Knowledge and Practice toward Coronavirus Disease among Patients With Selected Chronic Disease

Abstract

Background: Coronavirus disease (COVID-19) is an illness caused by a novel coronavirus, now called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Aim: to assess knowledge and practice toward coronavirus disease among patients with selected chronic diseases. Design: A descriptive cross-sectional design was utilized. Setting: The current study was conducted at the medical, diabetic, chest, and cardiac out-patient clinics, at Minia University Hospital and Cardio-Thoracic Hospital. Sample: A purposeful sampling consisted of 331 patients with chronic diseases (hypertension, diabetes mellitus, heart disease, and chronic lung disease) Collection of data: Data were collected using two tools Second tool( 1^st tool): It was included three parts: Part 1: Socio-demographic characteristics, part 2: Lifestyledata and  Part 3: Knowledge of chronic disease patients toward coronavirus disease: 2^nd tool: Practice of chronic disease patients toward coronavirus disease: Results: The main finding of the study 83.4.% of the studied sample had age ranged from 30 ≤ 49 years and 50 ≤ 69 years respectively with mean of (50.05 ± 9.90) and 63.1% of them were male. The main finding of the study 56.2% of the studied sample had poor knowledge and 73.1% of them had poor practice toward coronavirus disease. Conclusion: This study showed that poor knowledge and practice were found among the studied sample. There was a positive strong correlation between the total score of knowledge and the total score of practices of the studied sample toward Coronavirus disease. Recommendations: Educational workshops and periodical programs should be conducted for all people to increase their knowledge, attitude, and practice regarding the coronavirus disease.

Keywords: Chronic disease, Coronavirus disease, Patients knowledge, Patients practice

Introduction

Coronavirus is one of the major pathogens that mainly target the respiratory system of the human organ. Previous outbreaks of coronaviruses have been recorded in history as a severe acute respiratory syndrome (SARS)-CoV and the Middle East respiratory syndrome (MERS)-cov (Shahzad & Najafzadeh, 2020).

New coronavirus has been identified as the cause of acute respiratory disease since the end of December 2019. It was labeled as SARS-cov2 by the World Health Organization as a different strain of coronavirus from severe acute respiratory syndrome coronavirus (SARS) and Middle East respiratory syndrome coronavirus (MERS) coronaviruses. Here, the difference between them is the genetic make-up, clinical presentations, case fatality, and the rate of spread across the world. That is the SARS-cov2 is the virus that has caused coronavirus disease (COVID-19) became the newest virus causing global health fear (Tang et al., 2021).

       Coronavirus symptoms can range from mild (or no symptoms) to severe illness and are mainly characterized by fever, dry cough, dyspnea, headache, sore throat, rhinorrhea, and sometimes hemoptysis. The main route of transmission is close contact (about 6 feet or two arm lengths) with a person who has COVID-19 respiratory droplets when an infected person coughs, sneezes, or talks and touches a surface or object that has the virus on it, and then touching his/her mouth, nose, or eyes (Hui et al.,2020).

The World Health Organization (WHO) defines non-communicable diseases (NCDs) is as chronic conditions that do not result from an acute infectious process and hence are not communicable with a longer duration, which a complete cure is rarely achieved and are the result of a combination of genetic, physiological, environmental and behavioral factors. These non-communicable diseases include cardiovascular disease, cancer, diabetes mellitus, chronic respiratory disease, chronic neurological disorders, musculoskeletal diseases, and other non-infectious conditions (Boettler et al., 2020).

 Chronic conditions like diabetes, hypertension, obesity, heart, and lung disease have been associated with coronavirus disease (COVID-19) severity. The studies of patients with COVID-19 infection have shown that people with chronic diseases not only have a higher risk of developing the disease but also are more likely to die from the virus infection).

 Another factor influencing the mortality rate of COVID-19 is old age, especially over 60 years.  People with diabetes can help control their immune systems by controlling their blood sugar and preventing COVID-19 as much as possible (Kendzerska et al., 2021).  

 Individuals with chronic conditions have also faced significant lifestyle disruptions due to the COVID-19 pandemic, particularly regarding physical activity, sleep, stress, and mental health, which need to be better addressed by healthcare systems in the COVID-19-specific context. Conversely, mitigation of some lifestyle and environmental risk factors during quarantine, such as reduced exposure to traffic, air pollution, and other respiratory infections, may improve outcomes in individuals with chronic conditions. (Chandrasekaran & Ganesan, 2021). Meta-analysis of the data extracted suggested that diabetes and coronary artery disease were prevalent in 10.0% and 8.0% of the patients, respectively. The proportion of hypertension (20.0%) was much higher than that of chronic pulmonary disease (3.0%) in COVID-19 patients. (Liu et al, 2020).

