|Year : 2020 | Volume
| Issue : 2 | Page : 91-97
Evaluation of knowledge and perceptions among medical undergraduate students toward novel coronavirus (COVID-19) in Southern Haryana, India: A cross-sectional study
Abhishek Singh1, Ram Kumar Panika2, Avinash Surana3, Vikas Gupta2, Pooja Goyal4, Mitasha Singh4
1 Department of Community Medicine, SHKM Government Medical College, Nalhar, Haryana, India
2 Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
3 19 Infantry Division, Assistant Director Health, Bareilly, Uttar Pradesh, India
4 Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India
|Date of Submission||01-May-2020|
|Date of Acceptance||04-May-2020|
|Date of Web Publication||23-Jun-2020|
Dr. Vikas Gupta
Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
BACKGROUND: The year 2019–2020 has seen a worldwide pandemic resulting from corona virus disease 2019 (COVID-19), which can result in illnesses ranging from the common cold to severe acute respiratory syndrome. Hence, this global health crisis of COVID-19 pandemic offers a unique opportunity to investigate the level of knowledge and perceptions among undergraduate medical students.
METHODS: This prospective, web-based, cross-sectional study was conducted among 392 undergraduate medical students after obtaining informed consent during April 2020 using a 28-items structured questionnaire with close ended responses based on World Health Organization course materials and was distributed using Google forms. All the tests were performed at a significance level of 5%.
RESULTS: More than three-fourth (82.1%) of the participants reported that they heard about COVID-19 through news media, while only less than half of the participants (44.9%) reported government official websites as information source. Overall, the study participants' knowledge regarding COVID-19 was satisfactory. Majority of the participants (94.9%) were aware of the source of COVID-19 origin as bats. Nearly half of the participants (51.9%) strongly agreed that COVID-19 is a fatal disease.
CONCLUSION: Most medical students had minimal awareness regarding the source of reliable information, with satisfactory knowledge levels, and discrepancies in the perceptions of COVID-19, thus, with adequate training and counseling undergraduate medical students via structured teaching program, most medical students can act as a potential reservoir to fill the gaps in health-care services in the hour of need.
Keywords: Health care, online, pandemic, questionnaire, symptoms
|How to cite this article:|
Singh A, Panika RK, Surana A, Gupta V, Goyal P, Singh M. Evaluation of knowledge and perceptions among medical undergraduate students toward novel coronavirus (COVID-19) in Southern Haryana, India: A cross-sectional study. Indian J Health Sci Biomed Res 2020;13:91-7
|How to cite this URL:|
Singh A, Panika RK, Surana A, Gupta V, Goyal P, Singh M. Evaluation of knowledge and perceptions among medical undergraduate students toward novel coronavirus (COVID-19) in Southern Haryana, India: A cross-sectional study. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2020 Sep 29];13:91-7. Available from: http://www.ijournalhs.org/text.asp?2020/13/2/91/287411
| Introduction|| |
The year 2019–2020 has seen a worldwide pandemic resulting from severe acute respiratory syndrome (SARS) coronavirus 2, also known as coronavirus disease 2019 (COVID-19), which can result in illnesses ranging from the common cold to SARS. CoV is a zoonotic pathogen that can be transmitted via animals to humans and humans to humans via droplet, feco-oral, and direct contact with an incubation period of 2–14 days., In the past, multiple epidemic outbreaks occurred, which includes SARS during 2002 that resulted in 800 mortality and Middle East respiratory syndrome (MERS)-CoV during 2012 that resulted in 860 mortality., Approximately 8 years after the MERS-CoV epidemic, the current outbreak has rapidly spread to most countries and claimed several lives subsequent to its first report in Wuhan, Hubei Province in China in December 2019. On January 30, 2020, the World Health Organization (WHO) has declared COVID-19 as a public health emergency of international concern. Astonishingly, in the 1st week of March, a devastating number of new cases were reported globally, and subsequently on March 11, 2020, the WHO has declared the COVID-19 to be a pandemic. As of April 22, 2020, more than 2,475,699 cases of COVID-19 have been reported in over 213 countries and territories, resulting in more than and 169,134 deaths, whereas in India, the actives case counted 