JRSSEM 2022, Vol. 01, No. 11, 1986 – 2003

E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494

DOI : 10.36418/jrssem.v1i11.211 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

KNOWLEDGE, ATTITUDE AND PREVENTION PRACTICE

AMONG THE VOLUNTEERS (HCPs) IN IMPLEMENTING

5M

Julia Christy Labetubun

1*

Dian Ayubi

2

Tri Krianto

3

1,2,3

Faculty of Public Health, Universitas Indonesia, Depok, Indonesia

e-mail: juliachristy33@gmail.com

1

, dian.ayubi@gmail.com

2

, tkarjos[email protected]om

3

*Correspondence: juliachristy33@gmail.com

Submitted: 25 May 2022, Revised: 06 June 2022, Accepted: 15 June 2022

Abstract. Health care providers (HCP) are a group that has a high risk of being exposed to COVID-

19. Due to the large number of personnel needed to handle COVID-19, in several hospitals, health

volunteers were involved to assist in the treatment process. As workers who deal directly with

COVID-19 patients, volunteers are the targets in this study. HCP's health behavior can influence the

escalation of prevention and control cases at their level. Therefore, this study aims to examine the

practice of knowledge, attitudes, prevention (KAP) and factors related to the application of 5M on

volunteers (HCP) at Hospital "X", Jakarta, Indonesia. This type of research is a quantitative study,

with a cross-sectional research design. A cross-sectional study, with multiple logistic regression

analysis conducted on 232 volunteers (HCP) in 2021. The instrument used was a modified

questionnaire from 7 previous studies, both regional and international, which have been tested for

validity and reliability in the same study. group (30 volunteers) and the same hospital. Based on

the results, it was found that the implementation of 5M volunteers were categorized as "poor

prevention practices" (67.7%), "inadequate knowledge" (58.2%) and "negative attitudes" (55.2%),

with R square through multivariate test of 0.630 which means that the influence of the independent

variable on the dependent variable is 63% and the variables related to 5M behavior (p-value <0.05)

are knowledge and attitudes. Attitude is known as the most dominant variable with a p-value of

0.014.

Keywords: knowledge; attitude; prevention practice; volunteers (HCPs); 5M.

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 1987

DOI : 10.36418/jrssem.v1i11.211 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

INTRODUCTION

The escalation of COVID-19 cases in

Indonesia until December 23, 2021

amounted to 4,261,072 cases and has

reached 144,034 thousand (3,4%) people

who have been declared dead. Indonesia is

a country with the highest daily addition of

cases and the number of COVID-19 deaths

in the world (Lescure et al., 2020) to be

precise in September 2021, and is currently

ranked 7th in the world out of 25 countries

with the highest death rates. The area with

the highest number of cases in Indonesia is

Jakarta Province with a total of 864,825

cases (20.5%) (Report of the COVID-19

Handling Task Force, 2021).

The head of the Jakarta Provincial

Health Office explained that the effective

reproductive value (Rt) which is an

indication of the transmission rate of

COVID-19 has reached <1 (0.96) as of

November 17th, 2021. However, almost in

all islands have an increasing Rt value of

0,98, where the achievement target is 0.5-

0,7. Therefore, the government

recommends adherence to preventive

behavior, one of which is the

implementation of 5M behaviors we called

that consisting of wearing masks, washing

hands, maintaining distance, avoiding

crowds and reducing mobilization, which is

contained in KEPMENKES (Indonesian

Ministry of Health) No.

HK.01.07/Menkes/413/2020 Regarding

Guidelines for Prevention and Control of

COVID-19.

Based on international research, hand

washing reduces the risk of transmission by

35% (Stangerup et al., 2021). Other

literature also states that frequent hand

washing reduces the risk of transmission by

55%. The use of surgical masks can reduce

70% of the spread of COVID-19 (WHO,

2020). Maintaining a minimum distance of

2 meters can minimize the risk of spreading

by up to 85% Regarding to avoid crowds

and to reduce mobility, the research results

from the WGS (whole genome sequencing)

of Faculty of Medicine, Public Health, and

Nursing Department of Universitas Gadjah

Mada (UGM), Yogyakarta stated that the

higher of the social interaction, the higher

the chance of a spike in cases (Report of the

COVID-19 Handling Task Force, 2021).

