Epidemiology 8 complete worksheet RESEARCH ARTICLE COVID-19 knowledge, attitudes, and practices of United Arab Emirates medical and health sciences stud

Epidemiology 8 complete worksheet RESEARCH ARTICLE

COVID-19 knowledge, attitudes, and practices

of United Arab Emirates medical and health

sciences stud

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RESEARCH ARTICLE

COVID-19 knowledge, attitudes, and practices

of United Arab Emirates medical and health

sciences students: A cross sectional study

Noura Baniyas
1
, Mohamud Sheek-HusseinID

2*, Nouf Al Kaabi1, Maitha Al Shamsi1,
Maitha Al Neyadi

1
, Rauda Al Khoori

1
, Suad AjabID

2
, Muhammad Abid

2
, Michal Grivna

2
,

Fikri M. Abu-Zidan
3

1 United Arab Emirates University, Al-Ain, United Arab Emirates, 2 Institute of Public Health, United Arab

Emirates University, Al-Ain, United Arab Emirates, 3 Department of Surgery, College of Medicine and Health

Sciences, UAE University, Al-Ain, United Arab Emirates

* msheekhussein@uaeu.ac.ae

Abstract

The COVID-19 pandemic is the largest viral pandemic of the 21st century. We aimed to

study COVID-19 knowledge, attitudes, and practices (KAP) among medical and health sci-

ences students in the United Arab Emirates (UAE). We performed a cross-sectional study

between 2 June and 19 August 2020. The survey was distributed online using Survey Mon-

key. It was conducted in English and comprised two parts: socio-demographic characteris-

tics, and KAP towards COVID-19. 712 responses to the questionnaire were collected. 90%

of respondents (n = 695) were undergraduate students, while 10% (n = 81) were postgradu-

ates. The majority (87%, n = 647) stated that they obtained COVID-19 information from mul-

tiple reliable sources. They were highly knowledgeable about the COVID-19 pandemic, but

76% (n = 539) did not recognize its routes of transmission. Medical students were signifi-

cantly more knowledgeable compared with allied health students (P<0.0001, Mann Whitney U test) but there was no difference in knowledge between undergraduate and postgraduate

students (P = 0.14, Mann Whitney U test). Medical students thought that more could be

done to mitigate the COVID-19 situation compared with the allied health students (66.2%

compared with 51.6%, p = 0.002 Fisher’s Exact test). 63% (n = 431) were worried about get-

ting COVID-19 infection, while 92% (n = 633)) were worried that a family member could be

infected with the virus. 97% (n = 655) took precautions when accepting home deliveries,

94% (n = 637) had been washing their hands more frequently, and 95% (n = 643) had been

wearing face masks. In conclusion, medical and health sciences students in the UAE

showed high levels of knowledge and good attitudes and practices towards the COVID-19

pandemic. Nevertheless, they were worried about themselves or their family members

becoming infected. Medical students had more knowledge about COVID-19 pandemic

which was reflected in their opinion that more can be done to mitigate its effects.

PLOS ONE

PLOS ONE | https://doi.org/10.1371/journal.pone.0246226 May 12, 2021 1 / 15

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OPEN ACCESS

Citation: Baniyas N, Sheek-Hussein M, Al Kaabi N,

Al Shamsi M, Al Neyadi M, Al Khoori R, et al.

(2021) COVID-19 knowledge, attitudes, and

practices of United Arab Emirates medical and

health sciences students: A cross sectional study.

PLoS ONE 16(5): e0246226. https://doi.org/

10.1371/journal.pone.0246226

Editor: Jenny Wilkinson, Endeavour College of

Natural Health, AUSTRALIA

Received: January 14, 2021

Accepted: April 24, 2021

Published: May 12, 2021

Peer Review History: PLOS recognizes the

benefits of transparency in the peer review

process; therefore, we enable the publication of

all of the content of peer review and author

responses alongside final, published articles. The

editorial history of this article is available here:

https://doi.org/10.1371/journal.pone.0246226

Copyright: © 2021 Baniyas et al. This is an open
access article distributed under the terms of the

Creative Commons Attribution License, which

permits unrestricted use, distribution, and

reproduction in any medium, provided the original

author and source are credited.

Data Availability Statement: All relevant data are

within the paper and its Supporting Information

files.

Introduction

COVID-19 pandemic is one of the major global threats of the 21st century. Its virus (SARS–

CoV-2) was isolated after causing a cluster of fatal pneumonia cases in Wuhan, China [1]. The

pandemic spread swiftly because of the rapid transportation methods with major global impact

on physical and mental health and on the economy [2–4]. Currently more than 150 million

infected persons and 3 million deaths are attributed to this pandemic [5, 6].

