Improving knowledge, attitudes and practice to prevent COVID-19 transmission in healthcare workers and the public in Thailand

Abstract

Background: Key infection prevention and control measures to limit transmission of COVID-19 include social distancing, hand hygiene, use of facemasks and personal protective equipment. However, these have limited or no impact if not applied correctly through lack of knowledge, inappropriate attitude or incorrect practice. In order to maximise the impact of infection prevention and control measures on COVID-19 spread, we undertook a study to assess and improve knowledge, attitudes and practice among 119 healthcare workers and 100 general public in Thailand. The study setting was two inpatient hospitals providing COVID-19 testing and treatment. Detailed information on knowledge, attitudes and practice among the general public and healthcare workers regarding COVID-19 transmission and its prevention were obtained from a combination of questionnaires and observations.

Results: Knowledge of the main transmission routes, commonest symptoms and recommended prevention methods was mostly very high (> 80%) in both groups. There was lower awareness of aerosols, food and drink and pets as sources of transmission; of the correct duration for handwashing; recommended distance for social/physical distancing; and about recommended types of face coverings. Information sources most used and most trusted were the workplace, work colleagues, health workers and television. The results were used to produce a set of targeted educational videos which addressed many of these gaps with subsequent improvements on retesting in a number of areas. This included improvements in handwashing practice with an increase in the number of areas correctly washed in 65.5% of the public, and 57.9% of healthcare workers. The videos were then further optimized with feedback from participants followed by another round of retesting.

Conclusions: Detailed information on gaps in knowledge, attitudes and practice among the general public and healthcare workers regarding COVID-19 transmission and its prevention were obtained from a combination of questionnaires and observations. This was used to produce targeted educational videos which addressed these gaps with subsequent improvements on retesting. The resulting videos were then disseminated as a resource to aid in efforts to fight COVID-19 in Thailand and worldwide.

Fig. 1

Knowledge about COVID-19 transmission sources (a), symptoms (b) and existence of treatment or vaccination for COVID-19 (c) before (1) and after (2) the first videos and after the final videos (3). HCW = healthcare worker, PBC = public. P values are shown for significant differences

Fig. 2

Knowledge about which COVID-19 prevention measures (a) and which types of mask, hand hygiene and social/physical distancing (b) are effective to prevent transmission of COVID-19. Results are shown for before (1) and after (2) the first videos and after the final videos (3). HCW = healthcare worker, PBC = public. P values are shown for significant differences

Fig. 3

Sources of information about COVID-19 prevention stated by the public and healthcare workers (HCW) before (1) and after (2) the first set of videos. P values are shown for proportions before and after videos

Fig. 4

Trust in different sources of information about COVID-19 prevention assessed on a 7-point Likert scale before (1) and after (2) the first set of videos for the public and healthcare workers (HCW). Medians and interquartile ranges are shown

Fig. 5

Attitudes on a Likert scale of 1 (least) to 7 (most) before (1) and after (2) viewing the first set of videos. HCW = healthcare worker, PBC = public. P values are shown for comparison of before and after video viewing

Fig. 6

Stated practices for COVID-19 prevention measures (a) and which types of mask, hand hygiene and social/physical distancing (b) are used by participants to prevent transmission of COVID-19. Results are shown for before (1) and after (2) the first videos and after the final videos (3). HCW = healthcare worker, PBC = public. P values are shown for significant differences

Fig. 7

Proportion of healthcare workers (HCW) and public (PBC) who correctly washed their hands by count of areas out of 34, before (1) and after (2) watching the first set of videos

Fig. 8

Proportion of healthcare workers (a) and public (b) who correctly washed each area of the hands before (1) and after (2) watching the first set of videos