COVID-19 is a highly contagious infection that spreads through human to human contact causing serious health problems within communities. Depending upon the immune system of an individual it can cause symptoms ranging from mild to severe. Symptoms identified comprise of fever, cough, difficulty in breathing, loss of smell, while in extreme cases can lead to pneumonia, multi-organ failure and death [1-3].

The rapid spread of this infection is principally through respiratory droplets of 5-10 μm in diameter, spread through the mouth or nose, when an infected person coughs or sneezes. It is of great importance for the general public to have appropriate awareness regarding the signs and symptoms and the causative factors of this disease and preventive protocols that need to be followed, including social distancing, following proper hand hygiene protocol and use of face masks [4-7].        

A number of studies have done in different parts of the India on knowledge on COVID-19 but such studies are limited in hilly state of Himachal Pradesh having different type of customs and cultural pattern. Therefore, this study was undertaken to analyze the level of Knowledge, Attitude and Practices Regarding COVID-19 of the general public of Himachal Pradesh using an online survey. 

Objectives of the Study

To evaluate the Knowledge, Attitude and Practices Regarding COVID-19among General Population of Himachal Pradesh

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: Hilly state of Himachal Pradesh

• Study duration- between March 2021 to May 2021

• Study population: All adults above 18 years of age

who were staying in the Himachal Pradesh for 12 months or more. 

• Sample size: 400 Adults assuming 50% have adequate knowledge regarding COVID-19, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique: convenience & snowball Sampling technique

• Study tool A google form questionnaire consisting of questions regarding socio-demography, Knowledge, Attitude and Practices Regarding COVID-19 was created.

         The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents. 

Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more.

• Questionnaire: The questionnaire contains 30 structured closed ended questions regarding Knowledge, Attitude and Practices Regarding COVID-19. The participants have to choose right option. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 30 and minimum score was zero. Scoring was done on the basis of marks as >80% (24-30) = very good,60-79% (18-23) = Good,41-59% (12-17) = Fair<40% (< 12) = poor

• Validity of tool - by the experts in this field

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in both rural and urban area of Himachal Pradesh till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet.

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity were maintained. 

The present study was cross sectional descriptive study carried out to evaluate the Knowledge, Attitude and Practices Regarding COVID-19 among the general population of Himachal Pradesh.

A total of 400 respondents including 150(37.5%) were from urban area and 250(62.5%) were from rural area were participated in the study. Among the participants of the majority 268(67.0%) were males, 182(45.5%) were between 18-30 years, 152(38.0%) were Graduate, 254 (63.5%) were employee, 247(61.75%) were married and 383 (95.75%) were Hindu.

In the present study 121 (30.25%) study participants had very good (24-30 marks) awareness regarding COVID-19, 208 (52.0%) had good (18-23 marks), 49 (12.25%) had fair (12-17 marks) and 22(5.5%) had poor (<12 marks) awareness regarding COVID-19.

Table 1: Socio-Demographic Characteristics of Study Participants

Table 2: Knowledge, Attitude and Practices Regarding COVID-19

Table 3: Awareness Regarding COVID-19 Among Study Participants

The respondents for this online statewide cross-sectional survey conducted in the Himachal Pradesh primarily comprised young adults, males and educated individuals.

In the present study, respondents had sufficient knowledge regarding the prevention and control of COVID-19; however, their knowledge in terms of clinical presentations and COVID-19 transmission modes was needed further improvement. The respondents were optimistic about the control of COVID-19. Even though wearing a mask is mandatory still many respondents admitted that they did not wear a mask when leaving home and many others didn’t follow the standard precautions against COVID-19. But overall, the general public of Himachal Pradesh had either satisfactory knowledge Attitude and Practices Regarding COVID-19.

Similarly in the study done by Beenish Fatima Alam et al., [1], most of the participants (70%) claimed that they have good knowledge of novel COVID-19 disease. Mean knowledge score was 9.48±2.88 out of 16, which can be considered as good knowledge about the disease. Figure 1 shows the correct answer percentages of knowledge questions asked: 83% had awareness regarding the quarantine time; 82% used face masks whenever they left their homes; 98% were aware of the origin of the disease; fever and difficulty of breathing were correctly described as most common symptoms by 70%; 69% correctly stated that the disease can be transferred by touching each other or infected surfaces; and 21% stated that transmission of disease could be through running nose and aerosol. Another study by Dkhar et al.,[2], showed that the respondents have exhibited good knowledge, positive attitude and sensible practices regarding covid-19 during the pandemic.

