COVID-19 knowledge, attitude, and practice of United Arab Emirates heath providers at the start of the pandemic 2020

A total of 2371 SEHA healthcare providers responded to the survey, which is a good response rate as it represents 23% of SEHA Healthcare providers. Participants had a mean age of 39.94 years (SD 9.02) and were mostly female (1754, 74%). With regards to the site of work (1091, 46%) of them were working in inpatient hospitals, (494,20.8%) were working in primary health care, and (388, 16.4%) were working in emergency and ICU care settings. Most participants (1926, 81%) were from SEHA, and only (225, 9.5%) were from outside SEHA. Nurses constituted (1467, 61.9%) of the respondents and (445,18.8%) were physicians (consultants, specialists, residents), (330,13.9%) were technicians, and only (129, 5.4%) were pharmacists. Physicians who enrolled were from different specialties: family medicine (166, 7%); internal medicine, 8.6 (205,8.6%); obstetrics and gynecology (180, 7.6%); pediatrics (230, 9.7%); psychiatry (39, 1.6%); and surgeons, (208, 8.8%). Most participants were from Abu Dhabi and Al Ain (64%, 26.5%), respectively, and 8.1% were from the western region. The mean work experience was 14 years (SD 8.26). The demographic characteristics of the study population are summarized in Table 1.

Table 1 Characteristics of United Arab Emirates Heath providers at the start of the pandemic 2020

Regarding the healthcare providers' overall knowledge, attitude, and practice, more than half of them (55.7%) had good direct knowledge. In practice, 48% had good practices toward COVID-19. The overall attitude mean was also 2.8, from a maximum score of 7, indicating a positive attitude toward COVID-19.

The overall performance score based on participants' achievement from a total of possible 40 points if all were correct answers was mainly poor as half of the participants (49.1%) answered 20 or fewer correct answers. Another 41.8% scored between 20 and 30, and only 9.2% had a good performance score above 30 out of 40, meaning they would have chosen the right option for the cases given. The overall mean score was 17.14.

Figure 1 shows the overall performance scores among the specialties, with pediatricians having higher overall performance scores. Other key specialties in the pandemic were lagging, such as internal medicine and family medicine.

Fig. 1figure 1

Overall performance about COVID-19 Knowledge score distribution among specialty of United Arab Emirates Heath providers at the start of the pandemic 2020

Regarding the direct knowledge questions, only half of the respondents indicated a correct answer about the mode of transmission of the COVID-19 virus, either by respiratory droplets or contact with contaminated surfaces. As well, only 32.3% believed that COVID-19 virus transmission could be via the oral route. The social distancing of 2 m or more was reported correctly by 43.3% of healthcare providers as the correct distance to prevent transmission of the COVID-19 virus. In comparison, 11.3% of all healthcare providers believed that 1 m or more was considered a safe social distance, and 0.1% reported that they did not know the exact social distance. More than half of healthcare providers reported the following as high-risk groups: age > 60 years (55.5%), smokers (50%), diabetes mellitus (53.6%), hypertension (50.3%), patients with chemotherapy (55.1%), and patients with asthma and COPD (55.1%). Pregnant women, 48.2%, were also reported as a high-risk group. Table 2.

Table 2 COVID-19-related knowledge, attitudes, and practice (KAP) of United Arab Emirates Heath providers at the start of the pandemic 2020

The nasopharyngeal swab was reported by 39.7% to be recommended over the oropharyngeal swab for detecting the COVID-19 virus. Regarding the PCR test sensitivity and specificity, 17.8% of all healthcare providers believe that the sensitivity of the nasopharyngeal swab is 90%. In comparison, 13.5% think that the sensitivity is 70%, and 8.3% think that the specificity of the nasopharyngeal swab is 70% Table 2.

Wearing surgical masks was perceived by 32.2% of all healthcare providers as necessary for suspected COVID-19 infection patients, and 21% reported wearing surgical masks only with patients with respiratory symptoms such as fever and cough. While 20% reported that only medical staff and caregivers in close contact with patients should wear surgical masks, less than half of the healthcare providers (43.4%) reported that all communities should wear surgical masks Table 2.

The attitude of healthcare workers toward COVID-19 testing was assessed through the question, “what action they will take if they start to develop any symptoms like a dry cough in the absence of a history of contact with COVID-19 case or travel history. Nearly half of them (47.5%) reported that they would ‘‘do a COVID-19 PCR test’’ as an action, while 11.7% would continue to work without further action, and 6.3% would isolate themselves at home.

More than half of the HCWs practicing from the primary healthcare clinic reported that they would check for any signs of illness and notify their supervisors if they become ill, ensure wearing a face mask while in the clinic, and keep tools like the stethoscope in the clinic and use disinfectant wipes to clean it frequently; 51.1%,54.1%, and 51.1%). Similarly, 47.1% reported that they would not bring unnecessary staff to the clinic, and only 29.8% reported avoiding being in areas like coffee rooms and team changing rooms Table 2.

