|Year : 2021 | Volume
| Issue : 1 | Page : 18-23
Knowledge, attitude, and practice toward COVID-19 among the general public in Manipur: A cross-sectional survey
Shantibala Konjengbam1, Madhubala Devi Phurailatpam2, Jalina Laishram1, Victoria Loukrakpam2, Pooja Akoijam1, Sushma Khuraijam2
1 Department of Community Medicine, RIMS, Imphal, Manipur, India
2 Department of Pathology, RIMS, Imphal, Manipur, India
|Date of Submission||26-May-2021|
|Date of Decision||25-Jun-2021|
|Date of Acceptance||26-Jun-2021|
|Date of Web Publication||04-Aug-2021|
Department of Community Medicine, RIMS, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
Introduction: Various measures have been adopted to control the rapid spread of the ongoing COVID-19 epidemic in the state. Adherence to control measures by the population is influenced by their knowledge, attitudes, and practices (KAP) toward COVID-19.
Objective: The objective of this study was to determine KAP toward COVID-19 among the general public of Manipur.
Methods: A semi-structured questionnaire was used to interview the study participants. The demographics and KAP of the participants were investigated. Chi-square test and t-test were used for statistical analysis.
Results: Out of the total participants (n = 398), 240 (60.3%) were female. One hundred and seventeen (29.4%) participants have adequate knowledge regarding COVID-19. The number of participants who have adequate knowledge was significantly more among males, those residing in plain districts, those residing in rural areas, and among those who studied up to graduate and above. The study also showed that attitude toward practicing more hand hygiene during infectious disease outbreaks was significantly associated with residence, education, religion, and occupation. A significant association was also observed between the preventive practices and knowledge, gender, district, residence, and education.
Conclusion: Nearly one-third of the participants have good knowledge and positive attitude. However, when coming to practice, a little more than one-tenth of the study participants practiced preventive behaviors all the time. Knowledge on COVID-19 and practice of preventive behaviors were significantly associated with gender, district, residence, education, and occupation. The results of this study can help to identify the specific target groups with low KAP with well-planned, tailored strategies.
Keywords: Attitude, COVID-19, knowledge, practice
|How to cite this article:|
Konjengbam S, Phurailatpam MD, Laishram J, Loukrakpam V, Akoijam P, Khuraijam S. Knowledge, attitude, and practice toward COVID-19 among the general public in Manipur: A cross-sectional survey. J Med Soc 2021;35:18-23
|How to cite this URL:|
Konjengbam S, Phurailatpam MD, Laishram J, Loukrakpam V, Akoijam P, Khuraijam S. Knowledge, attitude, and practice toward COVID-19 among the general public in Manipur: A cross-sectional survey. J Med Soc [serial online] 2021 [cited 2021 Dec 8];35:18-23. Available from: https://www.jmedsoc.org/text.asp?2021/35/1/18/323165
| Introduction|| |
In December 2019, a pathogenic human coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), was recognized and has caused serious illness and numerous deaths. COVID-19 is a global public health threat and has evolved to become a pandemic crisis around the world, which is caused by the SARS-CoV-2. On March 11, 2020, the WHO changed the status of the COVID-19 emergency from public health international emergency (January 30, 2020) to a pandemic and called for collaborative efforts of all countries to prevent the rapid spread of COVID-19. Nonetheless, the fatality rate of the current pandemic is on the rise (between 2% and 4%), relatively lower than the previous SARS-CoV (2002/2003) and MERS-CoV (2012) outbreaks. The disease causes respiratory illness (like the flu) with main clinical symptoms such as a dry cough, fever, and in more severe cases, difficulty in breathing. COVID-19 is highly contagious with a certain mortality rate, and it was classified as a class B infectious disease and managed as a class A infectious disease in China in January 2020. This recent pandemic due to the novel coronavirus has become a major concern for the people and governments across the world due to its impact on individuals as well as on public health. COVID-19 prompted implementation of public health protocols to control the spread of the virus, many of them involving social distancing, handwashing, and wearing of face mask. There are concerns around misinformation that may impede public health responses. Fake news is common due to a surge in the use of the Internet and social media. Despite the merits of rapid information dissemination through mass and social media for public health action, misinformation can also be easily propagated through the same channels. In addition, confusion surrounding basic information on how to reduce transmission and exposure to the virus puts the people at risk of infection.,, The behavior of the general public will probably have an important bearing on the course of the COVID-19 pandemic. Human behavior is influenced by people's knowledge and perceptions. It is very much necessary to know how much the general public are aware about the disease, its preventive measures initiated by the government and practices which is critical in the ongoing planning and implementation of effective pandemic responses. However, for such measures to be effective, public adherence is essential, which is affected by their knowledge, attitudes, and practices (KAP) toward COVID-19.,,, Beliefs about COVID-19 come from different sources, such as from the government, social media and the Internet, previous personal experiences, and medical sources. Hence, this study was conducted to determine the knowledge level, attitudes, and practices toward COVID-19 among the general public of Manipur.
