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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 1  |  Issue : 1  |  Page : 16-20

COVID 19 knowledge assessment: A step towards protecting health care workers


College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India

Date of Submission08-Dec-2020
Date of Acceptance12-Dec-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Ms. Sarita Ahwal
College of Nursing, Institute of Liver and Biliary Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jascp.jascp_13_20

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  Abstract 


Background: Coronavirus disease 2019 (COVID-19) is an infectious respiratory illness caused by a novel corona virus. Being at higher risk of contracting COVID-19, knowledge of disease among health care workers (HCWs) can influence their attitudes and practices towards infection control measures. Aims and objectives: This study aimed to evaluate the knowledge towards COVID-19 among the HCWs through an online survey. Material and Methods: An online cross-sectional survey was conducted among the HCWs in various health facilities of India in May, 2020. The HCWs included nurses, physicians, Lab technicians, Physiotherapists and Pharmacists. A 20-item structured knowledge questionnaire was developed by the researchers after extensive review of literature and experts inputs. The main domains of the questionnaire included structure of the virus, general symptoms of COVID-19 infection and infection prevention and control measures. Results: A total of 189 HCWs participated in the survey. Majority of participants were in the age group of 18–30 years (82%). About two third (63%) of HCWs were nurses and only 14% were physicians. A large proportion (70%) of the participants was found to have poor levels of knowledge on COVID-19 and infection control measures. Conclusions: Since the HCWs are at a higher quantum of being infected with COVID 19, it is therefore of paramount importance that HCWs must have adequate knowledge about all aspects of the disease including clinical presentation, diagnosis, management and infection control practices

Keywords: Coronavirus disease, COVID-19 knowledge, health care workers, infection control, knowledge levels, nurses' knowledge


How to cite this article:
Ahwal S, Bist D, Anand AS, Adhikary P, Arora A, Dagar K. COVID 19 knowledge assessment: A step towards protecting health care workers. J Appl Sci Clin Pract 2020;1:16-20

How to cite this URL:
Ahwal S, Bist D, Anand AS, Adhikary P, Arora A, Dagar K. COVID 19 knowledge assessment: A step towards protecting health care workers. J Appl Sci Clin Pract [serial online] 2020 [cited 2021 Jan 25];1:16-20. Available from: http://www.jascp.com/text.asp?2020/1/1/16/306110




  Introduction Top


Coronavirus disease 2019 (COVID-19) is an infectious respiratory illness caused by a novel coronavirus first identified in Wuhan, China, in December 2019. WHO declared it as a public health emergency leading to pneumonia and respiratory failure in humans.[1] This virus has low pathogenicity and high transmissibility capability.[2],[3]

Evidence indicates that health care workers (HCWs) are particularly at risk of acquiring SARS-CoV-2 infection, due to repeated occupational exposure.[4],[5] Being at an elevated risk of contracting COVID-19, knowledge of disease can influence their attitudes and practices towards infection control measures. In different studies, HCWs have expressed their fears and concerns of acquiring or being infected by this highly contagious virus.[6],[7]

Transmission of microbes among nurses is affected by hand disinfection, mask wearing, overcrowding, lack of single rooms for isolation, and is enhanced by the fact that some nurses have inadequate awareness of infection control practices.[8] In this study, it was aimed to evaluate the knowledge towards COVID-19 among the HCWs in various hospitals of India through an online survey. This will help in planning relevant training and infection control policies to contain the COVID 19 infection. This will in turn lead to quality care and better clinical outcomes for patients with COVID-19.


  Materials and Methods Top


An online cross-sectional survey was conducted among the HCWs in various health facilities of India in May, 2020. The HCWs included nurses, physicians, Lab technicians, Physiotherapists and Pharmacists.

Development of tool

A 20-item structured knowledge questionnaire was developed by the researchers after extensive review of literature[9],[10] and experts inputs. The main domains of the questionnaire included structure of the virus, general symptoms of COVID-19 infection and infection prevention and control measures. The content validity of the tool was established (content validity index = 0.97) by the seven experts from medicine and nursing fields. The tool was found to be reliable as established using test retest method with a Cronbach's alpha, α = 0.98. For scoring, each correct response weighted score 1 and 0 for incorrect responses. The higher scores revealed higher knowledge of the HCW. Based on the aggregate scores, level of knowledge was classified into low level knowledge (<50%; 0–10 scores), moderate level knowledge (50%–79%; 11–15 scores) and high level knowledge (80%–100%; 16–20 scores) using modified Bloom's cut-off point. The questionnaire was then converted in Google form (via docs.google.com/forms) and distributed online among participants through different social media groups e.g., Whatsapp and Facebook.