Unlike in the early stage of the COVID-19 pandemic, our study found that sound knowledge has led to little improvement in attitude or practices during this time. Therefore, health education should focus on promoting a positive attitude and better practices in the public. For example, the public should be encouraged to adopt the correct attitude towards practices that can prevent COVID-19 [8,9]. Their knowledge of the practices should also be enhanced and the rationale for the 3Cs and 3Ws more clearly explained [10]. Greater emphasis should be placed on vulnerable groups such as young adults, males, and unmarried individuals as well as less-educated people, lower-income groups, and individuals from rural areas. In short, this study provides timely insights for the government and public health organizations to establish more appropriate policies and interventions for combatting COVID-19.

Limitations

The sample size and duration of the study are restricted to 400 respondents and 3 months in time; thus, the scope and extent of the conducted research might be minimized. It’s a convenience sample through social media, which has its own limitations. Social media statistics are dynamic and can change according to its popularity and due to specific group of users being educated and having access to that information. This is the reason most of the participants were graduates and above. This survey was conducted only in one state of India, and hence, these findings cannot be generalized all over India. Future work should focus on a larger, national representative sample population.

According to our survey findings, the general public had either satisfactory knowledge Attitude and Practices Regarding COVID-19. It is evident from our study that better knowledge leads to a positive attitude and in turn reflects on better practice. Our study also revealed how education can be an effective tool in awareness and timely adaptation which might help health authorities to formulate plans based on the areas of improvement. Further knowledge and awareness should be promoted. 

1. Alam, B.F. et al. “General Public Awareness, Knowledge and Attitude toward COVID-19 Infection and Prevention: A Cross-Sectional Study from Pakistan.” F1000Research, vol. 10, no. 946, September 2021, p. 946. https://doi.org/10.12688/f1000research.55536.1.

2. Dkhar, S.A. R. Quansar, S.M. Saleem, and S.M. Khan. “Knowledge, Attitude, and Practices Related to COVID-19 Pandemic among Social Media Users in J&K, India.” Indian Journal of Public Health, vol. 64, no. 6, June 2020, p. 205. https://doi.org/10.4103/ijph.IJPH_469_20.

3. Kanagavelu, A.K. “Knowledge, Attitude and Practice towards COVID-19 among the General Public in Tamil Nadu, India.” International Journal of Community Medicine and Public Health, vol. 8, no. 4, April 2021, pp. 1935–1944. https://doi.org/10.18203/2394-6040.ijcmph20211248.

4. Andrews, M.A. et al. “First Confirmed Case of COVID-19 Infection in India: A Case Report.” The Indian Journal of Medical Research, vol. 151, no. 5, May 2020, p. 490. https://doi.org/10.4103/ijmr.IJMR_2131_20.

5. Ministry of Health and Family Welfare, Government of India. COVID-19 Dashboard. Government of India, https://www.mohfw.gov.in/. Accessed June 2022.

6. Bhatia, R. “Public Engagement Is Key for Containing COVID-19 Pandemic.” Indian Journal of Medical Research, vol. 151, no. 2, February 2020, pp. 118–120. https://doi.org/10.4103/ijmr.IJMR_780_20.

7. World Health Organization. Protecting Yourself and Others from the Spread COVID-19. WHO, 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Accessed June 2022.

8. Anwar, S., M. Nasrullah, and M.J. Hosen. “COVID-19 and Bangladesh: Challenges and How to Address Them.” Frontiers in Public Health, vol. 8, April 2020, p. 154. https://doi.org/10.3389/fpubh.2020.00154.

9. Nour, M.O. et al. “Knowledge, Attitude and Practices of Healthcare Providers towards MERS-CoV Infection at Makkah Hospitals, KSA.” International Research Journal of Medicine and Medical Sciences, vol. 3, no. 4, October 2015, pp. 103–112.

10. Imtiyaz, B.S. et al.“Knowledge, Attitudes, and Practices about COVID-19 among Kashmiri Population: A Cross-Sectional Study.” Indian Journal of Psychiatry, vol. 63, no. 4, July 2021, p. 383. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_173_21.