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 Table of Contents  
ORIGINAL ARTICLES
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 182-188

A study on knowledge, attitude, and practices about COVID-19 among community health officer trainees under health wellness center program study centers in Maharashtra, India


Department of Community Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India

Date of Submission25-Feb-2022
Date of Acceptance16-May-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
Dr. Pallavi Bhimrao Kunde
Department of Community Medicine, MGM Medical College and Hospital, N6, CIDCO, Aurangabad 431003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_25_22

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  Abstract 

Background: Coronavirus disease-2019 (COVID-19) is a rapidly spreading pandemic. Under the Ayushman Bharat Scheme of Govt. of India, community health officer (CHO) trainees undergo 6 months of training to provide comprehensive primary health care to the patients attending health wellness centers. Aims and Objectives: This study was conducted to assess the knowledge, attitude, and practices (KAPs) about COVID-19 among CHO trainees in Maharashtra. The relation between sociodemographic factors of CHO trainees and their KAPs was also studied. Materials and Methods: An online study was conducted during September 15, 2020 to October 15, 2020 among CHO trainees of the March 2020 batch undergoing training under health wellness program study centers in Maharashtra using a prevalidated questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: One hundred and sixty CHO trainees participated in this study. The majority of respondents (98 [61.3%]) were females with a mean age of 27.86 years (SD 4.862) and (range 20–43 years). Seventy-five (46.8%) respondents were ayurvedic doctors, whereas 85 (53.2%) were nursing graduates. Overall, 159 (98.76%) had sufficient knowledge, 126 (78.26%) had a positive attitude, and 65 (40.37%) had fair practices toward COVID-19. Age >30 years was associated with good knowledge. CHO trainees with age ≥ 30 years and using social media to access information on COVID-19 were having a good attitude. CHO trainees with age ≥ 30 years, working in the civil hospital and those with Bachelor of Ayurveda, Medicine, and Surgery (BAMS) degrees were significantly (P < 0.05) more likely to have fair practices. Conclusion: Studies involving CHO training centers all over India should be conducted.

Keywords: Community health officer trainees, COVID-19, health wellness centers, knowledge attitude and practices


How to cite this article:
Kunde PB, Salve SB, Dase RK. A study on knowledge, attitude, and practices about COVID-19 among community health officer trainees under health wellness center program study centers in Maharashtra, India. MGM J Med Sci 2022;9:182-8

How to cite this URL:
Kunde PB, Salve SB, Dase RK. A study on knowledge, attitude, and practices about COVID-19 among community health officer trainees under health wellness center program study centers in Maharashtra, India. MGM J Med Sci [serial online] 2022 [cited 2022 Jul 6];9:182-8. Available from: http://www.mgmjms.com/text.asp?2022/9/2/182/347687




  Introduction Top


Coronavirus disease-2019 (COVID-19) is a rapidly spreading pandemic caused by severe acute respiratory coronavirus (SARS-Cov-2) an enveloped single-stranded RNA virus; previously known as 2019 novel coronavirus (2019-nCoV).[1],[2] The virus was first detected in December 2019 among patients with viral pneumonia in Wuhan city, China. It is by far the largest outbreak of atypical pneumonia.[3],[4] The World Health Organization (WHO) declared COVID-19 disease as a “Public health emergency of international concern” on January 30, 2020. Later on due to the continuous rise in the number of affected countries, cases, and mortality, WHO declared COVID-19 as a global pandemic on March 11, 2020.[5]

COVID-19 disease associated with symptoms of infection including fever, chills, cough, coryza, sore throat, breathing difficulty, myalgia, nausea, vomiting, or diarrhea is transmitted from person to person by close contact via respiratory secretion or by touching virus-contaminated surfaces. The WHO recommends the prevention of spread by measures like regular hand washing, social distancing, and respiratory hygiene.

