INTRODUCTION:

In the last month of 2019, an outbreak of viral pneumonia of unknown etiology occurred in Wuhan city in the east of China.¹ Gene sequencing revealed that the underlying pathogens were enveloped positive-stranded RNA viruses that belong to the family Coronaviridae and the order Nidovirales.²

The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses named it as 2019- nCoV and then changed it to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).³ On February 11, 2020, the World Health Organization (WHO) designated a new name for the epidemic disease caused by this virus – coronavirus disease 2019 (COVID-19). The most important transmission route that is currently agreed upon, is human-to-human via respiratory droplets or direct contacts.⁴

Coronavirus (CoV) infections are emerging respiratory viruses that are known to cause illness ranging from the common cold to severe acute respiratory syndrome (SARS).⁵ Corona virus is a zoonotic pathogen that can be transmitted via animal-to-human and human-to- human interactions. Multiple epidemicnoutbreaks occurred in 2002 (SARS), with approximately 800 deaths, and in 2012 (Middle East respiratory syndrome coronavirus, MERS-CoV), with 860 deaths⁶. About 8 years after the MERS-CoV epidemic, the current outbreak of coronavirus disease 2019 (COVID-19) in Wuhan City, Hubei Province, China, has emerged as a global outbreak and significant public health issue⁷. On January 30, 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern. Astonishingly, during the first week of March, a devastating number of new cases were reported globally, and COVID-19 emerged as a pandemic. As of March 12, 2020, more than 125,000 confirmed cases across 118 countries and over 4600 deaths had been reported. COVID-19 is spread by human-to-human transmission through droplet, feco- oral, and direct contact and has an incubation period of 2-14 days⁸. COVID-19 was first detected in India The first case of the COVID-19 pandemic in India was reported on 30 January 2020, originating from China. As of May 11 2020, the Ministry of Health and Family Welfare have confirmed a total of 67,152 cases, 20,917 recoveries (including 1 migration) and 2,206 deaths in the country. The infection rate of COVID-19 in India is reported to be 1.7, significantly lower than in the worst affected countries.⁹

To date, no antiviral treatment or vaccine has been explicitly recommended for COVID-19, although multiple trials are going on. Therefore, applying preventive measures to control COVID-19 infection is the most critical intervention. Health care workers (HCWs) are the primary sector in contact with patients and are an important source of exposure to infected cases in health care settings; thus, HCWs are expected to be at high risk of infection. By the end of January, the WHO and Centers for Disease Control and Prevention (CDC) had published recommendations for the prevention and control of COVID-19 for HCWs⁹. The WHO also initiated several online training sessions and materials on COVID-19 in various languages to strengthen preventive strategies, including raising awareness and training HCWs in preparedness activities¹⁰. In several instances, misunderstandings among HCWs have delayed controlling efforts to provide necessary treatment led to the rapid spread of infection in hospitals and put patients' lives at risk¹¹. Knowledge can influence the perceptions of HCWs due to their past experiences and beliefs¹². Indeed, it can delay recognition and handling of potential COVID-19 patients during the pandemic period. However, the level of knowledge and perceptions of HCWs toward COVID-19 remain unclear¹². In this regard, the COVID-19 pandemic offers a unique opportunity to investigate the level of knowledge and perceptions of HCWs during this global health crisis. In addition, we aim to explore health care worker’s source of information of COVID-19 during this peak period of pandemic.

Healthcare workers play a central role in providing quality healthcare for those affected by COVID-19. To prevent healthcare workers becoming infected and to prevent nosocomial spread of COVID19, a wide range of healthcare services must ensure effective infection, prevention and control procedures are conducted¹³. There are significant pressures on healthcare workers in providing care in epidemic conditions. Use of personal protective equipment (PPE) can be burdensome and the risk of infection for this group is high. There is also a risk of stigma due to perceptions that healthcare workers have high risk of spreading infection¹⁴. Research conducted during the SARS epidemic identified how organisational and social factors, including healthcare worker confidence in ability to effectively deliver infection prevention and control measures, were important to protect both physical and psychological health¹⁵.

Therefore, the present study aimed to identify the current status of knowledge & perception regarding COVID-19 among healthcare professionals.

