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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 17  |  Issue : 2  |  Page : 67-72

Knowledge, attitudes, and practices among older adults of Urban Rajasthan toward COVID-19: A cross-sectional survey


1 Department of Geriatric Medicine, SMS Medical College, Jaipur, India
2 Department of Community Medicine, SMS Medical College, Jaipur, India
3 Department of General Medicine, SMS Medical College, Jaipur, India
4 Asian Centre for Medical Education, Research and Innovation, Jodhpur, Rajasthan, India

Date of Submission24-Jun-2021
Date of Decision19-Jul-2021
Date of Acceptance17-Aug-2021
Date of Web Publication22-Oct-2021

Correspondence Address:
Dr. Sunny Singhal
Department of Geriatric Medicine, SMS Medical College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_18_21

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  Abstract 


Introduction: With no effective treatment in sight, preventive measures are the only effective way to fight coronavirus. As older adults are highly vulnerable in this pandemic, it is essential to understand and identify gaps in their knowledge, attitudes, and practices (KAP) regarding COVID-19 to address them. The study aimed to assess KAP among older adults of urban Rajasthan toward COVID-19 infection and its vaccination. Materials and Methods: The online cross-sectional survey was conducted in June 2021 using a questionnaire with close-ended questions on COVID-19 infection and vaccination with a convenience sample of 100 older adults above 60 years residing in Rajasthan. The questionnaire was developed and validated using Google Forms and circulated via social media. Results: The mean age of the participants was 68.2 years. Seventy-four were male and 72 had educational qualification graduate and above. They demonstrated a moderate level of KAP toward the coronavirus infection. However, <5% had completely correct score on either knowledge, attitude, or practices. Knowledge, attitude and practices of subjects regarding vaccination were good. 97% of the participants received at least one dose and 95% agreeing to recommend it to others too. However, only 36% knew that vaccine does not decrease immunity. Conclusion: Although older adults had reasonably good KAP relating to coronavirus infection and its vaccination, there are still some misconceptions and malpractices. Further, information, education, and communication activity can promote their positive attitude toward preventive measures into good practice of self-imposed lockdown.

Keywords: Attitudes, COVID-19, knowledge, older adults, practices, vaccination


How to cite this article:
Goyal LK, Sharma DK, Wadhwani D, Singhal S, Mathur A. Knowledge, attitudes, and practices among older adults of Urban Rajasthan toward COVID-19: A cross-sectional survey. J Indian Acad Geriatr 2021;17:67-72

How to cite this URL:
Goyal LK, Sharma DK, Wadhwani D, Singhal S, Mathur A. Knowledge, attitudes, and practices among older adults of Urban Rajasthan toward COVID-19: A cross-sectional survey. J Indian Acad Geriatr [serial online] 2021 [cited 2021 Nov 27];17:67-72. Available from: http://www.jiag.com/text.asp?2021/17/2/67/329019




  Introduction Top


As the second wave of coronavirus hit India, a rapid surge of cases in India, including the state of Rajasthan, occurred. With its high mortality rate in older adults, it has become a geriatric pandemic. Although some treatment strategies have been developed, prevention remains the key to decrease causalities, in the absence of a potent antiviral. However, several older adults are still not informed entirely or are not following proper guidelines for prevention, isolation, and treatment of COVID-19. With the focus on managing acute infection, the chronic comorbidities of older adults such as diabetes, hypertension, cognitive decline, depression, frailty, and others get overlooked. These uncontrolled comorbidities are known to be a risk factor of severe infection in older adults.[1] The first coronavirus vaccine was launched in India in January 2021.[2] However, there has been a significant vaccine hesitancy among people which has led to poor vaccination rates.[3] All of these factors are contributing to the raging pandemic in India. Furthermore, besides the acute infection, COVID-19 is known to have significant residual symptoms after the resolution of infection known as post-COVID sequelae.[4] Hence, the study was planned to identify these misconceptions and malpractices to be addressed later by targeted educational campaigns.

The study aimed to assess the knowledge, attitudes, and practices (KAP) of older adults of urban Rajasthan toward COVID-19 infection and its vaccination.


