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Knowledge, Attitude, and Practice (KAP) towards social distancing in pandemic Covid 19 among construction workers in Central India

Dr Neelam Chandwani Bajaj1*, Dr Manish Shrigiriwar2, Dr Suyog V Jaiswal3, Dr Samir Dwidmuthe4

1MDS Faculty, Dentistry Department, All India Institute of Medical Sciences Nagpur, Maharashtra, India

2 Professor, Forensic Medicine and Toxicology, All India Institute of Medical Sciences Nagpur, Maharashtra, India,

3Associate Professor, Psychiatry, All India Institute of Medical Sciences Nagpur, Maharashtra, India.

4Associate Professor, Orthopaedics, All India Institute of Medical Sciences Nagpur, Maharashtra, India.

*1[email protected]

ABSTRACT

The high probability of getting panic and bewildered by hearing the information from various informal and formal sources, makes it questionable in predicting the social distancing being practiced in the workers as most of them are uneducated or less educated.

Aim: This study aims to assess the knowledge, attitude, and practice level of social distancing among laborers working at construction site and its correlation with their education level.

Methodology: This cross-sectional survey was conducted on 250 construction labourers attending screening OPD of Medical College. A predesigned, self-developed, semi-structured questionnaire was used.Chi square test was used for testing statistical significance.

Results: 90.8% had knowledge about social distancing. 98.8% of participants believed that they would be affected by the disease by not practising social-distancing. Only 20.82 % of the participants could always follow social distancing at different work places.

Conclusions: The practice of social distancing is poorly followed despite a good knowledge among the participants. The knowledge, attitude and practice may be independent of education.

Keywords: attitude, knowledge, practice, social distancing, labourers

Introduction

The novel coronavirus (SARS-CoV-2) that causes COVID-19 has spread rapidly since emerging in late 2019, leading the World Health Organization (WHO) to declare the disease a global pandemic on March 11, 2020. [1]Governments across the world had to instantly adapt and respond to contain the transmission of the virus and provide medical care for the populations who have already been infected. Various measures of intervention like lockdown, travel restrictions, isolation, quarantine, shutting down of non-essential trades, social distancing etc are being followed at the national level to slow down the spread of pandemic.

Social distancing specifically involves avoiding public gatherings, limiting the number of visitors at home, keeping a safe distance from other people, avoiding unnecessary travels etc. [2] Social distancing is a non-pharmaceutical infection prevention and control intervention implemented to avoid contact between those who are infected with a disease-causing pathogen and those who are not, so as to stop or slow down the rate and extent of disease transmission in a community. This eventually limits the spread, morbidity and mortality due to the disease. [3]

There are millions of workers involved in construction work in India. They constitute the most unguarded segment amongst the unregulated workforce in the country. Most of the construction workers are migrants and landless labourers from economically weaker regions of India [5]. Quick adoption and implementation of preventive measures has led to confusion and panic amongst the major population. The high probability of getting bewildered by hearing the information from

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 19746 - 19757 Received 20 July 2021; Accepted 05 August 2021.

various informal and formal sources makes their predictability in practicing the precautionary measures completely questionable. [3, 4] The collection of information on the KAP of labourers regarding practicing social distancing and other measures to limit the spread of Covid 19 will give insight into the available knowledge among this group. For effective control and attenuating the effects of Covid 19, the timely epidemiological data specifying on practice of social distancing from labourers will help the authorities to design healthcare programs, vigorous policies and conciliations to control the spread of any pandemic disease in future. This study aims to assess the knowledge, attitude, and practice (KAP) level of social distancing among laborers working at construction sites.

Methodology

Study Design and Sample

This cross-sectional survey was conducted on 250 construction labourers. The goals, methodology, and protocols of the project were clarified to the participants. The he Institutional ethical committee approval was obtained for the study. (IEC/Pharmac/114/20).

Written informed consent was obtained from all the participants. They were assured of the confidentiality of the collected data.

Sample size:

As no similar study has been reported in the current study setting on social distancing practices of construction workers in Central India, the prevalence of favourable knowledge was empirically considered as 50% for calculating sample size. Considering 20% relative error and 5% alpha error and expected prevalence 50% and design effect as 2, the minimum sample size was calculated as 194. Further considering non-response rate as 20%, minimum sample size came as 234.

Sampling design:

As the participants attended out-patient department of one tertiary care institute for carrying out their routine formalities before leaving workstation (based on the existing Government guideline), this opportunity was used for incorporating the participants in this research. Two fixed days (Mondays & Thursdays were arbitrarily selected every week for data collection. On each day, a total of 25 participants were consecutively selected starting from a random point, and thus a total of 250 participants were included in this study after 10 days of data collection over 5 weeks.

