Knowledge deficit and fear of COVID-19 among higher education students during the first wave of the pandemic and implications for public health: a multi-country cross-sectional survey | BMC Public Health
This study found that 62.7% of respondents across the 26 countries were classified as having “good” knowledge about COVID-19. It further revealed that at the national level, Romania had the highest proportion of respondents classified as “good” knowledge (89%), while the lowest proportion was seen in Russia (31.8%). Previous studies in the general population and in healthcare professionals have shown that advanced education and work experience are associated with knowledge related to COVID-19 [21,22,23]. These results could explain our result, as Romania had the highest proportion of students in the health field and therefore the highest level of knowledge related to COVID-19. Our finding is consistent with a study conducted in India only among dental students which found adequate knowledge of COVID-19 to be 83%. . Although the result of the aforementioned study is higher than the total knowledge related to COVID-19 in the 26 countries, it is comparable to countries like Romania and Portugal which have a very high proportion of health students. On the other hand, our results regarding knowledge related to COVID-19 were much higher compared to a study conducted in Romania (10.8%) among oncology patients. . The discrepancy observed between the two studies may be due to the fact that our study was conducted only with ES students whereas the first was conducted with patients, the majority of whom (66.6%) had no no formal education. Other reasons for the high percentage of knowledge related to COVID-19 in countries such as Romania and Portugal may relate to their early public health responses to curb the spread of the pandemic, which may have included governments actively communicating and engaging with those specific communities before introducing a particular measure. This action could have created awareness of COVID-19 early on, leading to higher levels of knowledge . According to data from public health measures of European Union (EU) countries, Romania and Portugal closed educational institutions early. In comparison, the Czech Republic, which had the lowest level of knowledge about COVID-19 among EU countries, did not close any educational institutions, which may have contributed to the low level of knowledge about COVID-19 .
There is little research on the association of knowledge and fear regarding COVID-19. Our study found that after adjusting for potential confounders, knowledge related to COVID-19 is independently associated with both fear of SARS-COV-2 infection and severe COVID-19. The odds of being afraid of contracting SARS-COV-2 infection and severe COVID-19 among those with good knowledge were lower than those with poor knowledge.
Our results suggest that increased comprehensive knowledge related to COVID-19 may be associated with both lower fear of severe COVID-19 infection as well as SARS-COV-2 infection. The reason could be that respondents with more knowledge about COVID-19 will have a greater sense of control over the pandemic and therefore will not feel threatened enough to fear too much. This is reflected in a study conducted in China which found that people with low self-control were more likely to have an exaggerated perception of the severity of COVID-19. . This finding is also consistent with other variables in our study, such as field of study where the likelihood of having a fear of contracting SARS-COV-2 or severe COVID-19 among students in the health field was lower than that of non-health students. The reason behind such a finding could be that health students are expected to have more knowledge related to COVID-19 and therefore high self-control leading to less fear compared to their non-health student counterparts. Another important reason could relate to the infodemic, specifically the misinformation spread mostly on social media platforms during the pandemic, to which unhealthy students are vulnerable compared to healthy students. . This is especially true among teenagers, as they are the primary consumers of social media and are exposed to problematic social media use, with misinformation being one of its consequences. .
It should also be noted that the likelihood of being afraid of contracting SARS-COV-2 infection or a severe form of COVID-19 among students who strongly agreed to receive timely government information regarding the COVID-19 pandemic was weaker, compared to those who disagreed. This result is similar to a study conducted in Turkey, where satisfaction with accurate and up-to-date health information provided was associated with lower levels of anxiety and stress. . Our results therefore indicate that factors such as field of study and timely government information that increase knowledge related to COVID-19 are associated with lower fear of contracting SARS-COV-2 infection and COVID-19. severe. Additionally, receiving timely information from credible sources such as the government could also be specifically associated with less fear of contracting SARS-COV-2 infection and severe COVID-19, as it helps in combating the infodemic. and reduce the misinformation that typically leads to exaggerated fear. .
The negative burden of the COVID-19 pandemic, particularly on the mental health of higher education students, has been documented [16, 17]. Fear of contracting severe COVID-19 and SARS-COV-2 infection and lack of sufficient knowledge may further contribute to a higher level of depression among this population group, which is a major public health concern .
Increased smoking was negatively associated with both SARS-COV-2 fear and severe COVID-19. The myth that smokers are protected from SARS-COV-2 infection has received widespread media attention and has caused confusion even within the medical community. . Thus, erroneous reported claims about a protective effect of smoking may underlie the particular finding of our study. Physical activity, particularly increased moderate physical activity, was also negatively associated with both fear of SARS-COV-2 infection and severe COVID-19. Our finding was similar to a study conducted in the United States which found that increased physical activity is associated with reduced fear of COVID-19, post-traumatic stress disorder and other mental health issues. mental health due to the COVID-19 pandemic . However, no independent association was observed between vigorous physical activity and fear of SARS-COV-2 infection or severe COVID-19. This could be due to the fact that the containment measures in place were not conducive to the practice of vigorous physical activity while these measures were suitable for the practice of moderate physical activity. Additionally, it is worth noting other studies indicating that the transition to a virtual learning environment due to lockdown measures introduced during the pandemic may in itself trigger more mental health issues. [17, 30]. Finally, increased alcohol consumption was positively associated with both fear of SARS-COV-2 infection and severe COVID-19. This finding echoes Reynolds et al.  study in Ireland where fear during the COVID-19 lockdown was associated with increased alcohol consumption.
The limitation of this study is that it is cross-sectional and does not allow examining the possible causal effect of knowledge deficit on fear of SARS-COV-2 infection and severe COVID-19. In addition, the study used convenience sampling which is not representative of the study population. Additionally, as the study includes behavioral questions, social desirability bias is possible as potential confounders.
The strengths of this study, however, are that it is a cross-national survey, it has a large sample size, it examined random effects in 26 countries and observed differences between them. Additionally, it assessed fear of both SARS-COV-2 infection and severe COVID-19.
The results of this study will inform HEIs about their students’ level of knowledge about COVID-19 and provide a basis for action to increase awareness and understanding among the student body. It will also help with the exaggerated fear of severe COVID-19 and SARS-COV-2 infection which can lead to psychological issues such as depression. Additionally, by providing targeted and timely interventions to inform, address the knowledge gap on COVID-19 and combat the infodemic, it will promote psychological well-being and prevent mental health issues among students at the higher education both in current and future pandemics.
The intervention of all stakeholders to fight fear should not only be implemented by increasing the level of knowledge related to COVID-19, but also by focusing on timely information through media sources, intensifying the intervention on healthy behaviors such as moderate physical activity. Most importantly, government agencies, in addition to providing timely, up-to-date, and accurate information, should implement national public health measures as soon as possible that target both general and specific population groups such as students. of higher education, as this action could increase the number of cases of COVID-19. related knowledge, countering the infodemic and reducing fear.
A follow-up study is recommended to assess the current level of knowledge and fear of students 16 months after the initial confinement, as well as this relationship in low-income countries. We also recommend further exploring the relationship between physical activity, particularly moderate physical activity, and fear, as it was associated in our study. In addition, future studies should also assess the causal effect of COVID-19-related knowledge deficit and fear of COVID-19.