  Materials and Methods Top


The current study is a cross-sectional descriptive survey study conducted among the elderly (>60 years) of urban Rajasthan in June 2021. Considering the COVID-19 pandemic and its lockdown, it was not possible to do a door-to-door survey. Hence, we decided to do an online survey, thereby preventing physical contact and infection risk to both the participants and the investigators. The study included all older adults above the age of 60 years with sound mental health and the ability to understand and answer the questionnaire. It did not include people below the age of 60 years and living outside Rajasthan. The Institute Ethics Committee approved the study. Informed consent was taken from all participants.

An online questionnaire was developed in English using the Google Forms website (https://docs.google.com/forms/). The questionnaire was translated into Hindi – using a standard translating procedure so that every participant could understand the questionnaire easily. The questionnaire comprised sociodemographic information, followed by KAP questions related to COVID infection and vaccination. For general questions, a COVID-19 questionnaire used in Indian population[5] was used as a reference with modifications and additions. It was a close-ended questionnaire with questions asked by using yes, no, or maybe. The questionnaire was reviewed by a panel of experts including geriatricians and public health specialists, to assess for relevance. The questionnaire was modified based on review, and the final form was then disseminated for data collection.

Data collection

The access web link of the questionnaire along with a clear message stating its background, objectives, description of procedure, risks and benefits, voluntary participation, and confidentiality, was shared via social media. We also requested and encouraged the participants to share the questionnaire with their social contacts and fill it out, including the perspectives of family members and friends who were unable to use digital electronic media.

Sample size calculation

As COVID is a new word for the elderly, no literature is available to calculate sample size. Assuming that 50% know about coronavirus and its practices, a sample size of 100 was calculated considering the power of 80%, alpha error of 0.05, and absolute error of 10%.

Statistical analysis

Statistical analysis was done by Stata software version 12 (StataCorp. 2011. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP). Relevant descriptive statistics such as frequency, mean, standard deviation, range, and percentage of sociodemographic and KAP data were reported.


  Results Top


A total of 136 people filled the survey, out of which 36 were excluded due to age <60 years or incompletely filled survey. [Table 1] details the demographic characteristics of participants. The mean age of the population was 68.2 years. Seventy-four were male and 72 had educational qualification graduate and above. All of them were from urban locality (100%) and were either retired from government service (54%) or were self-employed (36%).
Table 1: Sociodemographic characteristics of participants

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Knowledge, attitudes, and practices toward COVID-19 infection

[Table 2] provides details of the knowledge, attitudes and practices of the subject towards COVID-19 infection. Regarding the knowledge items, only 4% of the participants were able to answer complete correct answers. Almost all the participants had heard about coronavirus (100%) or its symptoms (92%). Seventy-eight percent knew that COVID is a respiratory disease, however, majority were aware about the fever (90%) and dry cough (82%) being the symptoms of coronavirus infection. Most of the respondents knew that it may be spread by direct contact (95%) or by infected surfaces (94%), and 97% knew that regular washing of hands and staying at home can prevent the infection. However, only 28% knew that there are currently no effective antibiotics against COVID-19, and 46% knew that wearing gloves is not better than washing hands in prevention. Ninety-seven percent of the respondents were aware that older people are more susceptible, while 94% and 87% knew that it is dangerous for persons of weak immune system and with uncontrolled comorbidities. Sixty-five percent agreed that blood sugar may get high during the infection. Regarding post-COVID symptoms, 89% were aware that mild weakness and dry cough may persist for few days after infection, however, only 58% were aware that these symptoms resolve on their own.
Table 2: Knowledge, attitudes, and practices toward COVID-19 in participants

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Regarding the attitude, 77% were concerned about coronavirus and 79% felt that lockdown and quarantine are necessary. Ninety-four percent reported that they would take the COVID infection seriously, and 86% reported that COVID does not always cause death. While 93% of the respondents thought that drinking alcohol does not reduce the infection, only 8% and 5% felt the same about hot water and steam inhalation. Sixty-six percent considered the positive effect of kadha, while 6% denied it. While only 38% reported that patients with post-COVID symptoms are not infective, 85% understood that these usually do not require hospitalization.

