|Year : 2022 | Volume
| Issue : 1 | Page : 13-18
Comparison of knowledge, attitude, practices, and psychological impact of COVID-19 among the urban and rural population of Bangalore, Karnataka
Nuthan Bhat, Hiba Salam, Sushma Javvaji, Ananya Chakraborty
Department of Community Medicine, Vydehi Institute of Medical Sciences And Research Centre, Bengaluru, Karnataka, India
|Date of Submission||01-Sep-2021|
|Date of Decision||01-Oct-2021|
|Date of Acceptance||05-Oct-2021|
|Date of Web Publication||25-Feb-2022|
Vydehi Institute of Medical Sciences And Research Centre, 82, Nallurahalli, Near Bmtc, 18th Depot, Whitefield, Bengaluru - 560 066, Karnataka
Source of Support: None, Conflict of Interest: None
Context and Objectives: There is a strong urban-rural divide in India in terms of education, economic status, and availability of health care. This became more prominent during the COVID-19 pandemic. Hence, the government emphasized on preventive aspects, especially in terms of safety practices. With this context, this study sought to evaluate and compare the knowledge, attitudes, practices, and psychological impact of COVID-19 among the urban and rural population of Bangalore to study the differential effects on both communities. Materials and Methods: An online questionnaire was distributed to 142 participants between December 1 and 31, 2020. The goal was to receive responses from both urban and rural population of Bangalore. Informed consent was taken from all participants. The response scores were tabulated and analyzed using statistical software. Results and Conclusion: A total of 138 responses were evaluated. In comparison to the urban population, there was a statistically significant link between inferior education and occupation in the rural population. (P 0.001). There was a statistically significant difference between rural and urban respondents in terms of knowledge (P 0.001) and attitude (P 0.05). The rural population's COVID-19 practices and the psychological impact were shown to be worse, but this was not statistically significant. A holistic approach is required to increase the rural population's knowledge and practices to integrate them with the rest of the country and combat the COVID-19 pandemic more effectively.
Keywords: Attitude, COVID 19, pandemic, rural, urban
|How to cite this article:|
Bhat N, Salam H, Javvaji S, Chakraborty A. Comparison of knowledge, attitude, practices, and psychological impact of COVID-19 among the urban and rural population of Bangalore, Karnataka. J Surg Spec Rural Pract 2022;3:13-8
|How to cite this URL:|
Bhat N, Salam H, Javvaji S, Chakraborty A. Comparison of knowledge, attitude, practices, and psychological impact of COVID-19 among the urban and rural population of Bangalore, Karnataka. J Surg Spec Rural Pract [serial online] 2022 [cited 2023 Mar 31];3:13-8. Available from: http://www.jssrp.org/text.asp?2022/3/1/13/338532
| Introduction|| |
India has a disproportionate distribution of its population in rural and urban regions. According to the Census data of 2011, India's rural population comprises 68.84% of the total population whereas the urban population makes up 31.16% of the total population. This means that rural areas in fact comprise a larger population of India as compared to urban areas.
Urban and rural areas have disparities in various fields such as access to technology, economic growth, outreach of health care, living conditions, and access to better information in the form of media and transport services. Furthermore, rural areas have a lower literacy rate than urban areas due to which a detrimental effect can be observed in their social and economic development., Hence, it would be expected that a worldwide pandemic of a huge magnitude like the COVID-19 pandemic would probably have a differential impact on people of the rural and urban population.
Previous studies conducted in various countries mentioned that there exists a positive correlation between knowledge and attitude scores regarding COVID-19 with education, economic status, and other demographic profiles of participants. It was noted that rural residents did not follow adequate preventive behaviors, had decreased level of information assessment skills, and had a pessimistic attitude., However, there were no studies available from Bangalore, Karnataka. With this background, this study was undertaken to assess and compare the knowledge, attitude, and practice (KAP) regarding COVID-19 and the psychological impact of the virus on the urban and rural population of Bangalore. The results might aid better awareness regarding COVID-19, which can reduce transmission and enable adoption of better attitude and preventive measures in both urban and rural areas. The psychological impact of COVID-19 is also an important aspect to be measured in this changing scenario. This aids better legislation and measures that can be taken by the government to ensure that both the urban and rural population can overcome the pandemic despite their disparities.
| Materials and Methods|| |
This cross-sectional study was conducted in the month of December 2020. Ethical clearance was obtained from the Institutional ethics committee. An online validated questionnaire was used to assess KAP of COVID-19. The questionnaire was developed from a previously used questionnaire, with permission.
The psychological impact was evaluated using Depression, Anxiety, Stress Scale-21 (DASS-21) items.
