Attitude and practices of healthcare professionals of Riyadh

Original article
Knowledge, attitude and practices of healthcare professionals of Riyadh,
Saudi Arabia towards covid-19: A cross-sectional study
Syed Mohammed Basheeruddin Asdaq a,⇑
, Alshrari A.S b
, Mohd. Imran c
, Nagaraja Sreeharsha d
,
Rokeya Sultana e
aDepartment of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
bDepartment of Biological Science, Faculty of Science, Northern Border University, Arar, Saudi Arabia
cDepartment of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha, Saudi Arabia
dDepartment of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
eDepartment of Pharmacognosy, Yenepoya Pharmacy College and Research Centre Under Yenepoya Deemed to be University, Mangalore, India
article info
Article history:
Received 19 April 2021
Revised 9 May 2021
Accepted 18 May 2021
Available online xxxx
Keywords:
Healthcare professionals
COVID-19
Knowledge
Attitude
Practices
Riyadh
Saudi Arabia
KAP
abstract
Background & objectives: COVID-19 is an emerging pandemic that necessitates the implementation of
effective infection prevention and control steps. The knowledge, attitudes, and practices (KAP) of healthcare professionals toward COVID-19 affect their compliance to prevention and control initiatives. During
the evolving pandemic, we examined the KAP among healthcare professionals against COVID-19 in this
research.
Materials and methods: This was a cross-sectional study conducted among Riyadh region health care professionals from the beginning of December 2020 to the end of February 2021 using a validated selfadministered questionnaire. The knowledge questionnaire contained questions about COVID-19 clinical
characteristics, prevention, and management. The evaluation of attitudes and practices included questions regarding actions and adjustments in COVID-19 response activities. Knowledge scores were measured and compared using demographic characteristics, as well as attitudes and practices toward
COVID-19. Using SPSS-IBM 25, bivariate statistics were done to analyze the data.
Results: 146 healthcare professionals completed the survey. Physicians were the most prominent party in
the survey, accounting for 74 (51 percent), followed by nurses 44 (30 percent) and pharmacists 28 (19
percent). The participants’ average age was 39.69 ± 8.48 years. The participant’s mean knowledge, attitude, and practice scores were 11.43 ± 1.34, 3.89 ± 0.93, and 3.85 ± 0.81, respectively. With a positive attitude, the mean knowledge score was 11.52, and with proper practice, it was 11.32. With an improvement
in knowledge, the attitude score increased significantly (r = 0.172, P = 0.001). Besides, there was a greater
association between attitudes and practices (r = 0.170, P = 0.029). A significant enhancement in the practice score of the professionals was noted with an increase in knowledge score (r = 0.095, P = 0.010), an
indicator for a positive correlation between practice and knowledge scores.
Interpretation & conclusion: Healthcare practitioners have a good understanding of COVID-19. Improved
knowledge and a positive attitude toward COVID-19 infection are linked to appropriate practice. There is
a need for more manpower, better COVID-19 management training, and strategies to reduce anxiety
among healthcare professionals.
2021 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
A severe acute coronavirus respiratory syndrome triggers
COVID-19, a highly infectious disease. As per studies, the infection
spreads primarily through respiratory droplets/mists that are
released from the infected person during coughing, sneezing,
speaking, and even breathing (Rothan and Byrareddy, 2020). The
coronavirus disease 2019 (COVID-19) outbreak began in China’s
Wuhan province; the epidemic has spread farther than initially
https://doi.org/10.1016/j.sjbs.2021.05.036
1319-562X/ 2021 The Author(s). Published by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
⇑ Corresponding author at: Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia.
E-mail address: [email protected] (S. Mohammed Basheeruddin Asdaq).
Peer review under responsibility of King Saud University.