Regarding their comorbidities, 83% and 91% of the respondents understand that they need to monitor blood pressure and blood sugar, respectively, during the infection. However, 29% understand that they need not routinely change the medication dose, and 80% know that they should not change the dose on their own. However, none of the participants had a complete positively answered attitude.

Similarly, concerning practices, 96% keep distance, 98% wear masks, 92% avoided crowds and wash hands regularly, and 98% do not shake hands now. Fifty-three percent had consulted doctors for their chronic comorbidities, and 61% have done tests as advised. However, only 70% follow dietary advice and exercise as recommended by a doctor, and 79% are taking medicines as advised. Overall, only one participant was following completely correct practice.

Knowledge, attitudes, and practices toward COVID-19 vaccination

[Table 3] provides details of the knowledge, attitudes and practices of the subject towards COVID-19 vaccination. Regarding knowledge about COVID vaccines, 81% reported that vaccines effectively prevent infection and 72% reported them to be effective in preventing severe infection. Seventy-two percent know muscle pain, fever, and headache to be common side effects of the vaccine, 93% understand that these side effects are mild and resolve on their own, and 89% know that severe side effects are not expected. Ninety-eight percent of people understand that people need to wear masks and practice social distancing even after vaccination. However, only 36% knew that immunity does not get decreased after vaccination. Eighteen percent of the participants reported complete, correct knowledge about vaccination.
Table 3: Knowledge, attitudes, and practices toward COVID-19 vaccine in participants

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In terms of attitude, 93% understand that it is necessary to get vaccinated, 80% understand that one dose of vaccine is not sufficient, and 69% agreed that the vaccine should be taken even if previously infected. Sixty-one percent understand it to be effective against the new variants, and 95% will recommend it to others. Ninety-seven percent said that they would wear masks even after vaccination. Forty-two percent of the respondents had complete positively answered attitude.

Ninety-seven percent had received at least one dose of the vaccine, while 68% had received both doses, most of whom (74.7%) had received from government setup. Only 4.26% of the vaccinated individuals reported significant side effects. Among the three people who had not received their vaccine, two said that they were waiting for better vaccine, while one gave the reason due to its side effects.


  Discussion Top


We assessed the KAP among older adults toward COVID-19 infection and vaccination in the current study. We found that majority of the elderly are aware of coronavirus infection, its symptoms (including post-COVID sequelae), transmission, and its high risk to the elderly and immunosuppressed and multimorbid adults. As a result, majority knew that while coronavirus does not always cause death, it still needs to be taken seriously. Similarly, most of them were aware of precautions such as social distancing, handwashing, and masks. This reflects the result of aggressive awareness campaigns being taken by both the central[6] and state[7] governments continuing since the last year.

However, there are still gaps in people's knowledge and practices. As seen in our study, many participants still consider that there is an effective antibiotic for the infection and do not know the importance of washing hands over wearing gloves. Notably, only a few participants were aware of no role of hot water or steam inhalation in preventing infection. Similarly, many elderlies did not know the risk of hyperglycemia during infection. They hence did not consult their doctor or perform the advised tests for their comorbidities (such as diabetes and hypertension). A considerable number of senior citizens are also not following recommended dietary, lifestyle, or medication advice. Overall, <5% provided completely correct answers in the knowledge, attitude, or practice domain. Thus, there is room for improvement and information, education, and communication (IEC) campaigns need to be more focused and tailored according to the older adults. Media, especially social media, is an easily accessible, low-cost platform that can help in rectifying misinformation, misconceptions, and malpractices among older adults.

