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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 4  |  Page : 99-105

A population based epidemiological study in the Pune district of Western India to analyse knowledge, attitude, and practices relating to COVID-19 pandemic


1 Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Community Medicine, Armed Forces Medical Services, Pune, Maharashtra, India

Date of Submission17-Jun-2022
Date of Decision01-Sep-2022
Date of Acceptance02-Sep-2022
Date of Web Publication27-Oct-2022

Correspondence Address:
Maninder Pal Singh Pardal
Mandara A2/504, Nyati Epitome, Opposite Corinthian Club, Mohammadwadi, Pune - 411 060, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_18_22

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  Abstract 


Background: There is evidence that the population's knowledge, attitude, and practices (KAP) influence the implementation of nonpharmacological therapies. Given the paucity of research in this area, we felt compelled to conduct an immediate study of public knowledge of coronavirus disease 2019 (COVID-19).
Objective: The objective is to estimate the level of KAP regarding COVID-19 among the general population.
Materials and Methods: In the Western Indian District of Pune, a descriptive research was carried out. The study used a sample size of 400 people. Participants in the study were selected from residents of the study region who were at least 18 year old and willing to take part. A semi-structured, self-reported respondent-friendly questionnaire was used. Using the proper statistical tests, KAP scores according to various sociodemographic factors were compared. The confidentiality and anonymity of the study participants were maintained.
Results: The participants' average age was 30.53 years (standard deviation [SD] 6.98). The average score for knowledge was 15.28 (SD 2.63), attitude was 111.26 (SD 13.2), and practice was 13.43 (SD 1.1). We found a statistically significant knowledge gap across a range of age and educational categories. With the participants' advancing age, there was a significant variation in attitude (P = 0.02). Statistics showed that there were significant differences in practices for different age groups and educational levels.
Conclusion: According to the results of our study, it is frequently necessary to target vulnerable groups with information education and communication programs targeted at mobilizing and enhancing KAP relevant to COVID-19.

Keywords: Coronavirus disease 2019, India, knowledge, attitude, practice


How to cite this article:
Basannar D, Goyal AK, Singh Pardal MP. A population based epidemiological study in the Pune district of Western India to analyse knowledge, attitude, and practices relating to COVID-19 pandemic. MRIMS J Health Sci 2022;10:99-105

How to cite this URL:
Basannar D, Goyal AK, Singh Pardal MP. A population based epidemiological study in the Pune district of Western India to analyse knowledge, attitude, and practices relating to COVID-19 pandemic. MRIMS J Health Sci [serial online] 2022 [cited 2023 Feb 3];10:99-105. Available from: http://www.mrimsjournal.com/text.asp?2022/10/4/0/359951




  Introduction Top


The first case of coronavirus disease 2019 (COVID-19) was discovered in Wuhan, Hubei Province, in December 2019. The World Health Organization (WHO) declared it an outbreak and a Public Health Emergency of International Concern on January 30, 2020, and on March 12, 2020, the WHO declared COVID-19 a global pandemic.[1],[2] As per the WHO country figures, there have been 44,314,618 confirmed cases of COVID-19 with 527,253 deaths, in India, from January 3, 2020 to August 19, 2022.[3]

The WHO has recommended a number of nonpharmacological interventions, such as limiting unnecessary movement, keeping social distance, donning masks, and strictly adhering to hand hygiene, for the prevention and control of COVID-19.[4] However, there is evidence that the success of these nonpharmacological interventions is heavily dependent on the population's knowledge, attitude, and practices (KAP), and that sociodemographic and economic factors are related to the level of people's knowledge.[1],[2],[4] It is crucial to have adequate knowledge of the disease's transmission mechanisms, symptoms, and preventive measures, as well as the public's understanding and adherence to those measures, to introduce and implement preventive measures[1],[5] The knowledge gap resulting from this might exacerbate stress and turmoil, endangering efforts to contain the pandemic. In addition, harmful behaviors, false beliefs, and myths can make the pandemic's destructive and disastrous effects even worse. According to lessons learned from earlier epidemics like the Middle East Respiratory Syndrome and the Severe Acute Respiratory Syndrome, assessments of KAP can help identify myths, taboos and false information, as well as help, develop effective mitigation strategies for the pandemic.[4],[6]

There are very few studies regarding behavioral characteristics and associated vulnerability during the COVID-19 epidemic in India. The scarcity of studies on coronavirus outbreaks and the necessity to speed up pandemic containment led the researchers to feel that it was necessary to gauge public knowledge of COVID-19. The researchers therefore aim:

a. To investigate whether the general population has gained adequate knowledge, developed a responsible attitude, and practicing safety measures to avoid contracting the disease.

