key: cord-0780902-cu37fxhz
authors: Gohel, Kushalkumar H.; Patel, Prati B.; Shah, Pushti M.; Patel, Jay R.; Pandit, Niraj; Raut, Asavari
title: Knowledge and perceptions about COVID-19 among the medical and allied health science students in India: An online cross-sectional survey
date: 2020-08-12
journal: Clin Epidemiol Glob Health
DOI: 10.1016/j.cegh.2020.07.008
sha: dc67a8c0e745b7955302a19479250a441ffc3e74
doc_id: 780902
cord_uid: cu37fxhz

BACKGROUND: An infection (COVID-19) without any specific cure makes the people more vulnerable to get affected due to insufficient knowledge and unhealthy practices. In this scenario, healthcare students can act as reliable information providers. This study aimed to assess the knowledge and perception about COVID-19 among medical and allied health science students. METHODS: A web-based cross sectional survey was conducted during February and March 2020. A 24-item survey was developed and randomly distributed among the study population. Descriptive statistics was applied to represent participant characteristics and Chi-square test was used to evaluate the level of association among variables with a significance level of p < 0.01. RESULTS: Total, 97.95% (715/730) participants completed the survey. High proportion of students were from pharmacy (45.73%) followed by medical (22.52%), physiotherapy, nursing and dental background. Majority of participants were having adequate knowledge while about 18% had partial knowledge about the symptoms of severe COVID-19 cases. Students have shown a positive perception of COVID-19 prevention and control while few invalid responses related to the use of herbal medicines or garlic were noted. About 50% had rightly stated that, the antibiotics and vaccine are not effective in COVID-19 infection at present. CONCLUSION: As the COVID-19 cases are rapidly increasing worldwide, it is essential to improve the knowledge and beliefs among general public to prevent its spread. Health care students with their education background and basic understanding about COVID-19 can play a significant role by making community people aware about the seriousness of this pandemic situation.

Coronaviruses (CoV) are a broad family of viruses that are known to cause serious and sometimes fatal pulmonary diseases such as, Severe Acute Respiratory Syndrome (SARS-) and Middle East Respiratory Syndrome (MERS-). [1] In 2002-03, SARS-CoV first identified as a pneumonia in Guangdong, China, which later turned into life-threatening respiratory failure. Initially, it was only animal-human interspecies transmission that further progressed into human to human transmission. The virus infected about 8500 people with fatality rate of 10%. [2, 3] Similarly in 2012, the MERS-CoV epidemic appeared in Saudi Arabia where people experienced symptoms similar to SARS-CoV but dying at a much higher rate of 36%.

It was mainly transmitted to humans from dromedary camels. [4] In December 2019, similar cases were reported in Wuhan city, China. The virus was identified as a new form of Coronavirus (novel Coronavirus-2019) and also the illness it causes was named as COVID-19. [5] The World Health Organization (WHO) on January 30, 2020, declared COVID-19 a public health emergency and later on March 11, 2020, the outbreak was declared pandemic. According to the WHO situation report, globally approximately 3349786 confirmed cases of COVID-19 caused by the SARS-CoV-2 were reported, including an estimated 238628 deaths as on May 03, 2020. [6, 7] Preliminary scientific reports revealed that, COVID-19 would be possibly spread via animals to humans but the current findings states that human to human transmission could also occur through direct contact, and respiratory droplets. [8, 9] The incubation period of COVID-19 is 2-14 days [10, 11] and the initial symptoms would appear as fever, cough, shortness of breath, trouble breathing, pain or pressure in the chest, fatigue, myalgia or arthralgia, confusion, bluish lips or face. [12, 13] Standard recommendations to prevent infection spread includes, maintaining hand hygiene, covering mouth and nose when coughing or sneezing, avoid close contact with anyone showing symptoms of respiratory illness as well as to prevent unprotected contact with farm or wild animals. [1, 14] Till date, no vaccine or an antiviral treatment has been launched into the market for the prevention or management of COVID-19. Current treatment guidelines of Center for Disease Control and Prevention (CDC) as well as WHO majorly focus on symptomatic management and application of infection prevention measures. However, medications such as, chloroquine, hydroxychloroquine, remdesivir and lopinavir/ ritonavir are presently being tested in clinical trials. [15] As the risk of COVID-19 becomes more widespread, people should take steps to safeguard themselves from infection and limit its spread to others. Though the students from medical and allied health sciences are not directly involved in managing COVID-19 patients, they can serve as an information provider. They can sensitize community people about maintaining personal hygiene, symptoms of COVID-19 and how to prevent its spread. Students must possess the basic knowledge about novel Coronavirus and be able to clear the myths pertaining to COVID-19. With this background, our study is aimed to assess the knowledge and perceptions about COVID-19 among medical and allied health science students.

J o u r n a l P r e -p r o o f

A web-based cross sectional survey study was conducted using a "Google Form" to obtain responses from medical and allied health science students during February and March 2020.

The study was carried out in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines [16] . The ethical approval was obtained from the institutional ethics committee (Sumandeep Vidyapeeth Institutional Ethics Committee, Ref. Confidentiality of all study participants was maintained by making their information anonymous and they were requested to provide authentic answers.