The questionnaire was prepared in regional languages (Hindi and Marathi) and was distributed according to the language opted by the participant. Discrepancy between the two versions of languages was corrected and equivalence of measuring was ensured for all questions through a bilingual researcher. Only those participants who were willing to fill the questionnaire were recruited. The participants who were illiterate or did not know how to write, the questions were verbally read out to them by interviewer and the responses were noted. Data was collected using a semi-structured questionnaire which was prepared and validated by face and content.

The components of questionnaire comprised of four sections, namely 1) socio- demographic data that surveyed age, gender, qualification, home town and job title. 2) Questions related to knowledge. 3) Attitude towards Impact of not following social distancing. 4) Practice towards social distancing in day-to-day movements like at home, work place, market place, playground and travelling.

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Statistical Analysis:

Data was entered and analysed in Microsoft Excel spread sheet. Patient characteristics such as age was described as mean (SD) and factors like gender and education are summarized as frequencies and percentages (Table 1). Distribution of practice of social distancing measures in day-to-day movement was compared across demographic characteristics using Chi square/

Fischer Exact Chi square test. P value less than 0.05 was considered for statistical significance.

Results

A total of 250 participants participated in the study. Out of the total, 240 (96%) were males, 10 (4%) were females. The average age was 30.9 years (Standard Deviation (SD=11.3). (Table 1).

Other demographic characteristics are detailed in Table 1.

Result of Knowledge Assessment

A total of eight items were used to measure knowledge which included about awareness on Covid 19, modes of spread of COVID 19, reason for lockdown implementation, preventive measures, source of receiving information on social distancing, asymptomatic nature of illness, curability of the disease, and vaccine availability. Participants were given options like yes /no /not sure for these items. A correct response was assigned marks 1, while an incorrect or not sure response was assigned 0 points.

Assessment of knowledge

1. 100 % of population was well aware of pandemic Covid 19.

2. 65.1 % of population had the correct knowledge about the modes of spread of Covid 19.

3. 100 % of population had the correct knowledge about the reason of lockdown in country.

4. 90.8% of the population believed that social distancing is one of the best measures to prevent spread of pandemic.

5. 47.2% agreed in asymptomatic nature of the disease.

6. 72.4% believed that at present Covid is not curable.

7. 90% of the population believed that vaccine for Covid is not available.

8. 63.4 % of the population agreed in prevention of Covid due to various measures.

9. 78.61% of the population had highest scored knowledge.

Assessment of Attitude(Figure 1).

Participants were asked one question to measure the attitude with 04 different options. Each option was assessed by the scale of agree, disagree or not sure. Score 1 was given for the answer agreed and score 0 was given for disagree or not sure. Maximum score calculated for that question was 4 and minimum score was 0. Full score of 4 in attitude assessment was achieved by 32.8% of population only.

Assessment of Practice: (Figure 2)

Practices towards social distancing in day-to-day activities like a) work place b) Home c) market d) playground and e) travelling was measured. The options for each question were always, almost, often, sometimes, never. It shows that only 20.82 % of the participants could always follow social distancing at different places like work, home, market, playground, travel. Whereas 7.4% of the population could never follow social distancing at different work places. (Table 2 , Table 3)

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 19746 - 19757 Received 20 July 2021; Accepted 05 August 2021.

Age (years) N (frequency) Percentage %

15-35 191 76.4%

35-60 56 22.4%

>60 3 1.2%

Gender

N (frequency) Percentage %

Female 10 4

Male 240 96

Total 250 100

Education categories

N (frequency) Percentage %

Illiterate 78 31.2

Primary 53 21.2

High school 60 24

Higher secondary 37 14.8

Graduate 18 7.2

Post graduate 4 1.6

Total 250 100

Table 1: Demographic Characteristics

Gender P value Agegroups P value

Following social

Male 205/85.4

0.18

0-15 1 0.52

female 7/70.0 16-30 124

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distancing at home

212/84.8% 31-50 73

51-59 9

>60 5

212/84.8%

Not following social

distancing at home

Male 35/14.6 0-15 0

16-30 22

31-50 16

51-59 0

>60 0

38/15.2%

female 3/30.0 38/15.2%

Following social

distancing at market

Male 18/7.5

0.19

0-15 0 0.09

16-30 12

31-50 6

female 2/20.0 51-59 0

20/8.0 >60 2

20/8.0 Not following

social

distancing at

Male 222/92.5 0-15 1

16-30 134

31-50 83

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 19746 - 19757 Received 20 July 2021; Accepted 05 August 2021.

