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Year : 2022  |  Volume : 20  |  Issue : 2  |  Page : 142-146

Association of knowledge, perception, and fear regarding COVID-19 with the socioeconomic status of patients attending a dental hospital in Belagavi district: A cross-sectional study

Department of Public Health Dentistry, KLE VK Institute of Dental Sciences Belagavi, Karnataka, India

Date of Submission11-Jul-2021
Date of Decision28-Aug-2021
Date of Acceptance30-Mar-2022
Date of Web Publication8-Jun-2022

Correspondence Address:
V Deepika
Department of Public Health Dentistry, KLE VK Institute of Dental Sciences Belagavi, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_129_21

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Background: The COVID-19 pandemic has resulted in a significant loss of human life over the world and poses an unparalleled public health threat. As a result, it is critical to comprehend the patients' perspectives and knowledge on the subject. Aim: The aim of the study is to assess the knowledge, fear, and perception regarding COVID-19 among patients attending a dental hospital in Belagavi, India, and to compare it with their socioeconomic status using Kuppuswamy scale 2019. Materials and Methods: A cross-sectional questionnaire study was conducted among patients attending the dental hospital during the complete lockdown. A total of 170 respondents were included in the study. A self-designed, validated questionnaire with 14 closed-ended questions was prepared, among which 11 questions were knowledge based, two were on perception, and one on fear. Data were entered into Microsoft Excel and analyzed using the SPSS version 25. P ≤ 0.05 was considered statistically significant. Results: A total of 170 participants were included in the study. The age ranged between 26 and 80 years. Majority of the population (95%) knew the symptoms of COVID-19 and the measures to be taken to prevent it. An association was found between participants' educational status and their knowledge regarding signs and symptoms of novel coronavirus (P = 0.005). Most of the study participants were not aware of the distance to be kept during social distancing (45.8%). Lockdown caused financial burden to more than 70% of the study participants. Conclusion: Nonliterate youth and adults were most likely to be the hardest hit by educational, social, and economic impacts of COVID-19.

Keywords: COVID-19, lockdown, socioeconomical status

How to cite this article:
Deepika V, Sankeshwari RM, Ankola AV, Jalihal S, Choudhury AR, Deshpande AP. Association of knowledge, perception, and fear regarding COVID-19 with the socioeconomic status of patients attending a dental hospital in Belagavi district: A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:142-6

How to cite this URL:
Deepika V, Sankeshwari RM, Ankola AV, Jalihal S, Choudhury AR, Deshpande AP. Association of knowledge, perception, and fear regarding COVID-19 with the socioeconomic status of patients attending a dental hospital in Belagavi district: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2023 Sep 30];20:142-6. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2022/20/2/142/346876

  Introduction Top

The coronavirus disease pandemic of 2019 (COVID-19) is a global public health emergency on a scale never seen before in contemporary history. Following the United States, India has the highest number of COVID-19 cases and fatalities in the world. COVID-19-related mortality varies considerably between countries and communities within our country. While studies have found a variety of risk factors for mortality, such as age and concomitant disease, the current evidence suggests that social determinants of health can have an impact on outcomes. All facets of cultural functioning, including health-related quality of life, are influenced by socioeconomic variables. While a few studies have hypothesized the impact of socioeconomic status on the COVID-19 pandemic, quantitative research is sparse.[1]

From the standpoint of public health, socioeconomic inequities can lead to COVID-19-related health disparities. Lower-income people have been grouped together in overcrowded urban housing complexes and slum areas, making physical separation and self-isolation impractical and increasing the risk of contracting and transmitting COVID19. There is a body of proof, demonstrating that socioeconomic status is tied to a variety of health outcomes, and that people with low-socioeconomic status have shorter life spans. Where we live, what we eat, what type of employment we have, and whether or not we have access to health insurance and high-quality treatment are all influenced by our socioeconomic level.[2]

These socioeconomic factors, like practically all other health markers, influence the overall chance of getting COVID-19. Housing factors, for example, can have a significant impact on our chances of getting COVID-19. Poor housing circumstances frequently result in reduced sanitation (e.g., rodents, insects, and mildew), overcrowding, and the inability to physically detach oneself. All of these conditions raise the chance of COVID-19 transmission. Physical distancing is problematic in positions that need in-person attendance, and these jobs are frequently held by the economically poor. Furthermore, many low-income persons rely on public transportation to get to work, increasing physical contact, and the risk of COVID-19 transmission.[3]

Many studies have already been conducted to assess health-care personnel's understanding of COVID-19[4],[5],[6],[7],[8] and it has been reported differently in different studies. However, no studies have been conducted to assess the knowledge of patients attending a dental college. The aim of this study was to determine the knowledge, perception, and fear regarding the COVID-19 among patients attending a dental hospital in Belagavi District during complete lockdown period and to find its association with their socioeconomical status using Kuppuswamy scale 2019.

  Materials and Methods Top

A cross-sectional questionnaire research was conducted to assess the knowledge, perception, and fear of COVID-19 and its association with the socioeconomical status of patients attending a dental college in Belagavi District, India. The study included all the patients attending the dental college during nationwide complete lockdown from March 2020 to May 2020 and those who gave informed consent. Patients who were <18 years old and those who were not willing to participate in the study were excluded from the study. Ethical clearance was obtained from the respective institutional review board of the respective university (Ref no 1384), and informed consent was obtained from the study participants.

