Knowledge, attitude, and perception about the utilization of dental services during COVID-19 pandemic among the general population: A cross-sectional survey of an indian subpopulation

Sivagami Nachiyar; Subha Anirudhan; Vineetha Chakravarthy; Ambalavanan Parthasarathy; Minu Koshy; Hari Baskar

doi:10.4103/jiaphd.jiaphd_106_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 20 | Issue : 4 | Page : 375-378

Knowledge, attitude, and perception about the utilization of dental services during COVID-19 pandemic among the general population: A cross-sectional survey of an indian subpopulation

Sivagami Nachiyar, Subha Anirudhan, Vineetha Chakravarthy, Ambalavanan Parthasarathy, Minu Koshy, Hari Baskar
Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College, Coimbatore, Tamil Nadu, India

Date of Submission	17-May-2022
Date of Acceptance	20-Sep-2022
Date of Web Publication	19-Dec-2022

Correspondence Address:
Subha Anirudhan
Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College, Coimbatore - 641 006, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jiaphd.jiaphd_106_22

Abstract

Background: The impact of the COVID-19 pandemic made many countries impose lockdown, movement control, or “shelter in place” orders on their residents. The effectiveness of these mitigation measures is highly dependent on the cooperation and compliance of all the members of the population. Many patients were observed to approach dental hospitals and clinics for nonemergency procedures without understanding the risk of contracting the disease.Aim: The aim of this study was to assess the knowledge and attitude about the utilization of dental services during the peak of pandemic.Materials and Methods: An online questionnaire survey was prepared, and answers were collected from 355 participants residing in Tamil Nadu. Results: A total of 355 respondents were included in this preliminary report, and the mean knowledge score was 65.37%. The attitude of most respondents toward instituted preventive measures was satisfactory, with an average attitude score of 71.78%. Conclusion: The majority of the respondents had satisfactory knowledge of the disease, but the knowledge about the spread of infection from the dental office was deficient.

Keywords: COVID vaccination, COVID-19 pandemic, dental aerosol, infection transmission, severe acute respiratory syndrome coronavirus 2

How to cite this article:
Nachiyar S, Anirudhan S, Chakravarthy V, Parthasarathy A, Koshy M, Baskar H. Knowledge, attitude, and perception about the utilization of dental services during COVID-19 pandemic among the general population: A cross-sectional survey of an indian subpopulation. J Indian Assoc Public Health Dent 2022;20:375-8

How to cite this URL:
Nachiyar S, Anirudhan S, Chakravarthy V, Parthasarathy A, Koshy M, Baskar H. Knowledge, attitude, and perception about the utilization of dental services during COVID-19 pandemic among the general population: A cross-sectional survey of an indian subpopulation. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2023 Mar 23];20:375-8. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2022/20/4/375/364009

Introduction

The coronavirus disease (COVID-19) has impacted and changed lives on a global scale since its emergence and spread from China in late 2019.^[1] Coronavirus is a single-stranded RNA virus belonging to the Coronaviridae family similar to previously emerged severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus.^[2]

On December 31, 2019, the World Health Organization received a report on the presence of unknown causes of pneumonia in Wuhan, China.^[3] Later, this disease was defined as a novel coronavirus and also declared a public health emergency of international concern by January 30, 2020.^[4] It emerged as a pandemic where the spread was through droplets and close contact with infected persons. Despite the level of advancement in the medical field, the high-income countries appeared to be the worst hit during this pandemic, in terms of disease burden and total deaths.^[5]

The rate of infection due to COVID-19 in India is on the increase, which is about 3.41 crores with a mortality rate of about 4.52 L as of October 15, 2021, with Maharashtra, Kerala, Karnataka, and Tamil Nadu state alone comprising 1.67 crores (nearly 48%). However, despite the decrease in cases, we have not completely overcome the pandemic situation.^[6] To stop this pandemic, it is vital to establish effective infection prevention and control practices globally, nationally, and at the community level. The COVID-19 vaccination was introduced into practice on August 11, 2020, by Russia.^[7] As on January 20, 2022, the fully vaccinated population is 65.9 crores which accounts for 47.7% of the Indian population.

In the past 2 years, information related to COVID-19 has been conveyed not only through mass media but also through social media. Social media has emerged as an important tool in creating public awareness about the spread of COVID-19. The risk of transmission and susceptibility of different professions to COVID-19 is highly variable in each medical field and the rate is higher in the fields of dentistry, ear nose and throat (ENT), and ophthalmology.^[8]

During the active spread of the disease, patients were advised to seek only emergency dental treatment.^[9],[10] Routine dental treatment was not advised as the risk of infection spread is more through the aerosol generated during dental invasive procedures. Still, during the lockdown period, our institution witnessed patients seeking dental treatment for elective procedures. It is important to understand the knowledge of patients related to dental aerosol procedures in relation to the spread of COVID-19 and construct a plan to increase their awareness through various media platforms. Thus, this study was aimed at assessing the knowledge, attitude, and perception of the general population of Tamil Nadu about the utilization of dental services during the COVID-19 pandemic.