 Complications of COVID-19 include impaired function of the heart, brain, lung, liver, kidney, and coagulation system. COVID-19 can lead to myocarditis, cardiomyopathy, ventricular arrhythmias, and hemodynamic instability. Acute cerebrovascular disease and encephalitis are observed with severe illness (in up to 8% of patients) (Fournier et al., ‎2021). Case isolation, identification, follow-up of contacts, environmental disinfection, and use of personal protective equipment. Apply appropriate symptomatic treatment and supportive care to prevent the spread of COVID 19 (FMOH, 2020).

Handwashing with soap and water should be encouraged since it kills the virus. The use of alcohol-based hand rubs is also useful. There is a need to practice proper respiratory hygiene by covering the mouth and nose with bent elbow or tissue when coughing or sneezing (Hartmann et al., 2020). Touching of mouth, nose, and eyes should be avoided. Contact with an affected person needs to be minimized. Use of recommended face masks is advised if there is contact with someone with respiratory symptoms. Non-essential travel to major affected areas should be avoided to restrict the spread of infection (Selvin et al., 2020). It is important to take influenza and pneumonia vaccinations. The latter may decrease the chances of secondary bacterial pneumonia after respiratory viral infection (Macintyre, 2018).

The affected person needs to be isolated for fourteen( 14 days )or till the symptoms resolve (whichever is longer). Country-specific guidelines need to be followed. The majorities of patients have mild diseases and can be managed at home. Hydration should be maintained and symptomatic treatment with acetaminophen and steam inhalation can be given (Gupta et al., 2020).

Community nurses' role focus on the promotion of health and wellness, prevention of illness, and the care of people with differing abilities, the ill, and those needing palliative care. Community nurses collaborate with other home care nursing agencies outside of acute hospitals in the community care settings for patients requiring long-term support for nursing procedures, for example, wound care and medication management (Burmeister et al., 2019). Support immediate cash injections at the household level and the creation of neighborhood plans to protect the most vulnerable. Eliminate point-of-care user fees for COVID-19 testing, treatment, and care where these exist. Work with governments and funding partners to ensure that community health worker (CHW) budgets incorporate holistic support, including food supplementation, access to clean water, and mental health and psychosocial support. (Intinarelli et al.,2021)

Significance of the study

The spread of COVD-19, however still increases alarmingly from day to day and is not controlled. Poor understanding of the disease among the community, especially the high-risk groups is implicated in this increase in the spread of the infection and death. Therefore, successfully controlling and minimization of morbidity and mortality due to COVID-19 requires changing the behavior, which is influenced by people's knowledge and perceptions, of the general public, especially the high-risk groups (Akalu et al., 2020).

According to the World Health Organization( WHO) report, there were almost 70 million reported cases of COVID 19 in January 2022, to date more than 326,884,814 cases and 5,553,975 confirmed deaths, and 266,490,965 cured cases in were recorded in the world (WHO, 2020).  There were 401,308 confirmed COVID-19 cases in Egypt from January 2020 to January2022, including 22,179 deaths (Ministry of  Health and  Population  Egypt  (MOHP), 2020).

The proportions of hypertension, cardia-cerebrovascular disease, and diabetes in patients with COVID-19 were 17.1%, 16.4%, and 9.7%, respectively. The incidences of hypertension, cardia-cerebrovascular diseases, and diabetes were about two folds, threefold, and two folds, respectively (Ziegler, 2020).Consequently, it is mandatory to consider the Knowledge, Attitude, and Practice( KAP) and potential risk factors of high-risk groups in particular those chronic disease patients and helps to predict the effects of expected actions on COVID-19 (Zheng et al., 2020).

Aim of the study

This study aims to assess knowledge and practice toward coronavirus disease among patients with selected chronic diseases.

Research questions

1)       What are the levels of knowledge and practice toward coronavirus disease among patients with selected chronic diseases?

2)      Is there a correlation between knowledge and practice toward coronavirus disease and socio-demographic data among patients with selected chronic diseases?

Subjects and Methods

Research Design:

A descriptive cross-sectional research design was used in this study.

Setting:

The current study was conducted at the medical, diabetic, chest, and cardiac out-patient clinics, at Minia University Hospital and Cardio-Thoracic Hospital. Minia University Hospital is located in El-Cornish St.Minia, Egypt. The main university hospital includes about 13 different specialties (general surgery, neurology, heart, orthopedics, tumors, nose, and ears(E.N.T), dermatology, internal medicine). The hospital consists of five floors, other than the ground floor. It consists of nineteen(19) clinics. and Cardio-Thoracic Hospital. which is located in new minia, city includes three departments, the cardiac department, chest department, and cardiothoracic surgery, consists of four clinics (Chest Clinic, Open Heart Clinic, Heart Clinic, and Respiratory Function Clinic).

