practices.


  Materials and Methods Top


Study design

The study was cross-sectional in design and used a case–control framework to study factors associated with knowledge, attitude, and practice.

Setting and participants

The study was conducted among people (including both patients and their relatives) attending the general medicine outpatient department of a medical college and hospital in South India, during the study period (MayJune 2020). Consecutive patients and relatives of patients, over 16 years of age, were recruited.

Procedure and assessments

Written informed consent was taken from all participants. A structured questionnaire was administered to the participants in Tamil and English. The questionnaire was modified based on an existing knowledge, attitude, and practice questionnaire.[4] Knowledge was assessed on 20 items, with 20 being the highest possible score. Questions regarding attitude were scored out of 3 with a higher score denoting a more optimistic attitude. Questions regarding frequency of 6 preventive practices were scored on a 4-point Likert practice scale with a maximum possible score of 6.[5] Details of demography and sources of information used were also documented. Socioeconomic status was assessed by the 2019 version of the Kuppuswamy scale.[6]

The questionnaire was translated into Tamil and back-translated into English, by bilingual translators proficient in both languages, and a consensus was reached among the translators regarding the best version using standard procedure. The questionnaire was piloted among 10 patients to examine feasibility and exclude possible problems. A final consensus version was obtained. The study was approved by the institutional review board and ethics committee of the medical college (IRB number 12862).

Sample size

The required sample size was calculated to be 204 using the formula 4pq/d2, assuming that the prevalence of a good level of knowledge (p) is 50% and precision (d) is 7.

Analysis

Descriptive statistics and frequency data were calculated for continuous and categorical variables, respectively. Median scores were used to divide the population into high and low knowledge groups, more and less positive attitude groups, and good and bad practice groups. Knowledge, attitude, and practice scores were compared to demographic groups (age, sex, socioeconomic status, education, and occupation) and sources of information about COVID-19 to identify factors associated with high knowledge, positive attitudes, and good practice. Chi-square test and independent-sample t-tests were employed to assess the statistical significance of association for categorical and continuous variables, respectively. Variables significantly associated with bivariate analysis were entered into multivariate models.


  Results Top


A total of 268 patients were recruited. [Table 1] documents the socioeconomic characteristics and sources of information about COVID-19. [Table 2] documents the knowledge, attitudes, and practices of the participants. The majority of the study population knew the common symptoms of COVID-19 as listed by the WHO,[7] and a significant majority knew about preventive practices related to the disease. Most did not know that asymptomatic people can spread the infection.
Table 1: Sociodemographic characteristics of sample and sources of information about COVID-19

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Table 2: Knowledge, attitude, and practice related to COVID-19

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The majority of the study population were not worried that they or their families would be affected and felt that the spread of infection had been well controlled in India. However, this attitude was associated with lower and middle socioeconomic status and those who did not use the Internet on bivariate analysis. Only association with the absence of Internet use remained significant on multivariate adjustment.

High levels of adherence to common preventive practices were also reported in the majority of the population.

Factors associated with a high knowledge score, a positive attitude, and good practice are recorded in [Table 3]. The median scores used to divide knowledge (high/low), attitude (positive/negative), and practice (good/bad) were 14, 2, and 4, respectively. High knowledge scores were significantly associated with upper socioeconomic status, education past 12th grade, a professional or semi-professional occupation, Internet use, and a higher income on bivariate analysis. However, only higher education and Internet use remained significant in multivariate analysis.
Table 3: Factors associated with high knowledge, positive attitudes, and good practice scores

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Bivariate analysis revealed that higher knowledge levels, an optimistic attitude, residence outside Vellore district, and a professional or semi-professional occupation were associated with better practice. All of these factors remained significant after multivariate analysis.


  Discussion Top


This study is one of the few investigations from India which examined predictive factors for knowledge, attitudes, and practices toward COVID-19 infection. Most of our study population had a reasonable level of knowledge about the disease and a high level of knowledge regarding preventive practices. These findings are similar to other studies from the country.[8] Gender and age-related differences of higher knowledge that have been documented elsewhere among women[4],[9] and older people[10] were absent in our sample. The effect of higher income and socioeconomic status on knowledge levels is also similar to that documented in other countries.[10]

Knowledge levels are likely related to the effective role of mass media in disseminating information about the pandemic. However, factors such as higher education and Internet use were associated with significantly higher levels of knowledge. This suggests that a good basic education and easy access to information can improve a population's knowledge about COVID-19.

Nevertheless, the use of the Internet as a source of knowledge was also associated with a more negative attitude toward the disease. Investigations from other countries have also documented an inverse relationship between knowledge and attitude with higher knowledge associated with negative attitudes.[4] The use of the Internet and social media can improve knowledge but may also increase anxiety related to the disease. Another hypothesis is that Internet use provided a more accurate picture of the pandemic and therefore resulted in anxiety, fear, and more pessimistic attitudes.

The association between improved practice among women documented in some investigations was not recorded in our sample.[4] A reluctance to wear masks which has been documented in other countries was also not seen.[10] Good practice was associated with both a positive attitude and high levels of knowledge. Hence, strategies to improve practices in a population can target improving knowledge about the disease while also promoting a positive attitude toward disease prevention and outcomes. Better practice in those living outside the district in which the hospital is situated can possibly be attributed to higher levels of motivation in health-seeking behavior and disease prevention.

The association of socioeconomic factors in influencing knowledge and practice suggests a major role for improving education and employment and reducing poverty during a pandemic. Easy access to multiple sources of information on the Internet makes it a powerful tool for increasing and updating one's knowledge. Even as the COVID pandemic subsides, these findings remain relevant to improving health-related knowledge and practice in the general population.


  Conclusion Top


The study found high knowledge, positive attitudes, and good practice related to COVID-19 in the majority of the sample. Good practice was associated with higher levels of knowledge, a positive attitude, professional occupation, and distance traveled to reach hospital. While increased use of the Internet was associated with high knowledge scores, it was related to negative attitudes and unrelated to good practice suggesting a complex relationship.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organisation. Advice for Public. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. [Last accessed on 2020 May 01].  Back to cited text no. 1
    
2.
United Nations. UN Tackles 'Infodemic' of Misinformation and Cybercrime in COVID-19 Crisis | United Nations. Available from: https://www.un.org/en/un-coronavirus-communications-team/un-tackling-%E2%80%98infodemic%E2%80%99-misinformation-and-cybercrime-covid-19. [Last accessed on 2020 May 01].  Back to cited text no. 2
    
3.
Garrett L. COVID-19: The medium is the message. Lancet 2020;395:942-3.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    
5.
Kempf-Leonard K, editor. Encyclopedia of Social Measurement. Netherlands: Elsevier; 2005.  Back to cited text no. 5
    
6.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care 2019;8:1846-9.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Word Health Organisation. Q&A on Coronaviruses (COVID-19). Available from: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses. [Last accessed on 2020 Jul 06].  Back to cited text no. 7
    
8.
Maheshwari S, Gupta PK, Sinha R, Rawat P. Knowledge, attitude, and practice towards coronavirus disease 2019 (COVID-19) among medical students: A cross-sectional study. J Acute Dis 2020;9:100-4.  Back to cited text no. 8
  [Full text]  
9.
Al-Hanawi MK, Angawi K, Alshareef N, Qattan AM, Helmy HZ, Abudawood Y, et al. Knowledge, attitude and practice toward COVID-19 among the public in the Kingdom of Saudi Arabia: A cross-sectional study. Front Public Health 2020;8:217.  Back to cited text no. 9
    
10.
Azlan 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.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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