15,859, with 3960 cured cases and 652 deaths.,, The pandemic has also resulted in an overwhelming and unprecedented workload on the health-care systems across the world and till date, no validated vaccination or specific antiviral drugs has been extensively suggested for COVID-19. Therefore, applying preventive measures to control COVID-19 infection is the most crucial intervention. Guidelines for the prevention and control of COVID-19 for health-care workers were published by the WHO and Ministry of Health and Family welfare (MoHFW, India) and also to further strengthen preventive strategies, including raising awareness and training health-care workers in preparedness activities, the WHO and MoHFW (India) has initiated several online training sessions and materials on COVID-19 in various languages.,,, There have been various incidences of misunderstandings among health-care workers which have delayed the potential efforts to provide necessary treatment and control which led to the rapid spread of infection in hospitals and putting the patient's lives at risk. Consequently, most governments are contemplating training medical students to cater to the increase demand. Hence, this global health crisis of COVID-19 pandemic offers a unique opportunity to investigate the level of knowledge and perceptions among undergraduate medical students and also exploring the role of different source of information in shaping knowledge and perceptions, which will be overall the first step in identifying the potential areas for developing a structured training program in order to be prepared for the future in such instances.
| Materials and Methods|| |
Study setting and design
This prospective, web-based, cross-sectional study was conducted at SHKM Government Medical College, Nalhar situated in district Nuh, Haryana, during the 3rd week of April 2020. The college was started in 2013 with getting its first batch of MBBS students and since then, there is joining of 100 MBBS students each year, so currently, there are 627 MBBS students (regular batch and additional batch) including interns.
Study population and sample size
The study participants included MBBS students from 1st year to prefinal year with currently having access to the Internet and it counted to around 392 eligible students. The purpose of the study was explained and informed written consent was obtained from all the study participants, and anonymity and confidentiality of the participants was maintained.
A 28-item structured questionnaire with close-ended responses was developed using the WHO course materials on emerging respiratory viruses, including COVID-19 which covered the domains of participants' characteristics, awareness, information sources, and knowledge and perceptions related to COVID-19. The questionnaire was piloted among a small number (n = 20) of undergraduate students, and the average time taken to complete the survey was 10 min. The presentation and validity of the questionnaire were undertaken by 15 randomly selected faculty members for clarity, relevance, and acceptability. Refinements were made as required to facilitate better comprehension and to organize the questions before the final survey was distributed to the study population. The study questionnaire comprised four sections containing 28 items. Section 1 had six items that explored the demographic information of respondents including age, gender, year of study, location, and any health-care provider in the family and any relatives or friends who suffered from COVID-19. Section 2 comprised two items and aimed to gather students' sources of knowledge and awareness about COVID-19. Section 3 comprised ten items as multiple-choice questions and was designed to evaluate students' in-depth knowledge about COVID-19 including sources of origin, route of transmission, symptoms, incubation period, high-risk groups, complications, fatality, current treatment, vaccination, and preventive measures for COVID-19. Section 4 comprised ten questions and aimed to evaluate students' attitudes and beliefs or perception about COVID-19. Attitude questions were designed based on a 5-point Likert scale format (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Positive statements were scored on a 5-1 scale with “strongly agree” responses yielding 5 points and “strongly disagree” responses 1 point. Similarly, negative statements were scored on a 1–5 scale, with “strongly disagree” responses having a maximum score of 5. “Neutral” responses were scored 3. The questionnaire was developed and distributed using Google Forms.