Production and hosting by Elsevier
Saudi Journal of Biological Sciences xxx (xxxx) xxx
Contents lists available at ScienceDirect
Saudi Journal of Biological Sciences
journal homepage: www.sciencedirect.com
Please cite this article as: S. Mohammed Basheeruddin Asdaq, A. A.S, Mohd. Imran et al., Knowledge, attitude and practices of healthcare professionals of
Riyadh, Saudi Arabia towards covid-19: A cross-sectional study, Saudi Journal of Biological Sciences, https://doi.org/10.1016/j.sjbs.2021.05.036
thought, with cases now reported all over the world (Shi et al.,
2020). COVID-19 is a modern Betacoronavirus that can infect
humans (Zhu et al., 2020). According to the findings, the virus is
more closely related to BatCoV RaTG13, a bat coronavirus with a
96.2 percent overall genome sequence identity (Zhou et al.,
2020). According to these observations, bats may have been the
virus’s initial host (Zhu et al., 2020; Zhou et al., 2020).
Coronaviruses can cause a range of illnesses, from the common
cold to more serious conditions like Middle East Respiratory Syndrome (MERS-CoV) and Extreme Acute Respiratory Syndrome
(SARS-CoV-2) (Torales et al., 2020). COVID-19 is currently diagnosed using genomic techniques such as polymerase chain reaction (PCR) or deep sequencing to detect the virus or viral
components (Bai et al., 2020; Mehta et al., 2020; Liu et al., 2019).
According to the literature, everyone is at risk of contracting
COVID-19 (Wang et al., 2020a). For healthcare workers, the risk
of contamination and cross infection is higher. The COVID-19 pandemic has had a major impact on frontline healthcare staff such as
physicians, nurses, and pharmacists (Raudenská et al., 2020). This
pandemic has claimed the lives of hundreds of healthcare workers
(Bandyopadhyay et al., 2020). Even though the healthcare profession has never faced an obstacle like this from any other disease
before, they have demonstrated improved resilience to resolve it
(Albott et al., 2020).
A positive attitude and good work practices are aided by extensive knowledge, which reduces the risk of infection (McEachan
et al., 2016; Alshrari, 2020). The knowledge, attitudes, and practices (KAP) of healthcare professionals toward COVID-19 influence
their adherence to control initiatives. The knowledge, attitude and
practice (KAP) of health care professionals (HCP) regarding COVID19 are critical to stopping the spread of the virus and the success of
the overall COVID-19 response. The current literature indicates a
conflicting picture regarding HCPs’ KAP regarding COVID19. Some
studies (Kassie et al., 2020; Olum et al., 2020) have indicated that
HCPs have good knowledge of and positive attitude toward COVID19 as well as practice safer infection, prevention and control practices put forward by international and local health authorities. On
the other hand, an Ethiopian study reported poor prevention practices toward COVID-19 among HCPs (Asemahagn, 2020) while
close to half of HCPs in Nepal were reported to have negative attitudes toward COVID-19 (Limbu et al., 2020). An earlier study
(Temsah et al., 2020) published on KAP of Saudi Arabian health
care staff found that they had a good understanding of COVID19. However, the majority of the participants in this study were
nurses (75%) who worked in the critical care unit. As a result, there
is still a need for general health care professionals to understand
the KAP. Further, to have appropriate practices and protection, it
is important to understand the expertise of different classes of
healthcare professionals and identify the factors that influence
their attitudes and practices. As a result, the aim of this study
was to evaluate healthcare professionals’ knowledge, attitudes,
and practices regarding COVID-19 infections in the Riyadh region
of Saudi Arabia during the continuing pandemic.
2. Materials and methods
2.1. Study design
This was a cross-sectional study conducted among Riyadh
region health care professionals from the beginning of December
2020 to the end of February 2021 (Saudi Arabia). The purpose of
the study was briefly explained at the start of the questionnaire.
After reaching the study center, researchers shared an informed
consent form with participants electronically along with a questionnaire form that included sections on the study’s intent, risks,
expectations, financial and other compensation (if any), ways to
contact the investigators, and a request for a copy of the questionnaire filled out by the participants.
2.2. Study population
This questionnaire-based survey included 146 health care professionals, including physicians, nurses, and pharmacists, to determine their knowledge, attitudes, and practices about COVID-19.
2.3. Questionnaire design
This was a questionnaire-based cross-sectional study. The questionnaire used in this study was divided into two parts: part 1 covered sociodemographic variables and part 2 included 13
knowledge-based items, as well as five items in each of the attitude
and practice domains (KAP). The sociodemographic characteristics
included in part 1 were age (continuous variable), gender (male/female), marital status (married/unmarried), educational level
(bachelor/master/Ph.D.), professional type (Physician/nurse/pharmacist), nationality (Saudi/non-Saudi), hospital class (Tertiary/Secondary/Primary health care), and hospital nature (Private/Public).
