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doi: 10.4103/1995-7645.280396
Knowledge and attitude toward COVID-19 among healthcare workers at District 2
Hospital, Ho Chi Minh City
Huynh Giao1,6, Nguyen Thi Ngoc Han2, Tran Van Khanh3, Vo Kim Ngan4,5, Vo Van Tam1, Pham Le An6
1Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
2Infection Control Department, University Medical Center Ho Chi Minh City, Vietnam
3Department of Scientific Research, District 2 Hospital, Ho Chi Minh City, Vietnam
4Department of Nursing, District 2 Hospital, Ho Chi Minh City, Vietnam.
5Faculty of Nursing and Medical Technology, University of Medicine Pham Ngoc Thach at Ho Chi Minh City, Vietnam
6Center for the Training of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
ABSTRACT
Objective: To assess the knowledge and attitude toward coronavirus
disease-2019 (COVID-19) among healthcare workers at District 2
Hospital in Ho Chi Minh City (HCMC).
Methods: A cross-sectional study was performed between January
2020 and February 2020 at District 2 Hospital. A systematic random
sampling strategy was carried out and the data was collected through
a self-administered questionnaire of the knowledge and attitude
of healthcare workers regarding COVID-19. Descriptive analysis
was reported to describe the demographic, mean knowledge and
attitude score of healthcare workers. Inferential statistics including
t-test, ANOVA and Spearman’s correlation were used to evaluate the
relationship between study variables.
Results: A total of 327 eligible healthcare workers had a mean
score of knowledge and attitude of 8.17±1.3 (range 4-10) and
1.86±0.43 (range 1-5), respectively. They showed good knowledge
and a positive attitude. However, approximately two thirds of the
participants knew the mode of transmission, the isolation period
and treatment (67.0%, 65.8%, and 58.4%, respectively), and 82.3%
and 79.8%, respectively, held positive attitude regarding the risk of
personal and family members getting illness. There was a negative
correlation between knowledge scores and attitude scores (r=-0.21,
P<0.001). Additionally, healthcare workerspredominately used
social media to inform themselves about COVID-19 (91.1%).
Conclusions: The majority of healthcare workers had good
knowledge and positive attitude toward COVID-19. However, the
level of some knowledge and attitude lower than that expected
for their position level towards the virus. Additional education
interventions and campaigns are required for healthcare workers.
KEYWORDS: Knowledge; Attitude; COVID-19; Healthcare
worker; District 2 Hospital
1. Introduction
Coronaviruses are a large group of viruses that are rather common
throughout the community. Historically, evidence has shown that
the virus is transmitted through birds and mammals, with humans
being particularly vulnerable to infection and transmission of the
virus[1]. The previous outbreaks of coronaviruses such as Severe
Acute Respiratory Syndrom-Coronavirus (SARS-CoV) and Middle
East Respiratory Syndrome-Coronavirus (MERS-CoV) in 2003
and 2015, show similarities to the novel coronavirus, which was
first reported in December 2019, and is currently the disease in
questions resulting in the worldwide Coronavirus disease-2019
outbreak, COVID-19[2]. It was first reported by Chinese authorities
in Wuhan city, the capital of Hubei province in China at the end of
December 2019[3]. The infection began to spread rapidly throughout
many countries including Vietnam, the World Health Organization
(WHO) declared that COVID-19 infection was a Public Health
Emergency of International Concern. The WHO data was updated
on 6 March 2020, there were 98 192 confirmed cases and 3 380
deaths worldwide[4]. In Vietnam, the first case originated from a
Chinese man on a trip to Vietnam on 22nd December 2019[5]. Until
now, 17 cases of COVID-19 infection have been confirmed. The
Asian Pacific Journal of Tropical Medicine 2020; 13
Asian Pacific Journal of Tropical Medicine
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©2020
Asian Pacific Journal of Tropical Medicine
Produced by Wolters Kluwer-
Medknow. All rights reserved.
