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Published in: BMC Public Health 1/2021

Open Access 01-12-2021 | COVID-19 | Research article

Knowledge, socio-cognitive perceptions and the practice of hand hygiene and social distancing during the COVID-19 pandemic: a cross-sectional study of UK university students

Authors: Christine Barrett, Kei Long Cheung

Published in: BMC Public Health | Issue 1/2021

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Abstract

Background

During the first wave of the COVID-19 pandemic, social distancing and hand hygiene have been the primary means of reducing transmission in the absence of effective treatments or vaccines, but understanding of their determinants is limited. This study aimed to investigate knowledge and socio-cognitive perceptions, and their associations with such protective behaviours, in UK university students.

Methods

A cross-sectional online survey of 293 students was undertaken on 13 May 2020. Survey questions addressed demographics, knowledge of the disease and effectiveness of the protective measures, risk perception, socio-cognitive perceptions (e.g. attitude, social support, and self-efficacy), habit, time factors and trust, as well as the hand hygiene and social distancing behaviours. Multiple linear regression was used to identify the strongest associations of potential determinants with behaviour.

Results

Participants reported high levels of social distancing with 88.9% answering “Mostly” or “Always” for every activity, but only 42.0% reporting the same for all hand hygiene activities. Knowledge of the effectiveness of each activity in preventing transmission was high, with 90.7% and 93.5% respectively identifying at least 7 of 8 hand hygiene or 9 of 10 social distancing activities correctly. Habit (β = 0.39, p = 0.001) and time factors (β = 0.28, p = 0.001) were the greatest contributors to unique variance in hand hygiene behaviour, followed by ethnicity (β = − 0.13, p = 0.014) and risk perception (β = 0.13, p = 0.016). For social distancing behaviour, the determinants were self-efficacy (β = 0.25, p < 0.001), perceived advantages (β = 0.15, p = 0.022), trust in policy (β = 0.14, p = 0.026) and gender (β = − 0.14, p = 0.016). Regression models explained 40% hand hygiene and 25% social distancing variance.

