Document Type : Original Article


1 College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India


BACKGROUND: COVID‑19 was declared an emergency of international concern by the World Health
Organization in 2020. This study assesses patients’ awareness, perception, and mitigating measures
taken during the COVID‑19 outbreak visiting an apex tertiary health‑care center in North India.
MATERIALS AND METHODS: A cross‑sectional study was conducted between September 15,
2020, and November 15, 2020, in a tertiary care public hospital, North India, using a structured
self‑administered questionnaire. The survey included 809 patients using a consecutive sampling
strategy. The self‑structured and prevalidated questionnaire was used to collect information on
study variables. Chi‑square test and independent samples t‑test, followed by binary and multivariate
logistic regression, was used to determine the factors associated with awareness toward COVID‑19.
RESULTS: The mean age of participants was 32.41 (±11.24) years. Multivariate logistic regression
shows that married participants (OR: 0.660, 95 % CI: 0.440-0.989, P= 0.044), reading books/
magazine or attended institutional lectures (OR: 2.241, 95% CI: 1.545–3.249, P = 0.001), and watching
television and radio (OR: 1.824, 95% CI: 1.283–2.592, P = 0.001) are significantly more aware than
their counterparts. Participants with higher income group (>20,000 Indian rupee) significantly had
higher awareness than participants having salary <10,000 rupees (OR: 0.280, 95% CI: 0.178–0.440,
P = 0.001) or 10,001–20,000 rupees (OR: 0.481, 95% CI: 0.297–0.777, P = 0.003). Patients
avoiding traveling across or abroad had significantly much reasonably good awareness than their
counterparts (OR: 0.357, 95% CI: 0.139–0.918, P = 0.033).
CONCLUSIONS: Participants demonstrated good awareness, encouraging perception, and complied
with appropriate mitigating measures during the outbreak. Considering frequent waves and the
pandemic’s long duration, consistent reinforcement of government measures, including masks,
maintaining social distance, and frequent handwashing, is much needed.