Objectives

a. To estimate the level of KAP regarding COVID-19; and to detect sociodemographic variables associated with it.


  Materials and Methods Top


In Pune, Maharashtra, a descriptive study was planned to be carried out from July 1, September to September 30, 2021. According to previously published literature, roughly 70% of the general public had sufficient awareness of COVID-19 disease[7],[8] Sample size estimation was done using the following formula, assuming a prevalence of 70%, with a 95% confidence level; and d (margin of error) =0.05.

N = (Z1−/2) 2 × p × q/d2

As a result, a sample size of 323 was determined, and when the design effect was multiplied by 1.2, a sample size of 388 people was produced. The power of our investigation was significantly increased by using an even bigger sample size of 400 individuals for the study.

The general population of Indian citizens living in the study region at the time of the study, who were 18 years of age or older, employed or jobless, and who could understand the contents of the questionnaire, were chosen as study participants by stratified random sampling. The study instrument consisted of a semi-structured, self-reported, respondent-friendly questionnaire with sections on informed consent, procedures, the voluntary nature of participation, confidentiality and anonymity declarations, sociodemographic information, and KAP. The questionnaire was created using data from the WHO and Indian government's official websites for COVID-19.[9],[10]

The study tool has five sections: demographics, KAP, and others. One senior public health professional, one statistician, and one epidemiologist all reviewed the questionnaire. The specialists who were invited had at least 10 years of relevant professional experience and were willing to participate, among other requirements. The questionnaire was pretested by conducting a pilot research on 40 individuals before the study was officially launched. This was done to see if the questionnaire was clear and to check its dependability. The three experts' input was then used to rework the questionnaire into a shorter, easier, and more manageable form that could be completed in only 6 min. The final analysis did not include the data collected during the initial pilot study.

The questionnaire's first section asked for details about gender, age, education, and the permanent residential area (urban vs. rural). Twenty questions made up the second section of the questionnaire, of which 5 dealt with general information on COVID-19, 3 with the mechanism of transmission, 7 with the symptomatology, testing, and cure/treatment, and 5 dealt with COVID-19 prevention. All of these questions had numerous right answers, and some of them were multiple-choice questions. One mark was awarded for each correct answer, while 0 was awarded for each incorrect answer, or question left unanswered by the respondent.

Attitude toward COVID-19 was measured by 27 questions each of which had a graded response, namely strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree. The assessment of respondents' practices was made by way of 15 questions. In the section on knowledge and practices, one mark was awarded for each correct answer, while 0 marks were awarded for each incorrect answer, or question left unanswered by the respondent. In the section on attitude, each question was rated on a 5-point Likert scale. The total score ranged from 27 to 135, with a higher total score indicating a more positive attitude.

A score of 16 or more on the knowledge portion was regarded as having good knowledge, a score of 12–16 as having fair knowledge, and a score of <12 as having bad knowledge. A score above 130 on the attitude component was regarded as a positive attitude, a score between 120 and 129 as a moderate attitude, and a score below 120 as a negative attitude toward the COVID-19. A score of 14 or more was deemed to represent “excellent practices,” a score of 12–14 “moderate practices,” and a score of <12 for “weak practices” was given in the study. Previous researchers have already confirmed this approach of rating KAP as good/positive/strong, fair/moderate, and poor/negative/weak.[1],[4],[5],[11]

Statistical instrument

The mean KAP scores were calculated using each person's overall scores. Correct knowledge answer frequencies as well as diverse attitudes and practices were described. Both descriptive and inferential statistical analyses were performed. The characteristics of the study participants were provided in terms of frequency and percentage in the descriptive analysis.

Using the relevant statistical tests, namely mean scores, percentages and Chi-square, knowledge scores, attitudes, and behaviors of various individuals according to various sociodemographic factors were compared. Released 2015. IBM SPSS (Statistics for Windows, Version 23.0. Armonk, NY,USA: IBM Corp) and Microsoft Excel 2019 were used to analyze the data. For editing, sorting, and coding, Microsoft Excel was used. After that, the excel file was uploaded into the SPSS program. Statistical significance was defined as a two-tailed P < 0.05.

Ethics approval and consent of respondents

The Institutional Research Ethics Committee gave its approval to the research protocol, questionnaire, informed consent process, and consent statement. The rights of the respondents to voluntarily participate and to leave the interview at any moment were explained to them in the local language. The goals, nature, and procedure of the study were described in the consent form. The confidentiality and privacy of the information provided by respondents were guaranteed. The strictest confidentiality and anonymity were upheld.


