key: cord-0951557-mkeb770a authors: Fakhri, Nada; Jallal, Manar; Belabbes, Sanaa; Khudur, Khulud; Kaddar, Rochdi; Oubaasri, Ahmed; Elhadraoui, Najia; Mohammed Abdallahi, Ndjoubnane; Al Hassani, Wafaa; Nejjari, Chakib; Belouali, Radouane; Khalis, Mohamed title: COVID‐19 and Moroccan nursing students: A multicentre cross‐sectional survey on their related knowledge, attitudes and practices date: 2021-03-06 journal: Nurs Open DOI: 10.1002/nop2.790 sha: b50b1db2c77e747676aac12e6d22a5202c04d155 doc_id: 951557 cord_uid: mkeb770a AIM: To assess knowledge, attitudes and practices of Moroccan nursing students towards COVID‐19. DESIGN: Cross‐sectional study. METHOD: Data were collected using an online questionnaire consisted of demographic characteristics and 24 items about COVID‐19‐related knowledge, attitudes and practices. RESULTS: A total of 1,216 nursing students participated in this study. About 82% of the participants reported that the COVID‐19 virus spreads via respiratory droplets of infected individuals. The most clinical symptoms of COVID‐19 correctly identified by participants were fever (97.6%), dry cough (92.4%), dyspnoea (82%) and fatigue (74.9%). More than 56.6% of the participants were afraid of being affected by COVID‐19. Almost all participants reported that they avoid crowded places frequently. About 93.4% of the participants declared frequently wearing face mask when leaving home, and 85.5% maintained social distancing frequently. However, only 47.4% reported that they frequently washed their hands. About 51% stated that coronavirus outbreak has considerably changed their daily routines. many public health measures for stopping and controlling this disease (Ait Addi et al., 2020) , including isolation of confirmed and suspected cases, suspension of flights to and from Morocco, travel restrictions, confinement, closure of public spaces and all schools, and wearing of the mask. Gradual deconfinement was being implemented as of 11 June 2020, and a few weeks later, the number of cases and deaths increased. Healthcare professionals including nurses play a key role in the fight against COVID-19. They provide care for patients suffering from this highly transmittable pathogen. Good knowledge and appropriate practices about COVID-19 among healthcare professionals are necessary to protect themselves and for successful disease control and prevention (Hoe Gan et al., 2020) . Moreover, the educational needs of nurses can be revealed through an evaluation of their current knowledge, attitudes and practices. During the current COVID-19 pandemic crisis, hospitals need more assistance than ever to manage the influx of COVID-19 patients, and bringing additional skilled nurses into the workforce may support and enhance health system response to this disease. Many countries allowed nursing students and retired nurses to join the front lines in the fight against COVID-19. If the situation required it, Moroccan nursing students may be asked to participate in healthcare services and do their parts during this COVID-19 pandemic. Many studies have been conducted around the world on knowledge, attitudes and practices (KAP) about COVID-19 among general public and health service providers (Azlan et al., 2020; Kalet et al., 2020) . However, data from nursing students are extremely scarce. The aim of this study was to evaluate knowledge, attitudes and practices towards COVID-19 among Moroccan nursing students. To the best of our knowledge, this is one of the first KAP studies among nursing students in the ongoing COVID-19 pandemic. This was a descriptive cross-sectional study conducted during the COVID-19 pandemic period, between 20 April 2020-30 April 2020. The study was conducted in seven nursing schools in Morocco. The participants were nursing students who met the inclusion criteria of this study. The inclusion criteria consist of students regularly matriculated into these schools at the time of the survey, regardless of their year of study. Data were collected using an online questionnaire created in google forms. The link of the questionnaire was sent to participants through WhatsApp groups and other social media (Facebook). To reach as many respondents as possible, a snowball sampling technique was used. The development of the questionnaire was based on a review of literature and questionnaires used in other similar studies and WHO guidelines (Abdelhafiz et al., 2020; Gaffar et al., 2019) . The questionnaire started with a short paragraph describing the purpose of the study and indicating participants that all data are collected anonymously. The questionnaire was divided into four main sections: The first section included demographic and general information (e.g. age, sex, first source of information about COVID-19, specific training on Data analysis was performed using SPSS software, version 20. The results were presented as frequencies and percentages. The study protocol was approved by the Research Ethics Committee. Participation in this study was voluntary and was not compensated. Electronic informed consent was obtained from all participants. A total of 1,216 nursing students completed the questionnaire. Table 1 presents demographic and general information of the participants. The majority of the participants (95.6%) were in the 18-to 23-year age group, and 77.4% of them were female. The first source of information about COVID-19 was social networks for 67.9% of the participants, followed by television for 12.3%, health workers for 7.9% and family for 5.1%. Almost 60% of the participants had received specific training on COVID-19. Table 3 shows the answers provided by participants about attitudes towards COVID-19. More than half of the participants (56.6%) were afraid of being affected by COVID-19. The majority of participants (84.8%) felt that COVID-19 pandemic will successfully be controlled. About 90% of the participants agreed that Morocco would be able to win the battle against this disease. The majority of participants (96.2%) stated that social distancing is essential for preventing the spread of COVID-19. The majority of participants (92.8%) agreed to be on quarantine and isolate themselves if they had symptoms of COVID-19. Almost 60% of the participants would like to practice physical activities outside their homes during the confinement period. A high proportion of participants (81.8%) agreed to participate in caring for patients with COVID-19, if the situation required it. More than 66% of the participants stated that if they have symptoms of COVID-19 they will speak with their doctors first. Table 4 presents practices towards COVID-19 among the participants of this study. Almost all participants (98.4%) reported that they avoid crowded places such as market and grocery store frequently, and 93.8% of them avoid visiting their family and their neighbours in this pandemic period. Only, forty-seven (47.4%) of the participants reported that they frequently wash their hands. Less than half of the participants (47.9%) stated that they frequently use alcoholbased sanitizer during this coronavirus pandemic. About 93.4% of participants declared frequently wearing face mask when leaving home. The majority of the participants (85.5%) maintained social distance of at least one metre from other people frequently, and approximately 90% avoided shaking hands and kissing when giving greetings. Of the participants, 72% avoided touching their eyes, noses and mouths with unwashed hands frequently. About nine in ten participants (90.2%) used their bent elbow when coughing or sneezing frequently. Nearly half of the participants (51.1%) stated that coronavirus outbreak has considerably changed their daily routines. The purpose of our study was to assess the knowledge, attitudes and practices of nursing students during the COVID-19 epidemic. The main findings of the study showed that most of the participants had a good knowledge and attitudes towards COVID-19, and an acceptable level of practices towards COVID-19. The first source of information about COVID-19 was social networks for 67.9% of the participants of this study. Similar results were reported in a recent study conducted among Egyptian public. The Egyptian's study illustrated that the main source of information about COVID-19 was through social networks 66.9% (Abdelhafiz et al., 2020) . It is known that young people, such as our participants, tend to use social media more frequently. According to the last report of "We Are Social" (Global Socially-Led Creative Agency, 2018), there were about 16 million active users in Morocco, in January 2018. The large majority of participants in the current study held positive attitudes towards overcoming COVID-19. We found that most participants believed that COVID-19 pandemic will successfully be controlled, as well as they agreed that Morocco would be able to win the battle against the COVID-19 virus. Similar optimistic attitude was also documented in previous studies in China (Zhong et al., 2020) and Malaysia (Azlan et al., 2020) . The positive attitude shown in the present study could be attributed to the adequate prevention and control policies implemented by the Moroccan government since the first days of this COVID-19 pandemic (Ait Addi et al., 2020). Attitudes towards COVID−19 (n = 1,216) Distribution n (%) Are Practices towards COVID−19 (n = 1,216) Distribution n (%) Do you avoid going to crowded places (e.g. markets, grocery stores)? Most of the participants (92.8%) of this study agreed to be on quarantine/isolate themselves in case of apparition of COVID-19 symptoms, and 96.2% confirmed that social distancing is essential to prevent the spread of this disease. Similarly, in a study by Roy et al., 96% of the participants agreed to quarantine/ isolate themselves if they had fever and cough and 98% participants believed social distancing is a measure to prevent and control of COVID-19 (Roy et al., 2020) . In contrast, a KAP study conducted among Australian healthcare workers during an influenza pandemic indicated that only 45% of the respondents intended to comply with quarantine measures ). In our study, the majority of our participants (81.8%) stated that they can participate in providing care to patients with COVID-19. In line with our study, high percentage (74.2%) of medical and nursing students in the Spanish study agreed to caring for COVID-19 patients if the situation required it (Cervera-Gasch et al., 2020). Another study conducted among medical staff at a psychiatric hospitals in China reported that 77.17% of the participants expressed a willingness to care for psychiatric patients with COVID-19 disease (Shi et al., 2020) . This attitude was also reported in a Canadian study investigating willingness of nursing students to volunteer during the avian flu pandemic (Yonge et al., 2010) . Regarding prevention practices, the vast majority of participants in this study avoided crowded places, such as markets and grocery stores during COVID-19 pandemic. Similar results were reported in an earlier study, among Chinese residents, in which the vast majority of participants (96.4%) had not visited any crowded places during the confinement period (Zhong et al., 2020) . Similarly, a recent study among the Malaysian public showed that 83.4% of participants avoided going to crowded places such as weddings (Azlan et al., 2020) . In our study, the majority of participants avoid visiting their families and their neighbours in this pandemic period. Similarly, 92.5% of the participants in an Iranian study stated that they cancelled or postponed meetings with friends and eating out because of COVID-19 (Taghrir et al., 2020) . This may be explained by the fact that COVID-19 is a highly contagious infection and has infected a large population across the world. Evidence from the literature showed that hand hygiene is one of the most important measures to prevent and control infectious disease including COVID-19 (Cheng et al., 2020; Jefferson et al., 2009; Paludan-Müller et al., 2020) . In this study, only 47.4% of the participants reported that they frequently wash their hands. In contrast to our findings, an Indian study on medical students reported that 96.7% washed their hands more often than usual during the ongoing coronavirus pandemic (Taghrir et al., 2020) . In addition, the WHO's guidelines recommend the frequent use of alcohol-based sanitizer and considered this practice one of the most effective preventative measures in the community to prevent the spread of the new coronavirus (WHO, 2020) . While some studies on COVID-19 have confirmed the high frequent use of sanitizers among their responders (Azlan et al., 2020; Roy et al., 2020) , in the current study, only less than half of the participants stated that they frequently use alcoholbased sanitizer. This might be due to the shortage of hand sanitation products observed in the first weeks of the pandemic, as a result of huge demand. There are many reports across the world describing the great surge in demand of alcohol-based sanitizers leading to severe shortage in their supply (Berardi et al., 2020) . The cost of the alcohol-based sanitizer may also play a role in participants' access to these products. A recent Kenyan study on COVID-19 reported that the expensive price was a significant barrier for 53% of the participants to use hand sanitizers (Austrian et al., 2020) . As preventative measures to limit the spread of COVID-19, the (Van et al., 2010) . Our finding may be attributed to the severity of the current COVID-19 pandemic. The strengths of the current study include, first, to the best of our knowledge this is the first study assessing knowledge, attitudes and practices towards COVID-19 among nursing students in Morocco. Second, this study is a multicentre study including a large sample of nursing students. Third, this study was conducted on the early stage of the COVID-19 outbreak in our country. However, this study has some limitations. First, students had access to online correct COVID-19 information resources, which may have influenced their responses to COVID-19 knowledge. Second, participating in this survey required Internet access; therefore, participants without Internet access were not able to complete our questionnaire. The results of this study showed that most of the nursing students participated in this study had a good level of knowledge, very positive attitudes and an acceptable level of practices towards COVID-19. Sensitization and education campaigns are needed to improve their preventative practices, such as hand hygiene and wearing face mask. In addition, it may be of importance to incorporate competences into curricula to improve knowledge, attitudes and practices of future health professionals and to prepare them for emergencies and outbreaks. We are very grateful to all nursing students who participated in this study. The authors declare that there is no conflict of interest. The data that support the findings of this study are available, from the corresponding author, upon reasonable request. 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