|Ahead of print publication
Knowledge, attitude, and practices among police force toward COVID-19 pandemic during lockdown in Pune, India - An online cross-sectional survey
D Naresh Sonkawade1, A Aarti Kinikar1, Rajesh Kulkarni1, Chhaya Valvi1, C Uday Rajput1, Rahul Dawre1, Sameer Pawar1, Tushar Jadhav1, Ajay Chandanwale2, Muralidhar Tambe3, K Venkatesham4, Nishi Suryavanshi5
1 Department of Paediatrics, John Hopkins Clinical Trial Unit, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
2 Joint Director Department, DMER, Mumbai, Maharashtra, India
3 Department of Community Medicine, John Hopkins Clinical Trial Unit, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
4 Commissioner of Police Department, Pune, Maharashtra, India
5 John Hopkins Clinical Trial Unit, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
|Date of Submission||03-Jun-2020|
|Date of Decision||14-Aug-2020|
|Date of Acceptance||21-Sep-2020|
Department of Paediatrics, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: COVID-19 has affected millions of people and more than thirty thousand deaths. Social distancing and lockdown are important measures for prevention. Police personnel are losing their lives due to COVID-19 while doing their duty in this lockdown time. Aim: The study aims to assess knowledge, attitude, and practices (KAP) of police force toward COVID-19. To assess correlation of knowledge with their practices and attitude. Materials and Methods: A cross-sectional, self-administered, anonymous survey questionnaire was administered to 8706 police personnel and data collected over a time period from April 11 to 16, 2020. We used t-test and multivariable binary logistic regression analysis to identify the association between KAP and demographic variables. Results: In all 8706 police personnel participated in the study. The median age of participants was 35 years (interquartile range: 19–59), 6787 (77.9%) were male, 6675 (76.6%) were of constable grade. Seven thousand three hundred thirty-two (83.7%) of participants recorded accurate (high) knowledge, and 6790 (78%) reported following preventive practices. Female participants were more likely to follow preventive measures despite low knowledge as compared to their male counterparts (P < 0.0001). Female gender, age more than 35 years, and lower rank were associated with low knowledge and fear of contracting the disease. Multivariable binary logistic regression analysis showed that low knowledge is significantly associated with fear of getting disease odds ratio 1.29; 95% confidence interval (1.15–1.46). Conclusion: In a cohort of police personnel, overall knowledge about COVID-19 is high. Female participants are found to be practicing appropriate preventive measures and they have faced stigmatizing behavior from society. The study provides important information on the need for developing health awareness programs to improve COVID-19 KAP.
Keywords: COVID-19, knowledge, lockdown, police, practices
|How to cite this URL:|
Sonkawade D N, Kinikar A A, Kulkarni R, Valvi C, Rajput C U, Dawre R, Pawar S, Jadhav T, Chandanwale A, Tambe M, Venkatesham K, Suryavanshi N. Knowledge, attitude, and practices among police force toward COVID-19 pandemic during lockdown in Pune, India - An online cross-sectional survey. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Mar 5]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=309181
| Introduction|| |
In December 2019, a respiratory infection outbreak was reported in Wuhan, a city in the Hubei Province of China. By the end of December, it was discovered that the infection is caused by a virus. It was declared as a pandemic disease by the World Health Organization (WHO) on March 11, 2020. The WHO designated this disease as COVID-19 which stands for coronavirus disease 2019. The disease has caused more than 365,000 deaths Globally and is still causing devastation across the world. In India, it has caused more than 5000 deaths till now with total positive cases more than 180,000. This virus mainly affects the respiratory system and the mode of transmission is droplet spread, i.e., cough, sneezing, and contact spread. Following exposure, the incubation period is 14 days. Most of the exposed patients manifest symptoms by 5–6 days.,, Clinical features range from asymptomatic person to mild cough, cold, fever, malaise, headache, breathlessness to acute respiratory distress syndrome, and multiple organ failure syndromes. There is no specific medication for this illness. Government of India declared nationwide lockdown of all offices, educational institutions, malls, and cinema halls from March 25 to April 14 for 21 days which was extended to May 31 to prevent the spread of the COVID-19 diseases. Due to this lockdown, people are forced to stay at home except for only emergency services. Police personnel emerged as a major frontline force in this crucial situation to enforce lockdown at the directives of the Government of India, they are guarding containment zones, enforcing the lockdown and home quarantines, besides handling thousands of migrants hitting roads in their attempts to go home. The police force is untiringly working for community patrolling as well as escorting suspected or positive COVID-19 patients from their home to hospital. More than thousand police personnel contracted infection and more than ten have lost their life due to COVID-19 in a single Maharashtra State of India. There is no literature so far that has reported knowledge, attitude, and practice (KAP), and concerns of police force during such pandemics. To effectively manage COVID-19 pandemic without compromising their health it is important to understand the awareness of COVID-19 among the police force. In this study, we evaluated KAP of police personnel from Pune, Maharashtra, toward COVID 19. Finding from this study would provide important information in developing an Indian context-specific health education program for Police Personnel.