  Results Top


Sociodemographic information about the respondents: We obtained 400 completed questionnaires from the study's participants. Participants in the study were all men.

The participants' average age was 30.53 years (standard deviation [SD] of 6.98, range 16–48). [Table 1] lists the demographic information of the study participants.
Table 1: Descriptive statistics of study respondents (n=400)

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[Table 2] lists the proportions of individuals with good/positive/strong, fair/moderate, and poor/negative/weak KAP.
Table 2: Percentage of participants having good/positive/strong, fair/moderate and poor/weak knowledge, attitude and practices

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[Table 3] illustrates a comparison of the KAP scores across the respondents' sociodemographic traits. In our study, the mean knowledge score was 15.28 (SD 2.63, range 10–20). The average attitude score was 111.26 (SD 13.2, range 90–135). The average practice score was 13.43 (SD 1.1, range 12–15). [Table 4] illustrates the independent predictors of knowledge, attitude and practices in multivariate logistic regression.
Table 3: Mean scores of knowledge, attitude, and practice toward COVID-19 among the respondents

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Table 4: Independent predictors of knowledge, attitude and practices in multivariate logistic regression

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Analysis of knowledge, attitude, and practices score-related variables in a single variable

In terms of knowledge, there was a statistically significant difference between age groups and educational levels. However, there was no statistically significant difference between the participants' attitudes across educational levels (P = 0.42). However, there was a significant difference with the participants' advancing age (P = 0.02). Statistics showed that there were variances in practices for different age groups and educational levels. The elderly age group scored rather poorly in knowledge and practice. A greater degree of education was highly and positively connected with both knowledge (P = 0.001) and practices (P = 0.001).

Age and education both functioned as independent, positive predictors of good knowledge. Age was the only independent, favorable indicator of a positive attitude. Age and education were independent, favorable indicators of excellent behaviors.


  Discussion Top


COVID-19 has brought devastating effects since it was first detected in December 2019. For health authorities to effectively manage and inform the public, appropriate public management and education measures must be developed due to the high communicability and pathogenicity of SARS-CoV-2. Obtaining scientific facts on the situation and the factors affecting residents' KAP on COVID-19 prevention and control is crucial to develop effective strategies. To the best of our knowledge, this is one of the first epidemiological studies in India to analyze general public understanding, attitudes, and practices about COVID-19, as well as to pinpoint major problems and the need for national, subnational, and local interventions. The encouragement of key preventive behaviors, such as personal hygiene and social withdrawal, as well as an understanding of the difficulties brought on by lengthy lockdown and restrictions, depending on the collection of such data. For effective public health planning, implementation, and management, research of the population levels of KAP is essential given the novelty of COVID-19 and its clinical and epidemiological uncertainty.

Our epidemiological study of 400 respondents revealed that most of the participants had good knowledge of COVID-19-related information, and they also showed a positive attitude and proactive behavior during the outbreak, indicating that the extensive public education campaigns were successful in providing them with effective health education.

We also found certain demographic characteristics connected to KAP in our study. The target populations for COVID-19 prevention and health education will be identified with the use of these findings by public health policy-makers and health-care professionals.

As a multi-ethnic nation with disparate economic standings, levels of education, cultural heritage, and customs, India is expected to have a population with a range of knowledge, attitudes, and preventive practices. Even though a sizable portion of the sample exhibited positive KAP, the researchers believe that when consistent and uniform education and dissemination initiatives are promoted and put into practice, some population segments that lack Internet access or reside in areas where COVID-19 transmission is less likely may also exhibit reduced KAP regarding COVID-19. There is a chance that sizable populations will become less aware of and receptive to preventative measures.[12]

According to the results of our cross-sectional epidemiological study, the participants' KAP about COVID-19 were good in 91.50%, 88%, and 86.50% of cases, respectively. Our results are significantly different from those of other studies conducted in different parts of the world, including India, such as Pradeep M et al[8]. (Knowledge [K] =65.5%, Attitude [A] =51.5%, and Practices [P] =80.6%), Rabbani et al.[4] (K = 44.5%, A = 49%, and P = 46.5%), Baker et al.[13] (K = 82.5%, A = 18%, and P = 20%), Lau et al.[14] (A = 19.7% and P = 28%), Ngwewondo et al.[15] (K = 84.19%, A = 69%, and P = 60.8%), Ferdous et al.[16] (K = 48.3%, A = 62.3%, and P = 55.2%), Noreen et al.[6] (K = 71.7); and Habib et al.[17] (K = 30.47%, A = 17.8%, and P = 25.96%).

