Investigation and analysis of 14 034 college students on COVID-19 and its countermeasures and suggestions

Jia-Jia Zhang, Di Ma, Lu Chen, Shi-Xue Chen, Hai-Yang Peng, Dong-Xian Zhang

1.Institute of Management, Hainan Medical University, Hainan Haikou 570100

2. Haikou institute of health education, Hainan Haikou 571127

Keywords:College students COVID-19 Knowledge Attitude Behavioral

ABSTRACT Objective: To understand the current situation of college students' knowledge, cognitive attitude and behavior (KAP)towards the prevention and control of Corona Virus Disease 2019 (Corona Virus Disease 2019, COVID-19) during the epidemic, so as to provide theoretical basis for college students' resumption of study and campus prevention and control. Methods: A questionnaire survey was conducted among 16,410 college students by using the convenient sampling method of, One-Way ANOVA and Logistic regression analysis of the survey data. Results: The total awareness rate of college students on COVID-19 was 85%, the average knowledge score was (70.4±10.0), and the proportion of high cognition was 74.5%. The average attitude score of college students was (3.78±0.55), and only 3.9% of them held a positive attitude. The average score of college students' protective behaviors was (19.35±1.69), and 48.8% of them took good protective behaviors. Binary logistic regression analysis showed that the proportion of students with high cognition who adopt good protective behaviors is higher than that of students with low cognition (95%CI: 0.621-0.752). The proportion of students with a positive attitude to adopt good behaviors was higher than that with a negative attitude (95%CI: 1.398-2.009), Spearman rank correlation analysis results showed that there was a weak positive correlation between cognition and attitude (r=0.056,P ＜ 0.05), and a weak positive correlation between cognition and behavior (r=0.118,P ＜ 0.05), and a weak positive correlation between attitude and behavior (r=0.038,P ＜ 0.05). Conclusion: College students have a good overall cognition of COVID-19, but their attitudes and protective behaviors need to be further improved. Therefore, knowledge education, behavioral intervention and psychological counseling on COVID-19 epidemic prevention and control among college students should be strengthened to improve their prevention and control ability and physical quality.

1. Introduction

In early 2020, COVID-19 (Corona Virus Disease 2019, COVID-19) broke out in Wuhan and then spread to the whole country. Clinical studies have found that the main clinical manifestations of COVID-19 are fever, dry cough, fatigue, etc., but some patients may have no obvious symptoms, and these patients are not easily detected and not easily detected[1-2]. Of the highly infectious virus makes people feel nervous, spread of the disease and various kinds of unprecedented measures such as city of the seal brings people a big mood swings, and suspected cases fiddled with the growing public sensitive nerve, brought great trouble to people's production and living, but after work to the national people's resistance to disease, control group control, disease prevention and control war phased victory, at present all over the country is to return to work in order, and production, resumption to prepare schooling[3]. As one of the places with a high density of people, the university is an important place for prevention and control due to its extensive enrollment and personnel mobility, and will become another battle for epidemic prevention and control after resuming study[4]. During the COVID-19 epidemic, the university students' knowledge, cognitive attitude and behavior changes were studied in order to identify problems and weak links, and provide reference for health knowledge education, effective prevention and control, and healthy behavior development of university students after returning to school.

2. Materials and Methods

2.1 Materials

From February 1, 2020 to February 30, 2020, through the network questionnaire (questionnaire star), using WeChat, weibo and other major social software platforms to randomly distribute questionnaires to college students across the country.

2.2 Sampling Method

College students from all over the country are invited to fill in the questionnaire by using the network recruitment method. Then the college students fill in the questionnaire by sharing the twodimensional code of the network questionnaire or the link, the anonymous self-filling closed network questionnaire. This time, 16,410 questionnaires were collected, 14,034 were valid and the effective recovery rate was 85.5%.

2.3 Survey Tools

Based on a large amount of relevant literature at home and abroad and relevant policy documents issued by government departments, I consulted experts and scholars in the field of public health and health education, and finally worked out a questionnaire titled "Investigation of Cognition, Attitude and Behavior of College Students on novel Coronavirus infection". This questionnaire consists of four parts: (1) Basic demographic characteristics: gender, major, place of origin and nationality; (2) College students' cognition of COVID-19, including the nature of COVID-19 pathogen, management methods of infectious diseases and knowledge of prevention and control; (3) Attitude towards COVID-19; (4) Protection behavior of college students.

2.4 Scoring Criteria

There are 10 questions for COVID-19 cognition, 9 questions for single choice, and 1 question for multiple choice. You get 10 points for correct answer on a single choice, 0 points for incorrect answer,10 points for correct answer on all multiple choice questions, and 0 points for little or wrong choice. In terms of attitude, it involves 5 questions of single choice. If you hold a positive attitude, you will get 1 point; if you hold a negative attitude, you will get 0 points. There were 7 questions about COVID-19 protective behavior, with beneficial protective behavior increasing to 3 points, no change to 2 points, and decrease to 1 point. For COVID-19, the total score is 100 (≥60 for high cognition, ＜ 60 for low cognition). The full score of attitude is 6 (≥5 is positive attitude, ＜ 5 is negative attitude); The total score of protective behavior is 21 points (≥20 for good behavior, ＜ 20 for bad behavior).

