Assessment of knowledge, attitude, and practices of Indian medical and engineering students on COVID-19: A nation-wide online survey Priyadarshini B, Mondal H, Swarup SS, Behera JK, Panigrahi A, Basu A,

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ORIGINAL ARTICLE

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Assessment of knowledge, attitude, and practices of Indian medical and engineering students on COVID-19: A nation-wide online survey

Bhagyajyoti Priyadarshini¹, Himel Mondal², Shiba Sai Swarup³, Joshil Kumar Behera⁴, Akankhya Panigrahi¹, Ankan Basu⁵
¹ Medical Student, Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha, India
² Department of Physiology, Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha, India
³ Department of Community Medicine, Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha, India
⁴ Department of Physiology, ESI Medical College, Bihta, Patna, Bihar, India
⁵ Department of General Surgery, Kasturba Medical College, Manipal, Karnataka, India

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Date of Submission	05-Jan-2022
Date of Decision	13-Feb-2022
Date of Acceptance	15-Feb-2022
Date of Web Publication	27-Oct-2022

Abstract

Background: Coronavirus disease (COVID-19) has created fear, misconceptions, and apprehensions among the public including the youth of the society. We evaluated and compared the knowledge, attitudes, and practices toward COVID-19 among undergraduate medical and engineering students of India. Methods: An online cross-sectional survey was carried out on Indian undergraduate medical and engineering students in September 2020. A prevalidated and pretested questionnaire was used in this study. The questionnaire had eight items for knowledge, six items for attitudes, and four for practices. A snowball sampling method was used to collect data. Results: A total of 1757 (1137 [64.71%] medical, 620 [35.29%] engineering) Indian students participated in the study. The overall scores of knowledge were 5.77 ± 1.2, the attitude was 5.06 ± 0.83, and practices were 2.32 ± 0.93 (analysis of variance P < 0.0001). There was no gender difference in knowledge, attitude, or practice. The medical student scored higher in knowledge (P < 0.0001) and attitude (P < 0.0001) compared to engineering students. Medical students showed a significant positive correlation (r = 0.13, P < 0.001) of attitude with semester of study. Engineering students showed significant positive correlation of knowledge (r = 0.12, P = 0.002) and practice (r = 0.11, P = 0.008) with semester of study. Conclusion: Indian medical and engineering students had a good level of knowledge and positive attitudes towards COVID-19. Although medical students scored higher in knowledge and attitude, the practice showed no difference. The practice scores were the lowest among the three parameters. This reaffirms the need for more strategic planning to ensure good practices among students of both the major sectors of science.

Keywords: Attitude, COVID-19, engineering students, knowledge, medical students, practice

How to cite this URL:
Priyadarshini B, Mondal H, Swarup SS, Behera JK, Panigrahi A, Basu A. Assessment of knowledge, attitude, and practices of Indian medical and engineering students on COVID-19: A nation-wide online survey. J Appl Sci Clin Pract [Epub ahead of print] [cited 2023 Mar 29]. Available from: http://www.jascp.org/preprintarticle.asp?id=358993

Introduction

COVID-19 is an infectious respiratory disease caused by a novel coronavirus-severe acute respiratory syndrome coronavirus 2.^[1] It was first detected in Wuhan City, Hubei Province of China on December 31, 2019, and was soon declared a pandemic on March 11, 2020, by the WHO.^[2] With deceptively mild symptoms such as sore throat, fever, and myalgia (among others), this highly virulent virus induces severe complications in humans, often resulting in death. It (along with its many strains) has caused havoc by running amok, affecting innumerable lives and causing deaths in millions all over the world.^[3] In India, the first case was reported in Kerala on January 27, 2020. It has now more than millions of confirmed cases of COVID-19 and ranks second in the total number of cases in the world.^[4]

It would be myopic to limit the impact of the virus to the number of lives lost and the terrible health crisis it spawned. The resulting pandemic has caused a severe adverse impact on the economy and created fear, uncertainty, and doubt among the people. Large swaths of the population are now left dealing with their mental anxiety, psychological, and emotional distress.^[5] This heightened state of panic coupled with a surge of unverifiable, fake, and misleading information has spawned a parallel infodemic.^[6]

The global impact caused by the COVID-19 pandemic warrants immediate action across all levels–from the government to its citizens. Additionally, both the public and the private sectors need to work hand-in-hand to develop innovative strategies to fight this menace and curb its spread.^[7]

Accurate knowledge, the right attitude, and correct practices equip the population to form appropriate strategies to not only manage this ongoing pandemic but also help prevent other epidemic attacks in the future.^[8]

In India, undergraduate students studying in Medical and Engineering colleges constitute a significant percentage of the future working population of our country. A thorough study on the aforementioned groups is essential to assess their awareness and attitude toward the pandemic. It will also involve the institutions that these individuals are a part of to form policies to plan for educational interventions.^[9] To aid such initiatives, this study intends to evaluate the knowledge, attitudes, and practices toward COVID-19 among these students through a questionnaire and also draws a comparison between them to determine their role and contribution toward managing the current pandemic situation.

