Perception and awareness of COVID-19 among health science students and staff of Kuwait University: An online cross-sectional study

Study population

A cross-sectional survey study was conducted between June and July 2020 on students and staff at HCS of Kuwait University. Our target populations were: all undergraduate and postgraduate students enrolled in the five faculties (Medicine, Dentistry, Pharmacy, Public Health and Allied Health) of HSC and all the staff (faculty members, teaching assistants, and supporting staff) employed by HSC.

Data collection tool

Data collection was conducted via online questionnaire distributed to students and staff. During the study period, the university was closed, and no classes were held on campus nor through distance learning.

The questionnaire was developed based on validated survey tools provided by World Health Organization¹¹ and that used by Khasawneh et al.¹² The WHO survey tool provides general guidelines and questionnaire standard tool to conduct behavioral insights studies related to COVID-19. The survey by Khasawneh et al. is specific for medical students’ knowledge and attitude in relation to COVID-19. Their survey tool included sections on socio-demographics, sources of information, knowledge, and attitudes regarding COVID-19, and precautionary measures. Nonetheless, the questionnaire used in this study was adapted to our target population. Non-relevant or redundant questions were excluded from both survey tools and those that met the objectives of this study were included. Some of the questions taken from the previous survey tools were modified such as changes in the number of multiple-choice answers per question as well as rewording the questions to improve clarity.

The questionnaire was divided into six sections: socio-demography, risk and awareness, preparedness and prevention, source of information, policies, and social stigma. Socio-demography questions included questions about gender, academic year, faculty, and presence of chronic illness. Additional questions for staff included job classification and age. Risk and awareness section included questions about history of COVID-19 infection, risk of infection in the future and infection severity, awareness of consequences of infection as well as awareness of availability of treatment or vaccine for COVID-19. Preparedness and prevention section included questions about probability of avoiding infection with SARS-CoV-2, prevention measures taken to avoid infection measures as frequency based on the participants response to one of the following options: most times, rarely or sometimes, and never. Additional question on participants’ opinion on attending classes or working on-campus vs. online learning methods. The source of information section had questions about main sources of acquiring information. These included television news stations, family and friends, healthcare workers, online search, social media, official government press releases, and celebrities. Policies section included questions about COVID-19 vaccine timeline and willingness to uptake the vaccine and treatment. Furthermore, opinion of participants regarding the following: mandatory quarantine of COVID-19 contacts, wearing face mask in public places, legal punishment of who is COVID-19 infected and knowingly socialize with others and those spread share/spread falsified information about COVID-19. Social stigma section included questions about: participants’ reaction to knowing someone COVID-19 positive, blaming the person of who got the infection, what information the participants would like to know about those infected, community reaction to those infected (such as being socially rejected, denied medical care, job loss), and ways to reduce social stigma.

Two questionnaires were developed; one administered to students and another to the staff. Both questionnaires were very similar with only differences in the first section (i.e., socio-demography). The questionnaires were provided in English since the students and staff are familiar with this language.

The questionnaires were distributed and administered to the participants online via Google Forms. The questionnaires were sent via an email to all students and staff within HSC through Listserv. Additionally, student representatives at each faculty distributed the questionnaire to class groups via WhatsApp. Each of the six sections was composed of several questions (the copy of the questionnaires can be found in the Extended data). The questionnaires were validated and pilot tested on 10 students and 10 staff prior to administration to all participants. Based on the pilot testing, the survey tool was improved for grammatic errors and sentence structure to provide more clarity. Multiple reminders were sent to all participants to increase response rate.

The study has two main potential biases that are also common in cross-sectional survey studies. First, selection bias due to non-probability sampling method used in the study (i.e., convenience sampling) that could lead to non-representative sample of the target populations. We used this type of sampling since no sampling frame (a list of the students and staff) was available to conduct a probability-based sampling method. Second, a recall bias could occur if the certain participants can recall certain information because of their previous exposure to COVID-19 and differentially than those who were not exposed. Our data stratification shows those who have been infected or were exposed due to interaction with COVID-19 positive cases.