Participation in this survey was voluntary and was not compensated. Informed consent was obtained from each participant prior to participation. Undergraduate students were approached and recruited through social networking websites (Facebook, Twitter, and WhatsApp), and the password-protected survey links were posted on the same. An introductory paragraph outlining the aims and objectives of the study as well as instructions to complete the questionnaire was posted along with the survey especially mentioning that all questions were mandatory. Sufficient time was given to participants to read, comprehend, and answer all the questions, and the participants could not change the answers after submission of the questionnaire. The participants were given a week's time to voluntarily complete the questionnaire and those does not respond back to the questionnaire within defined time and reminders were declared as dropouts and were not included in the data analysis. The study was performed following the Checklist for Reporting Results of Internet E-Surveys guidelines.
The collected data were tabulated and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp. Armonk, NY, USA). All the tests were performed at a significance level of 5%. Categorical variables were presented as percentage (%). The variables with quantitative data were presented as mean (standard deviation), and ANOVA test was used to compare perception scores of participants in various batches.
| Results|| |
A total of 374 participants were assessed in the study [Figure 1]. The mean age of the study participants was 20.71 ± 1.65. There was nearly equal representation of participants from each academic year. Less than one-third of the participants (19.3%) had a health-care provider in the family. During this pandemic and lockdown situation, most of students were staying at home (88.5%) and only 10.2% were staying in hostels. More than three-fourth (82.1%) of the participants reported that they heard about COVID-19 through news media, followed by social media, while only less than half of the participants (44.9%) reported government official websites as their sources of information and only around one-tenth of the participants (10.4%) attended any lecture/discussion regarding COVID-19 [Table 1].
Overall, the study participants' knowledge regarding COVID-19 was satisfactory. Majority of the participants (94.9%) were aware of the source of COVID-19 origin as bats. Around half of the participants (50.0%) believed that COVID-19 is an air-borne disease, whereas four-fifth of the participants (80.5%) believed that it is spread by direct contact, furthermore, 97.6% of the participants stated that there is no vaccination against COVID-19 [Table 2]. While regarding preventive strategies for COVID-19, more than four-fifth of the participants (89.6%) believed that wearing a face mask in a crowded place could prevent the transmission of COVID-19 [Figure 2].
|Table 2: Knowledge regarding coronavirus disease 2019 among the study participants (n=374)|
Click here to view
|Figure 2: Knowledge regarding coronavirus disease 2019 among the study participants (n = 374). *Multiple response questions |
Click here to view
Nearly half of the participants (51.9%) strongly agreed that COVID-19 is a fatal disease. Furthermore, only four-fifth of the participants (84.5%) strongly disagreed on the fact the COVID-19 is a not a serious public health problem of concern. About majority of the participants (85.0%) strongly agreed that they have fear of self-infecting or infecting family members or infecting high-risk group people during COVID-19 pandemic, and also majority (86.6%) of the participants strongly agreed for educating people (such as washing hands with soap and water or social distancing) about COVID-19 is important to prevent the spread of the disease. The perception mean score among participants was 32.56 ± 5.01, and there was statistically significant difference when perception mean scores were compared for participants in various academic years [Table 3].
|Table 3: Perception regarding coronavirus disease 2019 among the study participants (n=374)|
Click here to view
| Discussion|| |
Currently, COVID-19 is a global topic of discussion in the media and among the public, especially among health-care workers and patients and because widespread public measures are key to a timely control of the infection, good knowledge, attitude, and practices among medical undergraduates regarding COVID-19 are vital and at present, there are only a couple of studies being conducted to assess the same. Through this study, we gained a deeper understanding into their comprehension of the disease and the measures they feel are necessary for protection against infection. Our study revealed that students had satisfactory knowledge about COVID-19 with positive perceptions on the prevention of COVID-19 transmission.
It was also found in the study that more than two-fifth of the participants (44.9%) used official government websites as a primary source of information about COVID-19. This indicates that the COVID-19-related updates posted online by official government health authorities had positive implications for improving medical students' knowledge levels. Relying on authentic sources is a key factor in believing transparent information about the emerging COVID-19 infection and is essential for students' knowledge and perceptions.