STATEMENT OF THE PROBLEM:

A cross- sectional study to assess the knowledge and perception regarding Novel coronavirus (COVID- 19) among the health care workers in Delhi --NCR

OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding Novel coronavirus (COVID- 19) among the health care workers in Delhi –NCR.

2. To assess the perception regarding Novel coronavirus (COVID- 19) among the health care workers in Delhi

–NCR.

3. To find out the association between knowledge and perception and selected demographic variables among the health care workers in Delhi –NCR.

MATERIAL AND METHODS:

A web-based, cross-sectional study was conducted using a survey instrument to obtain responses from health care workers in Delhi NCR region during the second week of May 2020. A 45-item survey instrument was developed using course materials available on WHO’s website on emerging COVID-19. The survey covered health care workers socio demographic profile, awareness, information sources, and knowledge and perceptions related to COVID-19. The developed draft survey instrument was made accessible through a link and was distributed to 10 experts from the field of nursing and health to comprehensively assess the content domains of the questionnaire (using a scale of 1-5 points and encouraged open commentaries). The pilot web survey was then conducted among 10 randomly selected health care workers to assess clarity, relevance, and acceptability. Feasibility and time required to answer the survey were evaluated on another 5 participants. These participants were not included in the research study.

Cross sectional Survey Research design

Target population

Health care workers including nurses/pharmacists/ lab technicians/others

Accessible population

Health care workers of Delhi NCR Regions

Sampling technique

Total Enumerative sampling technique

Sample size

250 samples

Description of the instrument

Web based structured questionnaire

Data collection

Assessment of knowledge & perception regarding COVID 19

Data analysis and interpretation

Descriptive and inferential statistics

Findings and conclusion

Fig 2: Schematic Representation of Research Design

Development and description of the tool: Development of the tool:

Structured- interview schedule was selected for the study. The tool was developed after adequate retrieval of research studies and under the guidance of nursing and medical experts.

Description of the tool:

The instrument used for data collection was a structured- questionnaire which consisted of two sections.

Section A: Demographic data Section B: Structured-Questionnaire Section A: Demographic data

1. It included the demographic variables such as gender, age, marital status, occupation, Sources of information about COVID 19, no. of children and no. of elderly at home.

Section B: Structured-Questionnaire

It consisted of 30 questions to assess the perception regarding regarding Novel coronavirus (COVID- 19) among the health care workers in Delhi –NCR.

Data Analysis:

The data were analyzed based on the objectives of the study using descriptive and inferential statistics. The plan for analysis is as follows:

Findings:

Table:1- Frequency and percentage distribution of demographic variables of health care workers in Delhi NCR N= 250

Frequency

Percentage (%)

Age

Under 20 yrs of age 20-30 yrs of age

30-40 years of age

More than 40 years of age

19.20

30.40

33.20

17.20

Gender Male

Female

105

145

42.00

58.00

Marital status Married Unmarried Separated

Prefer not to say

122

48.80

38.00

10.00

03.20

Years of experience

< 5 years

5-10 yrs

11-15 Yrs

>15 years

203

81.20

12.40

2.00

4.40

Type of job role Full time

Part time

209

83.60

16.40

Area of residence Delhi

Gurugram Noida Faridabad

148

59.20

32.00

6.40

2.40

Type of health care services PHC/ Community

Hospital

220

12.00

88.00

Attended lectures about COVID 19 Yes

213

85.20

14.80

Source of information about COVID 19

News Media Social Media

Government website Family /Friends

151

60.40

26.00

11.20

2.40

Caring responsibilities for any adult including those with over the age of 70 years

Yes No

141

109

56.40

43.60

No. of children at home under the age of 15 years

Or more

109

43.60

25.60

10.40

20.40

S=significant, NS= Non significant

Table 1 reveals that maximum number of health care workers (43.3%) falls under the age group of 30-40 years of age while only 17.3% of health care workers were above 40 years of age. Out of the total population 58% of respondents were female and 42% were male, 48% were married and 38% were unmarried while 3% participants prefer not to disclose their marital status. In terms of years of experience 81.2% of participants had less than 5 years of experience while only 4.4% had more than 15 years of experience. Full time health care workers constitutes 83.6% while 16.4% were part time employees in their job role. The total percentage of participants living in Delhi was 59.2% while 32% were from Gurugram, NCR. The type of health care services they were involved was hospital (88%) and PHC/CHC.