A pilot study was first conducted with 10 participants each from rural and urban population to validate the questionnaire and estimate the sample size. The Cronbach's alpha coefficient for the KAP questionnaire was calculated to be 0.68, and according to previous literature, the Cronbach's alpha coefficient for DASS-21 for the depression, anxiety, and stress subscales is 0.76, 0.73, and 0.71, respectively., The estimated sample size was with 55 urban and 55 rural responses.
The data collection was done by forwarding the questionnaire as a Google Docs form through various social networking sites with a message containing an introduction to the study, the statement of informed consent with the assurance that anonymity would be maintained and at any time, they could quit the study and that the information that they provide would remain confidential and would solely be used for research study. For the rural responses, the online questionnaire was forwarded to rural health-care workers and medical students working in rural Bangalore with translated versions in Hindi and Kannada.
Persons residing in Bangalore, Karnataka (rural/urban), aged 18 years or more, who gave informed consent, who agreed voluntarily to be a part of the study, and submitted complete forms were included in the study.
Incomplete responses were excluded from the study.
Details of questionnaires used
The first questionnaire used is a validated questionnaire (modified version of a previously used questionnaire, with permission) to assess KAP regarding COVID-19 with a Cronbach's alpha calculated to be 0.68 and consists of two parts: demographics and KAP.
Demographic variables include address (rural/urban), age, sex, level of education, and occupational status.
The knowledge, attitude, and practice questionnaire had 3 parts
- Knowledge section consisted of 12 questions: 4 regarding clinical presentations (K1-K4), 3 regarding transmission routes (K5-K7), and 5 regarding prevention and control (K8-K12) of COVID-19. These questions must be answered on a Yes/No basis. A correct answer was assigned 1 point and an incorrect answer was assigned 0 points. A score higher than 9 was considered as ≥75% knowledge
- Attitude section consisting of 3 questions to assess the attitude of the study population toward COVID-19, each graded as strongly agree, agree, don't know, disagree, and strongly disagree (Likert scale) with a score ranging from 3 to 15 with a score higher than 12 (≥75%) considered as positive attitude
- Practice section consisting of 7 questions to assess the practices of the study population with respect to COVID-19. The answered questions were on yes/no format. A correct response and incorrect response was allocated 1 point and 0 points, respectively. A score higher than 5 (≥75%) was considered as good practices toward COVID-19.
The second questionnaire assessing psychological impact of COVID-19 was DASS-21 items consisting of 21 questions (7 each for depression, anxiety, and stress), which has Cronbach's alpha values for the depression, anxiety, and stress subscales as 0.76, 0.73, and 0.71, respectively. Its scores were then calculated, tabulated, and analyzed using SPSS software (IBM® SPSS® Statistics).
| Results|| |
The questionnaire was administered to 142 individuals from rural and urban areas of Bangalore, Karnataka, all of whom completed the survey. Of the responses obtained, 4 were eliminated as they were either incomplete or did not fit the inclusion criteria of the study. The response rate was 97.2%. The number of urban responses was 71 whereas the number of rural responses was 67, hence to enable an accurate comparison, only the first 67 of the urban responses were studied. Hence, a total of 134 responses were evaluated: 67 from urban population and 67 from rural population.
Demographic profile of urban and rural population
The participants were between18 and 65 years of age. The highest number of respondents were from 21 to 30-year age group. In the same age group, 37.3% (25) of participants were from urban and 49.3% (33) were from rural areas, respectively. The results are shown in [Table 1].
|Table 1: Demographic profile of the study participants from the urban and rural population|
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In both the groups, 58.2% (39) of the participants were males, and 41.8% (28) were females. There were more male participants in the survey. The results are shown in [Table 1].
43.2% (29) of the urban respondents had completed postgraduation, 23.9% (16) of the respondents had completed graduation, 28.4% (19) are undergraduates, and merely 3% (2) had completed high school. In rural areas, 35.8% (24) of the responses were from those who were undergraduates and a relatively higher number of respondents, 20.9% (14) had completed high school. 31.3% (21) of the respondents had completed graduation while 10.5% (7) of the respondents had completed postgraduation. This association of lower educational background of rural responses was found to be statistically significant (P < 0.001) [Table 1].
4.5% (3) participants from urban areas and 20.9% (14) from rural areas completing the survey were unemployed. This association of poorer occupational background in rural areas was found to be statistically significant (P < 0.001) [Table 1].
