Knowledge, attitudes, and practices of university students regarding COVID-19: a cross-sectional study in Vietnam

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the SARS-Cov-2 virus. Springing from China in 2019, this virus spread globally and quickly led to the global COVID-19 pandemic [1]. As per the World Health Organization (WHO), as of 11 September 2022, there were 605.71 million COVID-19 confirmed cases and 6.49 million deaths globally. More than 3.13 million new cases and 10,935 deaths were reported from 5 to 11 September 2022 [2]. In Vietnam, as of 21 September 2022, more than 11.46 million cumulative COVID-19 patients, 10.58 million recoveries, and 43,142 deaths were confirmed by the Vietnam Ministry of Health (VMOH) [3]. From December 2021 to April 2022, an outbreak of the COVID-19 pandemic occurred in Vietnam, with tens of thousands of new cases per day [4].

Recently, thanks to the invention and global distribution of many types of COVID-19 vaccines, this pandemic has gradually come under control. Approximately 67.9% of the global population received at least one dose of a COVID-19 vaccine [5]. However, according to WHO, as of 22 May 2022, nearly one billion people in lower-income countries remain unvaccinated. Only 57 countries reached 70% vaccination coverage [6]. In Vietnam, as of 12 September 2022, more than 257 million doses of COVID-19 vaccines were distributed nationwide. 91.95% of the population received at least one dose of a COVID-19 vaccine, and 85.84% were fully vaccinated [7].

In Vietnam, numerous programs and measures were imposed in the entire country to mitigate the outbreak of the COVID-19 pandemic (for example, rigorous in-door quarantine, isolating individuals infected with COVID-19, constraining crowded activities, closing schools and universities, and recommending people to use face masks and hand sanitizers) [8, 9]. To broaden the public's COVID-19 knowledge, the government and the VMOH launched many health education programs, such as sending information on COVID-19 via mobile phone messages, leaflets, and texts to citizens. After a long time of studying via online learning platforms, students have gradually returned to their schools/universities since April 2022. There was a need to assess students' knowledge, attitudes, and practices (KAP) regarding COVID-19 and its prevention, thereby guaranteeing their safety in offline learning. There are many studies conducted to evaluate the KAP of university/undergraduate students regarding COVID-19 all over the world [10‐39], including several studies in Vietnam [10, 11]. Most of them were only carried out for medical students. This study investigated the KAP of medical and non-medical university students regarding COVID-19 in Vietnam.

This study was conducted during a wave of COVID-19 outbreaks in Vietnam. Schools and universities have been closed for a long time because of the detrimental impacts of this pandemic. The government strived to distribute COVID-19 vaccines nationwide and almost all people aged 18 years and above received at least two doses of vaccines [7]. Since April 2022, students have gradually come back to their universities. In the context of offline learning, students need to have adequate knowledge, positive attitudes, and good practices toward COVID-19. Our results showed that the KAP scores of a majority of Vietnamese university students were high. Despite being well aware of the main ways of COVID-19 transmission and symptoms, many students did not have adequate knowledge of COVID-19 treatment and prevention (WHO's mythbusters [40]) such as antibiotics, vitamins, and mineral supplements cannot treat or prevent COVID-19. In Italy, 19.30% of students thought that antibiotics were the first-line treatment for COVID-19 [27], far lower than the result of our study (42.73%). Wrong knowledge can lead to wrong actions/practices. Misusing antibiotics can contribute to the global increase of antibiotic resistance at an alarming rate in recent years. Another important finding was that females and medical students were significantly associated with higher KAP scores. In addition, several factors significantly associated with either the COVID-19 knowledge, attitudes, and/or practices of students included age, sex, year of study, major, and sources of COVID-19 information, in line with findings from studies in China [12], Indonesia [13‐15], Pakistan [16, 17], Ethiopia [18], Bhutan [19], Serbia [20], Bangladesh [21], Malaysia [22], and Iran [23].

Three-quarters (75.61%) of Vietnamese students had good COVID-19 knowledge, lower than results from studies in Bhutan (98%) [19], Ecuador (88%) [24], Hochiminh, Vietnam (86.6%) [10], and Ethiopia (81.8%) [25] but far higher than results from studies in Indonesia (29.8%) [13], and China (28.3%) [12]. Regarding attitudes, almost all Vietnamese students (98.24%) had positive attitudes towards COVID-19, consistent with the findings of studies in Hochiminh, Vietnam (92.8%) [10], Pakistan (92.5%) [26], Italy (90.6%) [27], and Bhutan (86.6%) [19], but far higher than the results of studies in Ethiopia (70.9%) [25], China (67.8%, 73.81%) [12, 28], and Indonesia (64.9%, 55.7%) [13, 14]. The KAP scores varied across different countries [44]. These comparisons are only approximate because of the differences in the time for conducting studies, location, the number and difficulty level of questions, and the cut-off points for analyzing scores. By way of illustration, the authors of a study conducted in Indonesia used Bloom's cut-off (≥ 80%) to dichotomize the KAP scores [13], while a 50% cut-off point was used in our study. This could be the rationale behind the lower percentages in the former study.

