Knowledge, attitude and practice towards Covid-19 pandemic of pharmacy students in University of Medicine and Pharmacy at Ho Chi Minh city, Vietnam

A cross-sectional study was fielded from February to July 2020 with the participation of pharmacy students at UMP, Vietnam. At the time of study, the total quantity of students in the faculty was 2,007, covering from freshmen to seniors. Due to the aggravation of the pandemic, schools were forced to shut down and E-courses were encouraged for theoretical classes [12]. For practical sessions and exams, they were asked to follow the safety protocol of the Health Ministry, such as keeping a safe distance from each other and washing hands with alcohol-based sanitizer [13]. Therefore, a Google form survey was developed and posted publicly by the Ho Chi Minh Communist Youth Union of Pharmacy Faculty, an organization which represents the interests of pharmacy students. Through this organization, the online survey was delivered directly to pharmacy students.

The questionnaire was constructed based on a systematic review of KAP towards COVID-19 on Pubmed, Cochrane Library and google scholar. A small group interview with 15 students (3 students of each class) was held to adjust words and structures of questions and statements. The questionnaire was validated based on official documents from the online portals of WHO and Vietnam Health Ministry. A pre-test was conducted on study sample of 100 students with 20 students each class to adjust the questionnaire.

The questionnaire included 2 parts (socio-demographic data and KAP part) and one reverse question in the KAP part to figure out unqualified answers. A reverse question has the contrarian content to one statement about prevention knowledge, and answers which had the same responses to both were eliminated from the study.

The survey provided the information of the study to all participants before taking the questionnaire and allowed them to join voluntarily by signing a consent form online.

Socio-demographic data investigated population characteristics such as sex, age, year of study, place of residence, co-habitant, infection status, quarantine status, source of information and update frequency. Demographic information of participants was anonymously collected by asking for initials and email addresses were obtained to remove duplicate answers.

The attitude domain (7 questions) focused on risk perception, such as the probability of getting transmitted and recovering, and whether the preventive measures enforced by the local authority kept them safe from the virus. On the Likert scale of 5, these participants were asked to rank from 1 (totally disagree) to 5 (totally agree) based on their perspective. The practice domain (13 questions) was to analyze the practice of students during the quarantine and their adaption to this global crisis. For each response, two points were added for the “more frequent” option, one point for “as usual” and zero for “less frequent”.

KAP scores were calculated by the following equation:

Based on the classification of Bloom B.S., the knowledge and practice of every participant were rated from good (8 – 10 points); average (6 – 8 points) to bad (less than 6 points). The attitude of each respondent was rated from positive (6 – 10 points) to negative (less than 6 points) [14]. Since all the questions were made compulsory, response rate was considered to be 100%.

Data retrieved from the questionnaire were analyzed using IBM SPSS Statistics 26.0 and Microsoft Excel 2010 with a confidence level of 95%. The level of students’ KAP was determined by simple frequency (n) and percentage (%). Statistical hypothesis tests were used to assess the correlation of different elements affecting the KAP result based on the normality of KAP score. In particular, a T-test or Mann-Whitney was used to discover the relevance between KAP and factors including sex, place of living, quarantine status, while the ANOVA test or Kruskal-Wallis was used to evaluate the connection between KAP and year of study, infection status. The relation between age and KAP was established using Pearson or Spearman. P-value of 0.05 or less was considered statistically significant, meaning “relevant”.

The survey received 1,213 responses and crossed out 124 unqualified answers based on the inclusion/exclusion criteria and reverse question. With 1,089 qualified responses, a demographic characteristic analysis was performed and demonstrated in Table 1.

According to Table 1, the participants aging between 19 and 26 (21.06 ± 1.65) were mostly female students (67.2%), twice as much as their male counterparts. Based on the year of study, the sophomores took up the majority with 23.9%. More than 90% of them were in Ho Chi Minh City at the time of the survey and most of them were staying with their friends. 91.7% of students had never had any contact with F1, F2, or F3 and more than 80% of enrolled individuals had never been in quarantine before. Most participants kept up with the information about COVID-19 from internet (93.6%), social network (89.3%) and SMS from Ministry of Health (77.2%) with 59.4% participants updating once or more times per day.

Table 2 described the outcome of the knowledge investigation of the study participants. Regarding each subtopic from the set of knowledge questions, almost every student had accurate replies about general knowledge (definition and initial source). More than 90% of students had an appropriate insight into the specific signs and incubation period. Virus transmission, treatment, and quarantine also received a large proportion of correct responses. However, the agreement on the use of flu vaccine against coronavirus varied, with 23.7% stating unsure and 14.5% having the wrong answer. The same happened to question about the necessity of N95 for people interacting with F0 (70.3% agreed; 19.4% disagreed and 10.3% uncertain).

Across the entire study sample, the median COVID-19 knowledge was scored 8.37 out of 10 points (IQR: 8 - 9). The majority participants (87.88%) attained a high score (≥8) with maximum score of 10 and no respondent scored less than 6 points.

Seven questions were given out and results were recorded in Table 3. As noted, more than 60% of students believed they would be more likely to catch the virus if no containing actions were applied. The percentage of students who thought their family could get germ-transmitted was nearly equal to those who did not. A three-fourths of the participants were supposed to develop to a more complicated state and only a quarter believed they could not recover. More than 70% of students believed in protective measures applied and the vast majority of them was confident that Vietnam could put this pandemic under control.

Some adjustments in students’ practice were demonstrated in Table 4. A large portion of these participants (80% approximately) were also reported to be more compliant with the compulsory guidance proclaimed by the Ministry of Health of Vietnam. These guidelines consisted of statements from P1 to P8. Some actions were also taken but with a smaller proportion of only 50 to 65% of the population, since these measures were not made obligatory by the authority, including: (1) avoid recirculating spaces, (2) rinse with salt water or mouthwash, (3) good nutrition, (4) healthy lifestyle, (5) do exercise.

This study discovered a correlation between knowledge – practice (r=0.042, p=0.019) and knowledge – attitude (r=0.067, p=0.005) (Figure 1). It has been found that related factors to practice were gender (U= 117,161.0, p=0.05) and year of study (χ2 = 12.6, p=0.013), while social distancing had a close relation with attitude (U = 255,77.5, p=0.024). A linear regression analysis was generated between the elements involved (Table 5). By that, practice score went down by 0.254 points when a male student (p=0.001); increased 0.173 points if they were freshmen, sophomores, or juniors (p=0.020); increased 0.154 points when knowledge score added 1 (p = 0.003).

Figure 1. KAP correlation

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