The items in the KAP were taken from the literature (Limbu
et al., 2020). Thirteen true and false questions were used to determine knowledge. These questions tested healthcare professionals’
knowledge of COVID-190
s clinical manifestations, transmission
mode, prevention, and control. Internal accuracy was calculated
by Cronbach’s alpha, which was 0.78, suggesting that the survey
was accurate. Expert researchers and statisticians conducted logical and material validity tests based on the suggested outcomes.
As a result, a self-administered pretest of the questionnaire was
conducted on a small sample of the target population. Correct
answers to knowledge questions received a 1 score, while incorrect
answers received a 0 score (hence the knowledge maximum score
was 13). Based on the adjusted Bloom’s cut-off points, each participant’s knowledge score was divided into three categories: poor
(60 percent: 8), fair (60 percent –79 percent: 9–11), and good
(80 percent: 12, 13). Positive and negative attitudes were analyzed.
The average attitude questionnaire score was measured and used
as a cutoff for positive and negative responses. The average score
was three, and any score below three was considered negative. In
terms of practice questions, the correct practice received a score
of 1, while the incorrect practice received a score of 0. (hence a
maximum practice score of 5). Improper practice was defined as
a score of 3 or less, whereas proper practice was defined as a score
of 3 or more.
2.4. Data collection
Medical staff physicians, pharmacists, and nurses from various
public and private hospitals (05 each) in Riyadh, Saudi Arabia, participated in this research. The questionnaire was distributed electronically to members via web-based media in compliance with
COVID-19 guidelines. The study’s five researchers directly visited
the participants at their worksites to distribute the questionnaire.
Data was collected from the beginning of December 2020 to the
end of February 2021. The Research Committee of College of Pharmacy, AlMaarefa University approved this project [MCST/(AU)-COP
20–42/RC dated 25/11/2020]. Participants were informed about
the study’s goal through verbal contact as well as a brief explanation written at the beginning of the questionnaire type. There was
no incentive or coercion for the participants. Their identity was
kept anonymous and secrecy of their responses was guaranteed
to them.
S. Mohammed Basheeruddin Asdaq, A. A.S, Mohd. Imran et al. Saudi Journal of Biological Sciences xxx (xxxx) xxx
2
2.5. Statistical analysis
The data was gathered and analyzed using SPSS statistical tools.
The chi-squared test was used to examine the relationship
between physicians, nurses, and pharmacists. The dependent variables (knowledge, attitude, and practice) were correlated with
sociodemographic characteristics using descriptive analysis. It is
considered significant if the P-value is less than 0.05.
3. Results
3.1. Knowledge level of health care professionals
Altogether 210 participants were approached, 156 participated
with a response rate of 74%. Further, 10 samples were removed due
to missing data. Finally, 146 healthcare professionals completed
the survey. Physicians were the most prominent party in the survey, accounting for 74 (51 percent), followed by nurses 44 (30 percent) and pharmacists 28 (19 percent). Table 1 shows the basic
characteristics of respondents based on their knowledge level
(poor, fair, and good). The Average age of participants was
39.69 ± 8.48 (mean ± Standard deviation) years. Overall, the mean
knowledge score of the participant was 11.43 ± 1.34. The significantly higher number of young aged participants (7 out of 8)
showed a good level of knowledge on the COVID-19, however, very
few respondents from this age group participated in our study. No
significant difference was found between the physician, nurses,
and pharmacist on the knowledge score. The average score of
physicians, nurses, and the pharmacist was 11.52, 11.38, and
11.25, respectively (Fig. 1). The number of pharmacists with good
knowledge scores was slightly lesser than the other two professionals. The mean knowledge score (11.54) of master’s degree
holders was non-significantly higher than bachelor’s degree holders (11.41) and Ph.D.’s (11.20). There was no significant difference
between male and female participants in terms of knowledge score
(11.59 female Vs 11.32 male). Similarly, professionals from Saudi
nationality had slightly better knowledge (11.59) compared to
non-Saudi participants (11.33). On the other hand, married participants (11.48 Vs 11.13), those working in secondary care hospitals
(11.69 Vs 11.40 and 11.09) and public hospitals (11.50 Vs 11.36)
showed non-significantly better mean knowledge score compared
to the unmarried, those working in a tertiary care/primary care and
private hospitals, respectively.