The United Arab Emirates (UAE) was the first country in the Gulf Cooperation Council to

report a COVID-19 case (on January 29, 2020) which was linked to Wuhan [7]. In the UAE,

more than 450,000 infections and 1,470 deaths had been reported to March 28, 2021 [8]. Due

to the initial lack of availability of vaccines at the outset [9], each country adopted various

responses to COVID-19 to slow down transmission and to prevent oversaturation of health-

care systems. The UAE government issued a set of guidelines and preventive measures to fight

the spread of COVID-19, including the closure of borders, educational institutions, and shop-

ping malls; introduction of remote working rules; restriction of public movement; and imple-

mentation of personal hygiene measures including using face masks, social distancing, mass

screening of asymptomatic cases, and contact tracing [10].

If these measures are to be effective, adherence is essential, and this is influenced by people’s

knowledge, attitude, and practices (KAP) towards COVID-19 [11, 12]. KAP towards infectious

diseases, including acceptance of immunization, are associated with emotional reactions

which can affect virus transmission and control [9, 13, 14]. KAP involves a range of beliefs

about the causes of the disease, risk factors, identification of symptoms, and available methods

of treatment and their consequences [15]. These beliefs come from different sources, including

preconceptions concerning similar viral diseases, governmental information, social media and

the internet, previous personal experiences, and medical sources. These beliefs may drive pre-

ventive behaviours that can vary across different populations. Lack of knowledge or false medi-

cal beliefs may carry potential risks [16]. A study from Henan, China, showed that higher

levels of information were associated with more positive attitudes towards COVID-19 preven-

tive practices [16]. Perception of risk is important for prevention of infection during pandem-

ics [17–20].

University students can be a source of increased health awareness and health education not

only for themselves but also for those around them as they take part in the dissemination of

pandemic-related knowledge supporting the prevention and control of the pandemic [21, 22].

Recent studies from Pakistan, Saudi Arabia and Japan have shown that medical students have

sufficient knowledge, positive attitudes, and proactive practices during the COVID-19 crisis

[23–25].

There are more than 138,000 students in the UAE colleges and universities [26]. From

March 2020 their classes were shifted to online learning which was a new learning experience

for them [27]. The students received information regarding COVID-19 by online lectures,

webinars, university websites, LinkedIn, WhatsApp groups, Facebook pages and Newsletters.

A recent study conducted in Sharjah University, UAE, showed that their students demon-

strated adequate knowledge, possessed good attitudes, and had low-risk practices towards pre-

vention of COVID-19 [28]. Nevertheless, this study was limited to a single university in UAE

and included both medical and non-medical students. We thought it was important to study

the KAP towards COVID-19 of medical and allied health sciences students in all UAE.

Accordingly, we aimed to evaluate the knowledge of COVID-19, awareness of preventive

behaviors, practice, and risk perception among the medical and allied health sciences students

in the higher education institutions in the UAE.

PLOS ONE Students and COVID-19 pandemic

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Funding: None.

Competing interests: The authors declare that they

have no competing interests.

Abbreviations: SARS-CoV-2, Severe acute

respiratory syndrome coronavirus 2; COVID-19,

Coronavirus disease 2019; HCW, Healthcare

workers; ICU, Intensive care unit; ILO, International

Labour Organization; IFAD, The International

Fund for Agricultural Development; WHO, World

Health Organization; FAO, Food and Agriculture

Organization; KAP, knowledge, attitudes, and

practices; UAE, United Arab Emirates; UAEU,

United Arab Emirates University.

Materials and methods

Ethical considerations

Ethical approval was obtained from the UAE University Social Research Committee [UAEU

ERS_2020_6119]. Participants’ data were anonymized at the point of registration. No personal

identifiable data were collected.

Study design

This is a cross-sectional study which was conducted among medical and health sciences stu-

dents in the UAE between 2
nd

June and 19
th

August 2020.

Sample size

We developed a sampling frame including the list of all medical and health sciences colleges

and universities in the UAE. As we did not have an access to the information about the num-

ber of students at relevant institutions we were not able to estimate a sample size. As the

method of data collection was an online-based survey, we used a non-probability sampling

approach, namely convenience sampling. The study invitation and survey link were sent

directly to the medical and health sciences colleges and universities in the UAE by e-mail and

circulated on multiple social media outlets including WhatsApp©. Participants were encour-
aged to forward the link to their fellow medical and health sciences students and to post it on

their social media platforms to maximize enrolment. Accordingly, we could not know the

response rate. The study invitation included an introduction, a brief description of the study,

and the link to the questionnaire. Respondents were grouped according to their educational

institutions.