Materials and Methods

Study design

An observational cross-sectional survey was conducted on the patients seeking dental treatment from Sri Ramakrishna Dental College and Hospital, Coimbatore, and also through a survey questionnaire circulated through social media to Tamil Nadu residents.

Study participants, sample size, and sampling

Tamil Nadu is a state in southern India. The most affected cities in Tamil Nadu by COVID-19 are Chennai and Coimbatore because of the large population density.^[11] Hence, this study was conducted among the general population of Tamil Nadu, with Sri Ramakrishna Dental College and Hospital, Coimbatore, as the center.

The target respondents included adults above 18 years of age and of all educational levels except dentists and dental students. To calculate the sample size for this survey, we hypothesized that at a 99.9% confidence interval, 50% of the respondents would have a satisfactory knowledge level of COVID-19. Using the Open-Source epidemiologic statistics for public health (OpenEpi), v. 3.01, Emory Rollins School of Public Health, Atlanta, United States (updated April 06, 2013), the needed sample size was 350 respondents and a random sampling technique was used. The online survey started on August 15 and the preliminary dataset (n = 355) was extracted on November 14, 2021.

Ethical considerations

Ethical clearance was obtained from the Institutional Ethical Committee of Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu (EC/2021/1108/CR/68). This approval suffices for a survey around Tamil Nadu. Participation was anonymous, confidential, and voluntary. Informed consent was sought from the respondents, and the participants could withdraw from the survey at any time as per the stipulations of the World Medical Association Declaration of Helsinki Ethical principles.^[12]

The questionnaire design

Due to the spread of the COVID-19 pandemic, a noncontact method avoiding paper-based questionnaires was preferred. Thus, respondents were reached through Google Forms and QR codes. Initially, respondents from Sri Ramakrishna Dental College and Hospital were recruited before the questionnaire administration spread to participants from other major cities and towns across Tamil Nadu. The online questionnaire-based survey was administered in the official languages bilingually (Tamil and English).

A 19-item, anonymous, pretested questionnaire was used to collect data from the study subjects. The questions used to assess the knowledge, attitude, and perception about the utilization of dental services during the COVID-19 pandemic were framed. It is a structured, English and Tamil questionnaire distributed through Google Forms (QR code and link) for self-completion. Those who did not know to use or have a smartphone were assisted in filling the forms with the help of personnel at the reception desk of the department.

The content of the questionnaire

The first section of the questionnaire consists of a brief introduction about the study and informed consent. The second section of the questionnaire consists of five questions framed with respect to the demographic data of the population attending the survey and seven questions framed to assess the knowledge about COVID-19 and seven questions framed to assess the knowledge about utilization of dental services during the COVID pandemic.

Data analysis

Data were summarized using Microsoft Excel 2019 and analyzed utilizing the Statistical Package for Social Sciences (SPSS) software version 22, (IBM, India) and the Open Epi. The demographic characteristics of respondents were subjected to descriptive statistics (frequency and proportions) to summarize the obtained data. To assess the knowledge, attitude, and perception levels of respondents, a numeric scoring pattern was used and the outcome (dependent) variables were computed. These outcome variables were further categorized as binary (satisfactory or unsatisfactory) based on cutoff (mean scores) marks. A Chi-square test was used to test for association between independent variables (demographics) and outcome variables (knowledge, attitude, and perception) at a 95% confidence interval with significant variables (P < 0.05) subjected to a logistic regression model.

Results

A total of 359 responses were received. Of them, four disclosed that they were not residing in Tamil Nadu, and hence, their responses were eliminated. Hence, only 355 responses were evaluated throughout the study. Of these, 175 of the sample population were males, 1 was transgender, and 179 were female. Factors influencing the background of respondents' knowledge levels were age (16–60 years) and education (college/bachelor's). The majority of the respondents practiced self-isolation, self-preventive measures, and social distancing, but only 152 followed all health-care recommendations. The perception of most respondents on the global efforts at controlling the virus and preventing further spread was satisfactory with an average score of 80.67%.

Discussion

Dentistry is an integral part of the health-care system and utilization of dental services during this pandemic becomes inevitable. However, during the active phase of this pandemic, many patients sought dental intervention for elective dental procedures. During the peak of the COVID spread, only emergency dental treatment was provided, so patients had to return disappointed without receiving treatment for their nonemergency needs. Hence, it is necessary to create public awareness about the high risk of disease transmission from a dental procedure during an airborne epidemic phase.

The first five questions of the questionnaire consisted of the demographic details of the participants, which include their name, age, gender, occupational status, and the place where they reside (within the state of Tamil Nadu). The average age of participants ranged from 18 to 72 years, with a mean age of 35.5 years.

