3.1 Demographical characteristics of subjects
All subjects (n=872) were recruited from ten universities in Xi’an, Shaanxi Province, including five public and five private schools. Among them, 534 out of 872 (61.2%) were females and 338 out of 872 (38.8%) were males. There were 49.3% (430 out of 872) medical students and 50.7% (442 out of 872) non-medical majors. 51.9% (453 out of 872) attended public schools and 50.7% (442 out of 872) were from private schools. 66.5 % (580 out of 872) were in their first year and the rest were in other higher grades. The average age of subjects was 20.1±0.1 with a range between 17 and 25 years old. The hometown of student was reported to cover 28 provinces, autonomous regions and municipalities of China.
3.2 Knowledge of COVID-19
COVID-19 related knowledge was assessed by 5 categories. Each question and answer options were described with graded scores in Table 1. Among the total 4,360 collected answers, 3,590 (82.3%) were correct. The female students had significantly a higher score for K5 than the males (p<0.05, Table 2); public school students showed significantly higher scores for K1 and K4 than private school students (p<0.05, Table 2). No other statistical significance was found between groups (Table 2)
Table 1 COVID-19 knowledge among undergraduate students
Variable categories
|
Options
|
Determination/ score
|
N (%)
|
K1: What type of infectious disease is COVID-19?
|
l Bacterial.
|
Incorrect/ 0
|
17 (2.0)
|
l Viral.
|
Correct/ 1
|
848 (97.3)
|
l I don’t know.
|
Incorrect/ 0
|
7 (0.8)
|
K2: What is the main transmission route of COVID-19?
|
l Respiratory droplets and close contact.
|
Correct/ 1
|
862 (98.9)
|
l Water.
|
Incorrect/ 0
|
2 (0.2)
|
l Food.
|
Incorrect/ 0
|
5 (0.6)
|
l I don’t know.
|
Incorrect/ 0
|
3 (0.4)
|
K3: How long is COVID-19 incubation period?
|
l 1~14 days.
|
Correct/ 1
|
579 (66.4)
|
l 3~7 days.
|
Incorrect/ 0
|
21 (2.4)
|
l More than 14 days.
|
Incorrect/ 0
|
265 (30.4)
|
l I don’t know.
|
Incorrect/ 0
|
7 (0.8)
|
K4: Who are susceptible to COVID-19?
|
l The old and children.
|
Incorrect/ 0
|
297 (34.1)
|
l People are generally susceptible.
|
Correct/ 1
|
441 (50.6)
|
l Young adults.
|
Incorrect/ 0
|
11 (1.3)
|
l People with pre-existing diseases.
|
Incorrect/ 0
|
117 (13.4)
|
l I don’t know.
|
Incorrect/ 0
|
6 (0.7)
|
K5: What are the main clinical manifestations of COVID-19?
|
l Fever and dry cough.
|
Correct/ 1
|
860 (98.6)
|
l Fatigue.
|
Incorrect/ 0
|
3 (0.3)
|
l Stuffy and runny nose.
|
Incorrect/ 0
|
1 (0.1)
|
l Sore throat and myalgia.
|
Incorrect/ 0
|
2 (0.2)
|
l Diarrhea.
|
Incorrect/ 0
|
0 (0.0)
|
l I don’t know.
|
Incorrect/ 0
|
6 (0.7)
|
Table 2 Comparison of COVID-19 knowledge between different groups
Variables*
|
Gender (n, %)
|
Major (n, %)
|
Grade (n, %)
|
Type of school (n, %)
|
Male
|
Female
|
χ2
|
P
|
Medical
|
Non-
medical
|
χ2
|
P
|
First year
|
Other grades
|
χ2
|
P
|
Public
|
Private
|
χ2
|
P
|
K1-correct
|
325
(97.0)
|
523
(97.9)
|
2.467
|
0.116
|
417
(97.0)
|
431
(97.5)
|
0.233
|
0.630
|
562
(96.7)
|
286
(98.0)
|
0.798
|
0.372
|
447
(98.7)
|
401
(95.7)
|
7.181
|
0.007
|
K2-correct
|
334
(98.8)
|
528
(98.9)
|
0.007
|
0.936
|
427
(99.3)
|
435
(98.4)
|
1.509
|
0.219
|
574
(99.0)
|
288
(98.6)
|
0.193
|
0.661
|
449
(99.1)
|
413
(98.6)
|
0.579
|
0.447
|
K3-correct
|
215
(63.6)
|
364
(68.2)
|
1.925
|
0.165
|
298
(69.3)
|
281
(63.6)
|
3.205
|
0.073
|
393
(67.8)
|
186
(63.7)
|
1.435
|
0.231
|
303
(66.9)
|
276
(65.9)
|
0.101
|
0.751
|
K4-correct
|
171
(50.6)
|
270
(50.6)
|
0.000
|
0.993
|
227
(52.8)
|
214
(48.4)
|
1.669
|
0.196
|
293
(50.5)
|
148
(50.7)
|
0.002
|
0.963
|
249
(55.0)
|
192
(45.8)
|
7.280
|
0.007
|
K5-correct
|
330
(97.6)
|
530
(99.3)
|
3.992
|
0.046
|
426
(99.1)
|
434
(98.2)
|
1.243
|
0.265
|
573
(98.8)
|
287
(98.3)
|
0.366
|
0.545
|
446
(98.5)
|
414
(98.8)
|
0.199
|
0.656
|
* The questions and correct option of each variable are described in Table 1.