Statistical analysis

Data were exported from Google Forms to an Excel spreadsheet for data management. The analyses were conducted in STATA statistical software ver. 15.1 (College Station, Texas). A descriptive analysis using cross tabulation of frequency and percentage of variables was conducted. Students were categorized into two groups: younger students (freshmen and junior student [years 1-3]) and older students (senior [years 4-7] and graduate students) for the purpose of the univariate (chi-square) analysis in STATA. Alpha of 0.05 was used as the significance level.

Ethics approval and consent to participate

All participants were provided with informed consent statement before starting the questionnaire. Upon agreement, they ticked the ‘I consent’ box and proceeded with the questionnaire. Agreeing to informed consent prior to starting the questionnaire was mandatory. Moreover, the participants were informed that they have the option to stop answering the questions through the process of completing the questionnaire. The research study was approved by the Ethical Committee of the Health Science Center at Kuwait University (2020/0622). Confidentiality of information was also respected by not asking names and the data was stored with limited access.

Demographics of participants

At the time of the study, there was approximately 2,000 eligible undergraduate students and about 110 graduate students (Master and PhD programs). In addition, there was approximately 450 eligible staff employed by HSC at the time of the study. All of the eligible participants were invited and reminded (as described the methods) to participate in the study. There were 592 students and 162 staff completed the questionnaire with a response rate of 28.1% and 36%, respectively. We did not collect information on reasons for non-participation.

The demographics of students (n = 592) and staff (n = 162) are shown in Table 1. Most the participants were females (for both students and staff). Female students account for 75% to 90% of the student population depending on the academic year and the faculty. Participants were proportionally distributed to the population of their faculties with the largest faculties being Medicine and Allied Health. Only Medicine and Dentistry faculties have a seven-year academic program; whereas Pharmacy is five-year program and both Allied Health and Public Health are four-year programs. While the undergraduate students’ age ranged between 19 and 26 years; graduate students’ age was between 25 and 45 years. About 50% of the staff participants were faculty members. Most of the staff were older than 30 years with 24% of them over the age of 50 years. Those who participated in the study completed the full questionnaire tool before submitting their responses. Therefore, we did not have missing responses.

On chronic condition reporting, the prevalence of self-reported having any chronic condition among students and staff was 14.0% and 19.1%, respectively. The highest chronic condition among students was asthma (42.2%) and among the staff was hypertension (36.6%).

Risk and awareness

The participants answered 10 questions related to SARS-CoV-2 risk of infection, risk of transmission and their information awareness about the virus. Based on participants’ self-reported SARS-CoV-2 infection (based on PCR confirmation test), the prevalence among students and staff was 2.7% and 1.2%, respectively. However, 85.0% and 86.4% of students and staff, respectively, reported that they have not been infected with the virus. Interestingly, 54.0% of students and 38.3% of the staff reported that they knew someone in their immediate social environment, such as relatives or friends, who have been/are infected with SARS-CoV-2.

When we asked the participants about their probability of getting infected with the virus in the near future, 3.9% of students responded as it was extremely unlikely; 23.3% indicated it is unlikely, but 5.5% responded it was likely. As for the staff, 5.6%, 21%, and 20.4% considered the probability to be extremely unlikely, unlikely, and likely, respectively. There was no significant (P = 0.374) relationship between the infection probability among staff participants and their age groups. Many of the students expressed that if they get infected with the virus, the disease will ‘not be severe’ (27.7%) or ‘slightly severe’, (24.6%). Similarly, many of the staff (20.4% and 21.6%) thought that if they get infected with the virus, the disease will ‘not be severe’ or slightly severe’, respectively.

The participant’s responses to questions regarding awareness related to proportion of COVID-19 patients that are likely to be admitted to hospital; if admitted to the hospital are likely to be admitted to the intensive care unit (ICU); and if admitted to ICU will eventually die is shown in Figure 1. Most of the participants either strongly disagreed or disagreed with the following statements: 1) majority of COVID-19 patients need hospitalization; 2) those hospitalized require ICU admission; and 3) those admitted to ICU will eventually die (Figure 1). Older students were significantly (P < 0.001) more likely to strongly disagree or disagree than younger students with the first two statements. No significant difference (P = 0.576) was detected between both student groups to the third statement. The faculty members were significantly more likely (P < 0.001) to strongly disagree or disagree compared to teaching assistant and non-academic staff. No significant difference (P = 0.583) detected between staff job groups by the response to those admitted to ICU will eventually die.

