Knowledge, Attitudes, and Practices Related to Covid-19 in College Students

ABSTRACT


Introduction
In late 2019, pneumonia with an unknown cause was first diagnosed in Wuhan, the largest urban center in Hubei Province, China [1].The new virus was named SARS-CoV-2 by the World Health Organization on February 11, 2020, and the disease was named Coronavirus Disease 2019 (Covid-19) [2].The World Health Organization declared Covid-19 as a global pandemic on March 11, 2020.A large outbreak of respiratory sickness was caused by this Corona Virus [2].Covid-19 was first reported in Indonesia on March 2, 2020, just approximately only 4 months apart after the first case was discovered in China [3].The first occurrences in Indonesia were discovered in early March 2020 with two cases and two more cases were discovered on March 6.Covid-19 cases have continued to rise until now.Initially, the cases multiplied within hundreds but now it has reached up to thousands.There were 743,196 confirmed cases on December 31, 2020, and 1.3 million cases were reported in Indonesia on March 10, 2021 [2,3].The government has taken a number of attempts to deal with the Covid-19 pandemic, including national budgetary policy, health emergency documentation, as well as social restrictions on large-scale [4].Massive health campaigns were enforced to educate the public about the regulations, including preventive regulations, as well as to encourage all parties to follow the national prudence standards [5].The World Health Organization (WHO) has established a number of restrictions as a means of preventing transmission, which has now become a collective responsibility.Furthermore, for general protection, specific measures should be followed, such as wearing masks, frequent hand washing, coughing and sneezing covered with the elbow, avoiding crowded places, keeping a safe distance from other people, and cleaning and disinfecting all objects and surfaces [6,7].The Indonesian government has mandated this practice to support the prevention of virus transmission [8,9].However, the success of the government-administered Covid-19-control program depends on everyone's involvement [5].
Obedience is crucial for the procedures taken to be effective and it is also determined by people's knowledge, attitudes, and practices (KAP) concerning Covid-19 [10,11].KAP entails beliefs that can induce preventative behaviors that differ among populations.Nevertheless, potential risks may emerge as a result of a lack of understanding or false medical assumptions [12].According to a study conducted in Henan, China, higher levels of information were correlated with more positive attitudes toward Covid-19 preventative practices [12].
It is mentioned that college students are the leading group when it comes to innovative technologies and ideas [13,14].Therefore, the students play an important role as the main force in encouraging health education and promoting the dissemination of knowledge related to pandemics, which is crucial for the prevention and control of this Covid-19 pandemic [15].It is also critical for the institution or university to understand how students react when confronted with public health emergency situations.In addition, to enhance preventive measures for Covid-19 in the community, the health authorities need KAP as well.The goal of this study is to compare students' knowledge, attitudes, and practices on Covid-19 among medical and non-medical students so that the institution or university can take more effective precautions to protect students' physical and mental health during the pandemic.