| Methods|| |
A population-based cross-sectional survey was conducted among individuals 18 years and above who have been residing in Manipur for the last 1 year. The study was conducted during November 2020 and February 2021.
Sample size was calculated, assuming a prevalence (P) of individuals having adequate knowledge to be 50% as it will give the largest sample size, confidence level (CI) of 95% with absolute allowable error (e) of 5%. The sample size was calculated to be 384. Expecting a nonresponse rate of 10%, the final sample size was 426.
There are altogether 16 districts in Manipur, of which 10 are hill districts and 6 are valley districts. One hill district and one plain district were selected by lottery method. An equal number of participants were approached in each district. From each district, one ward and one village were selected by lottery method so as to get equal representation for both rural and urban areas. In each village/ward, only the first household was selected randomly. Then, the next house was the one nearest to the front door of the household selected. This procedure continued till the required number of households is covered. Only one participant was selected from each household. If there are more than one eligible participant in a household, lottery method was done to select only one individual. For this study, a total of two wards and two villages in two districts were covered.
A semi-structured questionnaire was used for data collection. The questionnaire was prepared by reviewing the literature,,, and meeting the experts in the field.
After the initial draft of the questionnaire, it was pretested in thirty individuals drawn from the population of interest but not included in the study, and the information obtained was used to revise the questionnaire. The questionnaire consists of the following domains:
- Domain 1: Questions on sociodemographic characteristics
- Domain 2: Questions on knowledge on COVID-19
- Domain 3: Questions on attitudes toward COVID-19
- Domain 4: Questions on practices related to COVID-19.
Sociodemographic information was collected, including age, gender, religion, occupation, education, and location of residence.
To assess the level of KAP of the respondents, a total of 21 questions (including 10 for knowledge, 4 for attitude, and 7 for practice) were included.
The components of the knowledge section included the awareness of COVID-19 and the source of information, clinical symptoms, modes of transmission, individuals at risk, and preventive measures. For six knowledge questions, each correct answer was given a score of 1, while the wrong answer was given score 0. For the remaining four knowledge questions, a score of 0 was given for incorrect response, a score of 1 was given for <3 correct responses, and a score of 2 was given for ≥3 correct responses. The total score ranged from 0 to 14, with an overall greater score indicating more accurate knowledge. Any individual who scores more than or equal to the 75th percentile of the obtained score was said to have adequate knowledge.
Informed consent was taken prior to data collection. Data were collected by face-to-face interview. One medical officer and one medical social worker engaged for the purpose did the recruitment as well as the interview. As the data collection was done during the pandemic period, all the recommended standard operating procedures (SOPs) such as maintaining social distancing, wearing of face mask, and practicing hand hygiene for prevention of transmission of CoV-2 infection were followed.
Data collected were checked for consistency and completeness. Data were analyzed using SPSS version 21.0, Armonk, NY, USA: IBM Corp. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the data. Chi-square test and t-test were used to analyze the association between KAP and variables of interest.
Approval was obtained from the Research Ethics Board, RIMS, Imphal. Informed verbal consent was taken before data collection. Privacy and confidentiality were maintained. No names were taken. Code number was used. Data collected were not disclosed to anyone and accessible only to the investigators.
| Results|| |
A total of 398 individuals participated in the study giving a response rate of 93.4%. The mean age of the study participants was 40.04 (±16.35) years. The minimum age was 18 and maximum was 88 years. All the participants have heard about COVID-19. Majority, i.e. 328 (82.4%) of the participants, were worried that they might get infected. Only seventy (17.6%) were not worried. The reasons given by the participants for being not worried about getting COVID-19 were that they follow COVID SOP (Standard Operating Procedure),they did not go out of the house much, they are not scared of the disease, they are healthy and feel that they cannot be affected by COVID.