A survey with 24 Questions (in English language) was formulated using reference material, fact sheets and information leaflets on COVID-19 developed by WHO, CDC and National Health Services (NHS). The survey covered the domains of student demographics, general awareness, information sources, knowledge and perceptions related to COVID-19. The developed draft questionnaire was validated by face and content validation method by the five selected physicians and faculty members to assess its readability and validity before pretesting among ten randomly selected medical and allied health science students for clarity, significance, and acceptability. Modifications and refinements were made as per the comments received to enable better understanding and to organize the sequence of questions. The final survey link was distributed among the students in the form of "Google Form" via various media platforms such as, WhatsApp, Gmail, and Facebook.

As this is a knowledge and perception assessment study, we have considered the total population size of 10000, and at 99% CI with 5% margin of error the calculated sample size using Morgan's Table was 622 but the study received enormous response from the students across India and we have collected the data of about 730 participants.

The survey comprised 24 closed-ended questions which takes about 5-10 minutes to complete. The survey was divided into three parts, including participant information sheet, informed consent form and questionnaire. In total, 7 participant demographics questions and 24 knowledge-perception assessment questions were included comprising the core information such as, general knowledge about novel Coronavirus (11 items), source of information (1 item), precautions and risk prevention (1 item) and perceptions of COVID-19 (11 items) (Appendix 1).

All the collected data were entered into Microsoft Excel and cross checked for presence of any error to maintain its accuracy. Descriptive statistics was applied to calculate proportions and frequencies. The chi-square test was used to investigate the level of association among study variables. A p-value of less than 0.01 was considered statistically significant. Statistical analysis was performed using IBM SPSS software for Windows version 27 (NY, USA).

Out of 730 participants that filled out the web based survey, 715 participants have given their consent of voluntary participation and completed the questionnaire with a response rate of 97.95%. The mean age of the study participants was 21.81 ± 2.6 years. The majority students were from pharmacy (n=327, 45.73%) and medical (n=161, 22.52%) field, followed by physiotherapy, nursing, dental, and other allied health science background. Demographic characteristics of participants are detailed in Table 1 .

Participants were also inquired about the source of valid and reliable information about COVID-19. The main sources of information was social media (Facebook, WhatsApp, YouTube, Instagram) (n=466, 65.17%) followed by news media (TV/video) (n=149, 20.84%). Remaining participants reported that they got the information through print media (magazines, newspapers), and other sources. Few students obtained information from their college resources such as newsletters, posters and guest lectures. Details of above mentioned sources of information are represented in Figure I .

The subsequent table (Table 2) illustrates the knowledge about novel Coronavirus among the students. Majority of the study participants (70.91%) correctly identified novel Coronavirus i.e. COVID-19. A high proportion of study participants (85.31%) provided the correct response while 11.47% did not have any idea whether COVID-19 is contagious or not. 

On the basis of statistical analysis, significance with the participant background was observed in areas of identification of novel Coronavirus, its origin, asymptomatic behaviour and the modes of transmission. Majority of students with medical and dental background agreed that the patient with COVID-19 could remain asymptomatic (p<0.01) while considering the transmission route, the students from pharmacy background were found more conscious (p<0.01) that infection could spread through personal contact, respiratory droplets and possibly by faeces. The association was estimated using chi-square test and represented in Table 3 .

Students were further inquired to assess their beliefs towards prevention of COVID-19.

Majority of all the students (91.61%) positively agreed to the ways of preventing COVID-19

as prescribed by WHO. These precautionary measures are, cleaning hands with alcohol based sanitizer, avoid personal contact and maintaining at least 1 meter distance (Social distancing).

The results are further illustrated in Figure II .

A high majority of the participants (73.15%) believe that wearing a surgical mask is a were also noted in the perception of our study participants. As an example, around 30% of students believed that the use of herbal medicines and eating garlic can protect against COVID-19 infection. Similarly, 33.1% Egyptian public also incorrectly stated that eating garlic could prevent spread of disease. [21] Considering the association of climatic condition and COVID-19 infection, more than half of participants (58.32%) believe that it either occurs in winter or spring/ fall which is an incorrect perception as it could occur round the year as per available evidence.

Current global pandemic situation demands substantial awareness about the clinical presentation, spread, preventive measures and management of COVID-19. We discovered that the students from different institutions are having adequate awareness about COVID-19.

Also, it has been observed that majority of participants acquired the information form social media which is an unauthentic resource of obtaining evidence about diseases. Students should be informed about the authentic sources of information as provided by global health authorities and health ministry of respective countries. Our study finding also highlights the specific aspects of knowledge and perception where the partial or incorrect responses were noted and these areas should be addressed in future through webinars, leaflets and educational campaigns to improve understanding and to correct the myths about COVID-19.

In present study, the questionnaire was developed based on the information available on WHO, CDC and NHS websites as well as a dual validation was performed which increases the reliability of our study results.

Besides highlighting the facts about the knowledge and perception about COVID-19, this study has few limitations which should not be ignored. Firstly, as this is an online crosssectional survey, there are chances of recall bias in information as well as it is possible that the students may have looked up the answers to some of the questions before answering.

Secondly, the survey was conducted among the students from health science background so the findings cannot be extrapolated to the health care professionals. Lastly, as this is an internet-based online survey, responses from the regions without internet access may not be captured which may lead to demographic selection bias.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors declare that they have no conflict of interest. J o u r n a l P r e -p r o o f 

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