1. Guo Y, Cao Q, Hong Z, Tan Y, Chen S, Jin H, et al. The origin,
transmission and clinical therapies on coronavirus disease
2019 (COVID‑19) outbreak – An update on the status. Mil Med Res 2020;7:1‑10.
2. BikdeliB, TalasazAH, RashidiF, Sharif‑KashaniB, FarrokhpourM,
Bakhshandeh H, et al. Intermediate versus standard‑dose
prophylactic anticoagulation and statin therapy versus placebo
in critically‑ill patients with COVID‑19: Rationale and design
of the INSPIRATION/INSPIRATION‑S studies. Thromb Res
3. Coronavirus and COVID‑19: What You Should Know. 2020.
Available from:
Last accessed on 2020 Aug 27].
4. Tang D, Tou J, Wang J, Chen Q, WangW, Huang J, et al. Prevention
and control strategies for emergency, limited‑term, and elective
operations in pediatric surgery during the epidemic period of
COVID‑19. World J Pediatr Surg 2020;3:e000122.
5. World Health Organization. The 2019‑nCoV Outbreak is An
Emergency of International Concern; 2020. Available from: https://‑topics/health‑emergencies/
The WHO Director‑General%2C Dr, came into force in 2005. [Last
accessed on 2020 Aug 24; Last updated on 2020 Feb 16].
6. AlhazmiA, AliMH, MohieldinA, Aziz F, OsmanOB, AhmedWA.
Knowledge, attitudes and practices among people in Saudi Arabia
regarding COVID‑19: A cross‑sectional study. J Public Health Res
7. Ohns Hopkins Coronavirus Resource Center. Mortality
Analyses‑Johns Hopkins Coronavirus Resource Center;
2020. Available from:
mortality. [Last accessed on 2020 Aug 25].
8. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The
psychological impact of the SARS epidemic on hospital employees
in China: Exposure, risk perception, and altruistic acceptance of
risk. Can J Psychiatr 2009;54:302‑11.
9. MoHFW | Home. Guidelines on the Measure to be Taken by
Ministries/Departments of Government of India, State/Union
Territory Government and State/Union Territory Governments
and State/Union Territory Authorities for Containment of
COVID‑19 Epidemic in the Country; 2020. Available from: [Last accessed on 2020 Aug 25].
10. Kumar R, Singh V, Mohanty A, Gupta PK, Bahurupi Y. Corona
health‑care warriors in India: Knowledge, attitude, and
practices during COVID‑19 outbreak. J Edu Health Promot
2020;Forthcoming Jan. 2021. Available from https://www.‑care_
COVID‑19_outbreak. [Last accessed on 2020 Dec 21].
11. Tomar BS, Singh P, Suman S, Raj P, Nathiya D, Tripathi S, et al.
Indian community’s knowledge, attitude and practice towards
COVID‑19. [Internet].medRxiv 2020. Available from: http://
abstract.[ Last accessed on 2020 Dec 25].
12. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study
of knowledge, attitude, anxiety and perceived mental healthcare
need in Indian population during COVID‑19 pandemic. Asian J
Psychiatr 2020;51:1‑7.
13. Helen S. Hunting Down the Rumors of COVID‑19; 2020. Available
features/huntingdown‑rumours‑covid‑19. [Last accessed on 2020
Aug 24; Last updated on 2020 Apr 11].
14. Christy J, Kaur K, Gurnani B, Hess O, Narendran K, Venugopal A,
et al. Knowledge, attitude and practise toward COVID‑19 among
patients presenting to five tertiary eye care hospitals in South
India – A multicentre questionnaire‑based survey. Indian J
Ophthalmol 2020;68:2385‑90.
15. Gupta P, Gupta A, Dixit S, Kumar H. Knowledge, attitude, and
practices regarding COVID‑19: A cross‑sectional study among
rural population in a Northern Indian district. J Family Med Prim
Care 2020;9:4769‑73.
16. Kartheek A, Gara K, Vanamali D. Knowledge, attitude and
practices towards COVID‑19 among Indian residents during the
pandemic: A cross‑sectional online survey. J Dr NTR Univ Health
Sci 2020;9:107‑15.
17. MubeenSM, KamalS, KamalS, BalkhiF. Knowledge and awareness
regarding spread and prevention of COVID‑19 among the young
adults of Karachi. J Pak Med Assoc 2020;70 Suppl 3:S169‑74.
18. Honarvar B, Lankarani KB, Kharmandar A, Shaygani F,
Zahedroozgar M, Rahmanian Haghighi MR, et al. Knowledge,
attitudes, risk perceptions, and practices of adults toward
COVID‑19: A population and field‑based study from Iran. Int J
Public Health 2020;65:731‑9.
19. Zhong BL, Luo W, Li HM, Zhang Q, Liu X, Li W, et al.
Knowledge, attitudes, and practices towards COVID‑19 among
Chinese residents during the rapid rise period of the COVID‑19
outbreak: A quick online cross‑sectional survey. Int J Biol Sci
20. WHO. Q&A on Coronaviruses (COVID‑19); 2020. Available
novel‑coronavirus‑2019/question‑and‑answers‑hub. [Last
accessed on 2020 Nov 21].
21. WHO. WHO Coronavirus Disease (COVID‑19); 2020. Available
from:×4IC3YW_sBhh-Q9RNu-hIg-KMu9IOp_YSLbUclVF8HcHDoaAtmmEALw_wcB. [Last accessed on 2020 Nov
22. Anikwe CC, Ogah CO, Anikwe IH, Okorochukwu BC, Ikeoha CC.
Coronavirus disease 2019: Knowledge, attitude, and practice of
pregnant women in a tertiary hospital in Abakaliki, southeast
Nigeria. Int J Gynecol Obstet 2020;151:197‑202.
23. SunX, LiS, LiK, HuX. Pharmaceutical care of chloroquine phosphate
in elderly patients with coronavirus pneumonia (COVID‑19).
Aging Med (Milton) 2020;3:98‑101.
24. Alahdal H, Basingab F, Alotaibi R. An analytical study on the
awareness, attitude and practice during the COVID‑19 pandemic
in Riyadh, Saudi Arabia. J Infect Public Health 2020;13:1446‑52.
25. Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al.
Knowledge, attitude, and practice regarding COVID‑19 among
healthcare workers in Henan, China. J Hosp Infect 2020;105:183‑7.
26. Ranjan R, Ranjan GK. Knowledge regarding prevention of
novel coronavirus (COVID‑19): An electronic cross‑sectional
survey among selected rural community. Int J Trend Sci Res Dev
27. ChenY, JinYL, Zhu LJ, FangZM, Wu N, Du MX, et al. The network
investigation on knowledge, attitude and practice about Novel
coronavirus pneumonia of the residents in Anhui Province.
Zhonghua Yu Fang Yi Xue Za Zhi 2020;54:E004.
28. CDC. Centers for Disease Control and Prevention:
Coronavirus (COVID‑19); 2020. Available from: https://www.‑nCoV/index.html. [Last accessed on
2020 Nov 23].
29. Almutairi KM, Al Helih EM, Moussa M, Boshaiqah AE, Saleh
Alajilan A, Vinluan JM, et al. Awareness, attitudes, and practices
related to coronavirus pandemic among public in Saudi Arabia.
Fam Community Health 2015;38:332‑40.
30. Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F.
Coronavirus disease‑2019: Knowledge, attitude, and practices
of health care workers at makerere university teaching hospitals,
Uganda. Front Public Health 2020;8:181.
31. Huynh G, Nguyen T, Tran V, Vo K, Vo V, Pham L. Knowledge and
attitude toward COVID‑19 among healthcare workers at District 2
Hospital, Ho Chi Minh City. Asian Pac J Trop Med 2020;13:260‑5.
32. Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E.
Public knowledge, attitudes and practices towards COVID‑19:
A cross‑sectional study in Malaysia. PLoS One 2020;15:e0233668.
33. Abebe TB, Bhagavathula AS, Tefera YG, Ahmad A, Khan MU,
Belachew SA, et al. Healthcare professionals’ awareness,  knowledge, attitudes, perceptions and beliefs about ebola at
Gondar University Hospital, Northwest Ethiopia: Across‑sectional
study. J Public Health Afr 2016;7:570.
34. Ohnson EJ, Hariharan S. Public health awareness: Knowledge,
attitude and behaviour of the general public on health risks during
the H1N1 influenza pandemic. J Public Health 2017;25:333‑7.
35. Al‑Hanawi MK, Angawi K, Alshareef N, Qattan AM, Helmy HZ,
Abudawood Y, et al. Knowledge, attitude and practice toward
COVID‑19 Among the public in the kingdom of Saudi Arabia:
A cross‑sectional study. Front Public Health 2020;8:217.
36. ALdowyan N, Abdallah AS, El‑Gharabawy R. Knowledge,
attitude and practice (KAP) study about Middle East respiratory
syndrome coronavirus (MERS‑CoV) among population in
Saudi Arabia. Int Arch Med 2017;10 (254):1‑12. Available from:
view/2736. [Last accessed on 2020 Dec 23]
37. Banik R, Rahman M, Sikder DM, Rahman QM, Pranta MU.
Investigating knowledge, attitudes, and practices related to
COVID‑19 outbreak among Bangladeshi young adults: A web
based cross‑sectional analysis. Res Sq 2020;1‑15. Available from:‑37946/v3.[Last accessed on
2020 Dec 24]