Advanced Biomedical Research

Original Article: Latent class analysis of knowledge, attitude, and practice of a population-based sample of Iranian pregnant women toward COVID-19

Authors

Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‑Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aim of the study is to identify latent class (LC)-derived patterns of women's knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) in Iran. Materials and Methods: This cross-sectional survey of 2029 women, who participated in the PERSIAN Birth Cohort, was conducted in Isfahan, Iran. KAP was assessed by shortened and validated form of a recently used questionnaire in Iran. LC analysis was used to discover underlying response patterns of KAP toward COVID-19 using Mplus 8.0 software. Results: Three classes were identified: Class 1 (n = 514, 25.33%) “Low knowledge and poor practice, Class 2 (n = 423, 22.08%) “Moderate knowledge and proper practice,” and Class 3 (n = 1092, 53.82%) “Low knowledge and proper practice.” The lowest rate of positive attitude was seen in Class 3. Women living in rural areas, as well as those with lower education, were more likely to member classes with improper practice. Conclusion: The findings suggest that the LCA approach can provide important information reflecting different levels of adoption of protection toward COVID-19 infection. The results may be useful to conducting health-care programs during the outbreaks.

Keywords

1.
World Health Organization. WHO Coronavirus (COVID-19) Dashboard; 2021. Available from: https://covid19.who.int/. [Last accessed on 2021 Aug 15].  Back to cited text no. 1
    
2.
Daily New Cases in Iran-Daily New Deaths in Iran; 2020. Available from: https://www.worldometers.info/coronavirus/country/iran/. [Last accessed on 2021 Aug 15].  Back to cited text no. 2
    
3.
Manikandan N. Are social distancing, hand washing and wearing masks appropriate measures to mitigate transmission of COVID-19? Vacunas 2020;21:136-7.  Back to cited text no. 3
    
4.
Fan Y, Zhang S, Li Y, Li Y, Zhang T, Liu W, et al. Development and psychometric testing of the knowledge, attitudes and practices (KAP) questionnaire among student tuberculosis (TB) patients (STBP-KAPQ) in China. BMC Infect Dis 2018;18:213.  Back to cited text no. 4
    
5.
Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: A scoping review. Reprod Health 2021;18:10.  Back to cited text no. 5
    
6.
Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet 2020;395:931-4.  Back to cited text no. 6
    
7.
Taremwa IM, Ashaba S, Adrama HO, Ayebazibwe C, Omoding D, Kemeza I, et al. Knowledge, attitude and behaviour towards the use of insecticide treated mosquito nets among pregnant women and children in rural Southwestern Uganda. BMC Public Health 2017;17:794.  Back to cited text no. 7
    
8.
Harapan H, Rajamoorthy Y, Utomo PS, Anwar S, Setiawan AM, Alleta A, et al. Knowledge and attitude towards pregnancy-related issues of Zika virus infection among general practitioners in Indonesia. BMC Infect Dis 2019;19:693.  Back to cited text no. 8
    
9.
Napolitano F, Napolitano P, Angelillo IF. Seasonal influenza vaccination in pregnant women: Knowledge, attitudes, and behaviors in Italy. BMC Infect Dis 2017;17:48.  Back to cited text no. 9
    
10.
Shahbaznejad L, Navaeifar MR, Movahedi FS, Hosseinzadeh F, Fahimzad SA, Serati Shirazi Z, et al. Knowledge, attitude and practice of Sari birth cohort members during early weeks of COVID-19 outbreak in Iran. BMC Public Health 2021;21:982.  Back to cited text no. 10
    
11.
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.  Back to cited text no. 11
    
12.
Kibert NC. An Analysis of the Correlations between the Attitude, Behavior, and Knowledge Components of Environmental Literacy in Undergraduate University Students,[Electronic Resource]. Master's thesis: University of Florida; 2000.  Back to cited text no. 12
    
13.
Collins LM, Lanza ST. Latent Class and Latent Transition Analysis: With Applications in the Social, Behavioral, and Health Sciences. (Vol. 718): John Wiley & Sons; 2009.  Back to cited text no. 13
    
14.
Shahbaznejad L, Navaifar MR, Arabi M, Movahedi FS, Hosseinzadeh F, Fahimzad SA, et al. Knowledge, attitude and practice of Sari Birth Cohort members during early weeks of COVID-19 outbreak in Iran. BMC public health. 2021 Dec; 21 (1):1-2.  Back to cited text no. 14
    
15.
Taber KS. The use of Cronbach's alpha when developing and reporting research instruments in science education. Res Sci Educ 2018;48:1273-96.  Back to cited text no. 15
    
16.
McLachlan GJ, Lee SX, Rathnayake SI. Finite mixture models. Ann Rev Stat Appl 2019;6:355-78.  Back to cited text no. 16
    