Of all healthcare workers, 59.9% correctly reported the action after having a negative swab in a symptomatic patient. Of those who gave correct answers, 57.7% were nurses, and 65.5% were physicians. The action of healthcare providers after medium-risk exposure assessment was correctly answered by 36.7% of all healthcare providers, of which 37.9% of nurses responded correctly, with 33.1% physicians and 37.3% technicians. Action after low-risk exposure assessment was correctly answered by 35.1% of healthcare providers and 51.8% of all healthcare providers answered correctly regarding low-risk exposure with full PPE Table 2.

In the case scenario of dealing with a patient who had contacted a positive case, 50% of all healthcare providers answered incorrectly that they would wear full PEE before dealing with such cases. Only 34.2% reported that they would direct the contact of a positive case to the isolation room. In addition, 44.7% of healthcare providers reported that they would reassure the family and send the case home with self-monitoring and home quarantine. Only 36.5% of all healthcare providers reported consistently practicing infection control precautions in primary healthcare, and only 1% reported never practicing infection control precautions Table 2.

Participants' assessment of the risk level of COVID-19 infection, high, intermediate, or low after a case exposure, was assessed through developed scenarios. Almost three-quarters of participants, 67.2%, correctly answered the question regarding high-risk assessment for a healthcare provider who was not wearing full PPE when exposed to a positive case of COVID-19, including not wearing a face mask. There was no difference in identifying the correct risk level between the different disciplines, as nurses, physicians, and technicians performed the same. Table 3. Using linear regression, consultants and residents significantly performed worse in high-risk assessment knowledge (B = -0.045, P = 0.030) and (B = -0.043, and P = 0.037, respectively). Technicians, on the other hand, did significantly better in high-risk assessment knowledge (B = -0.049, P = 0.016).

Table 3 Application of risk assessment knowledge about COVID-19 through cases of United Arab Emirates Heath providers at the start of the pandemic 2020

Regarding healthcare providers’ exposure, while performing tooth extraction in a case of COVID-19, while wearing surgical masks and hand gloves with a medium-risk total exposure time of 20 min, 30% got the correct answer indicating medium risk Table 3 . Knowledge of medium-risk exposure assessment of healthcare providers was significantly and positively associated with the surgical specialty group (B = 0.48, P-value 0.019). Moreover, medium-risk assessment knowledge was significantly and negatively associated with age (B = -0.054, P = 0.009).

For the question on low-risk exposure assessment, most healthcare providers overestimated the risk of high-risk exposure (52%). The only significant performance of the study groups was that consultants did significantly better in identifying lower-risk situations (B = 0.079, P-value < 0.001).

Regarding the influence of different factors on knowledge, attitude, and practice, Table 4 shows that older age was significantly associated with better knowledge. Healthcare providers aged 41 to 50 had the best knowledge (59.8%) (p = 0.042). A higher mean for attitude score was noted in the same age group (41–50), but it was not significant (p = 0.054). On the other hand, higher knowledge (62.4%) and practice (51.5%) scores and attitude mean (3.48) were noted in the group with more years of experience (more than 30 years) as healthcare providers, but this as well was not significant (p = 0.055, p = 0.324, p = 0.375).

Table 4 Difference in health care provider’s knowledge, attitudes, and practice (KAP) about COVID-19 by demographics of United Arab Emirates Heath providers at the start of the pandemic 2020

For occupation, specialists had the highest scores in knowledge (62.2%), practice (53.1%), and attitude mean (3.4), with a significant P-value for practice (0.015). On the other hand, medical residents from all specialties had the lowest score, indicating poor knowledge (55.6%) and poor practice (65.6%). While Pediatrics had a significantly higher knowledge score (64.8%), P-value of (0.018), higher practice score (53.9%), P-value (0.039), and the highest means for the positive attitude of all specialties (3.37) Table 4.

Anxiety and depression scores were measured in a total of 1268 participants of healthcare providers. More than half of the participants reported anxiety symptoms (51.5%). Depression symptoms were revealed in 38.3% of participating providers. The detailed result of the mental screening was reported separately [13]. Depression was negatively associated with the overall performance scores, which means that those with good knowledge, practice, and positive attitudes had lower rates of depression (P-value 0.00).

With regards to the overall performance, using multivariate linear regression on all factors studied (gender, age, years of experience, occupation, specialty), only years of experience, being a pediatrician, or holding a specialist position showed significantly better overall performance scores than others (B = 1.881, p = 0.012), (B = 1.968, p = 0.013), (B = 0.065, p = 0.022) respectively. Knowledge scores were also significantly higher among pediatricians (B = 0.064, p = 0.003).

Regarding the practice score, those holding the position of medical resident trainee were negatively associated with practice scores (B = 0.047, p = 0.032). Years of experience were positively associated with practice scores, which means the experience can improve practice. The practice score was negatively associated with gender, which means that females had better practice scores. The P-value was not significant for all the mentioned variables.

Being a pediatrician or holding a specialist position was associated with a more positive attitude toward COVID-19, reflected in a higher attitude score (B = 0.068, P-value 0.002) (B = 0.087, p < 0.001), respectively.

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