Conclusions

This study indicated that communications about effectiveness of hand hygiene and social distancing behaviours had been effective in terms of knowledge acquisition. However, in the light of likely second waves of COVID-19, attention to maintaining social distancing behaviour and improving hand hygiene behaviour may need to address more difficult areas of changing habits, overcoming time factors and building trust, as well as interventions to increase self-efficacy and address risk perception concerns.
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Literature
1.
2.
3.
4.
5.
Rubin GJ, Potts HW, Michie S. The impact of communications about swine flu (influenza a H1N1v) on public responses to the outbreak: results from 36 national telephone surveys in the UK. Health Technol Assess. 2010;14(34):183–266.PubMedCrossRef
6.
Lau JTF, Griffiths S, Choi K, Lin C. Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic. Am J Infect Control. 2010;38(5):374–80.PubMedPubMedCentralCrossRef
7.
8.
Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108.PubMedPubMedCentralCrossRef
9.
van Wijhe M, Ingholt MM, Andreasen V, Simonsen L. Loose ends in the epidemiology of the 1918 pandemic: explaining the extreme mortality risk in young adults. Am J Epidemiol. 2018;187(12):2503–10.PubMedCrossRef
10.
Lemaitre M, Carrat F. Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic. BMC Infect Dis. 2010;10(1):162.PubMedPubMedCentralCrossRef
11.
Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China B. 2020;63(5):706–11.
12.
Furukawa NW, Brooks JT, Sobel J. Evidence supporting transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While presymptomatic or asymptomatic. Emerg Infect Dis. 2020;26:7.CrossRef
13.
Seale H, Mak JP, Razee H, MacIntyre CR. Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza. BMC Public Health. 2012;12(1):307.PubMedPubMedCentralCrossRef
14.
Hsu LY, Jin J, Ang BS, Kurup A, Tambyah PA. Hand hygiene and infection control survey pre- and peri-H1N1-2009 pandemic: knowledge and perceptions of final year medical students in Singapore. Singap Med J. 2011;52(7):486–90.
15.
Bish A, Michie S. Demographic and attitudinal determinants of protective behaviours during a pandemic: a review. Br J Health Psychol. 2010;15(4):797–824.PubMedPubMedCentralCrossRef
16.
de Vries H. An integrated approach for understanding health behavior; the I-change model as an example. Psychol Behav Sci Int J. 2017;2(2):555585.CrossRef
17.
Aunger R, Greenland K, Ploubidis G, Schmidt W, Oxford J, Curtis V. The determinants of reported personal and household hygiene behaviour: a multi-country study. PLoS One. 2016;11(8):e0159551.PubMedPubMedCentralCrossRef
18.
Gaygisiz Ü, Gaygisiz E, Özkan T, Lajunen T. Individual differences in behavioral reactions to H1N1 during a later stage of the epidemic. J Infect Public Health. 2012;5(1):9–21.PubMedCrossRef
19.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Epidemiology. 2007;18:6.
20.
21.
22.
Rubin GJ, Bakhshi S, Amlôt R, Fear N, Potts HW, Michie S. The design of a survey questionnaire to measure perceptions and behaviour during an influenza pandemic: the Flu TElephone Survey Template (FluTEST). HSDR. 2014;2:41.
23.
Pallant J: SPSS Survival Manual: Sydney: Allen & Unwin; 2010.
24.
Ergin A, Bostanci M, Onal O, Bozkurt AI, Ergin N. Evaluation of students' social hand washing knowledge, practices, and skills in a university setting. Cent Eur J Public Health. 2011;19(4):222–7.PubMedCrossRef
25.
Jeong JS, Choi JK, Jeong IS, Paek KR, In H, Park KD. A nationwide survey on the hand washing behavior and awareness. J Prev Med Pub Health. 2007;40(3):197.CrossRef
26.
Wong JSW, Lee JKF. The common missed Handwashing instances and areas after 15 years of hand-hygiene education. J Environ Public Health. 2019;2019:5928924.PubMedPubMedCentralCrossRef
27.
Cheung KL, Evers SMAA, Hiligsmann M, Vokó Z, Pokhrel S, Jones T, et al. Understanding the stakeholders’ intention to use economic decision-support tools: A cross-sectional study with the tobacco return on investment tool. Health Policy. 2015;120(1):46–54.PubMedCrossRef
28.
Brewer NT, Chapman GB, Gibbons FX, Gerrard M, McCaul KD, Weinstein ND. Meta-analysis of the relationship between risk perception and health behavior: The example of vaccination. Health Psychol. 2007;26:2.CrossRef
29.
Rubin GJ, Amlôt R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ. 2009;339(7713):156.
30.
Iacobucci G. Covid-19: UK lockdown is “crucial” to saving lives, say doctors and scientists. BMJ. 2020;368.
31.
Shamon H, Berning CC. Attention check items and instructions in online surveys: boon or bane for data quality? Surv Res Methods. 2020;14(1):55–77.
32.
Shmueli G. To explain or to predict? Stat Sci. 2011;25:3.
33.
Moran KR, Del Valle SY. A meta-analysis of the association between gender and protective behaviors in response to respiratory epidemics and pandemics. PLoS One. 2016;11:10.CrossRef
34.
Van D, McLaws ML, Crimmins J, MacIntyre CR, Seale H. University life and pandemic influenza: Attitudes and intended behaviour of staff and students towards pandemic (H1N1) 2009. BMC Public Health. 2010;10:130.PubMedPubMedCentralCrossRef
35.
Lin L, McCloud RF, Jung M, Viswanath K. Facing a health threat in a complex information environment: a National Representative Survey Examining American Adults’ behavioral responses to the 2009/2010 a(H1N1) pandemic. Health Educ Behav. 2018;45(1):77–89.PubMedCrossRefPubMedCentral
36.
Hoving C, Mudde AN, de Vries H. Intention to implement a smoking cessation intervention in Dutch general practice. Health Educ. 2007;107(3):307–15.CrossRef
37.