market 51-59 9

female 8/80 >60 3

230/92 230/92%

Following social

distancing at playground

Male 47/19.6

0.42

0-15 0

0.87

16-30 32

31-50 16

female 3/30.0 51-59 1

50/20.0 >60 1

50/20.0 Not following

social

distancing at playground

Male 193/80.4 0-15 1

16-30 114

31-50 73

51-59 8

female 7/70.0 >60 4

200/80.0 200/80.0

Following social

distancing at travel

Male 30/14.0

0.15

0-15 0

0.52

16-30 21

31-50 10

51-59 0

female 2/40.0 >60 1

32/14.5% 32/14.5%

Not following social

Male 185/86% 0-15 1

16-30 105

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distancing at travel

31-50 72

51-59 8

>60 2

188/85.5%

female 3/60%

188/85.5%

Following social

distancing at work

Male 58/24.2 1.0 0-15 0

0.64

16-30 39

31-50 17

female 2/ 20.0 51-59 3

60/24.0 >60 1

60/24.0 Not following

social

distancing at work

Male 182/75.8 0-15 1

16-30 107

31-50 72

female 8/80.0 51-59 6

>60 4

Table 2: Correlation of gender and age with practicing social distancing at different places.

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 19746 - 19757 Received 20 July 2021; Accepted 05 August 2021.

Education Following social

distancing at home

Not following social distancing at home

Probability

0.81

illiterate 66 12

primary 46 7

High school 48 12

High sec 32 5

graduate 16 2

PG 4 0

total 212 38

Following at market Not following at market 0.42

illiterate 3 75

primary 4 49

High school 7 53

High sec 5 32

graduate 1 17

PG 0 4

total 20/8.0 230/92.0

Following at playground Not following at playground

0.12

illiterate 14 64

primary 9 44

High school 9 51

High sec 9 28

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Table 3: Education level of participants and its correlation with practising social distancing at different places

graduate 8 10

PG 1 3

total 50/20.0 200/80.0

Following at travel Not Following at travel

0.95

illiterate 8 58

primary 8 42

High school 7 45

High sec 6 27

graduate 2 13

PG 1 3

total 32 188

Following at work Not Following at work

0.25

illiterate 14 64

primary 14 39

High school 12 48

High sec 11 26

graduate 7 11

PG 2 2

total 60/24.0 190/76

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 19746 - 19757 Received 20 July 2021; Accepted 05 August 2021.

Figure 1: Assessment of Attitude towards following social distancing

Figure 2: Assessment of Practice towards following social distancing Discussion

In today’s era, infectious disease outbreaks can spread rapidly across any corner of the world, catalysed by the speed with which we travel across the borders. [8]

Covid 19 is a relatively new virus that has had devastating effects within the short time since it was first detected. To date there has been no published data on knowledge, attitude and practices toward social distancing amongst Indian construction workers in Covid pandemic that makes this study unique. As per the results of this study, in spite of 31.2% of population being illiterate, 78.61% of the population had highest knowledge score about Covid 19 and 90.8% of population had knowledge about social distancing. This could be attributed to the vast spread of information by government official announcements, social medias and the higher authorities at work place.

98.8% of participants believed that they would be affected by the disease by not practising social distancing. This could be attributed to the belief in non-curability of the disease by 72.4% of population and knowledge about non-availability of Covid Vaccine by 90% of population. This

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

always follow social distancing

almost follow social distancing

often follow social distancing

sometimes follow social

distancing

never follow social distancing Assessment of Practice towards following social distancing

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suggests that the information about the spread of disease was efficiently and rapidly passed on even amongst the lower socio-economic status group like construction workers. In spite of high percentage of knowledgeable (78.16 %) population, only 20.82 % of the participants were able to always follow social distancing whereas 7.4% of the population could never follow social distancing at different work places. This could be attributed either to the lower education level or inability to follow social distancing due to the nature of work involved and the lifestyle. As per the past studies [9, 10], the environment and living style in the developing countries generally put people at a higher risk of health issues. People live in overcrowded households and lack access to good sanitation, clean water and public health services. In India, the media reported the first case of COVID-19 in a slum with 23,000 people in less than a square kilometre in Mumbai. [11] Most people working in informal sectors like construction site are devoid of the healthcare facilities and social safeguarding systems [12]. The question that was raised in the past study [13] whether really enforcing the social distancing and hand hygiene would be sufficient to contain the spread of this pandemic in developing country like India.

