Overall, we observed that undergraduate students at public universities in Malaysia have good levels of KAP associated with COVID-19. Our results are shown to be similar to the KAP study done in North Asia involving undergraduate students in China and Japan [13, 16]. Good KAP levels were also observed in a study involving 438 medical students at the International Islamic University of Malaysia (IIUM) [17].

In general, undergraduate students of public universities in Malaysia have a basic knowledge of COVID-19. This proved that Malaysian undergraduate students actively read news and current information related to COVID-19 [18]. This led to an increase in public knowledge and awareness of the disease. According to Hazirah et al. (2021), a high level of knowledge on COVID-19 is due to good access to information related to COVID-19 [19]. Omar et al. (2021) conducted a study that examines the effectiveness of spreading information on COVID-19 in Malaysia and found that the Malaysian government has succeeded in disseminating information related to the COVID-19 outbreak in order to spread knowledge and educate a high self-awareness among the public [20]. The effective medium used by the government to deliver the COVID-19 disease information has given wide exposure and increased the knowledge of undergraduate students across Malaysia.

However, there were still a number of students who had moderate and weak knowledge of COVID-19. This was believed to be caused by the dumping of information from inauthentic sources and fake news regarding COVID-19 [17]. Information on COVID-19 can be obtained from various sources such as magazines, government official websites, articles, journals or as simple as messages shared on social media. There was also information about COVID-19 that was not based on reliable sources such as scientific studies and based on the author’s opinion. This caused misunderstanding, confusion and difficulty for the students to determine the correct information about COVID-19 [9]. Hence, this could be the reason for some students to have low or moderate KAP levels. However, these gaps can be improved by enhancing the education programs, promoting positive attitudes and encouraging practical application.

Based on our study, the attitude of Malaysian public university undergraduate students was at a good level. Similar results were also obtained by a KAP study among medical students on the East Coast of Peninsular Malaysia, medical students at IIUM and undergraduates from University Science Islam Malaysia (USIM) [17, 21, 22]. The positive attitude shown by Malaysian undergraduate students proves that they are getting comfortable with the new norm [9]. During the beginning of the COVID-19 pandemic, students might have worried about COVID-19 because it was their first pandemic experience [23]. Therefore, their attitude was affected by panic and nervousness. Social media also creates anxiety about COVID-19 disease [24]. However, the speed of the authorities in dealing with the COVID-19 crisis has caused the students to put high trust in all government efforts [21].

The students’ attitude toward COVID-19 could also influenced by psychological factors such as personality [25]. Hatabu et al. (2021) argued that students’ personality affects their attitudes toward COVID-19 [16]. Students with an optimistic personality are more likely to have an open view of the impact of COVID-19 than students with a pessimistic mindset, who tend to think negatively and are not confident about the government’s actions in controlling the spread of the COVID-19 disease. However, according to Abd Rahim et al. (2021) differences in attitude instruments, cut-off scores to categorise attitude levels and sociocultural differences make the attitude assessment difficult to compare with the previous studies [17].

Additionally, our study also showed that Malaysian public university undergraduate students have good COVID-19 prevention practices. Good COVID-19 prevention practices prove that public university undergraduate students in Malaysia practice proactive basic COVID-19 prevention measures and adhere to the SOP issued by the government [9, 26]. Our study is similar to the KAP study on Malaysians by Hazirah et al. (2021) which showed that 76.4% of undergraduate students had a proactive level of practice against COVID-19 [19]. Peng et al. (2020) also support our findings, that students tend to display good practices because they feel the responsibility in the efforts to deal with the COVID-19 crisis [13]. Chai et al. (2021) reported that the higher the level of education, the better the prevention practices [27]. This was triggered because students have a deeper understanding of the COVID-19 disease and its outcome. The lack of understanding about the disease of COVID-19 leads to a lack of efforts to prevent COVID-19 in an individual [28]. The efforts of the Malaysian government to spread awareness of COVID-19 through media platforms led to increased efforts to prevent COVID-19 [19]. A high level of awareness of the risks of COVID-19 leads to students’ willingness to change their behaviour in the face of COVID-19 [9]. The lack of awareness about COVID-19 has a negative impact on an individual’s practice in preventing the disease of COVID-19 [28].

We also observed no difference in knowledge scores between sociodemographics among public university undergraduate students in Malaysia. At the same time, the basic knowledge of undergraduate students regarding the COVID-19 disease is not influenced by sociodemographic differences. Similarly, a KAP study on COVID-19 involving 951 university students in Palestine showed no significant difference in knowledge scores between sociodemographics [29]. Besides that, the results of the study showed differences in attitude scores between race, university zones and household income, which proves that student attitudes are influenced by these factors.

In this study, we perceived a significant difference in attitude scores between the races of the participants. The results of this study support the study of Hazirah et al. (2021) which states that attitudes depend on the race or ethnicity of the respondents [19]. On the contrary, Bachok et al. (2020) stated that Malay and Chinese have a negative attitude towards COVID-19 compared to other races [18]. However, our study shows that Indian students have the lowest mean score and this could be due to a smaller number of respondents involved. Similarly, Aidid et al. (2022) also concur this could be because of a small number of Indian and Bumiputera respondents from Borneo to represent the entire population [21]. Therefore, it can be said that the data distribution was unbalanced due to the sampling method used.