3.2. Attitude and practice scores of health care professionals
Fig. 2 depicts the mean attitude and practice score of the participants against demographic variables. The average attitude and
practice scores of the study participants were 3.89 ± 0.93 and
3.85 ± 0.81 (mean ± SD), respectively. No significant variation
was found between the demographic variables and attitude score
of the healthcare professionals, whereas, a significant (P
value = 0.050) increase in the practice score was noted in unmarried professionals compared to the married ones.
Table 1
Knowledge level of healthcare professionals on COVID-19.
Demographics Knowledge type P-value*
Poor
N (%)
Fair
N (%)
Good
N (%)
Total
Professional type 3 (2) 62 (43) 81 (56) 146 0.458
Physician 1 (1) 30 (41) 43 (53) 74 (51)
Nurse 2 (5) 17 (39) 25 (57) 44 (30)
Pharmacist 0 15 (54) 13 (46) 28 (19)
Gender 3 (2) 62 (43) 81 (56) 146 0.350
Male 3 (3) 36 (41) 48 (55) 87 (60)
Female 0 26 (44) 33 (56) 59 (40)
Age 3 (2) 62 (43) 81 (56) 146 0.023
25 years 1 (13) 0 7 (88) 8 (5)
26–40 years 2 (3) 33 (47) 36 (51) 71 (49)
>40 years 0 29 (43) 38 (57) 67 (46)
Educational level 3 (2) 62 (43) 81 (56) 146 0.579
Bachelor 0 (0) 24 (45) 29 (55) 53 (36)
Masters 2 (3) 24 (38) 38 (59) 64 (44)
Ph.D. or equivalent 1 (3) 14 (48) 14 (48) 29 (20)
Nationality 3 (2) 62 (43) 81 (56) 146 0.239
Saudi 1 (2) 19 (34) 36 (64) 56 (38)
Non-Saudi 2 (2) 43 (48) 45 (50) 90 (62)
Marital status 3 (2) 62 (43) 81 (56) 146 0.670
Married 2 (2) 53 (43) 69 (56) 124 (85)
Unmarried 1 (5) 9 (41) 12 (55) 22 (15)
Hospital type 3 (2) 62 (43) 81 (56) 146 0.553
Public 1 (2) 28 (42) 38 (57) 67 (46)
Private 2 (3) 34 (43) 43 (54) 79 (54)
Hospital class 3 (2) 62 (43) 81 (56) 146 0.178
Tertiary 1 (2) 29 (45) 35 (54) 65 (45)
Secondary 1 (2) 18 (37) 30 (61) 49 (34)
Primary health care 1 (3) 15 (47) 16 (50) 32 (22)
Attitude 3 (2) 62 (43) 81 (56) 146 0.563
Negative 1 (2) 22 (49) 22 (49) 45 (31)
Positive 2 (2) 40 (40) 59 (59) 101 (69)
Practice 3 (2) 62 (43) 81 (56) 146 0.326
Improper 2 (4) 21 (46) 23 (50) 46
Proper 1 (1) 41 (41) 58 (58) 100
*Pearson Chi-Square;*P value less than 0.05.
S. Mohammed Basheeruddin Asdaq, A. A.S, Mohd. Imran et al. Saudi Journal of Biological Sciences xxx (xxxx) xxx
3
3.3. Frequency of correct answers in knowledge, attitude, and practice
of the participants
Table 2 presents the frequency of the correct responses to
items of evaluations included in knowledge, attitude, and practices domains against the professional type of the participants.
There were thirteen items included in the knowledge domain
and the percentage of correct responses to the items ranged
between 72 and 100%. Item number 1 on determining the
knowledge of the participants on ’common clinical symptoms
of COVID-190 received 100% correct response, whereas, the ’possibility of transfer of infection from COVID-19 infected person
with fever to other people’ received only 72% correct response.