| Materials and Methods|| |
Study design and setting
A cross-sectional, self-administered, piloted and approved survey questionnaire was prepared by assuring knowledge guidelines issued by the WHO and the Ministry of Health and Family Welfare, Government of India (MOHFW). The questionnaire had a total 28 multiple choice questions categorized in demographic details, KAP, and an open-ended question about any other concerns police personnel have. This questionnaire was translated into Marathi language Google form (GF) with the help of a certified language translator. This Structured GF in the Marathi language was distributed to approximately 9000 police personnel on their smartphones with the help of their control room after obtaining a no-objection certificate from the police commissioner. This study was conducted for 6 days i.e., April 11 to April 17 2020 in the Pune district of Maharashtra India. Consent for participation in this study was obtained as the participant's answer to the first yes-no question of GF and willingness to participate. The initial part of the GF includes brief information about the study, voluntary nature of participation, declarations of anonymity, and confidentiality.
The survey questionnaire was divided into two parts. The first part collected information on demographics such as age, sex, department, cadre, and total service experience. Second section KAP was divided into three domains.
The knowledge domain of the questionnaire included 9 statements related to cause, route of transmission, symptoms, preventive measures for COVID-19. A scoring system was developed, where 1 score was given for each correct answer, and 0 was given for an incorrect answer including the response of “don't know.” The total knowledge score was 9 with a minimum of 0 and a maximum of 9 score, ≥6 considered as high/good score.
This domain had three questions regarding attitude if they have fear of contracting COVID-19, if they are experiencing obstreperous behavior from the society and if there is a change in behavior of the family. Each question has got score 1 for “yes” answer and 0 score for “no.” Attitude score of more than or equal to 2 out of 3 was considered having negative attitudes such as experiencing stigma and having fear regarding COVID-19.
It included five questions about preventive practices they follow during COVID-19 pandemic and lockdown while on duty. Score 1 was given for “yes” and 0 was given for “no” and “don't know” responses. Questions included were “use of types of masks,” “use of sanitizer,” “use of adequate personal protective equipment (PPE) while escorting positive patient,” the last question was about protection practice they use when they return to home after their duty hours. This question had multiple options and was graded by giving a score from 1 to the best-recommended practice and 0.75, 0.5, 0.25 for other lesser recommended practices as per MOHFW and 0 was allotted for those not practicing any preventive measure. A practice score ≥3 out of 5 was considered as appropriate.
The primary data were compiled into the Microsoft excel 2016. The analysis was carried out by IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics such as frequency, percentage, median, and interquartile range (IQR) were used primarily to describe the data. Continuous variables were compared using an unpaired t-test. KAP scores were compared with demographic characteristics using independent-samples t-test, and Chi-square test as appropriate. We performed multivariable binary logistic regression for one particular dependent variable, for example, Composite knowledge score all the independent variables available in the data, for example, practice score, gender, rank of the respondent, and age were considered. A Chi-square test was run to identify the subgroup with the highest proportion having poor knowledge. These independent variables were then divided in dichotomous options and binary regression was performed since all the dependent variables such as knowledge score, practice score, and attitude scores had binary outcomes. Among the variables in the equation, the significant Exp (B) values along with 95% confidence interval (CI) were used in the result tables for the simplification of result interpretation. The detailed tables including R2 tables, fitness of model and all variables in the equations have been added in the [Supplementary File]. F-test statistic which is a ratio of between group variance and within group variance was used while performing analysis of variance to statistically assess the equality of means.