Pilot study

A pilot study was conducted among 20 patients to check for internal consistency. A self-designed questionnaire was prepared with the value of Cronbach's alpha coefficient of 0.84, which showed good internal reliability of the questionnaire. The questions were framed after thorough review of the literature, and with the help of three experts, the questions were reviewed for content validity. Prefinal version of the questionnaire was tested during the pilot study of the intended respondents. Consistency of the questionnaire was evaluated using different parameters like internal consistency (0.82), test–retest reliability (0.84), and inter-rater reliability (0.83), respectively.

Each participant was approached in-person during the outpatient department and 10 min were provided for each study participant to fill the questionnaire. The study was conducted on all the patients who met inclusion criteria. A total of 179 questionnaires were distributed among which all filled questionnaires were collected back. All participants were interviewed by a single investigator. The questionnaire contained 14 closed-ended questions out of which 11 were knowledge-based while two were on perception and one was fear-based. Respondents' names were not elicited in the questionnaire to enhance participation and to maintain confidentiality. The first section of the questionnaire sought sociodemographic information from the respondents which included age, gender, educational status, occupation, and income. The second section inquired about their awareness of COVID-19, their perceptions of receiving dental treatment during the lockdown, their financial situation during the lockdown, and their future perceptions of COVID-19 control.

Data analysis

Collected data were entered and analyzed using the SPSS software version 25.0. IBM Corp. (Armonk, NY, USA). Descriptive statistics were employed to describe the characteristics of participants. Comparisons were made for attitudinal scores between socioeconomical status and knowledge regarding COVID-19 using the Chi-square test. P < 0.05 was considered to be significant.

  Results Top

Demographic profile

Out of the total 170 respondents, 58.1% were male, whereas 49.1% were female. The mean age was 48.73 ± 4.9 years and ranged between 26 and 80 years. Most of the study participants were (32.4%) 26–40 years old and only 10.1% were above 60 years. About 257% of the study participants had an intermediate level of education, whereas only 3.9% of the patients were holding a professional degree. More than 35% of the study participants were unemployed during the lockdown. Out of 179 participants, 116 (64.8%) were from upper-lower socioeconomical class, 35 (19.5%) were from lower class, 26 (14.5%) were from lower-middle class, and 2 (0.01%) were from upper-middle class [Table 1].
Table 1: Demographic information of the study participants

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Knowledge regarding COVID-19

Surprisingly 98.88% of the study participants had “above average” knowledge regarding COVID-19. A large percentage of participants (95%) were aware of the proper signs and symptoms of COVID-19, as well as how to prevent it. The majority of people were aware of the rules of social distancing. They were, however, unaware of the optimum distance to maintain during social distancing. Around 70% of individuals believe that an infected person with no symptoms can infect others, and 94.4% of participants knew that COVID-19 spreads through droplets. The majority of them were aware of the precautions that a dentist and they should follow when seeking dental treatment. There was an association established between research participants' knowledge of signs and symptoms and the preventive measures to be undertaken during lockdown (P < 0.004*). There was also an association between the education of the participants as well as awareness regarding social distancing (P < 0.00*) and occupation (P < 0011*) [Table 2].
Table 2: Comparison of knowledge regarding coronavirus disease-2019 according to socioeconomical class

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Perception regarding COVID-19

All of them believed that COVID-19 can be controlled successfully and majority of the study participants stated that (95%) even though there is no effective cure for COVID-19, early symptomatic and supportive treatment can help patients recover from the infection. Almost 60.89% of the patients had a positive perception regarding the control of the infection. According to 93.9% of the participants, medically compromised patients are more prone to COVID-19 Infection.

Economic changes resulted due to COVID-19 have caused much greater financial stress for many participants than they had faced before the pandemic. The financial fallout of the pandemic often loomed larger than the health threat. People with frequent symptoms of anxiety and poor physical health were much more likely to experience financial stress across the 1st month of the pandemic. We also found that financial stress had substantial effects on mental health. Financial problem was found to be the most common reason for not consulting any dentists during lockdown [Table 3].
Table 3: Comparison of perception regarding coronavirus disease-2019 according to socioeconomical class

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Fear of COVID-19 spread

The majority of the study participants (58.9%) were apprehensive about receiving dental treatment during and after the lockdown [Table 4].
Table 4: Comparison of fear regarding coronavirus disease-2019 according to socioeconomical class

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  Discussion Top

The COVID-19 problem has shown significant discrepancies among communities. To ensure more successful responses to current and future pandemics, it is critical to understand the sociocultural risk factors that make some communities particularly vulnerable. We will focus on socioeconomic status as a risk factor in this article. In a study conducted by Roy et al., the lowest educational level observed was to be standard 10th. The highest qualification of more than 90% of the study group was graduation and above. In contrast, the majority of the participants in the current study (25.7 %) had an intermediate level of education, whereas an insignificant number of participants had a professional degree. Most participants (97%) acknowledged that washing hands frequently could stop the spread of infection, which is similar to the current study. Most (98%) of the participants thought social distancing is essential to stop the virus from spreading which supports the result of the present study.[9]