Subject:

Purposeful sampling was utilized in this study. A selected number of patients with chronic diseases (hypertension, diabetes mellitus, heart disease, and chronic lung disease) attend the outpatient clinics and who met the inclusion criteria. The total numbers of patients attending the medical, diabetic, chest, and heart clinics during the year are 350, 300, 900, and 800 respectively. The sample size was calculated according to the equation for the sample size of the descriptive study design (Smith& Scott,2020)

n = required sample size.

 = is the Z score at   0.05 ( ).

p= Prevalence of Chronic Disease Patients in the medical, diabetic, chest, and cardiac out-patient clinics in 2019/2020(0.5).

m = Margin of error at 5 % (standard value of 0.050).

N= population size.

The result is 331 patients and the total sample was distributed among four outpatient clinics to the number of patients in each clinic as follows:

Inclusion Criteria:

• Patients over 18 years of age(male and females).
• patients who have a regular follow-up at medical, diabetic, chest, and heart out-patient clinics.

Exclusion Criteria

• Patients with chronic diseases that have been critically ill
• Chronic patients from health professionals staff.

Data Collection Tools:

Data was collected through a structured interviewing questionnaire that was designed by the investigator after an extensive review of the related literature. It consisted of two tools:

Tool Ӏ: It was included three parts:

Part 1: socio-demographic characteristics:

It consisted of (7) seven items related to the patient such as age, gender, residence, educational level, occupation, marital status, and type of family.

Part 2:Life style data:

It was included  (6) six items as smoking habits, duration of smoking, daily hours of sleep, source of information, use of mask, type of mask

Part 3: Knowledge of chronic disease patients toward coronavirus disease:

 This tool was adapted by (Gharpure et al., 2020) and modified by the investigator. It is used to assess the knowledge of chronic disease patients, it consists of (22) twenty-two including definition, causes, signs, and symptoms, high-risk group, ways of prevention….etc.

Scoring system:

The response of ״yes״, ״no״, or ״ don’t know״ was scored 1  for ״yes״, and “zero” for both ״no״ or ״ don’t know״ respectively. These scores were summed and converted into a percent score.

It will be classified into 3 categories:

• Good knowledge if score > 70%(> 16).
• Average knowledge if score from 50 - 70%(11-16).
• Poor knowledge if score <50%(<11).

Tool II: Practice of chronic disease patients toward coronavirus disease:

It was adopted by McIntosh et al., (2020.) to assess the practices of chronic disease patients towards COVID 19. It consists of (twelve) 12 practices wash hands frequently, avoid touching the face, avoid close contact with sick people, wear a mask, cover nose and mouth during coughing, avoid public transportation, safe distance, stay at home, and self-isolation………… etc.

Scoring system:

The response of yes״, ״no״, would be scored 1, 0 respectively These scores would be summed and converted into a percent score.

It will be classified into 2 categories:

• Good practice if score > or equal 70%(> 9).
• Poor practice if score <70%(<9).

Validity :

The content validity of the tools was determined to see how well they measured what was supposed to be measured. A panel of five experts in the fields of community health nursing and medical-surgical nursing evaluated the developed tools.

Reliability:

The extent to which the items measure the same definition and the extent to which the items are associated with one another was determined by measuring internal consistency. It was prepared in final shape and then tested for reliability by using, Cronbach’s alpha coefficient test (0.96, and 0.71) respectively.

Pilot study:

A pilot study was carried out on 10% (33 patients) of the expected sample size to test the content, the effectiveness, and the time consumed to fill in study tools. no modification was done in the basic sample, The pilot study was included on the study.

Data Collection Procedure:

• Permission to conduct the study was obtained from the Director of Minia University Hospital and Cardio-Thoracic Hospital. Approval of an ethical committee at the Faculty of Nursing at Minia University was obtained.
• The current study was conducted by preparing different data collection tools; It was done through the schedules of each outpatient clinic. The selected sample was informed by the investigator individually about the purpose and nature of the study, then the investigator obtained oral consent from those who accepted to participate in this study.
• The investigator collected patients from Minia University Hospital first,  then Cardio-Thoracic Hospital, and it took around 10-15 minutes to fill the tools with an average of 10-15 patients per day, The investigator visited each hospital(diabetes and medical outpatient clinics) and (chronic lung disease and heart disease clinic ) for Three days a week from 9:30 a.m. to 12:30 p.m. until the pre-determined sample size was achieved between the beginning of June 2021 and the end of November 2021 (over six months).  
• The investigator completed the questionnaires for the illiterate patients, whereas the educated patients completed the questionnaires By themselves.