Table 2 Frequency and percentage distribution of level of knowledge and association between demographic variables (Gender) among health care workers of Delhi -NCR N = 250

S. No	Level of Knowledge	Level of knowledge (Male)		Level of knowledge (Female)		Total
S. No	Level of Knowledge	Freq.	%	Freq	%	Freq(%)
1	Inadequate knowledge	6	5.71	18	12.41	24 (9.60)
2	Moderate knowledge	44	41.90	66	45.52	110(44.00)
3	Adequate knowledge	55	52.38	61	42.07	116(46.40)
	Total	105	100	145	100	250(100)

Table 2 depicts that a maximum of 46.40% health care workers from delhi NCR had adequate knowledge, (44.00%) of them had moderate knowledge and 9.6 % had inadequate knowledge regarding COVID -19. The value of pearson Chi² is 4.423 and p value is p= 0.001which indicates that there is no significant association between level of knowledge and gender of the participants.

Table 3 represents the variation of level of knowledge among the health care workers according to the age groups. The maximum percentage of participants with adequate knowledge falls under the age group of less than 20 years. The moderate knowledge maintains almost a constant pattern among all the age groups. For the age group between 30-40years 13% of participants had inadequate level of knowledge. The value of pearson Chi ² is 3.408 and p value is p= 0.756 which indicates that there is no significant association between level of knowledge and age of the participants.

Table 4 represents that a maximum of 46% of participants had adequate knowledge about COVID 19 while 44 % of participants had a moderate level of knowledge about COVID 19. The value of Pearson chi2 is 6.3547 and P value is 0.3 which is not significant at level of significance. This indicates that there is no significant association between marital status and level of knowledge among the participants.

Table 5 depicts the association between level of knowledge and the type of occupation of health care workers. Most of the participants having good level of knowledge belongs to the group of nursing officers while in other occupations most of the participants were having inadequate level of knowledge about COVID 19. The value of Pearson chi ² is 28.11 and P value is 0.000 which is significant at 0.05 level of significance. This indicates that there is a significant association between the type of job role and level of knowledge about COVID 19.

Table 3: Frequency and percentage distribution of level of knowledge & association between demographic variables (Age) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	<20Yrs		20-30Yrs		30-40Yrs		>40 Yrs		Total
S. No	Level of knowledge	Freq	%	Freq	%	Freq	%	Freq	%
1	Inadequate knowledge	2	4.17	6	7.89	11	13.25	5	11.63	24(9.60)
2	Moderate knowledge	22	45.83	34	44.74	35	42.17	19	44.19	110(44)
3	Adequate knowledge	24	50.00	36	47.37	e37	44.58	19	44.19	116(46.40)
	Total	48	100	76	100	83	100	43	100	250(100)

P* - 0.756 Non significant

Table 4: Frequency and percentage distribution of level of knowledge & association between demographic variables (marital status) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	Never married		Married		Separated		Prefer not to say		Total
S. No	Level of knowledge	Freq	%	Freq	%	Freq	%	Freq	%
1	Inadequate knowledge	14	11.48	7	7.37	2	8.00	1	12.50	24(9.60%)
2	Moderate knowledge	58	47.54	42	44.21	9	36	1	12.50	110(44%)
3	Adequate knowledge	50	40.98	46	48.42	14	56	6	75.00	116(46.40)
	Total	122	100	95	100	25	100	8	100	250(100%)

Table 5: Frequency and percentage distribution of level of knowledge & association between demographic variables (Occupation) among health care workers of Delhi -NCR N= 250

S. No	Level of knowledge	Others		Nursing Officers
S. No	Level of knowledge	Freq	%	Freq	%
1	Inadequate knowledge	10	97.44	14	6.33
2	Moderate knowledge	11	71.79	99	44.80
3	Adequate knowledge	8	30.7	108	48.87
	Total

Table 6: percentage and frequency distribution of level of knowledge & association between demographic variables (marital status) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	Never married		Married		Separated		Prefer not to say
S. No	Level of knowledge	Freq	%	Freq	%	Freq	%	Freq	%
1	Inadequate knowledge	14	11.48	7	7.37	2	8.00	1	12.50
2	Moderate knowledge	58	47.54	42	44.21	9	36.00	1	12.50
3	Adequate knowledge	50	40.98	46	48.42	14	56.00	6	75.00
	Total	122	100	95	100	25	100	8	100

