To the best of our knowledge, this is the first study in India which was done at state wide level to examine the KAP towards COVID-19 among general residents. The area of study is especially important given the impact of disease on the mankind with world leaders quoting the pandemic an important landmark in history of world, dividing the timelines into pre-corona and post-corona period. The study findings shall be utilized by the state government to effectively design future course of action in wake of COVID-19.
In the study we found an overall high correct rate in the knowledge questionnaire, indicating that most respondents are knowledgeable about COVID-19. High correct rate of knowledge in relation to COVID-19 among Jharkhand residents was not unexpected. Jharkhand state was 28th state in the country to report COVID positive patient [23]. The state was reportedly corona free till 31st March 2020 when the nationwide coronavirus death toll climbed to 32 while the number of cases had spiked to 1251, which is approximately two months after the reporting of 1st case in the country [24]. The transmission rate of COVID-19 in the state is also low when compared to the national average. As of 17th May 2020, there are only 101 active COVID-19 positive cases in the state. Serious situation of the epidemic and the overwhelming news reports on this public health emergency are also responsible for high correct rate of knowledge and good practices. The high level of awareness among study population regarding COVID-19 has been reported from other studies too [16, 19, 25]. However, many areas of concern have been identified based on the survey findings. Still 100% of the population is not aware of the symptoms related to COVID-19 and days taken to appear the symptoms. It is empirical for everybody to understand basic symptomatology since shorter the time taken to report to a screening centre the lesser will be the spread and the health effects. It is unknown to many that elderly age groups and those with the co-morbidities are more prone of getting infected. Several studies have shown that patients with older age and co-morbidities like hypertension, diabetes, cardiovascular disease and respiratory system disease need careful observation and early intervention to prevent the potential development of severe COVID-19 [26, 27]. These groups should especially be reached to make them more responsive towards implementing self-prevention measures. Ways of viral spread and suitable distance to be maintained with other people were not recognized by significant number of the participants. R naught value of the disease is higher than one, implying a faster and rapid spread of disease before it ceases down [28]. Addressing issues related to the spreadibility of disease will help prevent its exponential spread given the highly contagious nature of disease. Still one fourth of the participants were unaware of government guidelines on mandatory usage of face masks indicating a gap in framing, implementation and publicizing of the novel laws. Markets are these days floated with various kind of sanitizers with repots coming that many not following specifications required for prevention against COVID-19 [29, 30, 31] It is imperative for public to understand type of sanitizers to be used so that they do not stay in swag that they are adequately protected after using any sort of sanitizer available in the market.
The majority of the participants also held a hopeful attitude towards the COVID-19 pandemic. Most of them believed that COVID-19 will finally be successfully controlled, and had confidence that India will ultimately get though the situation. This is in synchronization with the results of another study carried out in another region of India where people also held optimistic attitude about the disease [32]. The confident attitude of the Jharkhand residents could be related to the unprecedented COVID-19 control measures such as country-wide lock down, mandatory wearing of masks and banning of pan masala by the state of Jharkhand, sealing of hotspots, developing dedicated COVID-19 hospitals with isolation, quarantine and management facilities for COVID-19 infected and suspected patients, sanitization drives and rigorous contact tracing of which enhance people’s confidence in winning the battle against the virus. [33]. Similar to results of another study carried out in China, in our study also respondents feared of death the most among all age groups [34]. The fear among participants to a certain extent is being answered in newer government campaigns that emphasize upon increasing body’s immunity so that even if the disease is encountered one may remain asymptomatic and apparently well. Also, gradually with increased understanding of the disease, we have more treatment options and better recovery rates [35, 36, 37]. Newer campaigns should definitely take into the account social stigmas attached to the disease. For example “Hate Disease but not the Diseased” is already been promoted across COVID-19 campaigns [38].
Sound knowledge and optimistic attitude of the participants was also reflected in their practices in this period [16, 17, 18, 19]. But there are concern areas; especially mask hygiene should be emphasized; firstly, wearing a mask for their as well as others safety is important and secondly, that outer surface of mask should never be touched. Also, indigenously developed corona tracker mobile application “AarogyaSetu” is not been used by all. Rigorous emphasis on its utility among masses in terms of daily updates, self-risk assessment and option for applying of e-pass could prove beneficial. Source of information for more than half of participants was government recommendations or state run online dashboards. It confirms that national and state governments are putting efforts to connect and reach to the people.
Age of the participants did have an impact on the knowledge of participants but the practices did not significantly improved with increasing age. Since, it can be assumed that people of all groups were sensitized and worried in the present scenario so everyone tried to perform good practices. Females out-performed their male counterparts as far as knowledge regarding COVID-19 was tested [16]. However, male participants performed significantly better practices than the females. The possible reason could be that in India, socio-cultural beliefs enable males to go out of home more frequently than females for daily routine chores or employment related work so they keep themselves more equipped and follow healthy hygiene practices more religiously. However, since females get more time to stay at homes and use internet so are more aware than the males.
At present there are generic awareness campaigns being carried out throughout the country and in the state as well. These campaigns are not been designed keeping in mind the felt needs, current knowledge and practice being performed by the residents. The areas identified with a knowledge lag could be specifically targeted using behavioral change communication techniques. The domains where already acceptable knowledge levels have been reached can only be targeted through sensitization and re-enforcement strategies. The future campaigns should definitely take into account the socio-cultural and economic context into account. Key stakeholders like non government organizations which are active in the region can be involved suitably. Many people believe that corona is going to stay for longer. Hence future information education communication/behavioral change communication campaigns should be more than just awareness raising campaigns government [25, 39]. They should also teach people on how to live with corona in times to come. Social taboos related to COVID-19 infection among residents should also be addressed so that people do not avoid visiting COVID screening facilities. Development of standard operating procedures for all job sectors shall help in early resumption of services to ease down financial worries besides preventing spread of corona at the workplaces. [40, 41]. Social media was source of information for significant proportion of population. Hence, social media platforms like WhatsApp and Facebook should be utilized for dissemination of authentic updates on COVID-19.
The study was a web based survey of the KAP practices among the residents of Jharkhand state, India. Opinion of considerable population which might not have an access to internet might have been left in the survey. However, the large sample size involved in the study validates the findings to an extent. Responses from all ages, educational & occupational classes and economic strata have been received with varying proportions that corresponds to their population size. There was possibility of hawthorne effect in this study but clause of anonymity and study being an online survey would have limited the bias. The study also touched the areas related to mental health, economic issues but did not take an elaborated opinion. Hence future studies examining impact of COVID-19 on mental health and economic aspects of individuals can be planned to bring a comprehensive policy or guidelines in relation to pandemic. Health impact of COVID-19 on should be assessed to reorient health care delivery system in the current situation demanding limited mobility of people.