How to cite this article: Huynh G, Nguyen TNH, Tran VK, Vo KN, Vo VT, Pham
LA. Knowledge and attitude toward COVID-19 among healthcare workers at District
2 Hospital, Ho Chi Minh City. Asian Pac J Trop Med 2020; 13. doi: 10.4103/1995-
7645.280396
Original Article
To whom correspondence may be addressed. E-mail: hgiaoytcc@ump.edu.vn
Article history: Received 1 March 2020
Accepted 6 March 2020
Revision 4 March 2020
Available online 27 March 2020
Impact Factor: 1.77
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2Huynh Giao et al./ Asian Pacific Journal of Tropical Medicine 2020; 13
infected cases in Vietnam were mainly from travelers returning
from Wuhan and following human-to-human transmission to their
family members[6]. Accordingly, the emergence of this infectious
disease has caused much anxiety within the Vietnamese and
Expat population across Vietnam due to the increasing number
of suspected cases and the virus’ unpredictable future. Currently,
there is no specific antiviral treatment and preventive vaccine.
Therefore, the guidelines are recommended to decline the spread
of infection and respond to the challenges during the epidemic. As
CDC recommends, coronavirus spreads mainly from person-to-
person by close contact (within about 6 feet) with infected people
via respiratory (coughs or sneezes) or transmitted by touching a
surface or object that the virus on it[7]. In terms of symptoms, the
WHO reported that more than 80% of COVID-19 patients showed
mild symptoms and recovered without any medical intervention,
approximately 20% of infected cases had a severe illness such as
shortness of breath, septic shock and multi-organ failure, and it has
been reported that an estimated 2% of cases can be fatal[8]. The risk
of increased severity was noticed in the elderly and with underlying
chronic diseases. The best prevention is to avoid being exposed to
COVID-19. This is done by washing hands with soap and water,
and using face masks, isolating confirmed and suspected cases[7,8].
In addition, healthcare workers (HCWs) are at a high risk of getting
the infection and the source of transmission in the community. Some
previous studies showed that HCWs had a lack of knowledge and
attitude toward MERS CoV[9,10], and SARS[11]. District 2 Hospital
is one of the largest hospitals in Ho Chi Minh City (HCMC) with
specialist service, so that the response to major medical issues
are available to all patients. It is also responsible for training and
research, as well as supporting the medical workers to treat the
suspected cases of COVID-19 infection in HCMC. Due to the
importance of this facility, and from evidence obtained from Wuhan
in China that HCWs were at a high risk of getting the virus within
medical facilities and also transmission to other patients within the
community. This study aimed to assess the knowledge and attitude
toward COVID-19 among HCWs at District 2 Hospital in HCMC.
The findings will help authorities organize the necessary educational
programs in order to provide up-to-date information and deliver the
best practice to control the COVID-19 disease.
2. Material and methods
2.1. Study population
A cross-sectional study was conducted between January 2020 and
February 2020 in District 2 Hospital. A systematic random sampling
strategy was carried out on all of 751 HCWs, with k=2 and we
chose 375 participants, but only 327 HCWs agreed and returned the
questionaire. Thus, 87.2%(327/375) HCWs completed and returned
the questionnaire. The HCWs including physicians, pharmacists,
nurses, and technical staff, were evaluated as eligible to participate
in the study.
2.2. Data collection
The data was collected through a self-administered questionnaire,
which was designed according to Ahmed M. Asaad’ study towards
the Middle East Respiratory Syndrome Coronavirus (MERs CoV)
and the Question and Answer about COVID-19 in the webpage
of WHO[12,13]. After translating to Vietnamese and correcting
to fit the COVID-19 virus, the questionnaire was sent to three
infectious disease specialists at the University of Medicine and
Pharmacy at Ho Chi Minh City to give their opinions regarding
its simplicity and full content. And then it was followed by a pilot
study, which was carried out by 10 HCWs at District 2 Hospital
who gave their opinions relating to the intelligibility of the
questionnaire. According to the result of the pilot study, the final
questionnaire was determined by the authors. The data of the pilot
analysis was not used for the final sample of the study. A structured
questionnaire included three parts. The first section comprised
demographic characteristics of the participants such as age, gender,
occupation, years of experience, and the source information of
COVID-19 knowledge. The second section included 10 questions
regarding the knowledge of COVID-19, and the last one estimated
the attitude regarding COVID-19, including 8 questions in which
the participants’ answers were assessed through 5 points Likert scale
of agreement. All were held at District 2 Hospital. Participants were
assured that the information collected would remain anonymous.