Table 1 Awareness rate of COVID-19 prevention knowledge among college students (n=14034)

Table 2 Comparison of COVID-19 knowledge awareness rates of different demographic characteristics

Table 3 College Students' attention attitude to COVID-19 (N=14034)

Table 4 Attitudes of college Students with different characteristics to COVID-19[Number (%)]

2.5 Evaluation Index

Single question awareness rate = (number of correct answers/total number of responses) ×100%, total awareness rate = (total score ≥60 points/total number of responses)×100%, positive attitude holding rate = number of positive attitudes/total number of responses ×100%.

2.6 Quality Control

The number of questions in the questionnaire was set reasonably, and the research subjects were all filled anonymously. The members of the research group checked the recovered questionnaires, and rejected any unqualified questionnaires including the respondents, filling age, filling school, filling time, filling time (≤2min) and the logic of the questionnaire.

2.7 Statistical Analysis

Data were exported from the "questionnaire star" platform to EXCEL2010 software. SPSS 23.0 statistical software was used for statistical analysis of the data, including descriptive analysis, chisquare test, one-way anova and multivariate analysis using binary Logistic regression analysis, and the test level was = 0.05.

3. Results

3.1 General conditions

Among 14,034 college students surveyed, the maximum age is 30, the minimum age is 17, and the average age is 20. Among them, 6561 (46.8%) are male students and 7473 (53.2%) are female students. There were 5,823 medical majors (41.5%) and 8,211 nonmedical majors (58.5%). 9,678 students (69.0%) from rural areas and 4,356 (31.0%) from urban areas; 13,658 (97.3%) of the Han nationality and 376 (2.7%) of the ethnic minorities; There were 11,125 (79.3%) juniors and sophomores, and 2,909 (20.7%) seniors.

Table 5 Behavior changes of college students (n=14034)

Table 6 Protective behaviors of college students with different characteristics against COVID-19 [Number (%)]

3.2 College students' cognition of COVID-19

The questionnaire included knowledge points about the nature of COVID-19 pathogen, management methods of infectious diseases and prevention and control knowledge. The average score of COVID-19 knowledge among college students was (70.4±10.0) points. Among 14,034 college students, the total awareness rate of COVID-19 knowledge was 85%, and the proportion of high cognition was 74.5% (10,458/14034). "Whether know outbreak of COVID-19 cause epidemic can spread from person to person" and the awareness of the highest, at 98.6%, in under the condition of "know 56℃, 30 minutes can kill virus" and "COVID-19 pathogens is a virus", 93.1% and 91.1%, respectively, and the main symptom of COVID-19, categories of infectious diseases and infectious diseases, the lowest in the measures for the management of population, were 25.7%, 22% and 65.3%, as shown in table 1.Among the surveyed college students, there were statistically significant differences in COVID-19 cognition among different genders, major categories, grades and places of origin(All P ＜ 0.05).There was no statistically significant difference between different health conditions（χ2=1.160,P=0.281), as shown in Table 2.

3.3 College students' attention to COVID-19

According to the survey on COVID-19 attitude of college students, 14,034 college students had an attitude score of (3.78±0.55), positive attitude (≥5) was 547 (3.9%) and negative attitude (＜5) was 13,487 (96.1%). "If you have a COVID-19 patient around you, do you panic?" The rate of positive attitude holding was low, only 7.8%. "Suspected cases were identified and isolated, can you understand?" The highest proportion of students with a positive attitude towards this question was 98.5%. 98.4% of students said they would "discourage their friends and relatives from eating game". 92.2% of students said they would "panic because of COVID-19 patients around them".There were statistically significant differences in COVID-19 attitudes among college students of different genders and majors(All P ＜ 0.05),while there were nostatistically significant differences among different nationalities(χ2=0.132,P=0.716),grades(χ2=1.019,P=0.313), student origin (χ2=0.001,P=0.981)and health status(χ2=0.597,P=0.440), as shown in Table 3 and Table 4.

Table 7 Variable assignment in Logistic regression analysis of COVID-19 protective behavior of college students with different characteristics

Table 8 Multivariate Logistic regression analysis of COVID-19 protective behavior of college students with different characteristics

3.4 College students' protective behaviors during COVID-19 epidemic

3.4.1 College students take protective behaviors

The average score of 14,034 college students' protective behavior was (19.35±1.69), among which 6,853 (48.8%) had good behavior≥20 points. The time or times of college students washing their hands and wearing masks outside increased significantly, which were 92.0% and 90.7% respectively. 92.5% of college students took buses less frequently, and the time and times of having dinner with family members, friends and classmates and going to public places where people gather significantly decreased, accounting for 93.4% and 94.6% respectively, as shown in Table 5.The differences of protective behaviors among different genders, majors, places of origin, health status, cognition degree and attitude were statistically significant(P＜0.05). The protective behaviors of college students of different nationalities(χ2=1.738,P=0.187)and grades (χ2=1.615,P=0.204)were not statistically significant, as shown in Table 6.