Ethical considerations

The survey was conducted a part of the work assigned to the authors by the institute and hence permission from IRB was not applicable. The participation was voluntary basis and no incentives were given to the participants for their participation in the study. The Google form included a participant information sheet and a consent form which the participants had to fill before responding to the questionnaire. Confidentiality was maintained throughout the study by making the participants' information as anonymous. Through snow ball sampling technique, the 189 participants filled the form after giving their online consent. The study was conducted following the Checklist for Reporting Results of Internet E-Surveys guidelines.[11]

Statistical analysis

Completion of all the items was enforced using Javascript. The fully completed questionnaires were extracted from Google Forms and exported to a Microsoft Excel for cleaning and coding. Data were analyzed using descriptive and inferential statistics at a confidence level of 95% using SPSS v25. The association of knowledge regarding COVID-19 and the demographic characteristics of the HCWs was calculated using independent t-test and one way ANOVA. A P < 0.05 was considered statistically significant.


  Results and Discussion Top


Participants' characteristics

A total of 189 HCWs participated in the survey. Majority of participants were in the age group of 18–30 years (82%). About two third (63%) of HCWs were nurses and only 14% were physicians. Nearly half of the HCWs (45%), were having work experience between 1 and 5 years [Table 1]. More than half of the HCWs (59.8%) had not taken any formal training/E-Learning/certificate course for COVID-19 [Figure 1], and majority of HCWs (87.3%) had self learnt the COVID-19 guidelines through WHO/CDC/MoFHW websites [Figure 2].
Table 1: Frequency and percentage distribution of health care workers in terms of their demographic characteristics (n=189)

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Figure 1: Any formal training/E-learning/certificate course for coronavirus disease 2019

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Figure 2: Self learning through WHO/CDC/MoFHW guidelines

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The HCWs showed their interest towards learning about this pandemic disease. Despite lack of trainings provided by the institutes or the hospitals, they had looked for the authentic sites to gain knowledge about COVID 19.

Very few (5.8%) of the participants had good level of knowledge regarding COVID-19 management and infection control. On the other hand a large proportion (37%) of the participants were found to have poor levels of knowledge on COVID-19 [Table 2] and [Figure 3]. Similar were the results of a study done by Parajuli et al. where they found that among HCWs knowledge related to COVID 19 vaccination, isolation period and treatment by antibiotics was poor.[12] Another study documented congruent results where it was found that a significant proportion of HCWs had poor knowledge of its transmission (n = 276, 61.0%) and symptom onset (n = 288, 63.6%).[13]
Table 2: Frequency and percentage distribution of health care workers in terms of their coronavirus disease 2019 related knowledge levels (n=189)

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Figure 3: Level of knowledge of health care workers regarding coronavirus disease 2019

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Knowledge is a prerequisite for establishing prevention beliefs, forming positive attitudes, and promoting positive behaviours, and individuals' cognition and attitudes towards disease affect the effectiveness of their coping strategies and behaviours to a certain extent.[14] Hence, it is utmost vital to organised robust training programmes for the HCWs to help them develop knowledge about COVID 19 disease and related infection control measures. However, inadequate knowledge is not the only risk factor for care but is related to the higher frequency of their occupational exposure.[15] It has been documented in previous researches that the HCWs were afraid of becoming infected at work,[7] gaining knowledge would help the HCWs to provide quality care to the COVID 19 victims with a reduced the risk of infection transmission.

[Table 2] depicts the association of Knowledge Scores of HCWs with their selected demographic characteristics. There was a significant association of knowledge scores was found with the Age group (F = 3.910, P = 0.022) and profession (F = 5.174, P = 0.007). Further post hoc test was used using Bonferroni Correction to assess the direction of association which has been presented in [Table 3] and [Table 4].
Table 3: Post hoc test using Bonferroni correction showing comparison of knowledge score among participants and age (years) (n=189)

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Table 4: Post hoc test using Bonferroni correction showing comparison of knowledge score among participants and profession (n=189)

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In [Table 5] it was found that participants who were in age group of 41–50 years had higher Knowledge mean scores as compared to other age groups. However, [Table 3] reveals no significant direction of association is present among age groups. Similarly, in one of the studies, the factors associated with knowledge included age >40 (odds ratio: 0.3; 95% confidence interval: 0.1–1.0; P = 0.047).[16]
Table 5: Association of knowledge scores of health care workers in terms of their demographic characteristics (n=189)

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Data in [Table 4] depicts that Physicians had significantly better Knowledge as compared to the participants under “Others” category of profession that included Lab technicians, Physiotherapists, Pharmacists with mean difference of −2.04 and P = 0.005. On the other hand, there were no significant differences found for the knowledge levels of Physician versus Nurses or Nurses versus others. Similar results were also documented by Olum et al. (2020)[6] where they found that the level of knowledge among the HCWs were similar irrespective of the cadre (P = 0.55) or academic qualifications (P = 0.67).