Fear is an adaptive response in the presence of danger. However, when the threat is uncertain and continuous, as in the current COVID-19 pandemic, fear can become chronic and burdensome. In a study conducted by Arina et al., only 43.3% of participants answered correctly when asked if the virus was airborne, in contrast in the present study, most of the participants (94.4%) were aware of the same. A majority of participants agreed that COVID-19 would successfully be controlled (83.1%) which is similar to the present study (95.5%) report. When inquired about hand hygiene, a majority of participants reported that they practiced proper hand hygiene, i.e., by frequently washing their hands and using hand sanitizer,(87.8%) which supports the current study results in which majority of the participants were aware of it.[10]

Health institutions (45.8%) and domestic settings (68.4%) were considered to be infectious in the study conducted by Zegarra et al. which supports the current study where 92.7% of the people believed that there is a higher risk of transmission from dentist to patient. The multiline analysis shows that knowledge has a slight but significant correlation with education (P < 0.031*), occupation (P < 0.016*), and age (P < 0.016*) which is similar to the current study where knowledge has significant relation with education (P < 0.005*), age (P < 0.014*), occupation (P < 0.003*), and income (P < 0.028*).[11]

Majority of participants were above 50 years of age (42%) and 15.54% were illiterate according to a study conducted by Christy et al. which supports the current study where 40% of the participants were above 40 years old and 8.9% of the participants were illiterate.[12] In a study conducted by Vaidya et al. most of the participants had an easy access to the Internet and also had access to various online information regarding prevention, symptoms, and recent updates regarding COVID19, resulting in a higher percentage of correct responses in the knowledge and attitude domains[13], which is similar in our study.

The current investigation was done from March 2020 to May 2020, during the early days of COVID-19's propagation and complete nationwide lockdown. Those were the days when just a few patients, those who needed emergency care, attended dental college. As a result, our study's sample size is quite small. However, in spite of strict lockdown imposed by the central government, patients made their way to reach the dental college, which shows how severe and important dental pain is. To improve the downside, more research is recommended.

  Conclusion Top

Most of the study participants (64.8%) were from upper-lower socioeconomical classes and most of the participants (63.1%) faced financial burdens during the lockdown. Financial burden was found to be the most important reason for not consulting dentist during the lockdown. Hence, we should focus our educational intervention toward vulnerable communities. Special care should be taken with elder people during treatment since they are more prone to infection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health 2020;25:278.  Back to cited text no. 1
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.  Back to cited text no. 2
Domingo-Fernández D, Baksi S, Schultz B, Gadiya Y, Karki R, Raschka T, et al. COVID-19 Knowledge Graph: A computable, multi-modal, cause-and-effect knowledge model of COVID-19 pathophysiology. Bioinformatics 2021;37:1332-4.  Back to cited text no. 3
Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus disease-2019: Knowledge, attitude, and practices of health care workers at Makerere University Teaching Hospitals, Uganda. Front Public Health 2020;8:181.  Back to cited text no. 4
Asaad A, El-Sokkary R, Alzamanan M, El-Shafei M. Knowledge and attitudes towards Middle East respiratory sydrome-coronavirus (MERS-CoV) among health care workers in south-western Saudi Arabia. East Mediterr Health J 2020;26:435-42.  Back to cited text no. 5
Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect 2020;105:183-7.  Back to cited text no. 6
Anargh V, Singh H, Kulkarni A, Kotwal A, Mahen A. Hand hygiene practices among health care workers (HCWs) in a tertiary care facility in Pune. Med J Armed Forces India 2013;69:54-6.  Back to cited text no. 7
Khan MU, Shah S, Ahmad A, Fatokun O. Knowledge and attitude of healthcare workers about Middle East Respiratory Syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC Public Health 2014;14:1281.  Back to cited text no. 8
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr 2020;51:102083.  Back to cited text no. 9
Yanti B, Mulyadi E, Wahiduddin W, Novika RG, Arina YM, Martani NS, et al. Community knowledge, attitudes, and behavior towards social distancing policy as prevention transmission of COVID-19 in Indonesia. J Adm Kesehatan Indones 2020;8:4-14.  Back to cited text no. 10
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.  Back to cited text no. 11
Christy JS, Kaur K, Gurnani B, Hess OM, Narendran K, Venugopal A, et al. Knowledge, attitude and practise toward COVID-19 among patients presenting to five tertiary eye care hospitals in South India – A multicentre questionnaire-based survey. Indian J Ophthalmol 2020;68:2385-90.  Back to cited text no. 12
[PUBMED]  [Full text]  
Vaidya B, Bhochhibhoya M, Baral R, Nakarmi S. Knowledge, attitudes, and practice regarding COVID-19 among patients with musculoskeletal and rheumatic diseases in Nepal: A web-based cross-sectional study. Open Access Rheumatol 2020;12:167-73.  Back to cited text no. 13


  [Table 1], [Table 2], [Table 3], [Table 4]


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