The distribution of data was found to be normal also the sample size is very large, hence we considered parametric tests. We performed only logistic regression since we restricted the outcomes of dependent variables in limited options. For the fitness of the model omnibus, test of model coefficients was used. For the simplification of result interpretation only Exp (B) values along with 95% CI were used.
In the multivariable binary logistic regression model used by us Cox and Snell R2 and Nagelkerke R2 statistics were used as measures to predict the dependent variable based on the independent variables.
The study and consent procedure were approved by Byramjee Jeejeebhoy Medical College and Sassoon General Hospital's Institutional Ethics Committee (Ref. No: BJGMC/IEC/Pharmac/ND-Dept 0420054-054 Dated 10/04/2020).
| Results|| |
The survey was distributed to 9000 police personnel. A total of 8706 (97%) police personnel completed the survey. Of these, 6787 (78%) were male, median age (IQR) was 35 (19–59) years and 6651 (76.4%) were of constable grade (lowest rank) of their departmental ranking.
[Table 1] shows descriptive statistics about all KAP domains where 7332 (84%) of participants have a mean knowledge score of 6.5 (standard deviation [SD]: 1.07, range 0–9), 6790 (78%) reported following preventive practices with mean 3.28 (SD: 0.62, range 0–5). Moreover, 5484 (63%) reported fear while on duty as well as obstreperous behavior of people with a mean score of 1.58 (SD: 0.68, range: 0–3) in attitude domain.
|Table 1: Descriptive statistics of knowledge, attitude, and practice scores|
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Knowledge scores significantly differed across age groups, gender, and departmental rankings (P < 0.0001). Participants in the age group of 41–50 years had higher knowledge, males have a significantly higher knowledge of COVID-19 as compare to females, and inspector grade has significantly higher knowledge than their other counterparts [Table 2]. High score for attitude indicates experiencing negative attitudes from society/family and fear about COVID-19 pandemic. This is presented as a mean score ± SD It is significantly higher among the younger age group (19–30 years) with a mean score 1.65 ± 0.64, female participants with a mean score of 1.69 ± 0.63 (P < 0.0001), and high-rank post with a mean score of 1.63 ± 0.59 (P < 0.0001) [Table 2].
|Table 2: Demographic characteristics by scores of knowledge, practices, and attitude|
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COVID-19 preventive practices by study participants were analyzed according to their demographic categories [Table 2]. Practice mean score was observed to be lowest with mean 3.20 ± 0.62 in older age group, i.e., 51–60 years as compared to other age groups, among males (mean 3.26 ± 0.61) and among technical staff/drivers with a mean score of 3.15 ± 0.62 (P < 0.000).
We assessed if there is an association between knowledge scores and gender, and practice scores and gender. Results shown in [Table 3] indicate that female police staff has significantly lower mean knowledge scores (6.25 ± 1.1 vs. 6.57 ± 1.03, P <0.001) however they were found to significantly adhere to better preventive practices than their male counterparts amid the COVID-19 pandemic.
Attitude changes were surveyed during lockdown due to COVID-19 Pandemic and our study revealed that the proportion of female participants (77%) were more fearful about contracting COVID-19 (P < 0.0001) than male police (68%). During the lockdown duties, the obstreperous behavior of people was significantly more toward female police than males (87% vs. 83%, P = 0.0002). Females are more likely to report the fear of family members acquiring infection because of them (P = 0.014) as compared to their male counterparts [Table 4].
Multivariable binary logistic regression analysis showed that female gender, age group ≥35 years, lower rank (below inspector) were significantly associated with low knowledge (score <6) as well as negative attitude score (score ≥2). In the practice domain, the female gender has good adherence to practices in-spite of poor scores in the knowledge domain [Table 5]. It was found that only 2.8%–4.7% variation of poor knowledge score, 1.4%–2.2% variation of poor practice score and 1.8%–2.4% variation of undesirable attitude can be explained by independent variables.
|Table 5: Multivariable binary logistic regression analysis on factors significantly associated with low knowledge, poor adherence to preventive practices, and undesirable attitude|
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| Discussion|| |
A total of 8706 study participants responded to this online study survey, 84% of participants reported accurate (high) knowledge about COVID-19 symptoms, transmission and prevention, and 78% reported following preventive practices. Female participants were more likely to follow preventive measures despite low knowledge as compared to their male counterparts. Study results also showed that females are at high risk of facing stigmatizing behavior from people and had a fear of contracting the disease.