Assessment of knowledge and its association with urban and rural population
The mean knowledge score of the urban and rural study population was 10.82 ± 1.21 and 10.03 ± 1.83, respectively. In the urban population, 94% (63) of the respondents had ≥75% knowledge and in the rural population, 70.1% (47) were observed to have ≥75% knowledge. This association between poorer knowledge in the rural population was found to be statistically significant (P < 0.001) [Table 2].
|Table 2: Comparison of knowledge, attitude and practices among the study participants from urban and rural population|
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Assessment of attitude and its association with urban and rural population
In the urban population, 65.7% (44) of the respondents had positive attitude (>75% attitude score), and in the rural population, 43.2% (29) were observed to have positive attitude. This association between attitude and community lived in by the individual was found to be statistically significant (P < 0.05) [Table 2].
Assessment of practices and its association with urban and rural population
In the urban population, 91% (61) of the respondents had good practices (>75% practices score) and in the rural population, 80.6% (54) were observed to have good practices. The urban areas had better practices regarding COVID-19 in comparison to rural areas. However, this association was not statistically significant (P = 0.08) [Table 2].
The responses to one of the questions of the practices section, Question 6, “Do you remove rings, bracelets, and bangles before washing your hands?” showed a surprisingly large percentage of responses that reflected poor practices. Fifty-four percent (73) of the total participants replied that they did not remove their rings before washing their hands. In the urban population, 46% (31) of the respondents replied that they did not remove their rings before washing their hands whereas in the rural population, 62.7% (42) of the respondents replied that they do not remove their rings before washing their hands. The rural respondents had a larger number of responses with poor practices. This was on the borderline of statistical significance (P = 0.056) [Figure 1].
|Figure 1: Do you remove rings, bracelets, and bangles before washing your hands?|
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Assessment of psychological impact of COVID-19 on urban and rural population
The assessment of psychological impact of COVID-19 among the rural and urban population included three parameters: depression, anxiety, and stress.
Assessment of depression and its association with urban and rural population
On assessing the depression among the study population, our study showed that 10.5% (14) of the total study population suffered from moderate to extremely severe depression. Among the urban responses, 7.5% (5) of the study population suffered from moderate to extremely severe depression while among the rural responses, 13.4% (9) of the study population suffered from moderate to extremely severe depression. This association of increased levels of moderate to extremely severe depression among the rural population was not statistically significant [Table 3].
|Table 3: Comparison of psychological impact of COVID-19 among the study participants from urban and rural population|
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Assessment of anxiety and its association with urban and rural population
On assessing the anxiety among the study population, it was found that 9.7% (13) of the total study population suffered from moderate to extremely severe anxiety. 9% (6) of urban population suffered from moderate to extremely severe anxiety while 10.4% (7) of the rural population suffered from moderate to extremely severe anxiety. This association of increased level of anxiety among the rural population was not statistically significant [Table 3].
Assessment of stress and its association with urban and rural population
On assessing the stress among the study population, it was found that 4.5% (6) of the total study population suffered from moderate to extremely severe stress. Our study surprisingly shows that 4.5% (3) of rural and 4.5% (3) of the urban population suffered from moderate to extremely severe stress [Table 3].
| Discussion|| |
The prevalence of wide disparities among the rural and urban population across various fields such as health and education will result in differences in the way that COVID-19 has impacted the rural and urban population in terms of the psychological impact and their knowledge regarding COVID-19.
Our response rate for the study was 97.2%. It is similar to a cross-sectional study done in Bangladesh which had a 97.3% response rate. Out of the 134 participant's responses that were evaluated, 43.28% (58) belonged to the age group 21–30 years. Thirty-two percent (43) of the participants were undergraduates, 27.61% (37) were graduates, and 44.02% (59) were students.
A study conducted in China to assess the knowledge, attitude, and practices of COVID-19 had similar results with 52.61% of participants in the age group 21–30 years, 36.40% were students, and 38.10% of the participants' education was junior college/bachelors' degree.
In a study conducted by Tomar et al., on Indian community's KAP toward COVID-19, the majority age group was 18–30 years, 70.04% held a degree of graduate or above, and 40.5% of participants were students.
The mean knowledge score for our study was 10.82 ± 1.21 for the urban population and 10.03 ± 1.83 for the rural population. In a similar study conducted in China, the mean knowledge score in the urban population was 11.98 ± 1.05 whereas in the rural population, it was 11.34 ± 1.54.
Our study showed that, in the urban population, 65.7% of the respondents had a positive attitude toward COVID-19 whereas 43.2% of the rural population had a positive attitude toward the virus. A similar study conducted in Bangladesh observed that 62.3% of its total respondents had positive attitudes toward COVID-19.