Methods

Study design and settings

This was an online survey-based descriptive cross-sectional study conducted from September 15 to September 25, 2020 (10 days period was decided by the Delphi panelists).^[10] We used a pre-designed, pre-validated (Cronbach's alpha α = 0·8), and standardized questionnaire [available in Annexure 1].

Ethics

We considered the online agreement for voluntary participation equivalent to a written consent for participation. The study protocol was approved by the Institutional Ethics Committee of Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha (Reference number: EC-04 [1], dated September 02, 2020). We further declare that the study was conducted in full accordance with the World Medical Association Declaration of Helsinki, updated in 2013.

The questionnaire

The questionnaire was developed by 3 tier modified Delphi method.^[10] The answers could be single or multiple choices (which were separately mentioned below the question). Scoring was done by awarding 1 mark for each correct answer and 0 for the wrong answer. There was randomization of the questions by the Google forms.

The questionnaire collected data on knowledge with 8 questions, attitude with 6 questions, and practice with four questions. This questionnaire was circulated online (on Google forms survey platform) to reach out to the maximum number of college-going undergraduate medical and engineering students all over India. The questionnaire contained a paragraph of text on the nature and aim of the study and the informed consent for voluntary participation. Clicking on the “agree” button would take the user to the survey questionnaire.

Participants

We included undergraduate medical and engineering students of any semester studying in any Indian institutions including both government-run and private institutions. We did not collect data from Dental, Nursing, Pharmacy, Traditional medicine students, or paramedical students.

Study sample

We used a snowball sampling technique to collect data from all over India. The survey links were shared from one respondent to other related respondents. It was ensured that there was no incomplete response in the questionnaire by marking all the questions as “required” in the Google Form to get a 100% response rate.

While we circulated the questionnaire, we included a paragraph of text along with the link. This paragraph of text contained the inclusion criteria. This text also contained a section for a request to participate in the survey voluntarily.

Bias

It was ensured with the Google form setting (limit to one response) that each participant gives a single response. However, if multiple E-mail addresses were used by some users, was beyond our control. As the sampling was a snowball sampling method, selection bias might occur. However, collection of pan India data in a short time was possible with this technique with involvement of limited resources. This geographical ecological study was not beyond the typical limitations of an ecological study.^[11] Furthermore, participants' social desirability, if any, was beyond our control.^[12]

Statistical analysis

Data were stored in Microsoft Excel 2010^® spreadsheet program for further analysis. Further statistical analyses were carried out in GraphPad Prism 6.01 (GraphPad Software, CA, USA). For all the statistical tests, we fixed a P < 0.05 to be statistically significant.

We expressed the data in number, percentage, mean, and standard deviation. Data were segregated according to gender, stream of the study, and semester. The categorical variables (e.g., medicine and engineering students according to gender) were compared by the Chi-square test. Mean scores of knowledge, attitude, and practice between male and female, and medicine and engineering students were compared by unpaired t-test. The mean score among the three groups of students according to semesters were compared by one-way analysis of variance (ANOVA).

Average knowledge, attitude, and practice score were calculated by dividing the total score by the total item number (e.g., for attitude, there were six items. Hence, if the sum score is X, then the average score for attitude is = X/6). This was done to compare the level of knowledge, attitude, and practice. Spearman correlation coefficient was used to find out any correlation between the semester of study and average knowledge, attitude, and practice score.

Results

A total of 1757 students participated in the survey and the response rate was ensured to be 100% by Google Form setting. Indian state-wise distribution of the sample is shown in [Figure 1]. The gender-wise distribution of the study participants based on their age, stream, and semester is given in [Table 1]. The mean age of participants was 20.42 ± 1.68 years. The majority of the students (64.71%) were pursuing medicine.

Figure 1: Distribution of sample according to Indian states

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Table 1: Distribution of research participants according to age, stream and semester of study

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The knowledge, attitude, and practice scores of the participants in respect to gender, stream, and semester are shown in [Table 2]. The overall correct response of 1757 participants in knowledge was 72% (score 5.77 ± 1.2 out of 8), the attitude was 84% (score 5.06 ± 0.83 out of 6), and practices were 58% (score 2.32 ± 0.93 out of 4). [Figure 2] shows the overall comparison between the three attributes of our study. We found a significant difference among knowledge, attitude, and practice scores (ANOVA P < 0.001). A post hoc analysis showed a significant difference between knowledge and attitude, knowledge and practice, and attitude and practice.

Table 2: Overall and gender, stream and semester wise knowledge, attitude, and practice scores

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Figure 2: Comparison of knowledge, attitude, and practice average score

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Association of the semester of the study with knowledge, attitude, and practice in medicine and engineering is shown in [Figure 3]a, [Figure 3]b, [Figure 3]c, respectively. There was a significant positive correlation (r = 0.13, P < 0.001) of the semester of the study with attitude in medicine students. Although there was statistical significance in the semester of study with knowledge and practice, the coefficient of determination (r²) does not indicate a good percentage of participants having a linear relation.^[13] We found significant positive correlation of knowledge (r = 0.12, P = 0.002) and practice (r = 0.11, P = 0.008) with semester of study in engineering students.