Among the knowledge questions, there were four remarkable questions. Firstly, only 34.34% of Vietnamese students knew that exposure to/eating wild animals could not lead to COVID-19 infection (question K5), lower than the findings of studies in Serbia (49.1%) [20], Egypt (47.2%) [29], and Bhutan (44.6%) [19] but higher than those in Indonesia (31.8%) [13] and India (13.9%) [30]. 74.2% of university students in Pakistan knew that COVID-19 could not be transmitted via mosquito bites (question K4) [31]. This figure in our study was only 47.22%. In addition, only 37.17% of Vietnamese students did not choose antibiotics for COVID-19 treatment (question K13), far lower than the results from a study in Italy (80.70%) [27]. Furthermore, more than 70% of Vietnamese students thought that vitamins and minerals could help prevent or cure COVID-19 (question K16). The percentages of Vietnamese medical students having correct answers for questions K4, K5, K13, and K16 were 56.68, 36.84, 52.83, and 18.42%; significantly higher than those of non-medical students (38.42, 32.02, 22.60, and 9.04%), respectively (p < 0.001, except for question K5: p = 0.1187). In general, the course of study of non-medical students does not include subjects involving health. This can be the reason for their lower knowledge scores compared to medical students. Both non-medical and medical students participated in our study, while in other studies [10, 20, 24, 29], only the latter were enrolled. This can explain the lower percentages of students having correct answers in our study.

Two years have passed since the first COVID-19 outbreak in China. Vietnam's pandemic has gradually been controlled, but most university students (87.80%) still thought that COVID-19 was an extremely dangerous disease. This figure was in line with the results of studies in Bhutan (86.2%) [19], Indonesia (92.6%) [13], and Afghanistan (91.1%) [32]. In Serbia [20], the percentage of students getting nervous/anxious when watching/reading COVID-19 news was low (19.9%), while this figure for Vietnamese students was high (69.56%). About 32.78% of students thought that the government should not let overseas people return home during the outbreak of the COVID-19 pandemic, higher than the result of a Chinese study [33]. These negative attitudes can explain the students' high compliance with the COVID-19 prevention guidelines of the VMOH.

Vietnamese students' common sources for seeking information on COVID-19 included social network/online newspaper (87.61%), mass media (television/radio) (65.85%), websites of WHO/VMOH, and scientific articles (56.98%), consistent with the results of many other studies conducted in Ecuador (scientific articles: 77.3%) [24], Moroc (social networks: 67.9%) [34], Jordan (social media: 83.4%) [35], Egypt (social media: 75.7%) [36], Ethiopia (television: 83.8%) [18], and Turkey (television: 43%) [37]. Not only Vietnamese students but also students in other countries (Indonesia [13], Bhutan [19], Pakistan [21, 26, 31], Moroc [34], Jordan [35], and Palestine [38]) had many practical measures which could help to prevent COVID-19, such as avoiding touching eyes/noses/mouths directly, maintaining a distance of at least one meter from others, and avoiding gathering/going out with friends. These good practices can guarantee students' safety when they study and learn in their universities. Besides many good practices, since many Vietnamese students thought antibiotics could be used to treat COVID-19, 48.0% of them bought antibiotics for storage at home. Furthermore, although Vietnam has a policy of providing free antiviral medicines to COVID-19 patients, 40.0% of students still bought this type of medicine to keep at home to prevent COVID-19. These poor practices were mainly from non-medical students (buying antibiotics: medical students 36.03%, non-medical students 59.13% (p < 0.001); buying antiviral medicines: medical students 29.55%, non-medical students 49.72% (p < 0.001)). These findings indicated that non-medical students were the group that needed to be improved their COVID-19 knowledge and practices.

Most Vietnamese university students had good knowledge, positive attitudes, and good practice toward COVID-19. However, many students did not know that antibiotics cannot be used to treat COVID-19 and vitamins/minerals cannot help prevent or cure COVID-19. Students' age, sex, year of study, major, and sources of COVID-19 information were several factors significantly associated with either the COVID-19 knowledge, attitudes, and/or practices of students. The leaders of Phenikaa University should focus on student groups having low KAP scores, such as non-medical students and males, to enhance their KAP toward COVID-19, thereby guaranteeing the students' safety in the context of offline learning.