Concentration of COVID-19 and/or

RNA (ribonucleic acid), it is known the

concentration of virus is higher in health

facilities, which can provide the potential

for indirect transmission of COVID-19

through the surrounding environment or

objects contaminated with the virus from

an infected person (for example, a

stethoscope or a thermometer (Chen et al.,

2020).

This shows that the hospital is one of

the environments that have great potential

for transmission. Data from the Ministry of

Health (KEMENKES) in 2004 stated that

transmission in hospitals was one of the

highest contributors to disease with a

percentage value reaching 93.4%. Research

related to disease transmission in hospitals

in the United States, England, and Kuwait

also shows that hospitals are places for the

spread of germs/viruses/bacteria,

especially from carriers (from patients to

officers or from officers to patients and

from patients to visitors or vice versa)

(Miller et al., 2020).

CDC (Center of Disease Control and

Prevention) in its weekly report issued a

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 1988

study on the characteristics of health

workers who were confirmed positive for

COVID-19 and the WHO then estimated

that around 80,000 to 180,000 health

workers worldwide died from COVID-19 in

the period of January 2020 to May 2021. A

study in Qatar revealed that COVID-19

transmission to health workers occurred in

45% of co-workers and 29% of patients

(Alajmi et al., 2020). In addition, research by

(Yang et al., 2020) in East Java regarding the

behavior of volunteers (HCPs) towards

health protocols was found almost entirely,

namely 87% of health workers did not

comply with the COVID-19 handling and

prevention protocol. However, this is likely

coupled with the fact that some HCPs have

inadequate knowledge of infection

prevention practices.

Indeed, protection of HCPs and their

working environment are relevant aspects

in pandemic responses. This requires that

HCPs must have up-to-date knowledge

and optimistic attitude towards the many

aspects of the pandemic. In addition,

increasing the awareness and preventive

behavior of HCPs with continuous updates

about COVID-19 is relevant. Health

behaviors of HCPs can influence prevention

and control actions implemented in

response to the pandemic.

Since HCPs are vital in the fight against

COVID-19 pandemic, their prevention

behavior takes a lion share of containing

the infection among themselves. This

notably depends on their knowledge,

attitude and practice in dealing with this

highly transmissible virus. As part of the

pandemic response therefore, exploring

HCP’s knowledge, attitude and prevention

practice (KAP) is very important. These

helps to notice deficiencies in COVID-19

understanding, related perceptions and

prevention practices and thereby justify the

significance to train frontline vulnerable

HCPs on IPC skills (Ashebir et al., 2022).

Studies in various settings have

indicated that there are huge differences in

terms of the KAP of HCPs in the fight

against the pandemic. Different factors like

socio-demographic, knowledge and

attitude were also identified to be

associated with COVID-19 prevention

practice. Despite the fact that HCPs play a

central role in the response to COVID-19, to

our knowledge information on HCPs/HCW

for COVID-19 is still very limited. Even

research for volunteers has not been found

in Indonesia, particularly in assessing the

KAP of volunteers (HCPs) to implement the

prevention practice of COVID-19 that

means 5M.

METHODS

This type of research is a quantitative

research, with a cross-sectional study

design. This research was carried out in

November 2021 at a hospital in Jakarta for

232 (samples) of 1.636 (populations)

volunteers (HCPs) whom actived in red

zone, which had been calculated using

two-proportion difference hypothesis test

formula with the help of sample size

software. The sampling technique in this

study used purposive sampling.

The dependent variable in this study is

the COVID-19 prevention practice namely

5M and the independent variables consist

of knowledge, attitude, and social

demographics (sex, age, education

categories, length of work as a volunteer,

1989 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

and previous work experiance before

volunteering). Age of volunteers (HCPs)

was divided in two categories: 1) 19-32

years and (2) 33-45 years. Education

category of volunteers (HCPs) was divided

in two categories: (1) Medical that consist

of physician and military/police physician;

(2) Non-Medical that consist of nurses,

medical laboratory technologist (MLT),

pharmacist, and medical record spesialist.