However, a finding of considerable concern is that a significant number of participants (64.1%) derived their knowledge from social media posts by friends and family, and the influence of social media on a student's life has been always of great concern, especially in today's day and age where everything can be learned from the Internet. Currently, the vast diversity of information available through the Internet, including unverified malicious information, can spread quickly and can misguide students. This has the potential to spread incorrect information, which should be discouraged. In particular, health authorities and scientists have warned that widespread misinformation about COVID-19 is a serious concern causing xenophobia worldwide., There are two ways to tackle this problem: first by motivating them to expand their knowledge on the subject and create awareness regarding the importance of doing so, and secondly, by providing them with reliable resources from which to obtain this information.
In the present study, the major response by participants regarding the mode of transmission of COVID-19 was air-borne disease (50.0%) and via direct contact (80.5%). The study by Cascella et al. reflected similar findings regarding the mode of transmission of COVID-19. In the study, more than half of the participants (51.9%) strongly agreed that COVID-19 is a fatal condition although the reported case fatality rate (CFR) of this virus is lower than that of MERS and SARS. According to the WHO, above 80% of patients with COVID-19 have a “mild disease and will recuperate because its reported fatality is 2%. On the contrary, outbreak of SARS had a CFR of approximately 10%, while MERS killed 34% of the affected people between 2012 and 2019. However, despite the lower CFR, COVID-19 has surprisingly caused a greater number of deaths when compared with SARS and MERS together, and this may be credited to the basic reproduction number of COVID-19 which was discovered to be 3.28, which exceeds WHO estimates from 1.4 to 2.5, as shown in the studies by Riou and Althaus, Liu et al., and Mahase.,,
In the present study, responses regarding the individuals falling into high-risk group for COVID-19 were people with immunosuppressed status (88.5%). The study by Auwaerter underscored that maximum deaths in patients occurred with comorbid conditions and often in elderly population so, old age can be considered as a risk factor. In addition, weak immune system may be envisioned as a significant aggravating factor. Nearly three-fourth of the study participants (75.6%) designated health-care providers or workers under high-risk group, which was in consensus with the study done by Joob and Wiwanitkit, where health-care workers have highest chances of getting infection and falls into high-risk group for COVID-19. Only half of the students (55.1%) responded symptomatic or supportive therapy as currently available first line of treatment for COVID-19, but as the disease has resulted into pandemic, there are various studies by Chen et al., Wang et al., and Stebbing et al., that are validating the efficacy of various drugs and plasma therapy for COVID-19.,, In addition, few study participants had inaccurate knowledge that COVID-19 can be treated with antivirals (16.6%) and that there is vaccine (2.4%) available for the same.
The practice of cough etiquettes (91.1%) and social distancing (94.7%) had been the major responses among students for COVID-19 prevention and because with the correct steps and precautions, the risk of infection can be minimized, but contrary to it, the studies by Gralton et al. and Bouchoucha and Moore have stated that although the protocols for the best use of personal protective equipment and other precautions for preventing transmission subsist in almost all health-care facilities, health professionals' amenability to consume them is typically inadequate, particularly in nonoutbreak situations or in the early stages before an outbreak is established., More than two-third of the participants (70.8%) strongly agreed regarding sharing of travel history as a measure to prevent the transmission of COVID-19, which was a validated procedure being revealed in the study by Jernigan.
The study revealed that a significant number of participants (85.0%) were afraid of getting infected themselves or infecting those who are vulnerable/high-risk groups or infecting family/friends. This is a potential source of resistance from the student's end, who might be hesitant to enter the hospital and its perimeter due to this fear. A research carried out by Abolfotouh et al. revealed that 70.4% of health-care workers sensed the threat of catching the MERS-CoV infection at work and 7.1% felt that changing job would be an appropriate option during the MERS-CoV outbreak at Saudi Arabia. The need of psychological support has also become the need of hour as reflected in the studies by Duan and Zhu and Fan et al.,
This finding provides an opportunity to focus awareness programs on these topics to fill in the gaps of knowledge and inculcate the positive perception. The benefits of increasing the knowledge and awareness regarding COVID-19 are two-fold as it will not only prepare the students with the basic education needed to provide medical care but also it will reduce the negative attitudes surrounding this outbreak.