Figure 3: Correlation of semester of study with (a) knowledge, (b) attitude, and (c) practice in medicine and engineering students

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Discussion

While our study primarily aimed at comparing the knowledge, attitudes, and practices of COVID-19 among the students of medical and engineering colleges, comparisons based on gender and semester had also been done.

We found that 72% of the Indian medical and engineering students had proper knowledge, 84% had a positive attitude, and 58% appropriate practice. It indicates the role of the mass reach of social media, television, and other forms of media and the success of the government intervention in creating awareness and educating the general population about the virus, disease, and its prevention.^[14],[15]

There has been no difference in the scores of knowledge, attitudes, and practices between males and females. It is in contrast to the study conducted among the medical students of Dehradun, which showed a significant correlation between gender and practices.^[16] It depicts that both the sexes have received equal opportunities in receiving knowledge and facts related to the pandemic and the attitudes and practices are not gender-specific as such.

We found a significant correlation in the scores of knowledge, attitudes, and practices according to the semesters, with the students of the end semesters scoring maximum in all three aspects followed by the students of the initial semesters and then the students of the mid semesters. One may infer from this result that since the students of end semesters are very close to joining the workforce of the population, therefore they have to be better prepared with the recent changes around the world and hence have scored better. Meanwhile, the students of the initial semesters, who have recently joined their colleges, are excited about learning new things.^[17] Their curiosity has fuelled their interest in being aware of COVID-19 and in performing well in the questionnaire. However, it seems that the students of mid semesters are under the inertia of being stable in their colleges and are apparently unaffected by the external affairs around them and hence have scored lesser than the rest.

Our study has shown significant association in the scores of the knowledge and attitude between the medical and engineering students but not in practices. Furthermore, medical students have scored higher than engineering students in all three aspects. It can be said that since the medical students are specially taught about these diseases, their spread, and their treatment and are also trained to manage such medical emergencies in future, it reflects in their knowledge and attitude.^[18] However the practices, which need to be personally adopted in daily life are unprecedented and are new for everyone to adapt, irrespective of their occupation or education.

Most of the engineering students could not answer whether COVID-19 is a virus or a viral disease or whether COVID-19 is the same as SARS or not and a noteworthy difference in the percentage of correct answers between the medical and engineering students was seen. But it was heartening to know that most of them could answer the mechanism of its spread and its symptoms correctly (according to guidelines at that time). Many engineering students and a serious number of medical students were unsure about who is more likely to develop serious illness after being infected by novel coronavirus.

There was a visible difference in the percentage of the correct answers between the medical and engineering students regarding the discrimination of the doctors and health staff during the pandemic. Although, an important and relevant issue that has been heightened even more during this pandemic, it is unfortunate that it hasn't come into the attention or concern of the nonmedicos. Doctors and health staff who were overburdened with the unimaginable number of cases have also faced abuses, stigma, and violence by society, which prevalently increased in this pandemic.^[19],[20] While many medical students have witnessed or known their seniors or professors being targeted by the angry mob, for nonmedicos such instances are merely a piece of news. Moreover, this view mirrors their response to that particular question. There was a promising response from both the engineering and medical students about the research and development deserving more attention. Both agree on the necessity of scientific evidence and proper infrastructures to conduct quality research for a better understanding of the disease and implement measures for its treatment and management.^[21]

As already mentioned before, the study has found no difference between the medical and engineering students in the practices. Our study has also noted a staggeringly low percentage in the question of choosing a trustworthy source of information regarding the COVID-19, in both streams. It highlights the present issue of misinformation, or as it is called “infodemic,” during this pandemic.^[6] This has led to people getting confused in choosing a reliable source of information about COVID-19 among a vast array of sources around them. This needs to be managed by the government and other scholars in educating the public about choosing the right sources to receive the information about recent changes in COVID-19.

Question-wise number of correct and wrong answers in Knowledge, attitude, and practice domain in Engineering and medical students are available from the following link: https://doi.org/10.6084/m9.figshare.19165952.v1.

Novelty, limitations, and recommendation

Several previous studies have reported the extent of knowledge, attitude, practice on COVID-19 among doctors, nurses, healthcare workers, and the general population.^{[22],[23],[24],[25],[26]} However, a comparative study among medicine and engineering was not available in the literature.

This study has several limitations. We included only the Indian student population. Hence, it cannot be generalized for all undergraduate students. This study depended on the recall ability of the participants. Hence, it might be subjected to recall bias. There might be potential sample clustering because of variation in the sample size of the individual category of participants according to the stream. Hence, we suggest a global survey with a similar number of participants in each category for a more generalizable result.

Conclusion

There was an overall good level of appropriate knowledge and positive attitudes toward COVID-19 in Indian medical and engineering students. Although medical students scored higher in knowledge and attitude, the practice showed no difference. Furthermore, practice showed the lowest score among knowledge, attitude, and practice in both medical and engineering students. Hence, a structured strategy is needed to dispense duties to both sectors of science in formulating effective measures for any other health emergencies in future.

Acknowledgment

We thank all the participants who voluntarily responded to the survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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