Discussion
The KAP plays a crucial role in dealing with major global health challenges like pandemics. India has suffered considerable losses in terms of human fatalities and economic growth due to the COVID-19 pandemic. As the scientific community attempts to find a cure to the disease, the population’s knowledge, attitudes, and practices are of foremost importance when it comes to combatting the virus. Our study shows the trend of these variables in the general population attending a tertiary care hospital for various cardiac surgeries, which is considered a high-risk subgroup for coronavirus infection.
Our study reported significantly lower knowledge scores among the older population (≥50 years) and illiterate individuals, similar to the study conducted by Christy et al. in South India 4. The younger population probably has better social and print media access which may explain their better knowledge. The most common source of information about COVID-19 were televised programs, the world web, local press, and social media 5,6. In recent times social media have emerged as the primary source of information, followed by web sources and scientific papers 7,8. The above explains the higher scores of knowledge, attitudes, and practices in the educated subgroup.
Narayanaswamy et al. 9 studied the KAP scores among cardiac patients at a tertiary hospital in South India. They did not find any difference in the level of knowledge in the urban patients compared to the rural individuals. They also reported a lower level of practice in rural and urban participants, unlike in our study, where the level of knowledge, attitudes, and practice was significantly higher in urban patients. It may be explained by the inadequate reach of awareness in rural areas due to lesser access to newspapers, media, and healthcare.
Pal et al. 10 studied the KAP among another high-risk subgroup of Type 1 Diabetes mellitus. They also concluded that the level of knowledge was significantly higher in the educated and urban patients. Younger patients were found to have average knowledge, positive attitude, and healthier practices for preventing COVID-19. Less-educated individuals residing in rural areas generally tend to have wider gaps in KAP 11,12. Differences in knowledge and behavior among urban and rural residents can result from socioeconomic incongruity between them 13.
In a study conducted among medical students, Maheshwari et al.3 reported appropriate knowledge, positive attitude, and acceptable practice toward COVID-19. Even in this educated study population, the knowledge level was better in the younger age subgroup (21-23 years). Unlike our study, Ferdous et al. 14found a better level of knowledge among the older participants in a study conducted in Bangladesh. However, when compared to the place of residence, the findings were similar to our study, wherein the urban individuals fared much better in terms of better knowledge, positive attitude, and healthier practices.
Our study shows that the rise in knowledge improves attitude and practices in the urban and educated subgroups of cardiac surgical patients. This is similar to the finding in the Korean study conducted by Lee et al. 15.
A study by BS Tomar et al. 16 stated a strong relationship between gender and knowledge score towards COVID-19. This could be explained by underlying confounding factors such as education level and occupation, providing better information access. Contradictory to the above study, the KAP survey in the Saudi community by Al Hanawi et al. 17 showed better knowledge, positive attitude, and good practice among females toward non-pharmacological preventive measures. This could be explained by the assumption that women were more apprehensive about the adverse effects of the vaccine than contracting COVID-19 18; however, in our study, we were unable to find any disparity in KAP scores in relation to the gender of the participants.
Individuals with higher knowledge about the disease and modes of transmission are associated with a more positive attitude and perception 19. Participants with better knowledge about disease tend to have a superior attitude reflected in their better perceptions of preventive actions, resulting in active engagement in positive practices. Several previous KAP surveys performed for various infectious diseases reported identical associations 19,20,21. A Chinese study demonstrated that higher education corresponds to better knowledge scores, but a similarly designed population survey of the Iranian population had varied conclusions 22,23.
According to Ntontis E et al. 24, poor knowledge, improper information, and deceit can result in hysteria and may cause panic buying. Such hysterical buying may break health supply chains as a shortage of sanitizers, masks, and essential drugs 25. However, patients in our study did not witness any shortage of cardiac medications at district-level pharmacies and were not involved in stockpiling.
Beliefs about COVID-19 are acquired from variable sources such as public discussions, knowledge about similar viral diseases, governmental outreach programs, social and print media, community experiences, and healthcare sources. The factuality of these beliefs and hence, knowledge determine the attitude and thus the practices for prevention of COVID-19 infection. It varies significantly in the population depending upon age, place of residence, and education, as shown by our study4.
The awareness campaign must be designed to reach people of all age groups equally and effectively, irrespective of their education status and place of residence. For instance, visual depiction of guidelines and awareness through audio campaigns may help target people with varying literacy levels. Social fabric among the community produces everlasting interpersonal bonds, which nurtures empathy and a sense of caring for others 26.
The limitation of our study was a smaller sample size, which could be justified by the fact that the study group was exclusive, and the number of elective cardiac surgeries declined during the lockdown. Regression analysis was not done to establish whether the level of knowledge corroborated with the attitude and practices in each subgroup.