Frigge M, Hoaglin DC, Iglewicz B. Some implementations of the boxplot. Am Stat. 1989;43:1.
38.
Taghrir MH, Borazjani R, Shiraly R. COVID-19 and iranian medical students; a survey on their related-knowledge, preventive behaviors and risk perception. Arch Iran Med. 2020;23(4):249–54.PubMedCrossRef
39.
Salman M, Mustafa ZU, Asif N, Zaidi HA, Hussain K, Shehzadi N, et al. Knowledge, attitude and preventive practices related to COVID-19: a cross-sectional study in two Pakistani university populations. Drugs Ther Perspect. 2020;36(7):319–25.CrossRefPubMedPubMedCentral
40.
41.
Oosterhoff B, Palmer CA. Attitudes and psychological factors associated with news monitoring, social distancing, disinfecting, and hoarding behaviors among US adolescents during the Coronavirus Disease 2019 pandemic. JAMA Pediatr. 2020:E1–7.
42.
Seale H, Heywood AE, Leask J, Sheel M, Thomas S, Durrheim DN, et al. COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic. PloS One. 2020;15:6.CrossRef
43.
44.
45.
46.
Kupfer TR, Wyles KJ, Watson F, La Ragione RM, Chambers MA, Macdonald AS. Determinants of hand hygiene behaviour based on the theory of interpersonal behaviour. J Infect Prev. 2019;20(5):232–7.CrossRef
47.
Barati M, Bashirian S, Jenabi E, Khazaei S, Karimi-Shahanjarini A, Zareian S, et al. Factors associated with preventive behaviours of COVID-19 among hospital staff in Iran in 2020: an application of the protection motivation theory. J Hosp Infect. 2020;105(3):430–3.PubMedPubMedCentralCrossRef
48.
Park JH, Cheong HK, Son DY, Kim SU, Ha CM. Perceptions and behaviors related to hand hygiene for the prevention of H1N1 influenza transmission among Korean university students during the peak pandemic period. BMC Infect Dis. 2010;10(1):222.PubMedPubMedCentralCrossRef
49.
Mitchell T, Dee DL, Phares CR, Lipman HB, Gould LH, Kutty P, et al. Non-pharmaceutical interventions during an outbreak of 2009 pandemic influenza a (H1N1) virus infection at a large public university, April-may 2009. Clin Infect Dis. 2011;52(SUPPL. 1):S138–45.PubMedCrossRef
50.
King DB, Kamble S, DeLongis A. Coping with influenza a/H1N1 in India: empathy is associated with increased vaccination and health precautions. Int J Health Promot Educ. 2016;54(6):283–94.CrossRef
51.
Kim HK, Niederdeppe J. Exploring optimistic bias and the integrative model of behavioral prediction in the context of a campus influenza outbreak. J Health Commun. 2013;18(2):206–22.PubMedCrossRef
52.
Gu J, Zhong Y, Hao Y, Zhou D, Tsui H, Hao C, et al. Preventive behaviors and mental distress in response to H1N1 among university students in Guangzhou, China. Asia Pac J Public Health. 2015;27(2):NP1867–79.PubMedCrossRef
53.
Kamate SK, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K. Public knowledge, attitude and behavioural changes in an Indian population during the influenza a (H1N1) outbreak. J Infect Dev Ctries. 2010;4(1):7.CrossRef
54.
Liao Q, Cowling B, Lam WT, Ng MW, Fielding R. Situational awareness and health protective responses to pandemic influenza a (H1N1) in Hong Kong: a cross-sectional study. PLoS One. 2010;5(10):e13350.PubMedPubMedCentralCrossRef
55.
Cowling BJ, Ng DMW, Ip DKM, Liao Q, Lam WWT, Wu JT, et al. Community psychological and behavioral responses through the first wave of the 2009 influenza a(H1N1) pandemic in Hong Kong. J Infect Dis. 2010;202(6):867–76.PubMedCrossRef
56.
Agüero F, Adell MN, Pérez Giménez A, López Medina MJ, Garcia Continente X. Adoption of preventive measures during and after the 2009 influenza a (H1N1) virus pandemic peak in Spain. Prev Med. 2011;53(3):203–6.PubMedPubMedCentralCrossRef
57.
Khasawneh AI, Humeidan AA, Alsulaiman JW, Bloukh S, Ramadan M, Al-Shatanawi TN, et al. Medical students and COVID-19: knowledge, attitudes, and precautionary measures A descriptive study from Jordan. Front Public Health. 2020;8:253.PubMedPubMedCentralCrossRef
58.
Clements JM. Knowledge and behaviors toward COVID-19 among US residents during the early days of the pandemic: Cross-sectional online questionnaire. JMIR Public Health and Surveill. 2020;6:2.CrossRef
59.
Wise T, Zbozinak T, Michelini G, Hagan C, Mobbs D. Changes in risk perception and self-reported protective behaviour during the first week of the COVID-19 pandemic in the United States. R Soc Open Sci. 2020;7:200742.PubMedPubMedCentralCrossRef
60.
61.
62.
Steelfisher GK, Blendon RJ, Kang M, Ward JRM, Kahn EB, Maddox KEW, et al. Adoption of preventive behaviors in response to the 2009 H1N1 influenza pandemic: a multiethnic perspective. Influenza Other Resp Viruses. 2015;9(3):131–42.CrossRef
63.
Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health. 2020;17:9.
64.
65.
Bartholomew Eldredge LK. Planning health promotion programs: an intervention mapping approach. 4th ed. San Francisco: Jossey-Bass; 2016.
66.
Rosenstock IM, Strecher VJ, Becker MH. Social Learning Theory and the Health Belief Model. Health Educ Q. 1988;15:2.CrossRef
67.
68.
69.
Liao Q, Cowling BJ, Lam WWT, Ng DMW, Fielding R. Anxiety, worry and cognitive risk estimate in relation to protective behaviors during the 2009 influenza a/H1N1 pandemic in Hong Kong: ten cross-sectional surveys. BMC Infect Dis. 2014;14(1):169.PubMedPubMedCentralCrossRef
70.
Metadata
Title
Knowledge, socio-cognitive perceptions and the practice of hand hygiene and social distancing during the COVID-19 pandemic: a cross-sectional study of UK university students
Authors
Christine Barrett
Kei Long Cheung
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
COVID-19
Published in
BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-021-10461-0

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