This pivotal strength of this study lies in that a validated questionnaire based on WHO training material for the detection, prevention, response, and control of COVID-19 was used in revealing the knowledge and perceptions of medical undergraduates toward COVID-19. In addition, the developed questionnaire was pilot tested, and close-ended questions limited the information bias. However, the study included only students from government medical institution and not the private ones, which may be considered as a limitation to the study, so future researchers should consider recruiting an equal number of students from both government and private institutions for better understanding of their knowledge and perceptions. Similarly, the data presented in this study were self-reported and partly dependent on the participants' honesty and recall ability, which could have resulted in recall bias. Despite these limitations, our findings provide valuable information about the knowledge and perceptions of undergraduate students during a peak period of COVID-19.
| Conclusion|| |
Most medical students had minimal awareness regarding the source of reliable information, with satisfactory knowledge levels, and discrepancies in the perceptions of COVID-19, thus, with adequate training and counseling undergraduate medical students via structured teaching program, most medical students can act as a potential reservoir to fill the gaps in health-care services in the hour of need.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Phan T. Genetic diversity and evolution of SARS-CoV-2. Infect Genet Evol 2020;81:104260.
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al
. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-3.
Zhong NS, Zheng BJ, Li YM, Poon, Xie ZH, Chan KH, et al
. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003. Lancet 2003;362:1353-8.
Eurosurveillance Editorial Team. Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro Surveill 2020;25:200131e.
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020;55:105924.
World Health Organization. Responding to COVID-19: Real-Time Training for the Coronavirus Disease Outbreak. Available from: https://openwho.org/channels/covid-19
. [Last accessed on 2020 Apr 16].
McCloskey B, Heymann DL. SARS to novel coronavirus – Old lessons and new lessons. Epidemiol Infect 2020;148:e22.
Ahmed N, Khan A, Naveed, Abdullah H, Moizuddin SM, Khan J. Concerns of undergraduate medical students towards an outbreak of COVID-19. Int J Current Med Pharma Res 2020;6:5055-62.
George DR, Rovniak LS, Kraschnewski JL. Dangers and opportunities for social media in medicine. Clin Obstet Gynecol 2013;56:453-62.
Shimizu K. 2019-nCoV, fake news, and racism. Lancet 2020;395:685-6.
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554776/
. [Last updated on 2020 Apr 06; Last accessed on 2020 Apr 16].
Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill 2020;25:2000058.
Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID- 19 is higher compared to SARS coronavirus. J Travel Med 2020;27. pii: taaa021.
Mahase E. Coronavirus covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ 2020;368:m641.
Joob B, Wiwanitkit V. COVID-19 in medical personnel: Observation from Thailand. J Hosp Infect 2020;104:453.
Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis 2020;20:398-400.
Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al
. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro
. Cell Res 2020;30:269-71.
Stebbing J, Phelan A, Griffin I, Tucker C, Oechsle O, Smith D, et al
. COVID-19: Combining antiviral and anti-inflammatory treatments. Lancet Infect Dis 2020;20:400-2.
Gralton J, Rawlinson WD, McLaws ML. Health care workers' perceptions predicts uptake of personal protective equipment. Am J Infect Control 2013;41:2-7.
Bouchoucha S, Moore K. Standard precautions but no standard adherence. Aust Nurs Midwifery J 2017;24:38.
Jernigan DB. Update: Public health response to the Coronavirus Disease 2019 outbreak – United States, February 24, 2020. MMWR Morb Mortal Wkly Rep 2020;69:216-9.
Abolfotouh MA, AlQarni AA, Al-Ghamdi SM, Salam M, Al-Assiri MH, Balkhy HH. An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia. BMC Infect Dis 2017;17:4.
Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry 2020;7:300-2.
Fan F, Long K, Zhou Y, Zheng Y, Liu X. Longitudinal trajectories of post-traumatic stress disorder symptoms among adolescents after the Wenchuan earthquake in China. Psychol Med 2015;45:2885-96.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]