In India, a confirmed case of COVID-19 was reported on January 30, 2020.[6] Among the states affected by COVID-19 in India, Maharashtra was always on the top since the beginning of the pandemic. On March 9 first case of COVID-19 in Maharashtra was reported from Pune. India’s share of global active coronavirus cases stands at 2.46% (one in 41) as reported on March 30, 2021. By late April, India led the world in new and active cases. On April 30, 2021, it became the first country to report over 400,000 new cases in 24 h.[7]

As a measure to break the chain of infection, after 14 h voluntary public curfew (Janta Curfew), the government of India immediately announced a complete lockdown for 21 days till April 14, 2020. It was further extended twice on May 3 and May 17 for 14 days each time (a total of 77 days of lockdown). The battle against COVID-19 is still unending in India.[8]

Under the Ayushman Bharat Scheme of the Government of India, community health officer (CHO) trainees undergo 6 months of training in a medical college or civil hospital to provide comprehensive primary health care to the patients attending health wellness centers, that is, today’s subcenter. They are Bachelor of Ayurveda, Medicine, and Surgery (BAMS), Bachelor in Unani Medicine and Surgery (BUMS) and Bachelor of Science in Nursing (B.Sc. Nursing) graduates undergoing training in medicine and allied, surgery and allied, obstetrics and gynecology, pediatrics, public health, Ayurveda, and Yoga. As frontline health-care workers they are also exposed to the risk of COVID-19 infection. Deaths due to COVID-19 were also reported among CHO trainees in Maharashtra.

Hence, this study was conducted to assess the knowledge, attitude, and practices (KAPs) about COVID-19 among CHO trainees under the health wellness center program study centers in Maharashtra with following the objectives:

  1. To study the sociodemographic profile of CHO trainees.


  2. To study the KAPs about COVID-19 among CHO trainees.


  3. To study the relationship between the sociodemographic profile of CHO trainees and their KAPs about COVID-19.



  Materials and methods Top


An online cross-sectional study was conducted involving health wellness center program study centers in Maharashtra during September 15, 2020 to October 15, 2020. CHO trainees of the March 2020 batch undergoing training under health wellness program study centers in Maharashtra were interviewed at the end of their training as their training was extended due to COVID-19.

Due to the COVID-19 situation, we used WhatsApp for enrolling the participants. We contacted the nodal officer or program coordinators through our common WhatsApp group. The Google form questionnaire was created for data collection. The Google form link to the questionnaire was sent to the participants via the WhatsApp groups. Informed consent of the participant was taken at the beginning of the online questionnaire in Google form.

The online questionnaire consisted of four sections:

  1. Sociodemographic profile of the participant


  2. Knowledge of CHO trainees about COVID-19


  3. Attitude of CHO trainees towards COVID-19


  4. Practices of CHO trainees to COVID-19


Data collection

A structured prevalidated questionnaire was made up of four parts.

Part I: Demographic details

It includes age, sex, academic qualification, and source of information on COVID-19 disease.

Part II: knowledge

There were 11 questions (adopted from Zhong et al.[9] and modified) in this part about the clinical presentation, transmission, prevention, and control of COVID-19 disease. A correct answer was given a 1 score whereas a 0 score was given for the wrong answer. The original Bloom’s cutoff[10] points were adapted and modified. The score for knowledge varied from 1 to 11 points and was classified into three levels as follows:

  1. High level: 9–11 scores;


  2. Moderate level: 6–8 scores and low level 0–5 scores.


Part III: attitude

There were 10 Likert item questions adopted from Goni et al.[11] and modified appropriately for COVID-19 disease. The rating scale was measured as follows: positive statements with choices strongly agree, agree, neither agree nor disagree, disagree & strongly disagree, and scores 5, 4, 3, 2, and 1, respectively. The scores varied from 0 to 50 and all individual answers were summed up for total scores and calculated for the mean. The scores were classified into three levels: (1) positive attitude: 39–50 scores, (2) neutral attitude: 33–38 scores, (3) negative attitude: 0–32 scores.

Part IV: practices

Practices were assessed using seven Likert item questions that have been developed by the WHO and the Ministry of Health and Family Welfare (MOHFW) Government of India recommended practices for the prevention of COVID-19 transmission. The responses were as follows: always, occasional, and never each weighing 3, 2, and 1 point, respectively, for good practice. They were classified as 1––good level: 16–21 scores; 2––fair level: 10–15 scores; and 3––poor level: 0–9 scores.

Data analysis

Data were transferred to Microsoft Excel from Google form. The cleaned data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. Bloom’s cutoff[10] of 80% was used to determine sufficient knowledge, positive attitude, and good practice. An unpaired t test was used to check statistical significance.


  Results Top


There were a total of 160 responses from CHO trainees undergoing training in civil hospitals and medical colleges from cities in Maharashtra such as Aurangabad, Nanded, Jalna, Usmanabad, Nashik, and Ahmednagar.