The level of the performance of all three classes of health care
professionals was not significantly different from each other for
twelve items, however, 93% of the physician and 82% of the
nurses understand that ’there is no current treatment of
COVID-19 infection, but early symptomatic and supportive treatment can help the most patient recover from infection’, while,
only 71% of the pharmacist had this knowledge. Therefore the
11.75
11.19 11.64 11.32 11.59 11.41 11.54 11.2 11.58 11.33 11.5 11.36 11.4 11.69
11.09 11.52 11.38 11.25 11.48 11.13
0
2
4
6
8
10
12
14
≤ 25
26-40
>40
Male
Female
Bachelor
Master
Ph.D.
Saudi
Non Saudi
Public
Private
Terary
Seconadary
Primary
Physcian
Nurse
Pharmacist
Married
Unmarried
Age Gender Educaonal level Naonality Hospital
type
Hospital class Professional
status
Marital
status
Fig. 1. Knowledge score against demographic variables.
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
≤ 25
26-40
>40
Male
Female
Bachelor
Master
Ph.D.
Saudi
Non Saudi
Public
Private
Terary
Seconadary
Primary
Physcian
Nurse
Pharmacist
Married
Unmarried
Age Gender Educaonal level Naonality Hospital
type
Hospital class Professional
status
Marital
status
Atude score Pracce score
Fig. 2. Attitude and Practice scores against demographic variables.
S. Mohammed Basheeruddin Asdaq, A. A.S, Mohd. Imran et al. Saudi Journal of Biological Sciences xxx (xxxx) xxx
4
level of knowledge on this item had a significant variation (P
value = 0.014) among different health care professionals.
The five items each of the attitude and practice domain are
also included in Table 2. No significant variation was found
among different healthcare professionals on all the ten items
included in this table. The percentage of the correct response
to the attitude items ranged between 65 and 88%. Only 65% of
the participants feel that ’all healthcare professionals from various departments actively involved in COVID-19 Pandemic
response‘‘, whereas, 35% of the respondents believe differently.
A majority (88%) of the healthcare professionals think that Saudi
Arabia will win the fight against COVID-19 and they enjoy good
family support during this time. The proper answers related to
the practice domain ranged between 56 and 90%. Most of them
say that they do not have any proper training to fight against
the virus (56%), while, use of face masks and gloves in their
practice received higher ratings (90%).
3.4. Percentage of participants with good knowledge, positive attitude,
and proper practice
Table 3 describes that the physicians have non-significantly
good knowledge, positive attitude, and proper practice than nurses
and pharmacists. The number of participants with good knowledge
among pharmacists was less compared to nurses. Similarly,
females, younger individuals, master’s degree holders, Saudi
nationals, married professionals, and those working in secondary
class hospitals and the public sector have better knowledge and
a positive attitude. Further, a good number of unmarried professionals showed proper practice skills towards managing COVID-19.
3.5. Correlation of knowledge, attitude, and practices
The mean knowledge score with a negative attitude (3 scores)
was 11.22 and with a positive attitude (score, >3) was 11.52
indicating no significant variation in knowledge score with a
change in attitude. However, a positive correlation was observed
between attitude and knowledge scores. The attitude score
increased significantly with an increase in knowledge score
(r = 0.172, P = 0.001). Further, the average knowledge score of
healthcare professionals with proper practice (score,>3) was
11.48 and those with improper practice (3 scores) had a score
of 11.32, a significant enhancement in the practice score of the professionals were noted with an increase in knowledge score
(r = 0.095, P = 0.010), an indicator for a positive correlation
between practice and knowledge scores. Additionally, a significant
positive correlation was found between attitude and knowledge as
well practices towards COVID-19, and also a similar correlation
was witnessed between practices with knowledge and attitude
scores (Table 4).
4. Discussion
The current cross-sectional study looked at the levels and determinants of KAP against COVID-19 among Saudi Arabian frontline
healthcare professionals. Our findings indicate that a large percentage of healthcare staff in Riyadh have a sound knowledge of
COVID-19, as well as a positive attitude and proper practice skills.
Developing a positive attitude that leads to proper practice
requires knowledge acquisition. Healthcare practitioners’ expertise
is more valuable because it impacts not just their own lives but
also the community’s standard of care. The more knowledge they
have, the more they will be able to monitor the spread of a panTable 2
Frequency of correct responses on knowledge, attitude and Practice [n (%)].