Ethical consideration:

The preliminary written approval was approved by the Research Ethics Committee of the Faculty of Nursing, Minia University. Oral informed consent was obtained from participants after explaining the nature and benefits of the study. Each assessment sheet was coded, and participants' names did not appear on the sheets for privacy and confidentiality. Participants were assured that they could withdraw at any time from the current study.

Statistical Analysis:

Statistical tests were used to computerize, tabulate, evaluate, and summarize the acquired data as Chi-square for quantitative variables and percentages for qualitative variables by using SPSS version 25. The level of significance was accepted at P <0.05

Results

Table (1): Distribution of the studied sample according to their socio-demographic characteristics (n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022

Table 1: shows that 83.4.% of the studied sample had ages ranging from 30 ≤ 49 years and 50 ≤ 69 years respectively with a mean of (50.05 ± 9.90). Regarding sex, 63.1% of them were male. Related to the residence 60.7% of them lived in an urban area, .also, more than half (53.8%) of the studied sample was illiterate. On the other hand, the result showed that 73.4% of the studied sample was not an employee and 79.8% of them were married. Finally, the majority of the studied samples 82.5% lived with their extended family

Table (2):  Distribution of the studied sample according to their lifestyle data (n=331), Minia University Hospital and Cardio-Thoracic Hospital, 202      

Table 2: reveals the distribution of the studied sample according to their lifestyle;

It was observed nonsmokers constituted 42% of the studied sample. Regarding the duration of smoking more than half (55.8%) of the studied sample had a duration of smoking from five to ten years. On the other hand, this table showed that 64.7% of the studied sample had their daily hours of sleep ranging from 6 to 10 hours. As regards the source of information about COVID-19, 45% of the studied sample obtained their information from family members followed by 41.4% through media such as TV and the Internet. While 0.9% is unheard it. Regarding the use of the mask, it was noted that the majority of the studied sample 88.8% used the mask. Regarding the type of mask used 62.6% of them were using the medical mask While 33.7% of them used cloth masks and only 3.7% used the nk95 mask

Table (3): Relation between total score of knowledge toward Coronavirus disease of the studied sample and their socio-demographic characteristics (n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022

Table (3) reveals the relation between the total score of knowledge toward Coronavirus Disease of the studied sample and their sociodemographic characteristics; statistically significant differences were found in the study sample's regarding age, residence, education level, occupation, family type, where the p-values were (0.001, 0.001, 0.007 & 0.001) respectively

Table (4): Relation between total levels of knowledge toward coronavirus disease of the studied sample and their lifestyle data(n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022.              

Table (4) reveals the relation between the total score of knowledge toward Coronavirus Disease of the studied sample and their lifestyle data; statistically, significant differences are found in the study sample's source of information, which included media such as TV and the Internet, using the mask and the type of mask where the p-values are (0.001, 0.02 & 0.001) respectively

Table (5): Relation between total score of practice toward coronavirus disease of the studied sample and their socio-demographic characteristics (n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022.

Table (5) shows a relation between the total score of practice toward Coronavirus disease of the studied sample and their socio-demographic characteristics; statistically, significant differences are found in the study sample's age, sex, residence, education, occupation, and the type of family where the p- values are  (0.001, 0.02, 0.001, 0.001, 0.04 & 0.01) respectively

Table (6): Relation between total score of practice toward coronavirus disease of the studied sample and their lifestyle data (n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022

Table (6) shows the studied sample relation between the total score of practice toward Coronavirus disease of the studied sample and their lifestyle data; it is observed that there are statistically significant differences between the studied sample (0,001) regarding the source of their information from media such as TV and the Internet, and P-V (0,001) regarding the type of mask from cloth mask

Figure (1): Distribution of the studied sample according to their total knowledge level of Coronavirus Disease (n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022.

Figure (1) illustrates that more than half (56.2%) of the studied sample had poor knowledge of coronavirus disease, while only (26.3%) of them had good score knowledge of coronavirus disease

Figure (2): distribution of the studied sample according to their total practice level toward Coronavirus Disease (n= 331), Minia University Hospital and Cardio-Thoracic Hospital, 2022.

Figure (2): shows that nearly three-quarters 73.1% of the studied sample had poor practice toward coronavirus disease. Whereas only more than one quarter of 26.9% of them had good practice toward coronavirus disease.

Table (7) Correlations between total score of knowledge and total score of practices of the studied sample toward Coronavirus disease (n=331), Minia University Hospital and Cardio-Thoracic Hospital, 2022.

Table (7) reveals that there is a positive strong correlation between the total score of knowledge and the total score of practices of the studied sample toward Coronavirus disease, which has the highest strong positive statistically significant correlation