Materials and Method
This study used an observational analytic (non-experimental) research methodology with a cross-sectional survey study approach in June 2021.Purposive sampling procedures are used by applying inclusion and exclusion criteria.The sample included 476 students from a private university in Surakarta.
A demographic questionnaire, comprising of gender, major, level, age, and city of origin, is used as an instrument in this study; The questionnaire for knowledge comprises five variables of knowledge in relation to Covid-19; The questionnaire for attitudes comprises five variables in relation to Covid-19; The questionnaire for practices comprises five variables about the practices in relation to Covid-19.The questionnaire for knowledge was acquired from the Diagnosis and Treatment Protocol (Tentative Version Six) of The National Health Commission of China, while the attitudes and practices questionnaires were adapted from earlier research [16].
In the knowledge questionnaire, the assessment was conducted using a common method which is 1 point for correct response and 0 for incorrect response.Meanwhile, the questionnaire for attitude and practices applied different grading methods which is 2 for positive choices, 1 for neutral choices, and 0 for negative choices.Knowledge scores vary from 0 to 5, attitudes from 0 to 10, practices from 0 to 10, and the total KAP scores from 0 to 25.
The data for this study was collected by distributing Google Form surveys through WhatsApp in the first week of June 2021.Each participant was asked to complete and submit the questionnaire that they have received.The first page of the Google form contains a consent form describing the overall scope of the study also the assurance of personal data security.The researcher provides detailed instructions to all students who fill out the questionnaires to ensure the validity and quality of the data obtained for this study.The platform used on this survey was Google Form which automatically checked all incoming questions that has been filled.Each student can only fill out the questionnaires once.
The SPSS V.25 was used to analyze the research data and the T-test was performed to compare the value of the average variable.In the meanwhile, the Chi-square test was employed to establish whether or not the compared variable was categorical, as well as its ratio.To compare the correlation between the two variables, the Pearson or Spearmen correlation analysis was used.The result showed that the p-value was less than 0.05, therefore it was statistically significant.Ethical Clearance: The Health Research Ethics Committee FK UMS No. 3596/B.2/KEPK-FKUMS/IV/2021approved and certified this study to be ethical.

Demographic Characteristics
Table 1 describes the participants of this study which were 476 college students with 185 male students and 291 female students ranging in age from 17 to 26 years.There are 245 medicine students, 231 non-medical students, 85 freshman-year students, and 391 other-than-freshman-year students.Five variables questions were used to assess the student's knowledge of Covid-19.Table 2 lists each question and its response.Table 2 shows that out of 2380 responses, 1807 (75.92%) were answered correctly.Approximately 97.5% of participants accurately answered questions concerning the causes of Covid-19, and 97.9% successfully answered questions about the transmission of Covid-19.Furthermore, the percentage of accurate answers about the incubation period, people who are vulnerable to Covid-19, and clinical manifestation are 85.1%, 27.5%, and 71.6% respectively (Table 2).It found a significant relationship in which females scored higher on questions about virus transmission tracking, incubation period, and clinical manifestations.Moreover, the medical department received higher scores on questions about the cause of Covid-19, the main track of transmission, and clinical manifestations, indicating a significant relationship.
Table 3 shows a significant correlation in which females scored higher on K2 (p=0.016),K3 (p=0.001), and K5 (p=0.001).Meanwhile, the medical department scored higher on the K1 (p Nida Faradisa Fauziyah et al (Knowledge, Attitudes, and Practice…) 0.001), K2 (p=0.009), and K5 scales, indicating a significant link (p=0.011).The first-year groups and the other grades had no statistical significance (Table 3).Females showed more positive attitudes on the A1 (p=0.001) and A2 (p=0.001), as seen in Table 5 (p=0.036).There was also a significant relationship between medical students' positive attitudes on the A1 (p=0.001) and A4 (p=0.001).Furthermore, medical students showed more positive attitudes on A1 (p=0.001) and A4 (p=0.001).There was no statistical difference between first-year groups and other grades (Table 5).As many as 77.1% of respondents stated they feared human-to-human transmission, 96.4% expressed a positive attitude on questions about expecting the end of the pandemic so that they may return to campus and 69.1% had neutral attitudes towards wildlife consumption questions.
The students showed a neutral attitude (50.8%) on the topic of whether they would be better prepared to survive in an emergency and students who agreed that the outbreak was impacting their schoolwork (81.7%).Furthermore, it found a significant relationship in females that had more positive attitudes between the transmission of Covid-19 from human to human and the assumption that the pandemic would end soon so they could return to campus.While there was a significant relationship in which the medical students had more positive attitudes toward the transmission of Covid-19 and believed they would be able to survive longer.Five questions were assigned in practice against Covid-19.Table 6 shows that 1,804 (75.79%) of the 2,380 responses received were proactive.According to Table 7, females shows a significant relationship more proactive in P3 (p=0.001), while medical students were more proactive in P2 (p<0.001) and P3 (p=0.001).In addition, first-year students and the other grades students also showed significant indication at P5 (p=0.030)(Table 7).
It is about 97.5% of students were proactive when asked about what they should do if they had a fever and cough, 51.7% were proactive when asked if they were willing to help fight the pandemic on the front lines and 91.6% were proactive when asked what they should do if they had close contact with a confirmed case.As many as 48.1% of respondents selected proactive practice when asked what to do when someone who had already been recovered wished to meet them and 89.5% selected proactive behavior when asked what becomes a priority once the pandemic has ended.There was a significant relationship in which females had a more proactive practice of what they would do if they came into close contact with a confirmed Covid-19 patient, as well as medical students who responded more proactive if they were needed to help rescue on the front lines.Meanwhile, there was a significant indication in the first-year students with the other grade's students on the practice of the primary priorities once the pandemic ended.