The present study revealed no significant association of Knowledge Scores with Work Experience (in years) (F = 2.399), attending any Formal Training/E-Learning/Certificate Course for COVID-19 (t = 1.808) and Self Learning through WHO/CDC/MoFHW Guidelines (t = 1.632) at 0.05 level of significance.

Limitations of the study

As it was a web based survey where self reporting method was used to collect the information, there is a probability of recall and response bias. The study is subject to volunteer effect.


  Conclusion Top


Since the HCWs are at a higher quantum of being infected with COVID 19, it is therefore of paramount importance that HCWs must have adequate knowledge about all aspects of the disease including clinical presentation, diagnosis, management and infection control practices. The present study found that the HCWs had a significant knowledge gap about the COVID 19 disease. It was also highlighted that there were insufficient formal training/E-Learning/certificate courses on COVID-19 available for the HCWs. Whereas, it can be concluded that majority of the HCWs were self motivated towards learning about COVID 19. WHO/CDC/MoFHW websites were proved to be the most common sources referred by a majority of them.

The findings of this study could inform the policymakers in HMC and other healthcare institutions in India to invest in training and improving staff's knowledge. The study recommends a great need to organise educational interventions to enhance the knowledge of HCWs.

Acknowledgment

We would like to thank all the study participants for their voluntary participation and sparing their time in answering the questionnaires to provide us valuable information.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Coronavirus disease (COVID-19) Pandemic. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Last accessed on 2020 Apr 14].  Back to cited text no. 1
    
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Jiang S, Shi Z, Shu Y, Song J, Gao GF, Tan W, et al. A distinct name is needed for the new coronavirus. Lancet 2020;395:949.  Back to cited text no. 2
    
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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. New Engl J Medi 2020;382:1199-1207.  Back to cited text no. 3
    
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Nguyen LH, Drew DA, Joshi AD, Guo CG, Ma W, Mehta RS, et al. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. medRxiv [Preprint]. 2020 May 25:2020.04.29.20084111. doi: 10.1101/2020.04.29.20084111. Update in: Lancet Public Health. 2020 Jul 30;: PMID: 32511531; PMCID: PMC7273299.  Back to cited text no. 4
    
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Selvaraj SA, Lee KE, Harrell M, Ivanov I, Allegranzi B. Infection rates and risk factors for infection among health workers during ebola and marburg virus outbreaks: A systematic review. J Infect Dis 2018;218:S679-89.  Back to cited text no. 5
    
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Al Hunaishi W, Hoe VC, Chinna K. Factors associated with healthcare workers willingness to participate in disasters: A cross sectional study in Sana'a, Yemen. Br Med J Open. 2019;19:e030547.  Back to cited text no. 6
    
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Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect 2020;105:183-7.  Back to cited text no. 7
    
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Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.  Back to cited text no. 8
    
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World Health Organization. Infection Prevention and Control during Health Care When Novel Coronavirus (nCoV) Infection is suspected: Interim Guidance, January 2020. World Health Organization; 2020. Available from: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125. [Last accessed on 2020 Nov 10].  Back to cited text no. 9
    
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Centers for Disease Control and prevention. Update and Interim Guidelines on Outbreak of 2019 Novel Coronavirus (2019-nCoV). Available from: https://emergency.cdc.gov/han/han00427.asp. [Last accessed on 2020 Nov 10].  Back to cited text no. 10
    
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Eysenbach G. Improving the quality of Web surveys: The checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res 2004;6:e34.  Back to cited text no. 11
    
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Parajuli J, Mishra P, Sharma S, Bohora KB, Rathour PS, Joshi J, et al. Knowledge and attitude about COVID 19 among health care workers working in seti provincial Hospital. J Nepal Health Res Counc 2020;14:466-71.  Back to cited text no. 12
    
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Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study. JMIR Public Health Surveill. 2020 Apr 30;6(2):e19160. doi: 10.2196/19160. PMID: 32320381; PMCID: PMC7193987.  Back to cited text no. 13
    
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McEachan R, Taylor N, Harrison R, Lawton R, Gardner P, Conner M. Meta-analysis of the reasoned action approach (RAA) to understanding health behaviors. Ann Behav Med 2016;50:592-612.  Back to cited text no. 14
    
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Jiang L, Ng IH, Hou Y, Li D, Tan LW, Ho HJ, et al. Infectious disease transmission: Survey of contacts between hospital-based healthcare workers and working adults from the general population. J Hosp Infect 2018;98:404-11.  Back to cited text no. 15
    
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Olum R, Chekwech G, Wekha G, NassoziDR, Bongomin F. Coronavirus disease-2019: Knowledge, attitude, and practices of health care workers at Makerere University Teaching Hospitals, Uganda. Front Public Health 2020;8:181.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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