Chi-square test was used to compare the percentage of correct knowledge between different groups: male vs. female, medical vs. non-medial majors, first year vs. other grades, public vs. private schools.
3.3 Attitude toward COVID-19
Questions about COVID-19 attitude included 5 categories. Each question and answer options were described with graded scores in Table 3. Among all 4,360 submitted answers, 3,218 (73.81%) showed a positive attitude. The females had significantly higher scores than the males for A1 (p<0.05) and A3 (p<0.05) (Table 4). Students from public schools scored significantly higher than those from private schools for A2 (p<0.05), A3 (p<0.05) and A5 (p<0.05) (Table 4).
Table 3 Attitude toward COVID-19 among undergraduates
Variable categories
|
Options
|
Determination/ score
|
N (%)
|
A1. Are you scared by human-to-human transmission of COVID-19?
|
l Yes, but I’m rational and I can protect myself.
|
Positive/2
|
812 (93.1)
|
l I don’t care; I feel the same.
|
Neutral/1
|
32 (3.7)
|
l No, I’m panic and don’t know what to do.
|
Negative/0
|
28 (3.2)
|
A2. Do you hope the outbreak to stop quickly so you can return to school soon?
|
l Yes.
|
Positive/2
|
673 (77.2)
|
l I don’t care.
|
Neutral/1
|
147 (16.9)
|
l No, I want to stay at home as long as possible.
|
Negative/0
|
52 (5.9)
|
A3. What’s your attitude towards wild animal consumption?
|
l I don’t eat wild animals, and I will accuse consumers.
|
Positive/2
|
689 (79.0)
|
l I don’t eat personally, but I won’t stop others
|
Neutral/1
|
155 (17.8)
|
l I don’t mind having a try.
|
Negative/0
|
28 (3.2)
|
A4. Do you think you will be more capable to endure such public health emergence?
|
l Yes, I’m more educated and thus more capable.
|
Positive/2
|
740 (84.9)
|
l I will be the same.
|
Neutral/1
|
111 (12.7)
|
l No, I’m too scared to withstand it anymore.
|
Negative/0
|
21 (2.4)
|
A5. Do you think this outbreak has impacted your study?
|
l Yes, it has.
|
Negative/0
|
568 (65.1)
|
l No. I’m self-disciplined and my study was not affected at home.
|
Positive/2
|
304 (34.9)
|
Table 4 Comparison of COVID-19 attitude between different groups
Variables*
|
Gender (n, %)
|
Major (n, %)
|
Grade (n, %)
|
Type of school (n, %)
|
Male
|
Female
|
χ2
|
P
|
Medical
|
Non-
medical
|
χ2
|
P
|
First year
|
Others
|
χ2
|
P
|
Public
|
Private
|
χ2
|
P
|
A1-positive
|
307
(90.8)
|
505
(94.6)
|
7.911
|
0.019
|
401
(93.3)
|
411
(93.0)
|
0.601
|
0.740
|
543
(93.6)
|
269
(92.1)
|
0.841
|
0.657
|
419
(94.5)
|
393
(93.8)
|
0.579
|
0.749
|
A2-positive
|
255
(75.4)
|
418
(78.2)
|
5.312
|
0.070
|
334
(77.7)
|
339
(76.7)
|
5.347
|
0.069
|
452
(77.9)
|
221
(75.7)
|
5.415
|
0.067
|
334
(73.7)
|
339
(80.9)
|
6.490
|
0.039
|
A3-positive
|
233
(68.9)
|
456
(85.4)
|
36.562
|
<0.001
|
353
(82.1)
|
336
(76.0)
|
5.101
|
0.078
|
471
(81.2)
|
218
(74.7)
|
5.044
|
0.080
|
370
(81.7)
|
321
(76.6)
|
8.819
|
0.012
|
A4-positive
|
276
(81.7)
|
464
(86.9)
|
4.593
|
0.101
|
369
(85.8)
|
371
(84.0)
|
0.978
|
0.613
|
494
(85.2)
|
246
(84.3)
|
0.248
|
0.883
|
385
(85.0)
|
355
(84.7)
|
3.319
|
0.190
|
A5-positive
|
114
(33.7)
|
190
(35.6)
|
0.313
|
0.576
|
142
(33.0)
|
162
(36.7)
|
1.264
|
0.261
|
199
(34.3)
|
105
(36.0)
|
0.232
|
0.630
|
175
(38.6)
|
129
(30.8)
|
5.897
|
0.015
|
* The questions and positive option of each variable are described in Table 3.