Questionnaire design

The questionnaire was designed and developed in May 2020 based on two similar published

studies [29, 30] and on our own review article which was accepted for publication on 25
th

March 2020 [3]. These three papers contained early knowledge about the COVID-19 pan-

demic. Zhong et al study was published on 15
th

March 2020 and contained 12 questions with

true, false, do not know answers [29] while Taghrir et al study [30] was published on 1
st

April

2020 and contained 15 questions with true/false answers. The attitude and practice sections of

Zhong et al [29] were measured using two questions each (agree, disagree, do not know or yes/

no). The attitude section of Taghrir et al [30] was measured using two items having a 4-point

Likert-type scale while practices were measured by 9 items using a yes/no answer.

Our questionnaire was developed under the direct supervision of an infectious disease

expert which was reviewed by another two experienced epidemiologists, one of them is a quali-

tative researcher. The questionnaire was then piloted among 10 participants for face and con-

tent validity. The questions were then modified, refined, rephrased, and restructured to be

simpler and clearer. The details of our final questionnaire are attached as S1 Appendix. Since

the COVID-19 pandemic is evolving quickly and hence influencing related knowledge and

attitudes we decided to depend on face and content validity, as reliability testing was not

feasible.

Consent was taken from the participants after providing a brief description of the study,

clarifying the voluntary nature of participation, and confirming the declaration of anonymity.

The questionnaire was conducted in English, and comprised two parts: socio-demographic

characteristics and KAP towards COVID-19. The KAP part consisted of 3 sections with a total

of 34 questions, described below.

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Knowledge. This section included 12 multiple choice and true/false questions which

assessed the participants’ knowledge about COVID-19. The items included etiology of the dis-

ease, transmission of the virus, symptoms, incubation period, diagnostic tests, treatment

options, and prevention. In the knowledge section, respondents were given options to answer

true, false, or don’t know.

Attitude. This section included 6 questions which assessed the participants’ attitudes

towards the COVID-19 pandemic using a Likert scale. This was coded as follows: strongly dis-

agree = 1, disagree = 2, undecided = 3, agree = 4, strongly agree = 5. Items included fear of get-

ting infected, stigma around infected individuals, government measures, and participants’

confidence in the measures.

Practice. This section included 16 questions which assessed the participants’ practices related

to COVID-19 using multiple-choice questions, yes/no questions, and a Likert scale. The items

were related to practices and compliance with preventative measures and precautions imple-

mented by the government, such as social distancing, wearing face masks, and hand washing.

Statistical analysis

Knowledge level was calculated as follows: incorrect or uncertain responses were given a score

of 0, and correct answers were given a score of 1. Choosing a correct answer along with an

incorrect answer was given a score of 0.5. The total score for knowledge ranged from 0 to 26,

with high scores indicating better knowledge of COVID-19. Poor practices were given a score

of 0, and good practices were given a score of 1. Choosing a good practice with a bad practice

was given score of 0.5. The total score for practices ranged from 0 to 25, with high scores indi-

cating better COVID-19 practices.

Continuous data were presented as median (range) while categorical data were presented as

number (%). Percentages were calculated from the actual available responses. Continuous data

(age and scores) did not have a normal distribution, hence nonparametric statistical methods

were used to compare different groups as such methods analyse the ranks, do not need a nor-

mal distribution, and can be used for small groups. Categorical data of two independent

groups were compared using Fisher’s Exact test. while continuous data of two independent

groups were compared using Mann-Whitney U test [31]. We used the Statistical Package for

the Social Sciences (IBM-SPSS version 26, Chicago, Il) for statistical analyses. A p value

of < 0.05 was accepted as statistically significant.

Results

A total of 712 responses to the questionnaire were collected. Table 1 shows the detailed

demography of the participants. 90% (n = 695) of respondents were undergraduates, while

10% (n = 81) were postgraduates. The majority of respondents (87%, n = 647) obtained

COVID-19 information from multiple sources, 7% (n = 52) obtained it from social media,

while the rest 6%, (n = 48) relied on either medical platforms, healthcare professionals, govern-

ment media briefings, or university newsletters. 406 respondents (57%) attended webinars to

learn more about COVID-19.

Table 2 shows the comorbidities and COVID-19 history of the participants. 8% of the par-

ticipants who were tested for COVID-19 had a positive result. 85% (n = 506) had had a family

member or friend who was tested for COVID-19, of which 15% (n = 89) had a positive result.