No Question Physician
[74 (100)]
Nurse [44
(100)]
Pharmacist
[28 (100)]
Total
(146)
P
value*
Knowledge
1 Fever, dry cough, difficulty in breathing, tiredness are the common clinical symptoms of COVID19.
74 (100) 44 (100) 28 (100) 146
(100)
–
2 Sneezing, runny nose, stuffy nose and headache are less common in persons infected with
COVID-19.
65 (88) 34 (77) 25 (89) 124 (85) 0.232
3 Loss of taste and smell are also the feature of COVID 19 infection. 55 (74) 31 (70) 20 (71) 106 (73) 0.891
4 Currently, there is no treatment of COVID-19 infection, but early symptomatic and supportive
treatment can help the most patient recover from infection.
69 (93) 36 (82) 20 (71) 125 (86) 0.014
5 Majority of COVID-19 infective patient will not develop severe illness but elderly, patient having
a chronic illness, DM, COPD are likely to develop severe illness.
62 (84) 38 (86) 24 (86) 124 (85) 0.923
6 COVID-19 infected person with fever can infect to other people. 55 (74) 29 (66) 21 (75) 105 (72) 0.568
7 COVID-19 virus spread via respiratory droplets. 58 (78) 33 (75) 24 (86) 115 (79) 0.552
8 Ordinary people should wear a general mask. 69 (93) 43 (98) 25 (89) 137 (94) 0.333
9 People maintain 2-meter distance in the public places. 68 (92) 42 (96) 24 (86) 134 (92) 0.341
10 Adherence to restrictive measures is effective to slow the spread of infection 70 (95) 44 (100) 27 (96) 141 (97) 0.295
11 People infected with COVID-19 should immediately place in proper isolation. 69 (93) 43 (98) 26 (93) 138 (95) 0.534
12 Suspected COVID19 patient should be sent to a quarantine centre or home quarantine 69 (93) 43 (8) 26 (93) 138 (95) 0.534
13 Health care professional with direct contact should take additional prophylactic steps. 70 (95) 41 (93) 25 (89) 136 (93) 0.638
Attitude
14 Can Saudi Arabia win the battle against COVID-19? 64 (87) 40 (91) 24 (86) 128 (88) 0.733
15 Are you confident to work in hospital during COVID-19 pandemic? 54 (73) 31 (71) 22 (79) 107 (73) 0.747
16 Does your family support you to work in a hospital during a pandemic? 63 (85) 39 (87) 26 (93) 128 (88) 0.556
17 Do you experience anxiety and fear while working with suspected COVID-19 patients? 57 (77) 34 (77) 20 (71) 111 (76) 0.818
18 Have all the healthcare professionals from various department actively involved in COVID-19
Pandemic response?
48 (65) 28 (64) 19 (68) 95 (65) 0.934
Practice
19 Are you being trained to work for COVID-19 patient? 47 (64) 19 (43) 16 (57) 82 (56) 0.098
20 Have you followed social distancing? 56 (76) 36 (82) 24 (86) 116 (80) 0.480
21 Have you been wearing a mask and gloves during hospital practice? 67 (91) 40 (91) 25 (90) 132 (90) 0.973
22 Do you regularly follow infection protection measures? 67 (91) 36 (82) 24 (86) 127 (87) 0.386
23 Are you attending patient suspected with COVID-19? 53 (72) 32 (73) 21 (75) 106 (73) 0.943
*Pearson Chi-Square;*P value less than 0.05.
S. Mohammed Basheeruddin Asdaq, A. A.S, Mohd. Imran et al. Saudi Journal of Biological Sciences xxx (xxxx) xxx
5
demic like COVID-19. The results of this study showed that healthcare professionals have a clear understanding of a variety of essential items that were assessed. The overall correct answer rate for
the questionnaire’s knowledge domain items was 88 percent. This
study’s results are close to those of a previous study conducted in
China during the lockdown period (Zhang et al., 2020), which
found that healthcare workers answered nearly 89 percent of the
knowledge domain items correctly. Although the participants in
this study had varying professional backgrounds (some were
physicians, nurses, and pharmacists), their expertise appeared to
be on par. In comparison, other studies have shown that different
types of healthcare professionals have different levels of expertise
(Giao et al., 2020). Since the research was conducted nearly 8–
9 months after the outbreak of the pandemic in the region, they
would have had enough time to gain valuable knowledge.