We also noticed that the public university zone in the study also affects the attitude scores. In support, a study by Azlan et al. (2020) stated that regions in Malaysia influence attitudes towards COVID-19 [9]. A KAP study during the end of the pandemic involving the Malaysian public found that respondents from the Eastern region of Malaysia were more optimistic because the number of cases of COVID-19 in that area was low compared to other areas [27]. This could be the reason undergraduate students studying at public universities in the East Zone show a positive attitude and are less worried about the COVID-19 disease.

Household income also affects the students’ attitudes towards COVID-19. Students with B40 status have higher attitude scores compared to those under M40 and T20 status. This finding was different from studies by Azlan et al. (2020) [9] and Chai et al. (2022) [27] and this difference in attitude scores is probably due to psychological factors. According to a study by Hatabu et al. (2021), Japanese university students’ attitudes towards COVID-19 were influenced by psychological factors such as self-awareness and personality [16]. According to researchers, individual behaviour patterns differ depending on their personality. Additionally, students from higher-income households typically have better access to access to accurate information and healthcare services, including testing, treatment, and vaccination. This can influence their attitudes towards the severity and management of COVID-19 [30].

Based on scores associated with COVID-19 practices, we found that gender, race and current accommodation of undergraduate students showed significant differences. This proves the practice of preventing COVID-19 was influenced by these factors. We observed female students have higher COVID-19 prevention practices and awareness than male students. Several studies also stated that compliance with COVID-19 prevention measures was influenced by gender, as female students took less risk against COVID-19 [13, 16, 19, 31]. Similarly, a study on the daily behaviour of people of different genders found that women have better behaviour than men because they take less risk [32]. In our study, students’ race also showed significant practice score differences. Chinese students have a significant practice score compared to Malay and Indian students. In contradiction, a KAP study among IIUM medical students showed no significant correlation between attitudes and race [17]. This could be because of the uneven distribution of respondents of various races.

Finally, we also found that students’ current residence influences their COVID-19 prevention practices. Students who live with family have a higher mean score than students who live apart from family members. Students who live with family members are more alert to the disease of COVID-19 and concerned about the safety of their family members. Parents are also pessimistic and overprotective of family members causing their COVID-19 prevention practices to be more proactive [21]. Because of that, students who live with families advise each other and take care of each other’s welfare. The results of this study differ from the study by Rahman et al. (2021) who think that university students who live without their families show better health practice behaviour because they are aware of the importance of self-protection against COVID-19 [33]. Even so, the results of this study support the study by Chai et al. (2022) who stated that individuals who live alone were less likely to practice COVID-19 prevention measures because they do not have the responsibility to protect close family members from being infected with COVID-19 [27].

Additionally, there was an association between knowledge and practice, but no significant correlation was observed between knowledge and attitude towards COVID-19. This proves that knowledge of COVID-19 disease among public university undergraduate students in Malaysia influenced their practice of COVID-19 prevention, but knowledge does not influence their attitude towards COVID-19. In such a situation, good knowledge would indirectly increase the intention and motivation to practice and comply with the preventive measures for COVID-19. Our findings differ from a study by Zubir et al. (2021) which showed no relationship between KAP among university students in Malaysia [23].

KAP survey theory states that knowledge is the basis for behaviour change [34]. An individual with a good knowledge of COVID-19 has an optimistic attitude and practices strict preventive measures [35]. The weak positive relationship between knowledge and practice was similar to the KAP study on COVID-19 by Chai et al. (2021) during the end of the pandemic in Malaysia [27]. The results of this study support the opinion of Lee et al. (2021) regarding knowledge being enough to change students’ health behaviour [36].

However, good knowledge does not affect the attitude of undergraduate students. Students’ attitudes depend on their ideas and acceptance of something. For example, even though students know about the SARS-CoV-2 virus infection and the COVID-19 disease, it does not change their view on the effectiveness of the vaccine in controlling the spread of COVID-19. This resulted in a group of students agreeing that the vaccine effectively controlled the spread of COVID-19 while the rest disagreed. Similarly, Zhang et al. (2021) also suggested that having good knowledge about COVID-19 does not necessarily lead to a positive attitude as the undergraduate students in China exhibited good knowledge of COVID-19, but this did not uniformly translate into a positive attitude towards the disease and its prevention measures [37]. Overall, human response to a situation is different according to their opinions and beliefs.

Despite the importance of understanding undergraduate students’ responses to the pandemic, existing research may have certain limitation, gaps or challenges that need to be addressed including (i) limited and uneven representation where the existing studies may not adequately capture the diversity of undergraduate student populations, and more inclusive sampling strategies needed to ensure representative insights into the knowledge, attitudes, and practices of all undergraduate students, including those from marginalised or underrepresented groups; (ii) longitudinal perspectives where many studies may offer cross-sectional snapshots of undergraduate students’ responses to COVID-19, overlooking progressive changes, evolving attitudes, and the impact of interventions over time and providing a more comprehensive understanding of students’ responses to the pandemic across different phases and contexts; and (iii) contextual factors, where effectiveness of public health interventions among undergraduate students may be influenced by various contextual factors, including institutional policies, socio-cultural norms, and peer influences.