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.