However, we discovered several differences in healthcare professionals’ knowledge and attitudes about COVID-19. For example,
approximately 30% of pharmacists and nurses are unaware that
COVID-19 causes loss of smell and taste, and 30% of pharmacists
believe that the infection is treatable. This insufficient information
would harm their practice. Nursing professionals often play an
important role in enforcing discipline and taking the required measures to avoid infection spreading. However, in this study, about
34% of them were unaware that an infected person with a fever
might spread the infection to others.
The presence of anxiety among health care professionals after a
long duration of exposure to COVID-19 was another troubling finding of this report. Although only 25% of healthcare professionals
reported anxiety in this survey, there is a need to resolve this problem because anxiety affects mental functioning, which can harm
their performance. Anxiety symptoms were identified in about
60% of healthcare staff in a study conducted in Turkey (Shahin
et al., 2020). In the early stages of the pandemic, 10% of healthcare
staff in Italy contracted Covid-19, with 3% dying (Mokhtari et al.,
2020). Anxiety and depression are common among healthcare
workers around the world as a result of the high infectivity and
mortality rates. More than 32% of healthcare staff in a previous
study in Saudi Arabia had a high level of anxiety (Thamer et al.,
2020), while the remaining 68 percent had a low or medium level
of anxiety. The current state of anxiety in our study is very promising, as there is a remarkably low number of anxious participants.
This may be due to healthcare providers’ experience with the
COVID-19 situation. Additionally, family support is important in
managing anxiety, as is an assurance of their family’s and children’s wellbeing (Martin, 2011). A significant percentage of study
participants (88%) reported that their families were fully supportTable 4
Correlation between knowledge, attitude and practice scores.
Variables Knowledge Attitude Practice
Correlation coefficient (r) P value Correlation coefficient (r) P value Correlation coefficient (r) P value
Knowledge 1 0.172 0.000 0.095 0.010
Attitude 0.172 0.000 1 0.170 0.029
Practices 0.095 0.010 0.170 0.029 1
Table 3
Percentage of participants with good knowledge, positive attitude, and proper practice.
Demographics Good Knowledge Positive Attitude Proper Practice
N (%) P value* N (%) P value* N (%) P value*
Professional type
Physician 43 (58) 0.458 49 (66) 0.729 53 (72) 0.476
Nurse 25 (57) 32 (73) 27 (61)
Pharmacist 13 (31) 20 (71) 20 (71)
Gender
Male 48 (55) 0.350 58 (67) 0.425 59 (68) 0.831
Female 33 (56) 43 (73) 41 (70)
Age
25 years 7 (88) 0.023 6 (75) 0.934 5 (63) 0.297
26–40 years 36 (51) 49 (69) 53 (75)
>40 years 38 (57) 46 (69) 42 (63)
Educational level
Bachelor 29 (55) 0.579 38 (72) 0.388 35 (66) 0.257
Masters 38 (59) 46 (72) 48 (75)
Ph.D. or equivalent 14 (48) 17 (59) 17 (59)
Nationality
Saudi 36 (64) 0.239 35 (63) 0.168 37 (66) 0619
Non-Saudi 45 (50) 66 (73) 63 (70)
Marital status
Married 69 (56) 0.670 85 (69) 0.696 81 (66) 0.050
Unmarried 12 (55) 16 (73) 19 (87)
Hospital type
Public 38 (57) 0.888 48 (72) 0.553 47 (70) 0.692
Private 43 (54) 53 (67) 53 (67)
Hospital class
Tertiary 35 (54) 0.852 45 (69) 0.998 45 (69) 0.812
Secondary 30 (61) 34 (69) 32 (66)
Primary health care 16 (50) 22 (69) 23 (72)
*Pearson Chi-Square;*P value less than 0.05.
S. Mohammed Basheeruddin Asdaq, A. A.S, Mohd. Imran et al. Saudi Journal of Biological Sciences xxx (xxxx) xxx
6
ive during this difficult period. Nonetheless, there is also room for
progress in terms of anxiety reduction.