Majority of the participants got the information regarding COVID-19 from social media, 210 (52.8%), followed by TV, 136 (34.2%), radio, 204 (51.3%), family/friends, 118 (29.6%), and newspaper, 14 (3.5%).
Majority, i.e., 227 (57%), were aware about the availability of COVID-19 vaccine. 66.7% were willing to get vaccinated, 30.8% were not willing to get the vaccine, and 1.3% were still undecided.
The mean knowledge score obtained by the participants was 9.14 (±2.32). Minimum score obtained was 3 and maximum score was 14. The median score was 9 and interquartile range was 7–11. One hundred and seventeen (29.4%) participants have adequate knowledge (knowledge score ≥11) regarding COVID-19.
[Table 1] shows the sociodemographic characteristics of the study participants. Majority, i.e., 240 (60.3%) of the participants, were female. Majority studied up to class ten 250 (62.8%) and majority were homemakers 134 (33.7%).
|Table 1: Sociodemographic characteristics of the study participants (n=398)|
Click here to view
[Table 2] shows the response to attitude questions. A little more than half of the participants, 202 (50.6%), opined that if they have symptoms such as fever, cough, and sore throat, they would stay at home and wait to get better. One hundred and sixty-six (41.7%) participants opined that they would contact a health worker if they have symptoms of fever, cough, and sore throat. Majority, i.e., 388 (97.5%), were willing to self-isolate and work from home if needed. Majority were also willing to undergo institutional quarantine. Three hundred and eighty-four (96.5%) opined that COVID-19 would be successfully controlled and 369 (92.7%) also opined that they would perform hand hygiene more often during infectious disease outbreaks.
[Table 3] shows the response to practice questions. Only 36 (9.0%) participants washed their hands all the time after any activity and social gathering was avoided all the time by only 44 (11.1%) participants. Social distancing was maintained all the time by 34 (8.5%) participants and face masks were worn all the time by only 53 (13.3%) participants.
[Table 4] shows the association between knowledge on COVID-19 and sociodemographic variables. There was no significant association between age and knowledge (P = 0.713). The number of participants who have adequate knowledge was significantly more among males 57 (36.1%), those who practiced Sanamahism 24 (54.5%), those residing in plain districts 76 (36.0%), those residing in rural areas 90 (42.9%), and among those who studied up to graduate and above 60 (58.8%).
|Table 4: Association between knowledge on coronavirus disease 2019 and sociodemographic characteristics|
Click here to view
The study also showed that favorable attitude toward practicing more hand hygiene during infectious disease outbreaks was significantly more among those with adequate knowledge (P = 0.001), staying in rural areas (P = 0.000), practicing Sanamahism (P = 0.001), those with higher education (P = 0.000), and employed (P = 0.000) but not significantly associated with district (P = 0.885) and gender (P = 0.551) (not shown in table).
Significant association was also observed between the practice: frequency of washing hands all the time and gender (13.9% males vs. 5.9% females, P = 0.002), district (16.3% in valley vs. 1.1% in hill, P = 0.000), residence (12.9% in rural vs. 4.8% in urban), and knowledge (100% among those with adequate knowledge, P = 0.002). Practicing social distancing all the time was also significantly associated with gender (12.7% males vs. 5.8% females, P = 0.036), district (15.6% in valley vs. 0.5% in hill, P = 0.000), residence (11.9% in rural vs. 4.8% in urban, P = 0.002), and knowledge (12.0% among adequate vs. 7.1% among inadequate, P = 0.004). Avoidance of social gathering all the time was also significantly associated with gender (16.5% males vs. 7.5% females, P = 0.003), district (19.4% in valley vs. 1.6% in hill, P = 0.000), residence (12.9% in rural vs. 9.0% in urban, P = 0.002), and education (P = 0.001). Knowledge was not significantly associated with the practice (P = 0.707). Wearing of mask all the time was also significantly more among those with adequate knowledge (not shown in table).