2.3. Data analysis
Each correct answer in relation to the knowledge of COVID-
19 was given one point. The total knowledge score for the HCWs
varied between 0 (with no correct answer) and 10 (for all correct
answers), and a cut off level of <7 was evaluated as poor knowledge,
and 曒7 indicated good knowledge. The score of the attitude based
on 5 points Likert scale, in which the score of 1 to 5 was given from
strongly agree to strongly disagree. A mean score of 曑2 (answering
for strongly agree or agree) was carried out as a positive attitude and
a score of 3 to 5 indicated a negative attitude (answering strongly
disagree or disagree or undecided). Therefore, the lower the attitude
scores were, the higher the probability of positive attitudes and the
reverse applied for a high score.
Data was analyzed using Stata 13.0 software. Descriptive analysis
was reported as frequency, percentage and mean scores. T-test
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Huynh Giao et al./ Asian Pacific Journal of Tropical Medicine 2020; 13
and ANOVA were used to analyze the relationship between the
dependent (knowledge and attitude), and independent variables
(demographic characteristics of the participants). Spearman’s
correlation was used to assess the relationship between mean
knowledge and attitude scores. All the differences of estimated
variables were considered statistically significant if P<0.05.
2.4. Ethical approval
All the eligible HCWs were informed about the objectives of the
study, and they agreed and signed consent form before participation.
The study was approved by the Ethics Council of District 2 Hospital
(protocol number 16/District 2 Hospital-Scientific Research).
3. Results
Of the study population, 327 (87.2%) of eligible subjects who
completed and returned the questionnaire had a mean age of
(30.1±6.1) years, most of them were female (74.0%), the highest
percentage of HCWs were nurses (70.9%) and the majority of them
had less than 5 years experience (62.9%). There were 98.2% of
participants who knew the COVID-19 outbreak. The main sources
of COVID-19 information were social media and the Ministry
of Health website (91.1% and 82.6%, respectively) (Table 1). As
depicted in Table 2. The majority of participants knew that COVID-
19 is a virus, how to prevent transmission between humans, and
that infected cases could result in death (99.1%, 98.2%, and 98.8%,
respectively). However, about two-thirds of participants knew
that the transmission was due to close contact with the infected
person, the suspected cases should be isolated for a minimum of
two weeks, and antibiotics were not the first-line treatment (67.0%,
65.8%, and 58.4%, respectively). The overall response to the
survey was good, the participants possessing sufficient knowledge
were recorded as 88.4%. The results of the questionnaire relating
to attitude were summarized in Table 3. More than 90.0% of the
participants responded positively toward COVID-19. However, there
were some negative attitudes, only three-quarters of participants
thought that they would probably get the illness (82.3%), one of
their family members may get an infection (79.8%) but they will
accept the isolation if suspected infection (97.9%). The association
of demographic characteristics and knowledge and attitude of HCWs
were presented in Table 4, in which occupation was correlated with
knowledge and attitude scores, according to which pharmacists who
showed higher levels of knowledge also found significantly higher
levels of a positive attitude about COVID-19 compared to those
who were employed as physicians, nurses and technical staff (8.55
vs. 8.33, 8.09, 7.80, P<0.05), and (1.79 vs.1.97, 1.85, 1.86, P<0.01).
Besides, Spearman’s analysis found that a significant negative
correlation between the mean knowledge and attitude scores of
HCWs about COVID-19 (r=-0.21, P<0.001). The lower the attitude
scores were, the higher the probability of positive attitudes; while the
higher the knowledge scores were, the higher the probability of good
knowledge. Therefore, a good knowledge COVID-19 was directly
associated with a positive attitude.
Table 1. Baseline characteristics of healthcare workers, District 2 Hospital,
2020 [n(%)].
Characteristics Participants (n=327)
Age (mean±SD) (years) 30.1±6.1
20-29 187 (57.2)
30-39 111 (33.9)
曒40 29 (8.9)
Sex
Male 85 (26.0)
Female 242 (74.0)
Occupation
Physician 43 (13.1)
Nurse 232 (70.9)
Pharmacist 42 (12.8)
Technical staff 10 (3.1)
Year of experience (n=318)
< 5 200 (62.9)
5-10 98 (30.8)
> 10 20 (6.3)
Know the COVID19 outbreak is
happening globally in 2020 (yes)
321 (98.2)
Source of COVID-19 information (yes)
Television 259 (79.2)
Social media 298 (91.1)
Websites of hospital/Health Ministry 270 (82.6)
Friends, relatives 142 (43.4)
Unheard 3 (0.9)
Table 2. Knowledge of healthcare workers toward COVID-19, District 2
Hospital, 2020 [n(%)].