Chi-square test was used to compare the percentage of positive attitude between different groups: male vs. female, medical vs. non-medial majors, first year vs. other grades, public vs. private schools.
3.4 Practice related to COVID-19
Practice related to COVID-19 was assessed by 5 single-choice questions. Each question and answer options were described with graded scores in Table 5. Among the 4,360 answers collected, 3,834 (87.9%) indicated a proactive practice. The females had significantly higher score for questions P2~P5, except P1 (Table 6). Students in higher grades had a significantly higher score for P5 than freshmen (Table 6).
Table 5 Practices related to COVID-19 among undergraduates
Variable categories
|
Options
|
Determination/ score
|
N (%)
|
P1: What would you do if you had fever and dry cough?
|
l I will analyze the situation rationally. Stay home for observation and self-quarantine or go to a hospital for a treatment.
|
Proactive/2
|
817 (93.7)
|
l I want to go to a hospital, but I’m afraid to be infected.
|
Neutral /1
|
39 (4.5)
|
l I feel panic. I don’t know what to do.
|
Passive/0
|
16 (1.8)
|
P2: If the country needs you, are you willing to help the frontline rescue?
|
l Yes, every citizen shall bear the country’s burden.
|
Proactive/2
|
812 (93.1)
|
l I’m not sure and need suggestions from the family.
|
Neutral /1
|
45 (5.1)
|
l No, it’s too dangerous.
|
Passive/0
|
15 (1.7)
|
P3: What would you do if you had close contact with confirmed cases?
|
l Proactively report to the community and stay home in quarantine as required.
|
Proactive/2
|
852 (97.7)
|
l Same as before.
|
Neutral /1
|
3 (0.3)
|
l I feel panic and don’t know what to do.
|
Passive/0
|
17 (2.0)
|
P4: What would you do if someone cured from COVID-19 wanted to meet you?
|
l I will meet them and show more kindness.
|
Proactive/2
|
697 (79.9)
|
l I will meet them just like before.
|
Neutral /1
|
40 (4.6)
|
l I’ll find an excuse to keep away from them.
|
Passive/0
|
135 (15.5)
|
P5: What will be your top priority when the pandemic ends?
|
l I will go back to school and restart a normal study.
|
Proactive/2
|
656 (75.2)
|
l Same as before.
|
Neutral /1
|
3(0.3)
|
l The outbreak is too scary. I need to enjoy my life as much as possible.