We also found that majority of the participants were concerned about the coronavirus and felt that lockdown or quarantine is necessary. This shows that older people are aware of the importance of lockdown and quarantine, and thus, the government may promote the practice of self-imposed lockdown among them. As lockdown has caused significant economic losses to the country,[8] this can therefore help the government in protecting the most vulnerable section while also keeping the economy open. A modeling study done by Teslya et al. reported that adoption of self-imposed prevention measures, as a result of information dissemination and awareness, can be an effective strategy to mitigate and delay the pandemic.[9]

Another positive effect of awareness campaign[10] can be seen by older people's KAP toward coronavirus vaccination. Most of the participants were aware of the efficacy and mild side effects of the vaccine and the need to maintain COVID-appropriate behavior even after vaccination. It was also worth noting that most of the respondents had received at least one dose of the vaccine and would be recommending it to others. However, there was common misinformation among participants that their immunity gets lowered for few days after vaccination and thus needs to be educated about through IEC.

We also found that majority of the respondents believed in kadha's role in preventing infection. Kadha refers to an ayurvedic decoction drink prepared by the extraction of various herbs and is part of complementary and alternative medicine. A recent survey showed that around 60% of the COVID-infected patients drink kadha.[11] However, as there is no standard preparation for this concoction and no clinical trial showing its efficacy, its use is questionable. However, it highlights the widespread popularity of alternative medicine among Indian older adults; thereby, it is vital to engage these health-care practitioners in spreading awareness and home care management.

The strength of our study is the exhaustive questionnaire which consisted of clear and concise questions covering all the aspects of COVID-19 infection and vaccination. To our knowledge, this is the first KAP study on COVID infection which is focused on the Indian elderly.

Limitations

There are few limitations to the study. As our study was quantitative in design, all questions were close ended. However, to have a detailed understanding of the misconceptions and malpractices, a qualitative survey with open-ended questions may be better. However, we could not do a door-to-door survey or focus group discussion because of the physical limitations owing to lockdown. As this is an online survey, many elderly who are not familiar with or not have access to internet, were not able to participate in the study.


  Conclusion Top


In this KAP study, older people of urban Rajasthan showed sufficient knowledge, positive attitude, and correct practices about COVID-19 infection and its vaccination. However, some glaring gaps need to be corrected through focused IEC campaigns on the elderly. The positive attitude of older adults toward lockdown and quarantine can help the government in promoting self-imposed preventive measures among them while not imposing mandatory lockdowns for all.

Acknowledgment

The authors would like to thank Munshi Roopram Memorial Foundation Jaipur and HelpAge India Rajasthan for their help provided in collection of data. We are also grateful to the participants in the study for their enthusiastic participation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Coronavirus | Narendra Modi to Launch Pan-India Rollout of COVID-19 Vaccination Drive on January 16. The Hindu; January 14, 2021. Available from: https://www.thehindu.com/news/national/pm-modi-to-launch-pan-india-rollout-of-covid-19-vaccination-drive-on-january-16/article33576441.ece. [Last accessed on 2021 May 25].  Back to cited text no. 2
    
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Logue JK, Franko NM, McCulloch DJ, McDonald D, Magedson A, Wolf CR, et al. Sequelae in adults at 6 months after COVID-19 infection. JAMA Netw Open 2021;4:e210830.  Back to cited text no. 4
    
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Pandey DK. Coronavirus | COVID-19 Awareness Campaign Aims to Reach Out to 90 Crore People. The Hindu; October 13, 2020. Available from: https://www.thehindu.com/news/national/covid-19-awareness-campaign-aims-to-reach-out-to-90-crore-people/article32846113.ece. [Last accessed on 2021 Jun 18].  Back to cited text no. 6
    
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Jaipur June 25 DAW, June 25 2020 UPDATED: 1st 2020 16:29. Rajasthan Govt Runs Awareness Campaign against Covid-19, Urges People to Upload Photos Wearing Mask. India Today. Available from: https://www.indiatoday.in/india/story/rajasthan-govt-runs-awareness-campaign-against-covid-19-urges-people-to-upload-photos-wearing-mask-1692640-2020-06-25. [Last accessed on 2021 Jun 18].  Back to cited text no. 7
    
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Teslya A, Pham TM, Godijk NG, Kretzschmar ME, Bootsma MC, Rozhnova G. Impact of self-imposed prevention measures and short-term government-imposed social distancing on mitigating and delaying a COVID-19 epidemic: A modelling study. PLoS Med 2020;17:e1003166.  Back to cited text no. 9
    
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