A majority of 98 (61.3%) of the participants were female and below 30 years of age 113 (70.5%). The majority 105 (65.6%) of the participants were undergoing training in medical college and 55 (34.4%) in the civil hospital. Seventy-nine (49.4%) participants were BSc nursing graduates, 75 (46.8%) were Bachelor of Ayurveda, Medicine and Surgery (BAMS) doctors, and 6 (3.8%) were MSc nursing graduates. Most participants were using News Media; official government sites and media, for example, Ministry of Health and Family Welfare, Indian Council of Medical Research (ICMR); official international health organizations; and social media for accessing COVID-19-related information [Table 1].
Table 1: Sociodemographic characteristics of the participants (n = 160)

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Knowledge

All (100%) of the participants knew that COVID-19 spreads through respiratory droplets and can be prevented by avoiding crowded places [Table 2]. One hundred and fifty-nine (98.76%) of the participants were having sufficient knowledge about COVID-19 [Table 3]. Age >30 years was significantly associated with good knowledge (Mean score 10.13 Vs. 9.70; P = 0.015; [Table 4]). Male trainees were more knowledgeable than females (9.85 vs. 9.80). The level of knowledge among the BAMS CHO trainees was more than BSc nursing trainees (mean score of 9.85 vs. 9.79). However, these differences were not statistically significant (P > 0.05).
Table 2: Results of the knowledge survey (n = 160)

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Table 3: Knowledge, attitude and practice scores among CHO trainees

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Table 4: Comparison of knowledge, attitude, and practice scores among different demographic variables

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Attitude

Approximately 127 (78.9%) participants were confident in hospitals dealing with COVID-19 patients. Approximately 130 (80.7%) believed that the lockdown of major cities will help India to control the COVID-19 virus [Table 5]. Overall, 126 (78.26%) CHO trainees had a good attitude toward COVID-19 prevention practices [Table 3].
Table 5: Results of the attitude survey (n = 160)

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Age >30 years was significantly associated with good attitude (mean score 43.71 vs. 41.84; P = 0.04; [Table 4]). CHO trainees who used social media, for example, WhatsApp, Facebook, Twitter, and Instagram to access information on COVID-19 were more likely to have a good attitude, this was statistically significant (P = 0.04).

Practices

The majority of the CHO trainees 155(96.3%) practiced hand washing before and after examining a patient. Approximately 138 (85.7%) trainees always put on a mask while in contact with the patients. Unfortunately, as high as 76 (47.2%) of the trainees had never refrained from shaking hands. Approximately 45% of CHO trainees visited crowded places occasionally [Table 6].
Table 6: Results of the practice survey (n = 160)

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CHO trainees with age ≥ 30 years, working in the civil hospital and those with BAMS degrees were significantly more likely to have fair practices [Table 4].


  Discussion Top


COVID-19 is an emerging, rapidly changing global health challenge.[12],[13] Being frontline health-care workers, CHO trainees are more at risk of acquiring this infection compared to the general population.[14] Therefore, they should have adequate knowledge about all aspects of the disease from clinical manifestation, diagnosis, proposed treatment, and established prevention strategies. To the best of our knowledge, this is the first study in Maharashtra to assess the KAPs of CHO trainees toward COVID-19. In this study, we were able to show that about nine in 10 of the CHO trainees had sufficient knowledge about COVID-19. Among these CHO trainees, the level of knowledge about COVID-19 was similar irrespective of the sex and workplace. From our study, a mean knowledge score of more than 80% (9.82; SD: 0.72) was obtained on questions about knowledge indicating good knowledge among CHO trainees. This score is slightly higher than the KAP toward COVID-19 among US residents (80%).[15] This is possible because the US studies assessed COVID-19 symptoms using one direct question rather than asking the participants to choose from multiple options. Also, one reason may be the difference in the educational level of the participants. The majority of the CHO trainees had sufficient knowledge about COVID-19 which is similar to the findings in Vietnam about COVID-19[16] and in contrast to surveys by Bhagavathula et al.[17] on COVID-19 which reported poor knowledge. From our study, more than 98% of CHO trainees had sufficient knowledge about COVID-19, which is higher than the values reported by Huynh et al.,[16] where 88.4% had sufficient knowledge of COVID-19. In our study, most of the participants used information from News media. g. TVs, Radios, Magazines, and Newspapers followed by official government sites, international health organizations and social media. Older CHO trainees (>30 years) were more likely to know COVID-19 unlike in Vietnam where age did not predict knowledge.[16] This age difference may be partly due to the diversity of the sources of information frequently used by older CHO trainees. Approximately 158 (98.1%)of CHO trainees believed that wearing general medical masks was protective against COVID-19 similar to findings by Ng et al.,[18] which showed adequate protection. Our study reveals that the majority of CHO trainees have a positive attitude toward COVID-19 which is in congruence with Giao’s study on COVID-19.[16] Our study shows that only 40% of CHO trainees have fair COVID-19 prevention practices in contrast to the findings by Alfahan et al.,[19] on corona viruses and the general population of the Chinese on COVID-19.[9]


