Potential impact of great lockdown on students’ knowledge, attitude and practices towards the COVID-19 outbreak

Introduction

The emergence of the novel COVID-19 coronavirus disease has become a global health concern. COVID-19, caused by SARS-CoV-2, was first detected in Wuhan city, China.^1–4 The most significant risk associated with COVID-19 is its potential to cause a severe acute response that may result in death. Epidemiological studies have revealed that the virus is spread, transmitted, and gains host entry by various means.^2,5–8 COVID-19 has directly impacted numerous sectors, such as public health, the economy, and education. During the early stages of the outbreak, higher education institutions responded in different ways, with some having strong reactions that disproportionally impacted students who experience anxiety. For example, students from the Imam Abdulrahman Bin Faisal University (IAU) responded to the unprecedented preventive measures that were enforced by the Saudi Arabian government to control the spread of COVID-19. However, students’ responses to non-therapeutic protective measures are significantly influenced by their knowledge, behavior, and attitude toward the disease. While poor understanding and risk perception of COVID-19 among community sectors, such as educational institutes and healthcare providers, may significantly increase disease spread and infection levels,^9–11 high knowledge and awareness levels among students can limit the disease spread.¹² Baloran¹³ reported that non-therapeutic interventions should be highly effective during a pandemic. In a study conducted during the MERS-CoV pandemic, Al-Mohaissen¹⁴ reported that most Saudi Arabian university communities were aware of the disease’s epidemiology and symptoms; however, there was less awareness regarding the preventive measures that could limit its spread. Olaimat¹⁵ reported that university students in Jordan had adequate knowledge regarding COVID-19 infection, with significant levels of knowledge observed among postgraduate students using the internet, social media, and mass media as sources of COVID-19 information.

In early March 2020, Saudi Arabia announced its first COVID-19 case. Subsequently, all on-premise educational activities, including at IAU, were suspended, with all activities becoming virtual.¹⁶ Several studies have been conducted on medical and non-medical university students in Saudi Arabia, including during the lockdown period, to explore their knowledge, awareness, and attitudes towards COVID-19.^17–20 On a community level, major precautions to combat the spread of the virus were taken by several countries, including Saudi Arabia. Several researchers have attempted to monitor the citizens’ knowledge levels and behaviors during lockdown periods.^21–27

This research aims to determine the impact of the lockdown on IAU students’ knowledge regarding COVID-19’s transmission methods and symptoms and their attitudes and practices regarding preventive measures during their study. Emphasis was placed on the impact of social media and family as sources of COVID-19 knowledge and awareness. Furthermore, this study documents the behavior changes of IAU students during the lockdown period, particularly their interaction with infected or individuals suspected of being infected, with a focus on student anxiety.

Methods

Results

Knowledge levels regarding COVID-19 infection

Figure 1 demonstrates participants’ knowledge levels regarding COVID-19 pre- and post-lockdown. Pre-lockdown, the mean knowledge score was 73.2%. Post-lockdown, this increased to 81.5%.

Figure 1. Students’ knowledge levels regarding COVID-19 infection.

Figure 2a and 2b show the distribution of the participants who received information about COVID-19. Pre-lockdown, 23.3% of participants had received information on the disease. Post-lockdown, this increased to 51.2%.

Figure 2. Participants who received information on COVID-19 infection: before lockdown (a) and after lockdown (b).

Figure 3a and 3b depict the sources of information used by students regarding COVID-19. All sources of information increased in use post-lockdown except for newspaper. University studies contributed to the awareness of16.3% of students pre-lockdown and 44.2% post-lockdown.

Figure 3. a: Sources of information regarding COVID-19 infection before lockdown. b: Sources of information regarding COVID-19 infection after lockdown.

Regarding information sources and their effects on participants’ knowledge, Table 6 shows no statistically significant differences between knowledge and any information sources pre-lockdown. However, two sources of information significantly affected participants’ knowledge post-lockdown; university studies (t = 2.149, p = 0.038) and friends (t = 2.6, p = 0.013).