Table 7: Percentage and frequency distribution of level of knowledge & association between demographic variables (years of experiences) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	<5 years		5-10 years		11-15 years		>15 years
S. No	Level of knowledge	Freq	%	Freq	%	Freq	%	Freq	%
1	Inadequate knowledge	18	8.87	4	12.90	0	0.00	2	18.18
2	Moderate knowledge	83	40.89	16	51.61	4	80.00	7	63.64
3	Adequate knowledge	102	50.25	11	35.48	1	20.00	2	18.18
	Total	203	100	31	100	5	100	11	100

Table 8 : Percentage and frequency distribution of level of knowledge & association between demographic variables (Attended lecture about COVID 19) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	Lecture Attended		Lecture Not Attended		Total
S. No	Level of knowledge	Freq	%	Freq	%	Freq (%)
1	Inadequate knowledge	19	8.92	5	13.51	24(9.60%)
2	Moderate knowledge	93	43.66	17	45.95	110(44.00%)
3	Adequate knowledge	101	47.42	15	40.54	116(46.40%)
	Total	209	100	41	100	250(100%)

Table 9: Percentage and frequency distribution of level of knowledge & association between demographic variables (Source of information about COVID 19) among health care workers of Delhi –NCR N = 250

S. No	Level of knowledge	News Media		Social Media		Government Website		Family & Friends
S. No	Level of knowledge	Freq	%	Freq	%	Freq	%	Freq	%
1	Inadequate knowledge	8	5.30	5	7.69	8	28.57	3	50.00
2	Moderate knowledge	66	43.71	35	53.85	7	25.00	2	33.33
3	Adequate knowledge	77	50.99	25	38.46	13	46.43	1	16.67
	Total	151	100	65	100	28	100	6	100

Table 10: Percentage and frequency distribution of level of knowledge & association between demographic variables (Caring responsibilities of any adult including those with medical conditions/ over age 70 years) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	Yes		No		Total
S. No	Level of knowledge	Freq	%	Freq	%	Freq (%)
1	Inadequate knowledge	12	8.51	12	11.01	24(9.60%)
2	Moderate knowledge	62	43.97	48	44.04	110(44.00%)
3	Adequate knowledge	67	47.52	49	44.95	116(46.40%)
	Total	141	100	109	100	250(100%)

Table 11: Percentage and frequency distribution of level of knowledge & association between demographic variables (No. of children living at home, if any, under the age of 15 years) among health care workers of Delhi -NCR N = 250

S. No	Level of knowledge	01		02		03		More than 03
S. No	Level of knowledge	Freq	%	Freq	%	Freq	%	Freq	%
1	Inadequate knowledge	8	7.34	3	4.69	3	11.34	10	19.61
2	Moderate knowledge	48	44.04	29	45.31	13	50.00	20	39. 22
3	Adequate knowledge	53	48.62	32	50.00	10	38.46	21	41.18
	Total	109	100	64	100	26	100	51	100

Table 12: Percentage and frequency distribution of perception regarding COVID 19 among health care workers of Delhi -NCR N = 250

S. No	Questionnaire on perception regarding COVID 19	Yes Freq (%)	No Freq (%)
1	I may become infected with COVID 19 more easily than others	211 (84.40)	39 (15)
2	I am afraid to be infected with COVID 19	222(88.80)	28(11.20)
3	COVID 19 symptoms appears in 2-14 days	200(80)	50(20)
4	COVID 19 is fatal	233(93.2)	17(6.80)
5	Flu vaccination is sufficient for preventing COVID 19	38(15.20)	212(84.8)
6	During the outbreak, eating well and safely cooked meat is safe	47(18.80)	203(81.2)
7	Sick patients should share their recent travel history with health care providers	250(100)	-
8	Washing hands with soap and water can help in the transmission of COVID 19 Transmission	224(89.6)	26(10.40)
9	Disinfect equipment and working area in wet market atleast once a day	228(91.2)	22(8.80)
10	Do you think there is a stigma related to COVID 19	250(100)	-
11	If I contracted the coronavirus It will have serious consequences for me and my relatives	235(94)	15(6)
12	Coronavirus problem will pass quickly	203(81.2)	47(18.80
13	Is effective medications & remedies available for COVID 19	16(6.40)	234(93.6)
14	Efficacy of treatment for coronavirus is high and patients have positive prognosis always	11(4.40)	239(95.60)