Knowledge

A total of 712 respondents completed the knowledge section of the survey (Table 3). 76%

(n = 539) of participants did not recognize the correct routes of transmission of COVID-19,

PLOS ONE Students and COVID-19 pandemic

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although the majority of respondents correctly recognized its symptoms, average incubation

period, best diagnostic test, and its management (95%, 85%, 89%, 89% and 70% respectively).

The majority of the respondents were aware of the COVID-19 preventative measures, includ-

ing methods to reduce viral spread, isolation of positive cases, N95 mask use limited to health

care workers, and the necessity of following preventative precautions among young adults and

children (83%, 92%, 84%, and 87% respectively).

There was a highly significant difference in the overall scores representing knowledge on

COVID-19 between medical students and allied health students (median (range) 17.5 (8.5–23)

score compared with 16.5 (5–22.5), P<0.0001, Mann Whitney U test). This represented a 22%

difference of the mean rank which is considered as a practical difference. There was no

Table 1. Characteristics of respondents of the KAP survey collected between 2nd June and 19th August 2020.

Variables� Median or Number Range or %

Age (years) 20 (16–48)

Gender

Male 108 14%

Female 690 86%

Nationality

UAE 480 60%

Non-UAE 315 40%

Emirate of residence

Abu Dhabi 421 54%

Dubai 125 16%

Sharjah 94 12%

Ajman 60 8%

Ras Al Khaimah 55 7%

Fujairah 15 2%

Um Al Quwain 6 1%

Academic affiliation

UAE University (CMHS) 247 32%

Fatima College of Health Sciences 169 22%

RAK Medical & Health Sciences University 116 15%

Sharjah University 77 10%

Mohammed Bin Rashid University 48 6%

Gulf Medical University 46 6%

Ajman University 24 3%

Other Colleges 49 6%

Speciality

Medicine 431 56%

Nursing 117 15%

Pharmacy 49 6%

Physiotherapy 45 6%

Dental 44 6%

Radiology and Medical Imaging 21 3%

Biomedical Sciences 20 3%

Medical Laboratory Technology 17 2%

Others 29 4%

�All variables are expressed as number (%) except age which is expressed as median (range)

https://doi.org/10.1371/journal.pone.0246226.t001

PLOS ONE Students and COVID-19 pandemic

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significant difference in knowledge scores between undergraduate and postgraduate students

(median (range) score 17.25 (5–23) compared with 17.5 (7.5–22.5), P = 0.14, Mann Whitney U

test) (Fig 1).

Attitude

A total of 686 respondents completed the attitudes section of the survey (Table 4). 63%

(n = 431) of participants were worried about getting COVID-19 infection, while the vast

majority (92%, n = 633) were worried that a family member could get infected with the virus.

67% (n = 461) of the respondents thought that infection with the virus is associated with

stigma. 83% (n = 570) agreed that the current measures taken by the UAE government are

effective in stopping the spread of the infection, and 89% (n = 614) were confident that the

UAE will be able to stop the spread of the virus. Nevertheless, 60% (n = 288) thought that

more measures could be implemented such as aggressive screening, full lockdown, further

education for the public, monitoring the media, and combatting rumors. Some were opposed

to the lockdown and suggested relaxing restrictions.

There were no significant differences in any of the negative attitudes between the medical

and allied health students or undergraduate and postgraduate students (Table 5). Nevertheless,

the medical students thought that more can be done to mitigate the situation compared with

the allied health students (176/266 (66.2%) compared with 112/217 (51.6%), p = 0.002 Fisher’s

Exact test). This difference was not significant between the undergraduate and postgraduate

students (261/435 (60%) compared with 27/49 (55.1%), p = 0.54 Fisher’s Exact test).

Practices

A total of 677 respondents completed the practices section of the survey (Table 6). 60%

(n = 407) did not attend family gatherings, and did not visit shopping malls, coffee shops,

industrial areas, hospitals or COVID-19 facilities for volunteering. 97% (n = 655) took precau-

tions when accepting home deliveries, 94% (n = 637) had been washing their hands more

Table 2. Comorbidities and COVID-19 history of the KAP survey respondents.

Variable Number (%)

Personal chronic condition

Asthma 28 37%

Diabetes 10 13%

Hypertension 5 7%

Inflammatory bowel disease 3 4%

Migraine 3 4%

Polycystic ovary syndrome 3 4%

Others 24 32%

Personal history of COVID-19

Tested for COVID-19 = yes 160 92%

Tested positive = yes 13 8%

Household history of COVID-19

Asymptomatic 16 19%

Quarantined with mild symptoms 57 67%

Admitted to hospital with severe symptoms 6 7%

Admitted to ICU with severe symptoms 3 4%

Died 3 4%

https://doi.org/10.1371/journal.pone.0246226.t002

PLOS ONE Students and COVID-19 pandemic

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frequently, and 95% (n = 643) had been wearing face masks. Meanwhile, out of 666 respon-

dents almost all followed curfew timings set by the UAE government (99% (n = 658)). Overall,

most medical students and allied health sciences students followed proper practices.