The authors believe that the significant disparities in the study population's levels of income, education, cultures, and traditions, the questionnaire that was used, as well as the scoring system and threshold they chose for good KAP, can help explain some of these stark differences between our study and earlier research. Therefore, it would be challenging to reliably draw conclusions or distinctions between the different research populations based solely on these results. Therefore, the authors believe there is a need for a state-or region-specific, culturally relevant, standardized, validated questionnaire that could be used by different state governments to evaluate the KAP.

The findings of our study regarding good knowledge, positive attitude, and strong practices are in consonance with those carried out by various researchers, such as, Yang et al.[5] (K = 85.2%, A = 92.9%, and P = 84.4%), Reuben et al.[18] (K = 99.5%, A = 82.3%, and P = 79.5%), Peng et al.[19] (K = 82.3%, A = 73.81%, and P = 87.9%), Zhong et al.[20] (K = 90%, A = 90.8%, and P = 96.4%); and Patan et al.[21] (K = 96.7%, A = 92.9%, and P = 90.8%).[5],[18],[19],[20],[21]

In their study, Lau et al. found that 94% of respondents had good knowledge of COVID-19.[14] Limbu et al. found that 81.5% of the study participants had good knowledge of COVID-19.[22] Noreen et al. found that 92.5% of respondents had a positive attitude toward COVID-19 and 95.4% followed strong practices regarding COVID-19.[6] The results of all these studies are in agreement with the findings of the studies carried out by Erfani et al.,[1] Lee et al.,[2] Yang et al.,[5] Rabbani et al.,[4] Faisal et al.,[7] Wen et al.,[11] Lau et al.,[14] Ferdous et al.,[16] Zhong et al.,[20] Patan et al.[21] Limbu et al.;[22] and Hatabu et al.[23]

We found a statistically significant relationship between knowledge and age and level of education, attitude and age, and practices and age group and level of education. In contrast to our study's findings, Habib et al. found that tertiary education was negatively associated with having good knowledge.[17]

The high knowledge score in our study population could partly be due to their high exposure to the information provided by the government and media about COVID-19 since the commencement of the pandemic. The finding of a high knowledge score in our study population was expected because our epidemiological study was conducted during the 2nd year of the epidemic. The strong adherence to preventive practices, as observed in our study, could primarily be attributed to the various advisories issued from time to time; and the very strict prevention and control measures implemented by local governments.

Constraints of the research

The study had a few restrictions, but not many. The sampling strategy is the study's primary constraint. This investigation was carried out in a constrained setting using the practical sampling method. The sample may have been chosen with bias. It is possible to increase the representativeness and generalizability of the results by using a more methodical, comprehensive sampling technique. Second, because we had to depend on self-reported data rather than practices that were actually seen, we are unable to confirm if social desirability bias was present in this measure. In addition, because our study relies so heavily on self-reported results, it is more susceptible to both informational and recall biases. Thirdly, only a small number of sociodemographic characteristics connected to KAP were studied as the influencing factors to avoid the recruitment of too many questions in the questionnaire and an excessively long response time. The second wave of the COVID-19 pandemic was when our study was conducted; therefore, it is possible that the KAP of our subjects solely reflects that time. As this study is not longitudinal, no conclusions about the relationship between the important factors and the KAP levels can be made. In order to better understand changes over time and as a result of pandemic development, longitudinal studies are required.


  Conclusion Top


Our study offers a thorough evaluation of the general population's KAP in India during the second COVID-19 pandemic wave. Our results strongly imply that the study participants had a high degree of knowledge of COVID-19, a positive outlook, and excellent COVID-19 prevention activities.

Recommendations

To improve COVID-19 knowledge, attitudes, and behaviors, our findings point to the need for efficient and personalized information education and communication (IEC) initiatives. Our research also suggests that due to the unequal distribution of knowledge, attitudes, and behaviors, some groups may be less likely to engage in healthy behaviors. Policy-makers and health-care authorities may effectively use our study's findings for additional health interventions, COVID-19 awareness campaigns, and IEC programs. IEC initiatives that target vulnerable groups must be developed in order to mobilize and improve COVID-19 knowledge, attitudes, and behaviors.

Advantages of the research

Despite the aforementioned drawbacks, our study also provides certain advantages. A large number of participants during the early stages of this public health disaster are one of the study's advantages. Unlike earlier KAP research, our analysis included age and educational status as determinant factors for KAP. Understanding these sociodemographic variables will aid us in raising KAP among the community we are trying to reach. We believe that the results of our study will encourage and inform program implementers and policy-makers who are working on appropriate IEC based on KAP levels toward COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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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. doi: http://dx.doi.org/10.2471/BLT.20.256651.  Back to cited text no. 1
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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