Table 10 represents that 47.52% of participants do have responsibilities of caring for an adult either with a medical condition or age over 70 years and those participants have a moderate level of knowledge about COVID 19. Only 8% participants who were having responsibilities of caring adults have inadequate knowledge. The value of Pearson chi² is 0.4869 and P value is 0.784 which is non significant and demonstrates no significant association between level of knowledge about COVID 19 and participants having an adult either with a medical condition or age over 70 years as caring responsibilities.

The table 11 shows that there is no significant association between level of knowledge and number of children living at home, if any, under the age of 15 years as indicated by Pearson chi² value which is 9.0628 and p value is 0.170. Table 12 shows the perception of study participants about COVID 19. After analysis of data it can be concluded that most (88%) study participants have a perception that they are afraid of getting infected with COVID19 more easily than others. Most of the participants perceive COVID 19 as fatal disease. About 85 % of study participants says that flu vaccination is not sufficient for preventing COVID 19. Approximately 81 % of sample perceives that eating well cooked meat is safe during COVID 19 outbreak. Total study participants accepts that patients should share their recent travel history with healthcare providers. About 89% of subjects expresses that COVID 19 transmission can be prevented by antiseptic soap handwashing. Disinfectants of equipment must be done at least a day as experienced by 91% of samples. 100% of study participants says that there is a stigma related to COVID 19 among general public. Most of the population (94%) feels that if they expose themselves to coronavirus it will have serious consequences on them and their relatives. Approximately 81 % believes that COVID 19 will pass quickly. Effectives medicines and remedies are not available as per 94% of study participants. About 95% of participants says that coronavirus treatment is not effective and does not have a positive prognosis always.

DISCUSSION:

The findings of this study could be used to set priorities in information campaigns on COVID-19. At present, COVID-19 is a global topic of discussion in the media and among the public, especially among HCWs and patients. With the currently mounting COVID-19 transmission raising tensions for everyone, including for health officials and health systems, an important question arises regarding how we manage information to help frontline HCWs in times of public health crisis. For this reason, we investigated HCWs’ knowledge and perceptions of the prevention and control of COVID-19 at the pandemic level. Knowledge and perceptions level about COVID-19 varied across different categories of HCWs. Our study revealed that HCWs have sufficient knowledge about COVID-19 and positive perceptions of COVID-19 transmission prevention. Currently, there is a vast diversity of information available through the internet, including unverified malicious information, that can spread quickly and misguide HCWs. In particular, health authorities and scientists have warned that widespread misinformation about COVID-19 is a serious concern. In this regard, HCWs should carefully evaluate COVID-19-related information and should use scientific and authentic content as information sources^16,17.

The findings of this study suggest a significant gap between the amount of information available on COVID-19 and the depth of knowledge among HCWs. Therefore, our findings suggest that greater encouragement from health authorities is needed to distribute COVID-19-related knowledge to all categories of HCWs.

CONCLUSION:

We identified a less significant gap in information source, poor knowledge levels, and discrepancies in perceptions of COVID-19 among our study participants. As the global threat of COVID-19 continues to emerge, greater efforts through educational campaigns that target HCWs and the wider population beyond borders are needed.

ACKNOWLEDGEMENT:

We thank all study participants for their voluntary participation and for providing essential information.

CONFLICT OF INTEREST:

The author has no conflict of intrest.

SOURCE OF FUNDING:

None

ETHICAL STATEMENT:

All participants completed the questionnaires with informed consent.

ACKNOWLEDGEMENTS:

We feel obliged to thank all medical staff who truly dedicates their lives to fighting against COVID-19.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193987/

Received on 25.05.2021 Modified on 26.06.2021

Asian J. Nursing Education and Research. 2021; 11(4):503-509.

DOI: 10.52711/2349-2996.2021.00120

Rashmi Negi, Arti

ABSTRACT: