Summary
Introduction: In December 2019, a new variant of coronavirus was identified in Wuhan city, China. It was named Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), and the disease it caused was defined as Coronavirus disease-2019 (COVID-19). The attitude of people and their knowledge level play an important role in coping with pandemics. Determining the level of public knowledge is also critical for identifying gaps in disease protection and strengthening disease prevention efforts. The present study aimed to describe the general knowledge regarding COVID-19 and the attitude toward the disease among patients applying to an otolaryngology clinic approximately one year after the COVID-19 pandemic.
Materials and Methods: We prepared a questionnaire comprising two sections with a total of 19 items. The first section had questions regarding demographic data including age, sex, education level, and job, and the second section had questions assessing knowledge and attitude toward COVID-19. Each correct answer was assigned 1 point; incorrect answers or unknown answers were assigned 0 points. A participant could receive a total knowledge score of 0-19; higher scores indicate better knowledge of COVID-19.
Results: A total of 404 participants were included in our study. The median knowledge score among all participants was 15.0±3.0. There was a statistically significant difference between primary school and university graduates (p<0.05) and between secondary school and university graduates in terms of knowledge scores (p=0.012). Similar to the primary and secondary school graduates, high school and university graduates differed significantly in terms of knowledge level (p=0.0001).
Conclusion: The mean rate of correct answers among patients regarding knowledge and perception questions on COVID-19 was 77.67%. Our results demonstrated that the sample we selected from the patients visiting our otolaryngology clinic had a high COVID-19 knowledge score. The average knowledge score was possibly high in our study owing to the fact that the participants were mostly university graduates (52.5%).
Introduction
Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) are the fatal pulmonary diseases caused by coronaviruses. Severe acute respiratory syndrome-CoV was first detected in China in 2002-2003, infected approximately 8500 individuals, and had a fatality ratio of 10%. In 2012, the MERS-CoV outbreak emerged in Saudi Arabia and was three times more fatal than SARS-CoV infection. In December 2019, a new strain of coronavirus appeared in Wuhan city, China; it was named SARS-CoV-2, and the disease it caused was defined as Coronavirus disease-2019 (COVID-19). With rapidly increasing cases, the outbreak evolved into a pandemic, as declared by the World Health Organization (WHO) on March 11, 2020. Although preliminary studies showed that COVID-19 might be transmitted from animals to humans, recent studies suggest that human-to-human transmission can occur via direct contact and respiratory droplets. In addition, it may take 2-14 days for symptoms to appear after exposure[1]. Severe acute respiratory syndrome-CoV-2 belongs to the beta-coronavirus family The provisional case fatality rate for COVID-19 declared by WHO is approximately 3.4%[2].
Of note, public knowledge and awareness are crucial in combating pandemics. In addition, determining the level of public knowledge is critical for identifying gaps in disease protection and strengthening disease prevention efforts[3]. Old age, especially >65 years, and co-morbidities such as heart diseases, lung diseases, and diabetes are risk factors for severe COVID-19. Currently, the primary treatment for COVID-19 involves supportive treatment modalities. Hand washing, using personal protective equipment, and avoiding hand-to-face contamination form hygiene practices that need to be opted to prevent COVID-19[4]. In the present study, we aimed to describe the general knowledge regarding COVID-19 and the attitude of patients visiting an otolaryngology clinic approximately 1 year after the COVID-19 pandemic.
Methods
The study was conducted at the Otolaryngology Department of Malatya Training and Research Hospital between December 16 and December 30, 2020. The study was performed after obtaining approval from the Ministry of Health, Turkey, and from the ethics committee of Malatya Clinical Research Ethics (approval number: 2020/172). Data were collected using a questionnaire prepared according to the guidelines published by the Centers for Disease Control and Prevention, WHO, and Ministry of Health, Turkey. Participants aged >18 years visiting the otolaryngology clinic were included in the study. Initially, we asked all participants if they were aware of the new variant of coronavirus; those who were aware were requested to complete our survey.
The questionnaire comprised two sections, with a total of 19 items. The first section had questions regarding demographics including age, sex, education level, and job, and the second section comprised questions regarding knowledge and attitude toward COVID-19: source from where participants first heard of COVID-19, whether the new coronavirus was contagious, prevention, transmission, incubation period, extra risk situations, isolation, whether the disease could be transmitted to children and young people, prognosis, whether antibiotics were used in COVID-19 treatment and whether consuming garlic and onion could prevent the disease, appropriate mask usage, ways to inactivate the virus, and special information line regarding COVID-19. For all 14 questions, participants were provided the following options to record answers: “yes,” “no,” and “do not know.” Four questions (regarding prevention methods, appropriate mask use, ways to inactivate the virus, special information line) were designed in a multiple-choice format.
Each correct answer was assigned 1 point; incorrect answers or unknown answers were assigned 0 points. A participant could receive a total knowledge score of 0-19; higher scores indicated better knowledge regarding COVID-19. We divided all participants into two groups: the first group (aged <30 years) and the second group (aged >30 years). Then, we determined the rate of correctly responding to questions according to age, sex, profession, and educational status. A total of 404 individuals participated in the survey. All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all participating individuals.
Statistical Analysis
All study data were analyzed using the Statistical Package for Social Sciences (SPSS 17.0) program. Results were expressed as percentage, median, minimum, and maximum values. As the variables were not suitable for the normal distribution of Kolmogorov-Smirnov test statistics (p<0.05), non-parametric test statistics were used. The Mann-Whitney U test was used to compare the two groups, and the Kruskal-Wallis test was used to compare the two groups. In statistical comparisons, an alpha error level of p<0.05 was considered significant.
Results
A total of 404 individuals participated in our study; survey questionnaires were answered face to face. The mean age of participants was 30.3 (±standard deviation: 10.35) years, and approximately 60% of participants were males. In addition, 57.2% of participants were under the age of 30 years. Demographic characteristics of participants including sex, education, and profession are summarized in Table 1. Of all participants, 47.6% had university education and 61.1% had a job. Moreover, 83.9% of participants first heard about COVID-19 through television and 12.6% through social media (e.g., Facebook, Twitter, LinkedIn, and Instagram) (Table 2). Answers of patients visiting the otolaryngology clinic to questions regarding knowledge and perception regarding COVID-19 are shown in Table 3. The median knowledge score of participants was 15.0±3.0. Table 4 shows rates of correct and incorrect answers for each item. The median knowledge score was 14±4 for primary school graduates, 14±4.5 for secondary school graduates, 14±2.5 for high school graduates, and 15±2 for university graduates.
There was a statistically significant difference between the knowledge scores of primary school and university graduates (p<0.05) and between secondary school and university graduates (p=0.012). Similar to primary and secondary school graduates, high school graduates and university graduates had a statistically significant difference in terms of knowledge level (p=0.0001). No statistically significant difference was noted between secondary, primary, and high school graduates regarding knowledge scores (p>0.05). The median knowledge score of individuals working as tradesmen was 14±3 and those working as healthcare personnel was 16±2.75.
When the participants were analyzed according to the rate of correctly answering questions based on their professions, we found a statistically significant difference in the knowledge scores of healthcare workers and tradesmen (p<0.05) (Table 5). We analyzed participants aged <30 years and those aged >30 and found no statistically significantly difference in the knowledge scores between these patient groups (Table 6) (p>0.05).
Discussion
The study was conducted at the Otolaryngology Department of Malatya Training and Research Hospital, the largest and most crowded hospital in Malatya city located in the east of Turkey. In our study, the median knowledge score among participants was 15.0±3.0. Knowledge scores significantly differed by educational levels, with participants with a university degree having higher scores than those with all other educational levels (15±2). The knowledge scores differed significantly between primary school and university graduates (p<0.05) and between secondary school and university graduates (p=0.012). Similar to the difference between primary and secondary school graduates, there was a statistically significant difference between high school and university graduates in terms of their knowledge level (p=0.0001).
Fever, fatigue, dry cough, malaise, and breathing difficulty are the main symptoms of COVID-19[5]. It is crucial to know the symptoms and high-risk conditions as well as to avoid contact with an infected patient and contaminated surfaces. Washing hands and maintaining social distance are the major precautions against the viral infection[2]. Older people and people with chronic illnesses are the most vulnerable population to COVID-19. Thus, people should be aware of who in their social network is at the most risk. The world has gained great experience about COVID-19 since the pandemic began. During the first year of the pandemic itself, researchers rapidly gathered information on the origin, transmission, and progression of the disease[6].
Government have executed numerous efforts to control the transmission speed of COVID-19. These efforts include the following: asking people to stay at home, not to prefer public transportation to prevent any close contact, encouraging the use of masks, and maintaining a suggested distance from people in crowded places; in addition, via various media sources, including television and popular social media platforms, the governments suggested exercises, healthy food consumption habits, and life-style modifications for people staying at home[7].
In Turkey, the first case of COVID-19 was identified on March 10, 2020, and the first death was recorded on March 17, 2020[8]. The Turkish government undertook several precautions against COVID-19 before the disease spread throughout the country. An operation center and a Science Board was created in the first few weeks of January 2020 to closely monitor developments. On January 14, the Turkish Ministry of Health published the “COVID-19 Disease Guide” to provide current and updated information regarding COVID-19 to the society. This guide is regularly updated according to recent developments. After the identification of the first COVID-19 case on March 10, the government announced a curfew for individuals older than 65 years and younger than 20 years from March 22 to April 6 2020. Wearing masks in public areas was made compulsory. Ayhan Başer et al.[9] found that Turkish individuals had adequate awareness and a positive attitude toward COVID-19. In addition, Honarvar et al.[10] determined that 50% of study participants thought that COVID-19 was a serious, fatal disease.
Governments should maintain public health education programs to strengthen knowledge and awareness among the public through multiple channels, especially social media platforms and television. Yue et al.[11] demonstrated that age, sex, education, and marital status were the factors influencing COVID-19 knowledge level and that married participants had a lower level of knowledge than unmarried residents.
We analyzed patients aged <30 years (first group) and >30 years (second group) and examined knowledge scores; we found no significant difference between these groups.
According to KONDA Barometer report, at the beginning of the pandemic in Turkey (March 7-8), people choose television (88%), social media (63%), virtual press (59%), and friends (42%) as their sources of information regarding COVID-19[9, 12]. Like in the study by Sari et al.[7] and as in the KONDA Barometer report[12], the most widely used sources of information in our study were television (83.9%) and social media (12.6%). In the study by Chen et al.[13], participants declared that they received COVID-19 information from social media. In addition, Yue et al.[11] demonstrated that social media was the most important source of COVID-19 information. Olaimat et al.[4] reported that the students in their study chose internet and social media as the main source of COVID-19 information.
Similarly, Alzoubi et al.[14] found that Mutah university students used social media for gaining knowledge regarding COVID-19.
Since the beginning of the COVID-19 pandemic, studies have been conducted to assess the knowledge and attitude levels of people. Chen et al.[13] showed that people had appropriate awareness regarding the major symptoms and transmission of disease as well as regarding proper use of mask, washing hands, and COVID-19 treatment; however, participants had low awareness regarding typical symptoms. Li et al.[15] demonstrated that Chinese people had a moderate level of COVID-19 knowledge. In the study by Yue et al.[11], the knowledge level of participants as 61.9%. Reuben et al.[5] showed that the level of knowledge regarding COVID-19 among Nigerians was appropriate. In another study, Al-Hanawi et al.[3] demonstrated that Saudi residents, especially women, had appropriate knowledge level, had positive attitudes, and good practices toward COVID-19. Olaimat et al.[4] reported that the overall COVID-19 knowledge score among students was 80.1%.
In our study, the mean rate of obtaining correct answers to knowledge and perception questions regarding COVID-19 was 77.67%. Our results revealed that the sample selected from the patients visiting the otolaryngology clinic had a high level of knowledge score regarding COVID-19. The high average knowledge score in our study may also be attributed to the fact that the participants were mostly university graduates (52.5%).
Zhong et al.[16] conducted a survey in China and revealed that the knowledge level among participants was 90%. This high level may be attributed to the highly educated participants enrolled in their study.
In contrast, Srichan et al.[17] found that Thai people had poor knowledge about COVID-19.
In the study by Mbachu et al.[18] conducted among healthcare workers in South-Eastern Nigeria, a great majority of participants (88.59%) had good knowledge and good preventive practices (81.39%). Qadah[19] determined that 88% of healthcare workers had positive knowledge and attitude toward COVID-19. In addition, in the study by Bates et al.[6], Ecuadorian participants had a substantially lower rate of knowledge about COVID-19.
Proper nutrition supports body immunity. Several healthy foods can induce immunomodulatory effects and their benefits cannot be ignored[7]. In their study, Gohel et al.[1] found that approximately 30% of participants considered that eating garlic could protect against COVID-19. In contrast, 33% of the Egyptian population assessed by Abdelhafiz et al.[20] incorrectly believed that consuming garlic can prevent the spread of COVID-19. Unfortunately, 23% of participants in our study believed that consuming garlic and onion could prevent COVID-19, similar to the findings by Gohel et al.[1] and Abdelhafiz et al.[20] Moreover, 27.7% of participants in our study were unaware of whether consuming garlic and onion could protect against COVID-19. Although herbal foods such as garlic and onion have been shown to have beneficial effects on the immune system in humans, we found no clinical studies providing evidence on the direct protective effect of these foods against COVID-19.
In Turkey, the Turkish Ministry of Health established a communication line that served as a direct consultation platform for the public during the COVID-19 pandemic. By directly dialing the phone number 184, people received counseling on COVID-19. In our study, 43.8% of participants were aware that they could get such a consultancy service.
To date, several countries have developed vaccines for COVID-19, and studies have provided promising results on the safety and efficacy of these vaccines. However, this does not mean that we will give up on protective measures. In order for vaccines to work, the community needs to attain a large degree of immunity, and this requires considerable people to be vaccinated and more time as well as living with protective measurements for a while.
Our study is with few limitations. Our study sample was small; thus, our findings may be supported by large patient groups in future studies. We used a self-reporting questionnaire, and the responses were subject to the participant’s honesty and, partly, recall ability; this parameter may have attributed recall bias.
Conclusion
In conclusion, our results suggest that the sample selected from the patients visiting our otolaryngology clinic had a high level of knowledge score regarding COVID-19 and showed positive knowledge and attitude toward the disease.
Ethics
Ethics Committee Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was conducted after obtaining approval of the Ministry of Health in Turkey and approval of the ethics committee in Malatya Clinical Research Ethics (Ethical number 2020/172).
Informed Consent: Was obtained from all participants included in this study.
Peer-review: Externally and internally peer-reviewed.
Financial Disclosure: The author declared that this study received no financial support.