Question (correct answer) Correct answer
COVID-19 is a virus infection (yes) 324 (99.1)
COVID-19 is transmitted by close contact
with the infected person (yes)
219 (67.0)
Fever, cough, sore throats and shortness
breath are possible symptoms of COVID-
19 (yes)
238 (72.8)
The isolation period is 2 weeks (yes) 215 (65.8)
COVID-19 vaccine is available in markets
(no)
292 (89.3)
Antibiotics are the first-line treatment (no) 191 (58.4)
Washing hands with soap and water,
and using face masks can help in the
prevention of disease transmission (yes)
321 (98.2)
Patients with underlying chronic diseases
are at a higher risk of infection and death
(yes)
259 (79.2)
Healthcare workers are at a higher risk of
infection (yes)
290 (88.7)
COVID-19 could be fatal (yes) 323 (98.8)
Knowledge toward COVID-19
(mean±SD)
8.17±1.30
Sufficient 289 (88.4)
Insufficient 38 (11.6)
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Table 3. Attitude of healthcare workers toward COVID-19, District 2
Hospital, 2020 [n(%)].
Item (correct answer) Response
You think you will probably get illness (yes) 269 (82.3)
You are worried one of your family members may get
an infection (yes)
261 (79.8)
If getting COVID-19, you will accept isolation in
health facilities (yes)
320 (97.9)
Transmission of COVID-19 can be prevented by
washing hands with soap frequently (yes)
303 (92.7)
Prevalence of COVID-19 can be reduced by the active
participant of HCWs in hospital infection control
programs (yes)
321 (98.2)
If a COVID-19 vaccine was available, I would have it
(yes)
302 (92.4)
Covid-19 patients should be kept in isolation (yes) 321 (98.2)
Medical staffs are ready to participate in anti-epidemic
in the community (yes)
320 (97.9)
Attitude (mean±SD) 1.86±0.43 (1-4)
Sufficient 305 (93.3)
Insufficient 22 (6.7)
4. Discussion
To the best of our understanding, there are no cases of COVID-
19 among HCWs reported in Vietnam[6]. Till now, the COVID-19
outbreak is considered an emergency and healthcare workers are
seen to have an increased risk of infection while there is no other
investigation of the knowledge and attitude of healthcare workers
towards the COVID-19. In view of this, the difference in our findings
has been compared with other related content as MERS, SARS.
The findings in our study showed that HCWs had a high level of
knowledge and a positive attitude towards the COVID-19 outbreak.
We found that the majority of the respondents know the COVID-
19 is a global issue and gathered their information through a variety
of media such as television (79.2%), social media (91.1%), the
website of hospital/Health Ministry (82.6%). However, this result
has not previously been described in Albarrak I.’s study with the
highest main source being seminars and workshops accounting for
48%[14]. The findings showed that HCWs are more interested in
social media to gather knowledge on an emerging infectious disease
like COVID-19 than the official website of the Ministry of Health
at the present time. This is an important issue for the government
of Vietnam because it’s important to consider a variety of channels
to update knowledge and learning materials about this epidemic
and, especially, to communicate information to the minority of
HCW’s who have a lack of knowledge or are not currently aware
of any issue relating to COVID-19 (0.9%). Also, it is necessary that
the website of the Ministry of Health or hospital should update its
website information regularly to encourage HCWs to access this
channel for all health-related issues and information. In addition,
valuable information was gathered from questions such as possible
symptoms and the best way of the prevention of transmission is
by washing hands and using face masks. Our results are similar to
the findings of Khan’s study about MERS[15], but different from
a research from the US in which participants had poor knowledge
of the symptom of SARS[16]. It can thus be suggested that the
positive influence of the educational program on the HCWs from the
Ministry of Health in Vietnam. By contrast, only 67.0%, 65.8% and
58.4% of good answers relate to the transmission by close contact
with an infected person, the isolation period and treatment of the
COVID-19 virus. Currently, no vaccine or specific treatment for
COVID-19 is available, the treatment aims to reduce the symptoms
without any specific antiviral medication for COVID-19. This result
is similar to the study of Bener and Khan et al. in which 40% and
57.6% of participants had no knowledge of the treatment of SARS
and MERS[15,17]. These findings suggested that media campaigns
Table 4. Distribution of knowledge and attitude scores among healthcare workers, District 2 Hospital.