17.
Porcu M, Giambona F. Introduction to latent class analysis with applications. J Early Adolesc 2017;37:129-58.  Back to cited text no. 17
    
18.
Collins LM, Lanza ST. Latent Class and Latent Transition Analysis: With Applications in the Social, Behavioral, and Health Sciences. (Vol. 718): John Wiley & Sons; 2010.  Back to cited text no. 18
    
19.
Lin TH, Dayton CM. Model selection information criteria for non-nested latent class models. J Educ Behav Stat 1997;22:249-64.  Back to cited text no. 19
    
20.
Muthen LK, Muthén BO. Mplus Version 8 User's Guide. Los Angeles, CA, USA : Muthen & Muthen; 2017.  Back to cited text no. 20
    
21.
Schreiber JB, Pekarik AJ. Using latent class analysis versus K-means or hierarchical clustering to understand museum visitors. Curator 2014;57:45-59.  Back to cited text no. 21
    
22.
Moro M, Vigezzi GP, Capraro M, Biancardi A, Nizzero P, Signorelli C, et al. 2019-novel coronavirus survey: Knowledge and attitudes of hospital staff of a large Italian teaching hospital. Acta Biomed 2020;91:29-34.  Back to cited text no. 22
    
23.
Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect 2020;105:183-7.  Back to cited text no. 23
    
24.
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr 2020;51:102083.  Back to cited text no. 24
    
25.
Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of coronavirus disease 2019 (COVID-19) beyond paranoia and panic. Ann Acad Med Singap 2020;49:155-60.  Back to cited text no. 25
    
26.
Rasmussen SA, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: Responding to a rapidly evolving situation. Obstet Gynecol 2020;135:999-1002.  Back to cited text no. 26
    
27.
Mann FD, Krueger RF, Vohs KD. Personal economic anxiety in response to COVID-19. Pers Individ Dif 2020;167:110233.  Back to cited text no. 27
    
28.
Oshitani H, Kamigaki T, Suzuki A. Major issues and challenges of influenza pandemic preparedness in developing countries. Emerg Infect Dis 2008;14:875-80.  Back to cited text no. 28
    
29.
Bodas M, Peleg K. Self-isolation compliance in the COVID-19 era influenced by compensation: Findings from a recent survey in israel. Health Aff (Millwood) 2020;39:936-41.  Back to cited text no. 29
    
30.
Venkatesh A, Edirappuli S. Social distancing in COVID-19: What are the mental health implications? BMJ 2020;369:m1379.  Back to cited text no. 30
    
31.
Andersen M. Early evidence on social distancing in response to COVID-19 in the United States. Available at SSRN 3569368; 2020.  Back to cited text no. 31
    
32.
Singh R, Adhikari R. Age-structured impact of social distancing on the COVID-19 epidemic in India. arXiv preprint arXiv: 2003.12055. 2020 Mar 26.  Back to cited text no. 32
    
33.
Kasemy ZA, Bahbah WA, Zewain SK, Haggag MG, Alkalash SH, Zahran E, et al. Knowledge, attitude and practice toward COVID-19 among Egyptians. J Epidemiol Glob Health 2020;10:378-85.  Back to cited text no. 33
    
34.
Afzal MS, Khan A, Qureshi UU, Saleem S, Saqib MA, Shabbir RM, et al. Community-based assessment of knowledge, attitude, practices and risk factors regarding COVID-19 among pakistanis residents during a recent outbreak: A cross-sectional survey. J Community Health 2021;46:476-86.  Back to cited text no. 34
    
35.
Ferdous MZ, Islam MS, Sikder MT, Mosaddek AS, Zegarra-Valdivia JA, Gozal D. Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An online-based cross-sectional study. PLoS One 2020;15:e0239254.  Back to cited text no. 35
    
36.
Chen X, Chen H. Differences in preventive behaviors of COVID-19 between Urban and rural residents: Lessons learned from a cross-sectional study in China. Int J Environ Res Public Health 2020;17:E4437.  Back to cited text no. 36
    
37.
Lai KY, Webster C, Kumari S, Sarkar C. The nature of cities and the COVID-19 pandemic. Curr Opin Environ Sustain 2020;46:27-31.  Back to cited text no. 37
    
38.
Moradzadeh R, Nazari J, Shamsi M, Amini S. Knowledge, attitudes, and practices toward coronavirus disease 2019 in the central area of Iran: A population-based study. Front Public Health 2020;8:599007.  Back to cited text no. 38
    
39.
Haftom M, Petrucka P, Gemechu K, Mamo H, Tsegay T, Amare E, et al. Knowledge, attitudes, and practices towards COVID-19 pandemic among quarantined adults in Tigrai Region, Ethiopia. Infect Drug Resist 2020;13:3727-37.  Back to cited text no. 39
    
Advanced Biomedical Research
Volume 2022, December
December 2022
Pages 1-9