Table 6. Differences between participants’ knowledge regarding sources of information.

Variable	N	Before lockdown Mean ± SD	N	After lockdown Mean ± SD
Did you get your information about the disease from social media?
Yes	39	74±10.4	42	81.3±7.9
No	4	65.6±5.9	1	87.5±0
t	2.462		-0.777
p	0.055		0.441
Did you get your information about the disease from radio & TV programs?
Yes	18	75±11.1	29	81.6±8.5
No	25	71.9±9.7	14	81.1±6.4
t	0.970		0.220
p	0.338		0.827
Did you get your information about the disease from newspapers?
Yes	8	73.1±10.7	1	70±0
No	35	73.2±10.4	42	81.7±7.7
t	-0.022		-1.501
p	0.983		0.141
Did you get your information about the disease from university?
Yes	7	76.1±12.5	19	83.68+8.3
No	36	72.6±10	24	78.7±6.8
t	0.801		2.149
p	0.428		0.038*
Did you get your information about the disease from friends
Yes	27	75.1±11.1	2.611	83.7±8.2
No	16	71.9±9.8	2.611	77.7±5.5
t	1.001		2.611
p	2.6		0.013*
Did you get your information about the disease from family?
Yes	17	73.1±10.4		82.7±8.5
No	26	73.3±10.5		78.1±4.7
t	-0.056		1.777
p	0.956		0.083

* Significant at p<0.05.

Discussion

Protection against a highly contagious disease, such as COVID-19, requires strict adherence to guidelines and rules, particularly regarding non-therapeutic interventions. Application of such measures requires adequate knowledge, attitudes, and practices on an individual and community level.^12,17,23 The present study assessed the influence of lockdowns on IAU students’ awareness levels during the COVID-19 pandemic. The majority of the participants, who were preparatory year students, were aged between 17–20 and 21–23 years old. As young students are considered to be typically asymptomatic carriers and tend to have more social lifestyles, they may play a significant role in the dissemination of the disease, particularly among their colleagues, family, and friends.^8,12

Assessment of participants’COVID-19 knowledge indicated that knowledge regarding different methods of COVID-19 disease transmission (e.g., sneezing, touching, and coughing) greatly improved following lockdown. The role of coughing and sneezing in disseminating the virus has been reported by several health agencies and organizations.^29,30 This increase in knowledge demonstrates the crucial role played by Saudi authorities in disseminating this knowledge during lockdown.²³

The participants in this study showed a good understanding that water, soil, meat, contact with domestic animals, camels, and seafood are not involved in the infection process. However, misconceptions about the cause of COVID-19 have been reported among other students.^29,30,12 All participants acknowledged that good personal hygiene and regular handwashing were important ways to protect themselves from COVID-19. Khasawneh et al.³¹ indicated that maintaining good personal hygiene and regular handwashing are the first lines of defense against COVID-19. IAU students demonstrated increased awareness levels regarding social distancing, avoiding hugging, wearing masks, and limiting person-to-person contact and increased knowledge of COVID-19 symptoms post-lockdown, supporting the international regulations and national precaution preventive measures that were put in place during lockdown.^{1,2,7,12,30,32–34} In a study assessing COVID-19 knowledge, attitude, and practices among the public of Saudi Arabia, approximately half of the respondents were unaware that COVID-19 could spread from person to person via aerosols.²³ However, a study in Qassim found that 90.1% of participants were aware of person-to-person transmission.¹⁸ Moreover, in other studies, 90% of undergraduate students in China and 79% of undergraduate students in Indonesia acknowledged the role of respiratory droplets in disease transmission and increased infection risk.^3,35