3.4.2 Multi-factor analysis of college students' protective behaviors

Binary Logistic regression analysis is performed by Backward Stepwise(LR) method[5]. After univariate analysis of COVID-19 protective behaviors in populations with different characteristics, statistically significant independent variables such as cognitive level (X5) and attitude (X6) were incorporated into the multivariate analysis model, as shown in Table 7. Hosmer fitting degree test P=0.568 (P ＞0.05), H0 hypothesis was accepted, and the data fitted well with the regression model. Binary Logistic regression analysis results show that:Students with high cognition were 0.612 times (95%CI: 0.621-0.752) of those with low cognition, and those with positive attitude were 1.398 times (95%CI: 1.398-2.009) of those with negative attitude, as shown in Table 8.

3.5 The relationship among COVID-19 cognition, attention attitude and protective behavior of college students

Spearman correlation analysis showed that students' cognitive score of COVID-19 was weakly positively correlated with their attitude score (r=0.056,P ＜ 0.05), cognitive score was weakly positively correlated with their behavior score (r=0.118,P ＜ 0.05), and attention attitude score was weakly positively correlated with their behavior score (r=0.038,P ＜ 0.05).

4. Discussion

The results of this survey show that college students have a good overall cognitive level of COVID-19, with a total awareness rate of 85% and a high cognition rate of 74.5%. College students of COVID-19 route of transmission, etiology of knowledge such as knowledge awareness is higher, but the main symptoms of COVID-19 witting rate was only 25.7%, especially for countries to COVID-19 identified as b class infectious diseases (22.0% awareness) according to the understanding of the class a management (awareness 65.3%) degree is low, it reflects most of the students to the state policy of prevention and control of attention is not enough,COVID-19 prevention and control knowledge is not comprehensive, need further emphasis, targeted to strengthen the popularization of college students and epidemic prevention knowledge. College students with different characteristics have different cognition of COVID-19. Medical students have a higher knowledge of COVID-19 than non-medical students, which may be related to the background knowledge of preventive medicine and basic medicine of medical students. This suggests that the targeted health education of the group should be highlighted after the resumption of university education, and differentiated and precise health education strategies should be suggested[6], with emphasis on increasing the publicity of relevant prevention and control knowledge for students from nonmedical schools. The study found that the overwhelming majority (97.8%) of college students supported the quarantine measures taken by the government, and had a clear attitude towards eating game (98.4%), reflecting that college students supported and understood the prevention and control measures taken by the government, and had a strong sense of social responsibility and a certain sense of self-protection[7].The proportion of college students with negative emotions reached 93.1%, and 92.2% were afraid of being infected by COVID-19, among which the proportion of female students with negative attitudes was higher than that of male students. Studies have reported that college students during the period of COVID-19 outbreak generally have mild pressure stress reaction, and college students living in rural women are also more prone to physical or cognitive reaction[8], sources of information for college students in a variety of forms, but on the discrimination ability of the information itself is not strong, lead to college students' psychological problems may be more likely than other groups to[9].Therefore, the school should also provide timely psychological counseling services for students by carrying out online psychological lectures, setting up online psychological counseling rooms, telephone support hotlines and other ways to timely psychological counseling for students. "Fast, accurate and extensive" are the advantages of network platforms such as WeChat, weibo and official accounts. Making full use of electronic network and other multimedia means can broaden the channels of information exchange[10].

According to the investigation of college students' behavior,During the COVID-19 epidemic, only 48.8% of college students adopted good behaviors, and some of them still increased their behaviors that were not conducive to the prevention and control of COVID-19. For example, 1.9% of students took buses, 3% of students visited public places where crowds gathered, and 2.4% of students did not wear masks outside. Suggest resumption after school schooling lifestyle intervention should also be timely to strengthen students' behavior, advocate a healthy lifestyle, more measures and guide the student to make clean sanitation, start from their own complete protection, advocate students to strengthen physical exercise, a balanced diet, assure enough sleep, avoid contact with respiratory patients, suggest that students less as far as possible to go or not much and closed places[11].Logistic regression results show that college students' attitude and cognition are important factors affecting their protective behaviors. This study found that college students' cognition, attention attitude and protective behavior of COVID-19 were significantly correlated, with a weak positive correlation. Therefore, the more positive college students' attitude towards COVID-19 is, the higher their cognitive level is, the higher their score of protective behavior is, which conforms to the theory of knowledge, trust and practice[12-13].