Comparison of KAP Scores Related to Covid-19 Between Different Groups
The overall score for Knowledge, Attitude, and Practices is 18.95 ± 2.188, with the following values: Knowledge 3.80 ± 0.848 (range: 0 ~ 5), Attitude 6.48 ± 1.425 (range: 0 ~ 10), and Practice 8,67 ± 1,133 (range: 0 ~ 10).A positive correlation was found between attitude and practice (r=0.157,p=0.001) (Table 8).According to the statistical analysis shown in Table 8, it can be inferred that the level of knowledge was significantly higher in females (p<0.001) and departments of medicine (p=0.023).Medical students demonstrated a more positive attitude (p<0.001), as did proactive practice (p<0.001)(Table 9).Knowledge, attitude, and practice did not show a significant indication in relation to the variable of student level (Table 9).

Discussion
Students play an important role as the main force in encouraging health education and promoting the dissemination of knowledge related to pandemics, which is crucial for the prevention and control of the Covid-19 pandemic.It is also critical for the institution to understand how to enhance preventive measures for Covid-19 in the community, the health authorities need KAP as well.The study aims to compare students' knowledge, attitudes, and practices about Covid-19 among medical and non-medical students so that institutions or universities can take more effective precautions to protect students' physical and mental health during the pandemic.
The majority of the 476 respondents in this cross-sectional study were female, medical students, and senior-level students, with an age range of 21-26 years.It's in line with the findings of other Chinese studies, which showed that the majority of respondents are female medical students, but that the majority of them are first-year students [16].
According to the findings of this study, students' knowledge of Covid-19 seems to be quite good, reaching 75.92%.According to a study conducted in China, students' knowledge of Covid-19 is 82.34% [16].Other studies have found comparable findings to this one, with 82% of students having an adequate understanding of the current pandemic [17].This result seems to be much better than a study conducted in India, in which students' knowledge was estimated to be as high as 66% [18].
Females scored higher on questions about the transmission track, incubation period, and clinical manifestation, which indicated a significant relationship.It is consistent with the findings of another study conducted in China by Gao demonstrate female students have a greater comprehension of transmission and prevention than male students [19].Furthermore, there is a substantial relationship in which the medical student receives a higher score on questions about the cause of Covid-19, the main transmission track, and clinical manifestations.Medical students have a high level of knowledge, which can be attributed to their clinical medicine and public health training.It is their job and responsibility to fight this pandemic because future medical professionals are encouraged to have a more positive attitude and proactive practice during this state of public health emergency [20].In addition, this finding concurs with another study conducted in Indonesia by Muslin and Sari, which found that the majority of participants have adequate knowledge of Covid-19 [21,22].This is due to the fact that, since the first case of Covid-19 in Indonesia was discovered in March 2020, information about the disease has been widely published around the world; as a result, the people of Indonesia have sufficient knowledge about Covid-19 [22].
According to our findings, 52.26% of students had a good attitude toward Covid-19.This is consistent with earlier studies by Tamang in Nepal, which found that 54.7% of respondents have a positive attitude [23].Meanwhile, according to a Chinese study, 73.81% of respondents have a positive attitude toward Covid-19 [16].The participants had both negative and positive feelings regarding the epidemic, with the majority concerned that they or members of their families would become infected [24].It is also consistent with what has been reported among college medical students in China by Peng and in Pakistan by Hasan [16,25].However, this finding contrasts with other studies in Indonesia, which demonstrate that the majority of individuals have a positive attitude toward Covid-19 [21,22].