Knowledge

The participants had asatisfactory knowledge on the utilization of dental services during the COVID-19 pandemic. About 78.6% of people responded that the main source of information was through mass media such as newspapers, television, and radio. About 13.8% responded that they gained knowledge through social media such as Facebook, Instagram, and WhatsApp [Figure 1]a. About 88.8% of people responded to the survey that the disease is fast spreading and they are susceptible to the disease. About two-thirds of participants responded that they were effectively following the universal preventive measures such as wearing masks (99.15%), washing hands (93.52%), social distancing (90.7%), and sanitizing hands (77.18%). When we asked for the common mode of transmission of the disease, 66% were aware that it was transmitted through direct contact with the affected individuals and through the infected droplets in the air. On enquiring about the aerosol production in the dental office, which is the most common mode of spread of infection from the dental office, about 49.9% of participants responded that they did not have any idea about aerosols and only 27.9% of participants had an idea about it [Figure 1]b.

Figure 1: Pie chart depicting public awareness. (a) Knowledge source for COVID pandemic, (b) Awareness on the transmission of COVID through aerosol, (c) Reason to seek dental treatment during pandemic, (d) Attitude toward dental treatment during lockdown

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Attitude and perception

The attitude and perception of people bring an end result in any condition we look for. About 18% of the respondents sought elective dental treatment, whereas 82% visited the dentist only for emergency dental management [Figure 1]c. About 24.5% of people had been affected by COVID-19. About 42.5% of the respondents had received at least one dose of vaccination. About 55.5% of the participants responded that the vaccination is safe and 36.9% of them had no idea about the safety of the vaccination. Probing about the utilization of dental services after vaccination for COVID-19, 84.5% responded that they felt safe to avail of any dental service after vaccination. The common attitude of vaccinated participants shows that they felt safe enough to go ahead and seek dental consultation and nonemergency treatment procedures after vaccination, despite evidence showing that vaccinated individuals are also likely to contract COVID-19.^[13] Their confidence of not being susceptible to the disease also stems from their lack of knowledge about the aerosol spread.

Regarding the effect of the pandemic and drastic lockdown on the hospital and clinical visits of the participants, 50.7% responded that they have been affected. About 72.4% of people responded that it is necessary for dental facilities to be functioning during the pandemic since dentistry is a specialty that provides health care.

On the question about how they would handle in case they develop tooth pain, the responses showed that 39.7% of people would call their dentist for an opinion, 32.7% of people would buy medicines from the pharmacy, and the remaining 27.6% of people would visit the nearby clinic. At the same time, 35% of people agreed with the statement, “people are visiting dental clinics for general checkups during the lockdown as they have enough time during lockdown” and 65% of the respondents agreed with the statement, “people are visiting dental clinics only for emergency procedures during this pandemic” [Figure 1]d.

Although studies on dental students' and dental personnel's knowledge, perception, and behaviors with regard to COVID-19 have been conducted,^{[5],[14],[15]} studies on the attitude and perception of dental patients are not available.

The aerosols and droplets released during dental treatments have the potential to infect dental staff and others in the dental office.^[16] Although it is impossible to totally eradicate the risk posed by dental aerosols, as with any infection control technique, it is necessary to minimize these risks as much as possible.^[17],[18] Hence, awareness among people should be created to avoid seeking elective dental treatment during the community spread phase of the COVID-19 pandemic.

Limitations and strengths

An online questionnaire was used for assessment to minimize person-to-person contact. Although an attempt was made to include those without Internet access by assistance from the reception personnel on the department computer, this approach cannot entirely justify that those without access were included. Another limitation of this study was that most of the responses we received were from the educated section of society.

A large number of respondents in this study were linked to patients availing of dental services; therefore, this study may also have exhibited good knowledge of the disease among participants. Unfortunately, the study may not have exactly represented all the proportions of our current society; however, it may reflect a general overview of the behaviors present in society. Some myths are also prevalent among the public. Such gaps need to be addressed in the education and awareness programs for a better response toward utilization of dental services during COVID-19. Since each state had its own policy to create awareness among the public on the transmission of infection, our study was localized to only Tamil Nadu. Future studies can be carried out by conducting surveys in other states of India to expand the scope of this study and to create an overall picture of the state-specific knowledge and attitude of patients.

Conclusion

In summary, the findings of our survey suggest that a majority of educated Tamil Nadu residents followed appropriate practices and optimistic approaches during the peak of a COVID-19 infection. The mean scores of knowledge and attitudes were 65.37% and 71.78%, respectively, but still, the knowledge on the spread of infection from the dental office is deficient.

The education and health programs should aim at improving the knowledge of the general population about the utilization of dental services during COVID-19 while maintaining safe practices and optimism in people's attitudes through mass media and social media.

Ethical clearance

Taken from Sri Ramakrishna Hospital Ethical Committee-EC/2021/1108/CR/68.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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