In our study, the majority of the rural population had poor practices (68.4%) and 47% had good practices. Whereas, in urban areas, 53.0% had good practices and 31.6% had poor practices against COVID-19. This disparity in practices among the rural and urban population could be due to the lack of access to social media, spread of wrong information, and lack of education among the rural population., Similar results were seen in a study conducted in Bangladesh where 52.8% of the rural population had poor practice and 47.2% had good practice. In the urban population, 41.3% had poor practice and 58.7% had good practice.
Our study showed that 89.55% (120) had normal to mild depression and 10.44% (14) had moderate to extremely severe depression. For the anxiety scales, 90.29% (121) participants suffered from normal to mild anxiety and 9.7% (13) participants suffered from moderate to extremely severe anxiety. Furthermore, 95.22% (128) participants had normal to mild stress and 4.47% (6) participants had moderate to extremely severe stress.
These findings are similar to those of a study based on immediate psychological responses and factors associated with it during the COVID-19 epidemic among the general population in China which showed that 83.47% had suffered normal to mild depression and 16.52% had moderate to extremely severe depression. For the anxiety scales, 71.15% suffered from normal to mild anxiety and 28.8% suffered from moderate to extremely severe anxiety. 91.8% of their participants had normal to mild stress and 8.1% of them had moderate to extremely severe stress.
Our study surprisingly showed similar responses among the rural and urban population on assessment of stress. This similarity in responses could be due to the smaller sample size, and therefore, a larger sample size can illustrate the variation in stress among the rural and urban population in a better way. This is one of the limitations of our study.
| Conclusion|| |
A statistically significant association was found to exist between poorer education and occupation in rural population in comparison to the urban population (P < 0.001). A statistically significant association was found between poorer knowledge (P < 0.001) and attitude (P < 0.05) in rural respondents than among the urban respondents. The practices and psychological impact of COVID-19 was found to be poorer in the rural population but was not statistically significant.
Thus, there is an alarming difference between the KAPs regarding COVID-19 and its psychological impact among the urban and rural population. This needs to be addressed at the grass root level. This could be attributed to reduced access to the latest guidelines and media and poorer educational background. Hence, better investment must be made in the education and health-care delivery to rural areas to fully integrate them with the urban community. Due to the lack of access to mainstream media and technology, the rural population fails to obtain valid and recent information about the various preventive measures that must be followed. Moreover, due to poverty and lack of basic facilities, they cannot enforce safety measures even if relevant information is obtained.
A holistic and systematic approach is of utmost importance to ensure that the rural community does not fall behind the rest of the country in successfully fighting against the COVID-19 pandemic. Better legislative measures can be enforced by the government to improve the progress toward a healthier future inclusive of both urban and rural communities smoother.
We thank Ms. Supriya Acharya, Biostatistician, Vydehi Institute of medical sciences and research centre, Bangalore, for her support and guidance in the statistical analysis of this study. We thank Dr. G. Prabhakar, Dean, VIMS and RC, Bangalore, for his support. We also thank all the participants involved in this study for their time and cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Das D, Pathak M. The growing rural-urban disparity in India: Some issues. Int J Adv Res Technol 2012;1:1-7.
Yue S, Zhang J, Cao M, Chen B. Knowledge, attitudes and practices of COVID-19 among urban and rural residents in China: A cross-sectional study. J Community Health 2021;46:286-91.
Tomar BS, Singh P, Suman S, Raj P, Nathiya D, Tripathi S, Chauhan DS. Indian community's knowledge, attitude and practice towards COVID-19. Indian J Soc Psychiatry 2021;37:48-56. Available from: https://t.co/iYCrTWOUfI
. [Last accessed on 2021 Jan 30].
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, 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 2020;16:1745-52.
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd
ed. Sydney: Psychology Foundation; 1995.
Singh K, Junnarkar M, Sharma S. Anxiety, stress, depression, and psychosocial functioning of Indian adolescents. Indian J Psychiatry 2015;57:367-74.
] [Full text]
Banik R, Rahman M, Sikder MT, Rahman QM, Pranta MUR. Knowledge, attitudes, and practices related to the COVID-19 pandemic among Bangladeshi youth: A web-based cross-sectional analysis. J Public Health (Berl.) 2021. https://doi.org/10.1007/s10389-020-01432-7
Gao H, Hu R, Yin L, Yuan X, Tang H, Luo L, et al
. Knowledge, attitudes and practices of the Chinese public with respect to coronavirus disease (COVID-19): An online cross-sectional survey. BMC Public Health 2020;20:1816.
Ferdous MZ, Islam MS, Sikder MT, Mosaddek AS, Zegarra-Valdivia JA, Gozal D. Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An online-based cross-sectional study. PLoS One 2020;15:e0239254.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al.
Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:E1729.
[Table 1], [Table 2], [Table 3]