To the best of our knowledge, this is the first study in India (probably in the world) examining the KAP toward COVID-19 among police force who are one of the major front line workers for the prevention of COVID-19 through the implementation of lockdown and social distancing strategy in the absence of effective treatment for COVID-19. India, being a developing country, requires awareness campaigns to make its people aware and well equipped with the disease condition. The awareness level among police personnel evaluated as three separate domains namely knowledge, attitude, and practice have demonstrated the preparedness of the country's law implementers against COVID-19. As there is no other KAP study in the police force (regarding any pandemic disease) as per our knowledge, we have tried to compare this study with other related pandemic studies done in the past globally. In this study, predominantly male population participated, as compared to study done by Zhong et al. where 67% were female. Probably, the difference is because we have included a police force where there are more male employees compared to general population studies. We found an overall 84% of the total study population had good knowledge of COVID-19. Zhong et al. recorded 90% of knowledge score among the general population about COVID-19. Our study showed that 98% of participants answered cough, cold, and fever as a common symptom of COVID-19 and knew about the route of transmission namely through droplet spread. However, knowledge about preventive strategy was low namely social distancing recommended distance, most vulnerable age category in COVID-19 were some of the questions that need appropriate education. Very few were aware of proper hand washing practices which is the most important strategy for the prevention of COVID-19. Koul et al. in 2016 recorded 58% low-grade score of knowledge about influenza virus among corporate workers in India despite their high education level. Low knowledge is significantly associated with female gender and lower grade of police personnel indicating the need for health education with an emphasis on females and lower grade staff. Police personnel were a major strategy implementing government forces during the lockdown period of COVID-19 pandemics and probably they were trained adequately.
The study showed that most police personnel took precautions to prevent infection by COVID-19: like wearing masks, use of sanitizer, use of adequate PPE when on duty and practice they follow when they return to home from duty. These strict preventive practices could be attributed to very strict control measures implemented by governments such as the compulsion of wearing a mask when going outside home. Furthermore, they had good knowledge regarding the transmission of COVID-19 virus, which might have translated to practice preventive behavior. The present study still showed 22% did not practice preventive guidelines as required. These risky behavior are more among males. A similar finding was reported by an earlier study.
Attitude change during this pandemic was assessed by the feel of fear of contracting COVID-19 while on duty, fear due to obstreperous behavior of society members, and an open-ended question about concerns revealed that they have fear of carrying the infection to home. The female population had more fear of carrying the infection to home as well as they have experienced more obstreperous behavior of society as compared to their male counterpart probably because in the Indian cultural context females are the primary caregiver to their family and perceived to be with family in such crucial time of pandemic. However, due to their job, they become more vulnerable to experience stigmatizing behavior. Young population in study participants were more afraid of this pandemic probably they are not experienced with disaster management situations like this as compared to their older age colleagues. The strength of our study is a large sample size which may be representative of the police force of the state of Maharashtra. Significant associations between demographic variables and KAP toward COVID-19 in this study revealed there is a need to target the police force having more likely to have poor knowledge, negative attitudes, and inadequate preventive practices towards COVID-19. Study findings have revealed that study participants have had high knowledge and exercised a high level of preventive measures against COVID-19. However, there were a significant number of participants who were not aware of many preventive practices. The majority of study participants, especially females, experience stigmatizing behavior from society and reported to have fear of infection to themselves and their family members. The WHO has highlighted stigma and discrimination directed at persons diagnosed with COVID-19, at people of Asian descent or who have traveled to affected countries and even emergency responders and health-care professionals. Similarly, police force was also a victim of similar situation in India. One of the limitations of the study that due to the limited time, we did not get the chance to validate the survey questionnaire, though it was pilot tested before administration.
| Conclusion|| |
In a cohort of police personnel, overall knowledge about COVID 19 is high. Female participants are found to be practicing appropriate preventive measures and they have faced stigmatizing behavior from society. These results hold importance for the formulation of health education guidelines and preventive protocols which could be part of police training programs so that these training prepare them to tackle such pandemic effectively without compromising their health
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]