Figure 1. Participants awareness of consequences of COVID-19 patients.*

* Infected to hospital admission is based on the question: Do you agree or disagree that majority of SARS-CoV-2 infected people need admission to a hospital; Hospital to admission to ICU is based on the question: Do you agree or disagree that majority of SARS-CoV-2 patients who are admitted to the hospital require receiving care in the intensive care unit (ICU); and ICU to death is based on the question: Do you agree or disagree that majority of SARS-CoV-2 patients who are admitted to the ICU will eventually die. A: students and B: staff.

We asked the participants about their reaction to suspicion of being infected; nearly 52% of the students and 50% of staff indicated that they would immediately get tested for the virus and follow government isolation instructions (if tested positive); whereas, 28.2% and 36.4% of students and staff, respectively, would stay at home and taking precautionary measures so they do not spread the virus to others, and 19.6% and 13% of students and staff, respectively, would wait for few days until symptoms worsen before they get tested and/or seek medical care. On the topic of treatment or vaccine for COVID-19, most of the participants (80.6% of students and 85.8% of staff) indicated that, at the time of this study, there is no treatment or vaccine.

On the question of self-rate perception on how to prevent SARS-CoV-2 spread, most students rated themselves as having either very good knowledge (30.4%) or good knowledge (45.7%) with significantly (P < 0.001) higher proportion among older students than younger students. On the same question, 43.8% and 37.7% of staff rated themselves as having very good knowledge and good knowledge, respectively, with significantly (P = 0.02) higher proportion among faculty members compared to other groups. In term of misconceptions, students either strongly disagreed (19.4%) or disagreed (21.8%) that SARS-CoV-2 was made in a laboratory then accidentally released. Similarly, 14.2% and 17.3% of staff either strongly disagrees or disagreed, respectively. Moreover, while most of students (30.2% strongly disagreed or 40.6% disagreed) that hot summer slowdown/stop the transmission of the virus, significantly (P < 0.001) fewer staff strongly disagreed and disagreed (14.2% and 17.3%, respectively) with that statement.

Precautionary measures to prevent infection with SARS-CoV-2

The participants answered 15 questions about precautionary measures for SARS-CoV-2 infection (Table 2). Among students, 92.4% wore face mask in indoor places (outside of their home) ‘often/all the time’ compared to wearing it outdoors (69.3%); whereas, for staff, it was more common to wear it outdoor than in indoor places (75.9% vs. 81.5%). Regular hand washing was more common than using disinfectants among both participant’s groups (Table 2). Avoiding crowded places, avoiding shaking hands, avoiding kissing, staying home as much as possible and following social distancing guidance was practiced ‘often/all the time’ by more than 80% of the participants. There was no significant difference (P > 0.05) between staff than students with regard to these percentages. Nearly 50% of students did often clean/disinfect their phone, avoided eating outside of home, got sufficient sleep, and persuade people around them to follow precautionary guidance. This percentage was between 60–70% among staff (Table 2). Additionally, we asked the participants a question on how difficult/easy it is to avoid infection with the virus, 27.8% of students indicated that it is easy to avoid infection while 21.1% thought it would be difficult. Similarly, 30.2% of staff thought it would be easy to avoid infection while 20.4% of them thought it would be difficult.

Sources of information

We assessed the level of trust in COVID-19 information sources among the participants using 5 Likert scale (very little trust, little trust, neutral, moderate, and great deal of trust) against 8 sources of information (Table 3). The greatest deal of trust was in official government press release such as that from the local Ministry of Health (58.8% and 53.7% among student and staff participants, respectively), and consultation with healthcare workers (49.7% and 38.9% among student and staff participants, respectively). Moderate trust was TV stations and online sources (Table 3). Interestingly, there was both very little and little trust (ranging between 60% and 80%) in sources of information from celebrities, social media (such as Twitter, Facebook, and WhatsApp), and conversations with family and friends (Table 3).

Small percent of students indicated that they update themselves about COVID-19 multiple times a day (8.4%); whereas, most of students do that either once a day (34.4%) or once a week (40.3%). In comparison, 25.9% of staff update themselves multiple times a day; whereas 43.8% and 25.3% do that once a day and once a week, respectively.

