Abstract
Introduction
The spread of COVID-19 worldwide gave rise to one of the largest evolving pandemics in modern times. Analysis of data from countries grappling with established epidemics has demonstrated that health workers (HWs) face elevated levels of COVID-19 mortality and morbidity. As a result, it is crucial to equip healthcare providers with the necessary knowledge, attitudes, and preventative practices (KAP) related to mitigating the spread of disease among themselves. This research sought to evaluate the KAP of HWs regarding their occupational exposure to COVID-19, as well as the socio-demographic factors associated with KAP scores.
Methods
This online cross-sectional survey was conducted between July and August 2022, among 312 HWs at five sites of the Health and Research organisations that are operating in the North-West and Gauteng Provinces of the Republic of South Africa (SA). The sites included the cities and towns of Klerksdorp, Rustenburg, Johannesburg, Kempton Park, and Pretoria. A self-administered online questionnaire was distributed among nurses, physicians, pharmacists, community workers, administrative staff, laboratory staff and research assistants. The RedCap web-based software application tool was used to create a survey. The necessary written informed consent form, and the questionnaire was sent as a link via the Health Research organisation’s communication email. The online questionnaire consisted of four main sections: (i) socio-demographic characteristics (S1-S8), (ii) source of information (I1-I4), (iii) knowledge (K1-K15), attitudes (A1-A15), and (iv) practices (PR1-PR15). A convenient sampling method was used for the selection of HWs for participating in the study.
The researcher reviewed the completed questionnaires on the RedCap web-based application tool for data completeness and then exported these in a Windows MS Excel sheet. Stata 16.1 statistical software was used for data cleaning, coding, and analysis. The final analysis included (i) descriptive analysis to summarise the HW’s socio-demographic characteristics, (ii) Cronbach’s alpha to assess the reliability and validity of the study questionnaires, (iii) exploratory factor analysis to assess the validity of the KAP scores, and (iv) binomial logistic regression analysis to identify socio-demographic indicators that were independently associated with KAP scores. The frequencies and percentages for categorical variables were presented in the descriptive analysis, while the continuous variables were represented by mean ± standard deviation or mean and interquartile ranges. Data for the logistic regression analysis model were presented as crude and adjusted ratios with confidence intervals (95%) and p-values. A p ≤ 0.05 was considered significant for statistical comparisons, and all were two-tailed-sided.
Results
A total of 270 HWs working at the Health and Research organisation completed the online web-based questionnaire, with an 86.5% response rate. Of the five sites that took part in the study, the Kempton Park site provided most of the participants (48.5%). More than 60% (165 of 270 or 61.1%) of HWs who took part in the study were females, with the majority (85.1%) being black African, single (73.1%), with a diploma (25.4%) or bachelor’s degree (21.1%), and
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44.2% belonging to the age group between 26 and 35 years. Over 60% of HWs (63%) reported having been employed at the Health and Research organisation for one to five years, with more community workers (26%) and researchers (17%) responding to the survey than other professions. Most HWs reported the news (60%) as the most reliable source of information for COVID-19 infection, followed by social media (21%) and the workplace (10%).
The overall mean score for knowledge, attitudes, and practices among the HWs at the Health Research organisation was 9.86 ± 1.89 (SD), 10.56 ± 2.29 (SD), and 10.74 ± 2.97 (SD), respectively. The Cronbach’s alpha to measure the reliability of questions on knowledge was 0.75, attitudes were 0.67, and practices were 0.75. Overall, 44% (95% CI: 38.1-50.2) of HWs had good knowledge about COVID-19 infection; 35% (95% CI: 29.5-41.2) had a positive attitude towards COVID-19 and 47.4% (95% CI: 41.3-53.5) reported acceptable preventative COVID-19 practices.
In a logistic regression analysis model, the odds of having good knowledge increased among HWs who worked as nurses (OR: 5.33, 95% CI: 1.63-17.49, p = 0.006), laboratory workers (OR: 3.33, 95% CI: 1.00-11.12, p = 0.050), and those who have a diploma (OR: 3.33, 95% CI: 1.14-9.73, p = 0.028). HWs who worked at the Pretoria site tended to have poor knowledge about COVID-19 infection (OR: 0.09, 95% CI: 0.01-0.74, p = 0.025). The odds of having positive attitudes towards COVID-19 practices increased among HWs who worked as doctors and who belonged to the white race group (OR: 6.25, 95% CI: 1.48-26.39, p = 0.013, OR: 2.64; 95% CI: 1.02-684, respectively). Additionally, the odds of reporting acceptable COVID-19 preventative practices increased among HWs working at the Kempton Park site (OR: 5.65, 95% CI: 2.31-11.90, p = 0.000), who have worked for 6 to 10 years (OR: 1.99, 95% CI: 1.03-3.85, p = 0.042), have a diploma (OR: 4.56, 95% CI: 1.48-14.00, p = 0.008), have a certificate (OR: 5.65, 95% CI: 1.75-18.21, p = 0.004) and work as community workers (OR: 9.08, 95% CI: 3.45-23.89, p = 0.000).
Conclusion
The study found that most of the staff at the Health and Research organisation do not have good knowledge, attitudes or practices relating to COVID-19. There are gaps in KAP among employees in the organisation. Training to improve employees’ skills and create awareness will benefit the organisation’s health and safety of all staff members. Therefore, interventions should be put in place to increase staff members’ preventative practices regarding COVID-19.