Characteristic Knowledge t-value F-value P-value Attitude t-value F-value P-value
Age
20-29 8.15±1.25 -0.08 0.300 1.82±0.45 -1.92 0.151
30-39 8.19±1.42 -1.92±0.40 -
曒40 8.24±1.24 -1.82±0.35 -
Sex
Male 8.21±1.27 -0.333 -0.740 1.92±0.41 1.522 -0.129
Female 8.16±1.32 -1.83±0.43 -
Occupation
Physician 8.33±1.19 -1.85 0.015*1.97±0.40 -1.44 0.001*
Nurse 8.09±1.38 -1.85±0.45 -
Pharmacist 8.55±0.92 -1.79±0.27 -
Technical staff 7.80±1.34 -1.86±0.30 -
Year of experience (n=318)
< 5 8.29±1.24 -2.52 0.325 1.82±0.44 -1.55 0.453
5-10 7.92±1.40 -1.91±0.40 -
> 10 8.10±1.37 -1.88±0.38 -
Average 8.17±1.30 1.86±0.40
Data were expressed as mean±SD. t-test and ANOVA were test used to a comparison between demographic
characteristics of healthcare workers and the score of knowledge and attitude, *P<0.05.
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should focus on the transmission, the isolation of suspected cases
and the treatment of COVID-19 to avoid an outbreak. The majority
of HCWs were aware that patients with underlying chronic diseases
are at a higher risk of infection and mortality accounted for 79.2%.
This was similar to some previous studies about COVID-19 in
Vietnam and China[3,5]. It showed that HCWs need to be cautious in
patients with chronic diseases because these patients are more likely
to die from the illness.
Another important finding was that the vast majority of the
participants had a positive attitude about COVID-19. However, there
remains a significant concern that they could contract the virus and
in turn pass the virus to family members, particularly their parents.
Only 97.9% of the participants agree to isolation if it was needed.
These results are likely to be related to a lack of knowledge within
the HCW’s about current and important prevention and isolation
strategies.
It was also observed that occupation was significantly associated
with knowledge and attitude. Pharmacists showed relatively more
knowledge. Additionally, good knowledge has a higher probability
of positive attitudes, this result has not previously been described[15].
The goals of the upcoming educational program should focus on the
HCW’s with insufficient knowledge and this should improve the rate
of positive attitudes of HCWs.
This study had some limitations in interpreting the results because
COVID-19 is a novel coronavirus and no research has been studied
to compare; the study samples were collected at the District 2
Hospital in HCMC in the current condition. Therefore, it was
difficult to generalize results across the general population. Future
studies could estimate the knowledge and attitude of HCWs on
a larger scale to be able to design appropriate interventions on a
national level.
The findings showed the majority of HCWs at the District 2
Hospital had good knowledge and positive attitude toward COVID-
19, but there are some lower knowledge and negative attitudes than
expected. Additional education intervention and campaigns are
required for HCWs to avail them with the knowledge of the mode of
transmission, the isolation period and treatment strategies, as well as
the risk of personal and family infection with COVID-19.
Conflict of interest statement
The authors declare that there is no conflict of interest.
Acknowledgments
We thank Assoc. Professor Cao Ngoc Nga, Assoc. Professor. Tran
Thien Thuan, and Dr. Nguyen Ngoc Lan for participating as content
expert reviewers. We wish to acknowledge the cooperation and
support of all healthcare workers at District 2 Hospital for the time
and effort that they devoted to the study.
Authors’ contributions
All authors substantially contributed to drafting and revising the
article, as well as the final approval of the version to be submitted.
HG, PLA, and NTNH contributed to the conception and design of
the study and acquisition of the data. VVT and VKN conducted
the data analysis and HG and TVK were the contributors to the
interpretation of the data.
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