Policies related to COVID-19

We listed number of questions related to formulation of policies and regulations about COVID-19. Most of the participants (62.6% and 83.3% of students and staff, respectively) follow ‘very much so’ the recommendations issued by the authorities to prevent the spread of SARS-CoV-2. On questions related to taking COVID-19 vaccination if becomes available, 50% of students strongly agreed and an additional 25.8% agreed to taking it. Interest in vaccine uptake was lower among the staff (28.4% and 34.6% strongly agreed or agreed, respectively).

Participants strongly agreed or agreed (72.5% and 19.6% of students as well as 68.5% and 22.2% of staff) that wearing face mask in public should be obligatory. On the role of government, 67.4% of students strongly agreed and 23.1% agreed on enforcement of quarantine of contacts of COVID-19 cases (compared to 45.7% and 38.2%, respectively among staff). Moreover, 81.4% strongly agreed and 14.4% agreed that there should be a legal punishment for those who know they are infected but continue to socialize with others without wearing protective equipment; whereas, lower percentage of staff strongly agreed or agreed (69.1% and 22.8%, respectively). Furthermore, 55.4% strongly agreed or agreed (i.e., 27.4%) that legal punishment should be taken against those who share/spread falsified information about COVID-19 without verifying the source (compared to 46.3% and 33.3% among staff).

On COVID-19 testing policies, 45.1% and 29.6% strongly agreed or agreed that more COVID-19 testing should be carried out, which is similar to the responses by the staff (40.1% and 30.9%, respectively). Among students, 32.5% and 41.0% strongly agreed or agreed that people should have more information about COVID-19 cases in Kuwait since what is being currently reported has minimal information (i.e., number of new cases, number active and recovered cases, number of PCR tests, number of cases in ICU, and number of deaths). These figures were very similar to the responses by the staff (i.e., 32.8% and 37.7% strongly agreed or agreed). Figure 2 shows the responses about what type of information the participants would like to know about SARS-CoV-2 infectives.

Figure 2. Percentages of participants response to the type of information you would like to know about those infected with SARS-CoV-2.

A: students and B: staff.

We asked the participants about their opinion about resuming the university classes on-campus (in person) at the start of the semester in August 2020. Approximately 43% of students and 46% of staff indicated that they are very worried. In addition, 35% of students and 20% of staff indicated that they are slightly worried. Regarding the option of resuming teaching online/distance learning, 75.4% of students and 84% of staff agreed with this option.

Social stigma

We asked questions to assess social stigma related to SARS-CoV-2 infection. Interestingly, in response to the question “If anyone you know personally got infected with SARS-Cov-2, what would be your reaction?”, approximately 68% of student and staff participants responded that they would advise the infected to seek medical care immediately; whereas about 29% of both participant groups indicated they would advise to wait for the symptoms to appear before seeking medical care. Interestingly, on the question “Do you think COVID-19 patients did something wrong and consequently got infected”, 12.8% and 18.9% of students strongly disagreed or disagreed; however, 51.8% of them were neutral about it. For the same question, higher proportion of staff 35.2% and 27.8% strongly disagreed or disagreed, compared to 27.2% were neutral about it.

On the question “If you knew a person (e.g., a relative or a friend) has COVID-19, what would you do” with multiple answers permitted, most of the responses by students and staff indicated that they will avoid contact with infected person (83.3% and 80.9%) but understand his/her condition (81.1% and 77.2%). Only 1% or less indicated they would blame the person for getting infected with the virus, but 29% would tell others about the infected person. Moreover, around 20% of students and staff thought that infection with COVID-19 would lead to social rejection; however nearly 75% of students and staff thought COVID-19 would not affect the person’s medical care coverage, job security, finding a job, or getting married. Finally, participants (82.8% of students and 84.6% of staff) indicated that raising awareness about COVID-19 disease will reduce the unjustified stigma toward COVID-19 patients.

Underlying data

OSF: COVID19 students. https://doi/org/10.17605/OSF.IO/SQXEB.³¹

This project contains the following underlying data.

Extended data

OSF: COVID19 students. https://doi/org/10.17605/OSF.IO/SQXEB.³¹

This project contains the following extended data.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).