|
Passive/0
|
213(24.4)
|
Table 6 Comparison of COVID-19 practice between different groups
Variables*
|
Gender (n, %)
|
Major (n, %)
|
Grade (n, %)
|
Type of school (n, %)
|
Male
|
Female
|
χ2
|
P
|
Medical
|
Non-medical
|
χ2
|
P
|
First year
|
Others
|
χ2
|
P
|
Public
|
Private
|
χ2
|
P
|
P1-proactive
|
311
(92.0)
|
506
(94.8)
|
3.126
|
0.210
|
411
(95.6)
|
406
(91.9)
|
5.219
|
0.074
|
550
(94.8)
|
267
(91.4)
|
3.985
|
0.136
|
419
(92.5)
|
398
(95.0)
|
2.295
|
0.318
|
P2- proactive
|
297
(87.9)
|
515
(96.4)
|
24.885
|
0.000
|
407
(94.7)
|
405
(91.6)
|
4.196
|
0.123
|
542
(93.5)
|
270
(92.5)
|
1.191
|
0.551
|
420
(92.7)
|
392
(93.6)
|
1.331
|
0.514
|
P3- proactive
|
326
(96.5)
|
526
(98.5)
|
3.890
|
0.049
|
421
(97.9)
|
431
(97.5)
|
0.152
|
0.696
|
565
(97.4)
|
287
(98.3)
|
0.662
|
0.416
|
443
(97.8)
|
409
(97.6)
|
0.031
|
0.860
|
P4- proactive
|
273
(80.8)
|
424
(79.4)
|
9.294
|
0.010
|
348
(80.9)
|
349
(79.0)
|
1.903
|
0.386
|
470
(81.0)
|
227
(77.7)
|
1.504
|
0.471
|
367
(81.0)
|
330
(78.8)
|
0.747
|
0.688
|
P5- proactive
|
270
(79.9)
|
386
(72.3)
|
6.411
|
0.011
|
324
(75.4)
|
332
(75.1)
|
0.006
|
0.936
|
421
(72.6)
|
235
(80.5)
|
6.494
|
0.011
|
338
(74.6)
|
318
(75.9)
|
0.192
|
0.661
|
* The questions and proactive option of each variable are described in Table 5.
Chi-square test was used to compare the percentage of proactive practice between different groups: male vs. female, medical vs. non-medial majors, first year vs. other grades, public vs. private schools.
3.5 Comparison of COVID-19 related KAP scores between different groups
In the whole study population, the overall score for Knowledge was 4.1±0.7 (range: 0~5), Attitude was 8.5±1.2 (range: 0~10), and Practice was 8.9±1.4 (range: 0~10). There was a positive correlation between Attitude and Practice scores (r=0.319, P<0.05). Subgroup analysis indicated that Knowledge level was significantly higher in students from public schools and medical programs than those from private schools and non-medical majors (P<0.05) (Table 7). There was a significantly higher score of Attitude in females than males (P<0.05) (Table 7). Practice level was found no statistically significant difference between groups by gender, grade, major or school style (Table 7).
Total KAP score was 21.6±2.3 among the subjects, in which a positive correlation was observed between the Attitude and Practice (r=0.319, P<0.05). Total KAP score was significately different among gender groups and major groups(P<0.05, P<0.05) (Table 7).
Table 7 Comparison of COVID-19 related KAP scores between different groups
|
Variables
|
(n)
|
Knowledge
|
Attitude
|
Practice
|
Total KAP
|
|
|
|
|
P
|
|
|
P
|
|
|
P
|
|
|
P
|
|
Gender
|
Male
|
338
|
4.07±0.78
|
-1.537
|
0.125
|
8.30±1.33
|
-4.706
|
0.000
|
8.92±1.46
|
0.176
|
0.860
|
20.55±2.38
|
-2.827
|
0.005
|
|
Female
|
534
|
4.15±0.73
|
|
|
8.69±1.09
|
|
|
8.90±1.41
|
|
|
20.98±2.04
|
|
|
|
Major
|
Medical
|
430
|
4.17±0.71
|
2.240
|
0.025
|
8.59±1.16
|
1.058
|
0.290
|
9.00±1.37
|
1.751
|
0.080
|
21.00±2.13
|
2.437
|
0.015
|
|
Non-medical
|
442
|
4.06±0.78
|
|
|
8.50±1.24
|
|
|
8.83±1.49
|
|
|
20.64±2.23
|
|
|
|
Grade
|
First year
|
580
|
4.13±0.73
|
0.686
|
0.493
|
8.59±1.16
|
1.758
|
0.079
|
8.89±1.43
|
-0.474
|
0.636
|
20.85±2.17
|
0.588
|
0.557
|
|
Others
|
292
|
4.09±0.78
|
|
|
8.44±1.28
|
|
|
8.94±1.43
|
|
|
20.75±2.23
|
|
|
|
School type
|
Public
|
453
|
4.18±0.75
|
2.636
|
0.009
|
8.52±1.25
|
-0.548
|
0.584
|
8.89±1.51
|
-0.472
|
0.637
|
20.82±2.29
|
0.082
|
0.935
|
|
Private
|
419
|
4.05±0.74
|
|
|
8.57±1.15
|
|
|
8.93±1.35
|
|
|
20.81±2.07
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Independent sample T-test was used to compare the scores of KAP between different groups: male vs. female, medical vs. non-medial majors, first year vs. other grades, public vs. private schools.