There was no significant difference in the COVID-19 practice scores between medical stu-

dents and allied health students (median (range) 15 (0–25) score of compared with 15 (0–25),

P = 0.15, Mann Whitney U test, and between undergraduate and postgraduate students

(median (range) score of 15 (0–25) compared with 15.5 (0–24), P = 0.3, Mann Whitney U test)

(Fig 2).

Discussion

Our study has shown that the majority of medical and allied health students at UAE were

knowledgeable about COVID 19, worried about getting infected or having a member of their

family infected, and had proper practices and precautionary measures for preventing COVID-

19. Nevertheless, medical students were more knowledgeable about COVID-19 and thought

that more can be done to mitigate the COVID-19 situation compared with allied health stu-

dents. There was no difference in knowledge, attitudes, or practices towards COVID-19 pan-

demic between undergraduate and postgraduate students.

Table 3. Responses to the survey on COVID-19 knowledge.

Statement Correct Incorrect/

Uncertain

Total�

n (%)� n (%)�

COVID-19 is a new disease caused by virus SARS-CoV-2. 570 80% 142 20% 712

Answer: True
Which animal is most likely to transmit this virus to human? 633 89% 79 11% 712

Answer: Bat, Pangolin, or Civet Cat
SARS-CoV-2 can be transmitted between humans by the following routes? 173 24% 539 76% 712

Answer: Respiratory droplet, or surfaces
Which of the following are COVID-19 symptoms? 679 95% 33 5% 712

Answer: Fever, Dry cough or with sputum, Shortness of breath, Nausea, Vomiting, diarrhea, Loss of taste or smell, Runny nose
What is the average incubation period of COVID-19? 602 85% 110 15% 712

Answer: 7–14 days
What is the best diagnostic test for COVID-19? 636 89% 76 11% 712

Answer: RT-PCR
COVID-19 can be treated by using the following: 500 70% 212 30% 712

Answer: Antiviral, Anti-malarial, or Convalescent plasma transfusion
Which of the following can reduce the spread of COVID-19? 591 83% 121 17% 712

Answer: Social distancing, Self-isolation, Wearing face masks, or Avoiding crowded places
People who are asymptomatic and COVID-19 test positive must stay at home until they are free of the infection: 653 92% 59 8% 712

Answer: True
Who should wear N95 masks? 601 84% 111 16% 712

Answer: Healthcare professionals who are dealing with COVID-19 patients
Persons with COVID-19 cannot transmit the virus to others when a fever is not present. 635 89% 77 11% 712

Answer: False
It is not necessary for children and young adults to take measures to prevent infection from COVID-19 virus. 616 87% 96 13% 712

Answer: False

Percentages may not total 100 because of rounding

�Percentages were calculated out of 712, which is the total number of respondents who completed the knowledge items

https://doi.org/10.1371/journal.pone.0246226.t003

PLOS ONE Students and COVID-19 pandemic

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A recent study of Sharjah University students [28] compared COVID19–related KAP

between students of health-related and non-health related majors. Similar to our study, it was

carried out during the early period of the pandemic. Students of health-related majors had

higher knowledge about the COVID-19 pandemic and used face masks more compared with

students of non-health related majors, despite both groups having the same attitudes [28]. A

study from 10 universities in China reported that knowledge of COVID-19 was significantly

higher in public universities and among medical majors compared with in private colleges and

among non-medical majors [22]. In contrast other studies from Japan [25] and India [32] did

not show any differences between medical and non-medical students. The high knowledge

about COVID-19 among medical and allied health students in the UAE is similar to findings

reported from Japan [25], Saudi Arabia [24], Portugal [33], and Pakistan [23] (96%, 86%, 82%,

72% respectively). These studies used different sets of questions to explore the KAP among

Fig 1. Box-and-whiskers plot of overall score for knowledge comparing medical students with allied health students

(A) and undergraduate students with postgraduate students (B). The box represents the 25th to the 75th percentile

IQR. The horizontal line within each box represents the median. ��� = p < 0.0001, Mann-Whitney U test, ns = non

significant.

https://doi.org/10.1371/journal.pone.0246226.g001

PLOS ONE Students and COVID-19 pandemic

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