Frequency of washing hands all the time was significantly more among those with adequate knowledge 20 (17.1%) as compared to 16 (5.7%) with inadequate knowledge.
| Discussion|| |
The present study assessed the KAP of the study participants. The study observed that 117 (29.4%) participants have adequate knowledge of COVID-19. Knowledge of COVID-19 was found to be significantly associated with gender, place of residence, district, religion, education, and occupation. Practice of preventive practices and favorable attitude are more among those with adequate knowledge. Practices such as washing hands all the time and social distancing were significantly associated with gender, religion, education, occupation, and knowledge on COVID-19. However, the practice of avoiding social gathering is not significantly associated with knowledge on COVID-19.
A study conducted in Bangladesh has shown that accurate knowledge regarding COVID-19 was associated with age and residence. Another study conducted in China has revealed that COVID-19 knowledge score was significantly associated with socioeconomic status and gender. A study conducted by Maheshwari et al. also observed that gender had a significant impact on practice scores.
In addition, majority, i.e., 384 (96.5%) of the participants, opined that COVID-19 will be successfully controlled. Another study conducted by Zhong et al. has also shown that majority of the residents (97.1%) had confidence that China can win the battle against COVID-19. More than 90% opined that they were willing to isolate themselves if needed and perform hand hygiene more often, especially during infectious disease outbreaks.
Those who have adequate knowledge of COVID-19 practiced handwashing and maintained social distancing more frequently than those with inadequate knowledge. A significant association was observed between the practices: frequency of washing hands, practicing social distancing, wearing of face masks and knowledge on COVID-19, gender, district, residence, education, religion, and occupation. However, the practice of avoiding social gathering all the time is observed to be not significantly associated with knowledge on COVID-19.
A study conducted by Ferdous et al. has revealed that sociodemographic factors associated with more frequent preventive measures were being female, older age, having higher education, urban area residence, and higher income. One important observation in this study is that knowledge on COVID-19 was significantly more among males, those residing in plain districts, and those residing in rural areas. Similarly, when it comes to practice, preventive practices were more prevalent among males, those residing in valley districts, and those residing in rural areas. However, the prevalence of adequate knowledge is still very low and the constant practice of the preventive measures is also still very low. Therefore, the importance of these measures should be emphasized even more.
The strengths of the study are adequate sample size, high response rate (93.2%), and use of stratified random sampling method enabling the results of the study generalizable to the population of Manipur. The use of the interview method has ensured that there is less chance of error or misinterpretation of information.
The limitation is that practice is self-reported and not directly observed. Hence, there is the possibility of social-desirability bias.
| Conclusion|| |
The study has revealed that less than one-third of the participants have adequate knowledge on COVID-19. The study has also highlighted that favorable attitude and preventive practices were more among those with adequate knowledge. The study has identified specific target groups who are likely to have inadequate knowledge and targeting them with well-planned, tailored strategies to spread awareness using various channels such as social media, TV, and radio is the need of the hour.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Parikh PA, Shah BV, Phatak AG, Vadnerkar AC, Uttekar S, Thacker N, et al.
COVID-19 Pandemic: Knowledge and perceptions of the public and healthcare professionals. Cureus 2020;12:e8144.
Malik YS, Sircar S, Bhat S, Vinodhkumar OR, Tiwari R, Sah R, et al
. Emerging Coronavirus Disease (COVID-19), a Pandemic Public Health Emergency with Animal Linkages: Current Status Update. Preprints 2020, 2020030343 (doi: 10.20944/preprints202003.0343.v1).
Zhong NS, Wong GW. Epidemiology of severe acute respiratory syndrome (SARS): Adults and children. Paediatr Resp Rev 2004;5:270-4.
Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:m1211.
Modi PD, Nair G, Uppe A, Modi J, Tuppekar B, Gharpure AS, et al.
COVID-19 awareness among healthcare students and professionals in Mumbai metropolitan region: A questionnaire-based survey. Cureus 2020;12:e7514.
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al.
Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.
Ferdous MZ, Islam MS, Sikder MT, Mosaddek ASM, Zegarra-Valdivia JA, Gozal D. Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An online-based cross-sectional study. PLoS One 2020;15:e0239254.
Maheshwari S, Gupta PK, Sinha R, Rawat P. Knowledge, attitude, and practice towards coronavirus disease 2019 (COVID-19) among medical students: A cross-sectional study. J Acute Dis 2020;9:100-4. [Full text]
[Table 1], [Table 2], [Table 3], [Table 4]