Different experts pointed out the challenging conditions in refugee camps [14,15] that prevented people from adopting the WHO recommended measures necessary to fight COVID-19. The conclusions of the past studies coincide with the same results in this study about practising social distancing amongst this group of population.

In the present study, 33.6% of population believed that even if they do not follow social distancing, they would remain unaffected. This attitude amongst the workers may be attributed due to the lower education level or fear of losing their jobs. Government information sources are considered to be the most trusted among the public. Trust in government sources was positively associated with accurate knowledge about COVID-19 and adherence to social distancing.

There was non-significant correlation of different age groups , gender and education level with practising social distancing at different work places (Table 2 and 3). This could be again attributed to the accessibility of the population to all types of sources of information. Also the fear of getting affected and awareness about non availability of the vaccine made the worker population more knowledgeable.

Conclusion

The practice of social distancing is poorly followed despite a good knowledge among the participants. The knowledge, attitude and practice may be independent of education, age and gender.

Limitations

The sample size of 250 cannot be generalized for more than millions of workers working in India.

A large sample size in needed to correlate the results with the large population group.

Acknowledgement

We are grateful to Director and CEO AIIMS Nagpur Dr Vibha Dutta SM for her guidance and support.

References

[1] Taylor Riley, Elizabeth Sully, Zara Ahmed, Ann Biddlecom. Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- And Middle-Income Countries. Int Perspect Sex Reprod Health 2020 Apr 16; 46:73-76.

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 19746 - 19757 Received 20 July 2021; Accepted 05 August 2021.

[2] SteelFisher GK, Blendon RJ, Kang M, Ward JR, Kahn EB, Maddox KE, et al . Adoption of Preventive Behaviors in Response to the 2009 H1N1 Influenza Pandemic: A Multiethnic Perspective; Influenza Other Respir Viruses. 2015 May; 9(3):131-42.

[3] Qazi A, Qazi J, Naseer K, Zeeshan M, Hardaker G, Maitama JZ, Haruna K.Analyzing Situational Awareness Through Public Opinion to Predict Adoption of Social Distancing Amid Pandemic COVID-19: J Med Virol. 2020 Jul; 92(7):849-855.

[4] Qiuyan Liao, Benjamin Cowling, Wing Tak Lam, Man Wai Ng, Richard Fielding.

Situational Awareness and Health Protective Responses to Pandemic Influenza A (H1N1) in Hong Kong: A Cross-Sectional Study. PLoS One 2010 Oct 12; 5(10):e13350.

[5] Construction Worker Federation of India - Statistics & Database www.cwfigs.org › statistics database. Available from: https://www.cwfigs.org › statistics database

[6] Svenn-Erik Mamelund, Clare Shelley-Egan & Ole Rogeberg. The association between socioeconomic status and pandemic influenza: Protocol for a systematic review and meta- analysis .Systematic Reviews 2019 ; volume 8, Article number: 5

[7] Ilona Fridman , Nicole Lucas , Debra Henke , Christina K Zigler. Association between Public Knowledge About COVID-19, Trust in Information Sources, and Adherence to Social Distancing: Cross-Sectional Survey. .JMIR Public Health Surveillance 2020 Sep 15;6(3): e22060. doi: 10.2196/22060.

[8] Sandra Crouse Quinn, Supriya Kumar. Health inequalities and infectious disease epidemics: a challenge for global health security. Biosecur Bioterror Sep-Oct 2014;

12(5):263-73.

[9] Ezeh A, Oyebode O, Satterthwaite D, et al. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet. 2017; 389:547–558.

[10] Schwerdtle P, Bowen K, McMichael C. The health impacts of climate-related migration. BMC Med. 2017;16:1–7.

[11] Ayeb-Karlsson S, van der Geest K, Ahmed I, et al. A people-centred perspective on climate change, environmental stress, and livelihood resilience in Bangladesh. Sustain Sci. 2016;11:679–694.

[12] Ayeb-Karlsson S, van der Geest K, Ahmed I, et al. A people-centred perspective on climate change, environmental stress, and livelihood resilience in Bangladesh. Sustain Sci. 2016; 11:679–694.

[13] Kluge HHP, Jakab Z, Bartovic J, et al. Comment refugee and migrant health in the COVID-19 response. Lancet. 2020.

[14] Shammi M., Robi M. R., Tareq S. M. (2020). COVID-19: Socio-environmental challenges of Rohingya refugees in Bangladesh. Journal of Environmental Health Science and Engineering, 18(December), 1709-1711.

[15] Vince G. (2020). The world’s largest refugee camp prepares for covid-19. British Medical Journal, 368, m1205. Available from: https://www.alnap.org › files › bmj.m1205.full_.pdf

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