The proactive practice of 75.79% of the students in this study indicates that the practice of students related to Covid-19 is considered to be good.This is consistent with the findings of other studies, which show that respondents had good practice, with a value of 78.9% [23].Another study by Peng in China showed that 87.94% of students had proactive practice toward Covid-19 [16].According to Z. Gao's findings, although most of the students are fully aware of the serious risk caused by COVID-19, all students who engaged in the survey expressed optimism that COVID-19 will be under control [19].A similar study found that Indonesians have better practices in dealing with the Covid-19 epidemic [21].
Similar to ours, the study was done during the early stages of the epidemic.Students in the health department are more knowledgeable about the Covid-19 epidemic and are more likely to wear masks than students in the non-health department, although having the same attitude [25].According to a study of 10 Chinese universities, state universities, and medical departments had significantly knowledgeable about Covid-19 than private universities and non-medical departments [16].Other studies from Japan [26] and India [18], on the other hand, find no differences between medical and non-medical students.Covid-19 is well-known among medical students, according to studies [27,28].These medical students are frequently approached for medical advice by family members, who encourage them to study more about Covid-19 [29,30].
Knowledge, attitude, and practice are all interconnected.People with good knowledge are required to put their knowledge into good practices and preventive measures.This study reveals a gap between knowledge that has been integrated into good practice but not into a positive attitude.Respondents with sufficient knowledge and practice do not necessarily have a positive attitude.This is due to a variety of factors that influence the construction of one's attitude, including personal experience, the influence of important persons, cultural influences, mass media, educational institutions, religious organizations, and the impact of emotional aspects.This finding is nearly identical to those of other Indonesian studies which show a disparity between knowledge that is not turned into a positive attitude and prevention related to Covid-19 [31].
We are aware that there are several limitations to this study.To begin with, our respondents are all from the same university.As a result, the findings may not apply to the entire population of Indonesian college students.Second, we depend on respondents to accurately describe and comprehend their feelings without the ability to investigate them because this is an online survey.This, however, is generally true of all online surveys.Despite these limitations, we feel that the findings will be valuable in providing further insight to policymakers in the fields of education and health.This study could provide useful information about public health education and preventive measures at Indonesian universities during the Covid-19 outbreak.

Conclusion
Although college students have good knowledge and proactive practice against Covid-19, only half of them still have a positive attitude toward the virus.In the fight against Covid-19, medical students are more knowledgeable, optimistic, and proactive.Our findings suggest that the majority of undergraduate students have developed a fundamental understanding of Covid-19, although their performance varies by gender, department, and level.It is still necessary to develop a strategy to help students cope with the pandemic more positively.This pandemic, which has been ongoing for over a year, has undoubtedly had serious psychological consequences for a large number of students.As a result, during the pandemic, psychological support and social proactive services for students should be considered vital.

Declaration
will be your top priority when the pandemic ends?I will go back to school and restart normal study Same as The outbreak is too scary.I need to enjoy my life as much

Table 3 .
Comparison of Knowledge Against Covid-19 in Each Group Five variables questions were used to assess the students' attitude toward Covid-19.Table4shows each question and answer relating to attitudes toward Covid-19.It shows that 1243 (52.26%) of the 2380 responses had a positive attitude.

Table 5 .
Comparison of Attitudes Against Covid-19 in Each Group

Table 7 .
Comparison of Practices Against Covid-19 in Each Group

Table 9 .
Comparison of KAP Scores Related to Covid-19 Between Different Groups