In the current study, the participants demonstrated significant knowledge levels regarding the three major COVID-19 symptoms. Post-lockdown, fever and shortness of breath were correctly identified by all participants, while cough was identified by almost all. Similar results have been observed among the Saudi Arabian public, Saudi Arabian medical interns, Chinese undergraduate students, and in the Qassim region, with 94.75%, 96%, 98.6%, and 97.4% of respondents in these groups correctly identifying coughing as a symptom.^18,19,23,35 Additionally,89.7% Indonesian undergraduate students correctly identified cough and fever as COVID-19 symptoms.³

Knowledge regarding COVID-19 drugs and vaccines was satisfactory among the current study participants; only a small number believed there was a vaccine against the infectious agent. Similarly, 96% of the Saudi Arabian public knew there was no clinically approved treatment for COVID-19.²³ Unfortunately, during the time of the current study, Singh et al.¹² reported that 92% of students were aware that no vaccine exists for COVID-19.

Social media and TV programs demonstrated significant impacts on the dissemination of knowledge and information regarding COVID-19 infection post-lockdown. Furthermore, the influence of social relationships with family and friends in providing COVID-19 information increased improved by 2.3-fold and 1.5-fold, respectively, post-lockdown. The influence of friends was particularly significant among 17–20-year-olds. Similarly, the role of IAU in improving students’ knowledge increased 2.7-fold, particularly among 17–20-year-olds. As expected, newspapers were not significantly used as sources of information pre- or post-lockdown.

Similarly, a cross-sectional study by Sobaih et al.³⁷ cited the impact of social media usage during COVID-19 and its importance in promoting social learning among students from nine public higher education institutions in underdeveloped countries. In a case study, Hashim et al.³⁸ reported that social media, particularly television broadcasts, were viewed as the most trusted source of information among approximately 147 students from a Malaysian technical university. A cross-sectional study analyzing the COVID-19 knowledge, attitudes, and practices of students from the University of Sharjah, United Arab Emirates, reported that the internet and social media were major sources of information for 85.2% of health-related and non-health-related students.³⁹ Khasawneh et al.³¹ carried out a cross-sectional study involving students from six medical schools in Jordan, revealing that social media (83.4%) and online research engines (84.8%) were the preferred sources of COVID-19 information among the students. The preference of students to share verified COVID-19 information with family and friends via social media, which can be considered a third-party method of information, is an interesting finding.

The current study’s results indicated that the influence of family and friends in providing COVID-19 information increased following lockdown. However, mutual knowledge exchange between students and their families may occur, particularly regarding COVID-19 information.¹² Saud et al.⁴⁰ noted the importance of social media platforms as ab easy and accessible way to disseminate COVID-19 information between family and friends.

The current study revealed that IAU students experienced increased levels of anxiety due to COVID-19, particularly around having contact with IAU colleagues. Furthermore, an increased level of absenteeism was observed following lockdown. On the contrary, students in Japan were less anxious due to their adherence to precautionary behaviors.⁴¹ The impacts of lockdown on students’ mental health and the need for psychological support have been reported by many researchers.^42–48 The assessment of IAU students’ responses toward suspected or infected persons indicated a high level of awareness regarding the importance of following strict safety and protective measures. However, research on how individuals react towards other individuals with COVID-19 is scarce; this is an area that requires further investigation.

Conclusions

The frequent variation in the COVID-19 genome has led to the requirement of different vaccine types, reflecting the importance of preventive measures in mitigating the risks associated with COVID-19 infection. Students’ lack of knowledge regarding the nature of the disease and the precautions that should be taken may have increased disease spread. The findings of the current study suggest that IAU preparatory students had acceptable levels of knowledge, awareness, and attitudes toward COVID-19 infection. The results highlight the impact of media on the improvement of preventive measure uptake. Students’ COVID-19 knowledge may be significantly improved if a proactive health education program is designed for them. The work presented in this study can serve as the basis for the construction of awareness programs that can act as efficient non-therapeutic interventions for students with limited basic pandemic knowledge.

Data availability