  Conclusion Top


More than two-thirds of CHO trainees have sufficient knowledge of the modes of transmission, diagnosis, and prevention of COVID-19. CHO trainees aged more than 30 years were having significantly more knowledge, good attitude, and fair practices about COVID-19. More than 78% of the CHO trainees have a good attitude, especially those who used Social Media to access information on COVID-19. Only 40% of the CHO trainees had fair practices toward COVID-19 especially those aged 30years or more, working in the civil hospital and those with BAMS degrees.

Sociodemographic factors like sex, place of work and education were not associated with sufficient knowledge and good attitude about COVID-19 among CHO trainees.


  Recommendations Top


The behavior change communication (BCC) model can be developed to promote positive preventive practices about COVID-19 among the BSc nursing CHO trainees and those working in medical colleges. Studies involving CHO training centers all over India should be conducted. A similar study may be extended to the community.

Limitations

No standardized tool for assessing KAPs on COVID-19 has been previously validated. We have however adopted and modified a previously published tool for assessment of KAP toward the prevention of respiratory tract infections, and a tool used to assess KAP among Chinese residents.[9],[10] Only CHO trainees in Maharashtra were included. Therefore, the results of this study may not be generalized to the entire country.

Ethical consideration

Institutional Ethics Committee, MGM Medical College and Hospital, Aurangabad, Maharashtra, India has approved the study protocol in its meeting held on June 18, 2020 communicated vide their letter no. MGM-ECHRS/2021/36 dated June 22, 2021.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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3.
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. N Engl J Med 2020;382:1199-207.  Back to cited text no. 3
    
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Lu H, Stratton CW, Tang YW Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2.  Back to cited text no. 4
    
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World Health Organization. WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19. 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. [Last accessed on 2020 Nov 6].  Back to cited text no. 5
    
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Vijayan P Update on #Coronavirus incident: A patient has tested positive for Novel #Coronavirus infection and is kept in isolation. The infected patient is a student of Wuhan University. We are closely monitoring the situation. Available from: https://twitter.com/vijayanpinarayi/status/1222819465143832577. [Last accessed on 2020 Mar 29].  Back to cited text no. 6
    
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Wikipedia. 2021 coronavirus pandemic in India [Online] Available from https://en.wikipedia.org/wiki/2021_ coronavirus_pandemic_in _ India#. [Last accessed on 2021 May].  Back to cited text no. 7
    
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Singhal T A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr 2020;87:281-6.  Back to cited text no. 8
    
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Kaliyaperumal K Guideline for conducting a knowledge, attitude, and practice (KAP) study. AECS illumination 2004;4:7-9.  Back to cited text no. 10
    
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Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, et al. Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian hajj pilgrims. BMC Public Health 2020;20:189.  Back to cited text no. 11
    
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Kassema JJ COVID-19 outbreak: Is it a health crisis or economic crisis or both? Case of African counties. SSRN Electr J 2020; 9:4-14.  Back to cited text no. 12
    
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McKibbin WJ, Fernando R The global macroeconomic impacts of COVID-19: Seven scenarios. SSRN Electron J, 45 p, posted on 4 March 2020. doi: 10.2139/ssrn.3547729.  Back to cited text no. 13
    
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Clements JM Knowledge and behaviors toward COVID-19 among US residents during the early days of the pandemic: Cross-sectional online questionnaire. JMIR Public Health Surveill 2020;6:e19161.  Back to cited text no. 15
    
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Huynh G, Nguyen TN, Tran VK, Vo KN, Vo VT, Pharn LA Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pacific J Trop Med 2020;13:260-5.  Back to cited text no. 16
    
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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;6:e19160.  Back to cited text no. 17
    
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Alfahan A, Alhabib S, Abdulmajeed I, Rahman S, Bamuhair S In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: A cross-sectional study. J Community Hosp Intern Med Perspect 2016;6:32151.  Back to cited text no. 19
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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