The length of work as a volunteer was

divided in two categories; (1) <6 months

and (2) ≥6 month), also the previous work

experiance was divided in two categories;

(1) Ever (divided in <5 years and ≥5 years)

and (2) Never.

The data related to KAP of volunteers

(HCP’s) and socio-demographic

characteristics that collected using a

questionnaire (adapted and modified from

7 previous regional and international

studies), which has been tested for validity

and reliability on 30 participants in the

same hospital and on the same research

subject.

The instrument (questionnaire) was

assessed using a total of 45 items (13

knowledge items, 12 attitude items and 20

prevention practice items) of 5M. The

different number of items used to

categorize KAP were then modified from

the theory of Olum et al., Bloom et al. and

Goni et al, (2021). Accordingly, a cut-off

≥80% ( ≥11 points out of 13), ≥80% (≥10

points out of 12), and ≥75% (≥18 points

out of 20) was used to determine adequate

knowledge, positive attitude, and good

prevention practice.

Volunteers' knowledge of COVID-19

prevention practice is based on a 13-items

scale. Every knowledge questions have a

possibility "True" and "False" answers. The

correct answer (True) was coded as 1, while

the wrong answer (False) was coded as 0

during analysis. Accordingly, the total score

ranged from 0–13, with an overall greater

score indicated adequate knowledge. For

who scored ≥80% of the correct knowledge

questions was considered as having

“adequate knowledge” and for who scored

<80% was considered as having

“inadequate knowledge”.

Attitudes toward the implementation

of the prevention practices (5M) was based

on a 12-items scale. Responses to each

statement were shown on a 4-point Likert

scale as follows: 4 (“Strongly agree”), 3

(“Agree”), 2 (“Disagree”), and 1 (“Strongly

Disagree”). Thus, the total score ranges

from 0–12, with a larger overall score

indicating a positive attitude. Based on

Bloom's modified cut off, scoring 80% of

the attitude statements (≥10 points out of

12) considered to have a "positive attitude"

and those who scored <80% (<10 points)

was considered as having “negative

attitude”.

The prevention practice in this study is

based on a 20-items scale that assesses the

behavior of volunteers in implementing the

5M. Each behavior-related statement was

responded with 4 points “Constantly” a

score of 4, “Frequently” a score of 3,

“Rarely” a score of 2 and “Never” a score of

1. Thus, the total score ranges from 0–20,

with the overall greater scores indicate

good prevention practices. Based on

Bloom's modified intersection, scored

≥75% of the total of practice items (≥18

points out of 20) considered to have “good

prevention practices” and who scored <75%

(<18 points) is deemed to have “poor

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 1990

preventive practices”.

Data checked by google form, entered

into microsoft excel, coded and exported to

SPSS version 23.0 for windows analysis.

Descriptive statistics such as frequency,

percentage, average, and standard

deviations were calculated to summarize

the categorical data. The modified by

Bloom about cut-off point was used to

determine adequate knowledge (80%),

positive attitude (80%) and good

preventive practice (75%).

The collected data is then processed

through 3 stages of analysis, namely (1)

Univariate (where the normality test in this

study uses the skewness value and

standard error. If the skewness value is

divided by the standard error value, it

results in a number <2 then the data is

normally distributed); (2) Bivariate (Using

Pearson correlation test to see the

relationship between variables, chi square

test to select candidate variables with a

reference p-value <0.25. For independent

variables with p-value >0.25, but

substantially important, then these

variables can be entered into the

multivariate model); (3) Multivariate

(Performing elimination by maintaining the

variables that have a statistical significance

determined by p value < 0.05 and the

presence of associations was described

using the odds ratio (OR) or relatif risk (RR)

with their confidence intervals (CI) 95%).

Ethical approval were obtained from

the Ethics Review committee of the

Universitas Indonesia and the hospital

under study in Jakarta. After the research

objectives are clearly explained, written and

inform consent was obtained from all study

participants. Consent form documenting

research objectives, benefits, and

procedures. Privacy and confidentiality

information is also strictly guaranteed by all

data collectors and researchers.