The participation of their colleagues is a fascinating finding
made by healthcare professionals. Around a third of them feel that
not all of their colleagues are actively participating in the COVID19 pandemic management. The healthcare professional is likely
to be under additional stress as a result of the pandemic, and, as
a consequence, they feel they’re not receiving the help they need
from their colleagues. The shortage of frontline healthcare staff is
the source of the problem’s magnitude. The proposed strategy for
improving COVID-19 staffing could include a call for all experts –
retired practitioners with vital expertise, skills, and attitudes – to
assist in delivering holistic treatment for COVID-19 patients
(Legido-Quigley et al., 2020; Valdez and Nichols, 2013). This will
enable hospitals to expand their capacity and accept more patients.
It could be suggested that requests for volunteers, such as healthcare interns and students who are willing and have worked in a
clinical environment, be made to overcome the shortage of frontline health care workers.
COVID-19 received a positive attitude from 78 percent of
healthcare professionals. This result is close to that of other Chinese studies (Jiang et al., 2018). A large majority of healthcare professionals believe Saudi Arabia will defeat COVID-19. Saudi
Arabia’s authorities took the requisite measures to prevent the
spread and lethality of COVID-19 starting in March 2020. According to the estimated number of cases in the provinces and regions,
the regulations and restrictions have changed and updated from
time to time. Riyadh, the capital and most populous city in Saudi
Arabia, has the largest number of confirmed cases. However, owing
to the combined efforts of the public and authorities, the situation
is still under control and is expected to improve in the coming
days. The Kingdom of Saudi Arabia had removed many of the
COVID-19 restrictions at the time of this study. Saudi Arabia,
according to the healthcare professionals who took part in this
report, will be able to successfully tackle the pandemic.
Unfortunately, 56% of the participants say that they were not
given enough training to combat the pandemic. The pandemic’s
onset was so abrupt that officials did not have enough time to
implement the requisite plans and actions to prepare health care
professionals. However, healthcare professionals must be qualified
to prevent and monitor the spread of this infectious disease
(Allegranzi and Pittet, 2007). Authorities and policymakers have
taken a range of steps to prepare practitioners in the latter half
of 2020 and early 2021. Overall, the participant’s mean practice
score was over 77 percent, suggesting that proper practice was
present among the healthcare staff.
The practices of healthcare professionals were found to be largely acceptable, regardless of their demographic characteristics
or knowledge scores. Also, the practice had a clear correlation with
their attitude. This result is similar to one from a similar study in
China, which found that 89.7% of healthcare staff adopted proper
COVID-19 practices (Zhang et al., 2020). Furthermore, since they
are the most susceptible to infection, they can not disregard their
defense at work by adopting best practices (Wang et al., 2020b).
We discovered a strong positive association between knowledge and attitudes in the current study, which is consistent with
previous COVID-19 research (Salman et al., 2020; Kumar et al.,
2020). However, our study’s magnitude of correlation was poor,
close to a previous Indonesian report (Sari et al., 2020). This is possible since, while knowledge is critical in shaping attitudes, it is not
the only factor to be considered. The relationship between attitudes and practices was found to be greater, meaning that promoting knowledge alone is inadequate, and that successful strategies
to improve practices should concentrate on promoting both appropriate knowledge and positive attitudes.
Since this study only involved a limited number of healthcare
professionals in the Riyadh region of Saudi Arabia, the results
should be viewed with caution. Furthermore, self-reported practices may not be correct, necessitating further analysis. Also, since
the pandemic situation is still changing, some new items considered essential for handling COVID-19 will need to be added to
make the tool for evaluating KAP more comprehensive and
accurate.
5. Conclusions
According to this study, there is a correlation between healthcare professionals’ knowledge of COVID-19 and the use of effective
clinical practices. The attitude of healthcare professionals is
directly linked to their practice. As a result, despite having more
knowledge, a more positive attitude at the place of practice is
needed. During the COVID-19 pandemic response, education and
training on prevention and protective measures are also needed
to promote positive attitudes and better work practices.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared
to influence the work reported in this paper.
Acknowledgment
The authors are thankful to AlMaarefa University for providing
support to do this research.
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