RESULTS AND DISCUSSION

Socio-demographic Related

Characteristics of Respondents

From a total of 232 volunteers (HCPs),

the average age was 27 years (SD± 5.39),

which concludes that the age range of

respondents is dominated by the age of 19-

32 years (81,9%). 60,3% of the respondents

were women. Most of the them were non-

medical (65.1%) who were nurses (42.7%),

and from the total of all respondents, 71.6%

who have been actived volunteers for <6

months. Specifically, 44% of volunteers

(HCPs) have no previous work experienced,

while of the total 41,9% have a previous

work experienced for ≥5 years. The

majority of professions that had work

experienced before becoming a COVID-19

volunteers were the nursing profession

(43,8%) and followed by the medical

profession (30,8%) out of a total of 130

volunteers who had work experienced table

1.

1991 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

Table 1. Distribution of Respondents Based on Socio-Demographic Variables (n=232)

Variable

Categories

n

(%)

Sex

Male

92

39,7

Famale

140

60,3

Age

19 – 32

190

81,9

33 – 45

42

18,1

Education Categories

Non Medical

▪ Physician

▪ Millitary/Police

Physician

Medical

▪ Nurses

▪ Medical

laboratory

technologist

(MLT)

▪ Pharmacist

▪ Medical

record

spesialist

151

68

13

81

99

10

30

12

65,1

29,3

5,6

34,9

42,7

4,3

12,9

5,2

Length of Work as a Volunteer

< 6 months

≥ 6 months

166

66

71,6

28,4

Previous Work Experience Before Volunteering

Ever

▪ <5 years

▪ ≥5 years

Never

130

75

54

102

56,0

58,1

41,9

44,0

Total

232

100

Knowledge of Volunteers (HCPs) About

Prevention Behavior (5M). The findings of

this result of study showed that more than

half of the volunteers (HCPs) were 135

respondents (58,2%) had “inadequate

knowledge” about 5M. The average

cumulative score of knowledge obtained

by volunteers (HCPs) about 5M was <80%

(72.26) with the minimum scores was 46

and the maximum scores was 92. From

each question item, it was found that >80%

of volunteers knows the indicators of 5M,

the moment of using mask, the distance to

avoid physical distancing, the right

standing position in the elevator, and how

to avoid high mobility (Table 3). Only 59,5%

of volunteers knows how to wash the hands

with soap and running water, 57,3% of

volunteers who knows the effective time of

wearing mask, and 53,9% who knows about

social distancing table 2.

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 1992

DOI : 10.36418/jrssem.v1i11.211 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

Table 2. Description of Volunteers’ (HCPs) Length of Work and Previous Work Experience

Before Volunteering Based on The Professions Specification (n=232)

Tabel 3. Description of Knowledge, Attitude and Prevention Practice (5M) Among

Volunteers (HCPs) Based on The Professions Specification (n=232)

Variables

Knowledges

Attitudes

Prevention

Practice

Adequat

e

Inadequat

e

Potitive

Negative

Good

Poor

n

%

n

%

n

%

n

%

n

%

n

%

Medic

al

Physician

s

31

13,4

37

15,9

29

12,

5

39

16,

8

2

5

10,

8

43

18,

5

Military/

Police

Physician

s

1

0,43

12

5,17

7

3,0

2

6

2,5

9

6

2,5

9

7

3,0

2

Non

Medic

al

Nurses

42

18,1

57

24,7

42

18,

1

57

24,

6

2

3

9,9

1

76

32,

8

MLT

2

0,86

8

3,45

8

3,4

5

2

0,8

6

2

0,8

6

8

3,4

5

Pharmaci

st

14

6,03

16

6,9

11

4,7

4

19

8,2

1

5

6,4

7

15

6,4

7

Medical

record

spesialist

7

3,02

5

2,16

7

3,0

2

5

2,2

4

1,7

2

8

3,4

5

Total

97

41,8

135

58,2

10

4

44,

8

12

8

55,

2

7

5

32,

3

15

7

67,

7

Table 4. Distribution of Respondents Based on Knowledge Items About 5M (n=232)

Items

Response

True

False

n

%

n

%

Indicators of 5M.

210

90,5

22

9,5

The correct steps of washing hands

167

72,0

65

28,0

1993 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

Items

Response

True

False

n

%

n

%

How to wash the hands properly with soap and running water

rightly

138

59,5

94

40,5

Duration of hand washing with soap and running water.

143

61,6

89

38,4

Duration of hand washing with hand sanitizer.

154

66,4

78

33,6

The right technique of using mask correctly.

150

64,7

82

35,3

The effective time duration for using mask.

133

57,3

99

42,7

The moment of wearing mask.

218

94,0

14

6,0

An example of implementating social distancing.

125

53,9

107

46,1

Provisions for physical distancing distance

199

85,5

33

14,2

The right position when in the elevator during pandemic

conditions.

203

87,5

29

12,5

Definition of avoiding crowds.

138

59,5

94

40,5

One feature of the behavior to reduce mobility.

196

84,5

36

15,5

Attitudes of Volunteers (HCPs) in

Implementing 5M

As indicated by the findings of this

study, 128 volunteers (HCPs) (55,2%) had a

“negative attitude” towards the

implementation 5M (Table 3). The average

of volunteers score was 77,19 (<80%) to

achieve a positive attitude standart, with

the minimum percentence scores was 58

and the maximum was 92.

The standard by Bloom which is also

adjusted to the professional background

and of course adjusted to the acquisition of

training and information related to COVID-

19 prevention practice organized by the

hospital before becoming a volunteers and

with the increasing escalation of COVID-19

cases. However, it turns out that this is not

enough to provide support for volunteers

(HCPs) to have a positive attitude.

Most respondent “strongly agree” that

5M is the best way to prevent the

transmission of COVID-19 (84,1%); shaking

hands or interacting physically can increase

the transmission (76,7%); utilizing online

platforms to reduce outside activities; hand

washing is a basic thing in preventing the

spread of COVID-19 (69%) and trying to not

leave the hospital/mess area (64,7%) table

5.

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 1994

Table 5. Distribution of Respondents Based on Attitude’s Items in Implementing 5M (n=232)

Items

Responses

Strongly

Agree

Disagree

Strongly

Disagree

n

%

n

%

n

%

n

%

5M practices is the best way to

prevent the transmission of COVID-19

195

84,1

33

14,2

4

1,7

0

Washing hands is a basic thing in

preventing the spread of COVID-19

160

69,0

71

30,6

1

0,4

0

Shaking hands or interacting

physically can increase the

transmission

178

76,7

47

20,3

4

1,7

3

1,3

Using hand sanitizer even when using

a handscoon at work is important.

68

29,3

0

105

45,3

59

25,4

Feeling lazy when wearing mask

during activities

56

24,1

34

14,7

91

39,2

51

22,0

Feeling tired and having difficult

breathing when wearing mask

29

12,5

43

18,5

84

36,2

76

32,8

Using double masks is very stifling

20

8,6

19

8,2

141

60,8

52

22,4

Hospital police regarding the

prohibition of gathering outside the

room is very important

136

58,6

90

38,8

6

2,6

0

Try to minimize activities outside

(gatherings, visiting or something like

that) if not needed.

71

30,6

147

63,4

14

6,0

0

Do not use the elevator when it over

capacity

83

35,8

84

36,2

55

23,7

10

4,3

Utilizing online platforms to reduce

outside activities such as

grab/gofood, online shop, etc.

164

70,7

56

24,1

1

0,2

11

4,7

Try to not leave the hospital/mess

area.

150

64,7

60

25,9

12

5,2

10

4,3

Preventive Practices Carried Out by

Volunteers (HCPs) Related To 5M

Based on the findings of this study,

there were 67,7% of the volunteers (HCPs)

(157 respondents) that had “poor

prevention practices” of 5M (Tabel 3). The

average percentage of prevention practice

of the 5M volunteers (HCPs) was <75%

(68,32) with minimum percentence scores

was 52 and the maximum was 80.

From the result, 86,2% of respondents

stated doing “frequently” in taking

positions back to back in the elevator adapt

1995 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

to the cycle in hospital that very crowded;

76,3% stated “always” never do activities

outside the hospital/mess area as long as

it's not a work thing; 72,4% stated “always”

washing hands with soap and running

water according to 6 steps; 72,8% stated

“always” washing hands with hand sanitizer

before and after touching patients even

when using handscoon. Aside from that,

71,1% stated “rarely” minimizing direct

contact with patients according to

treatment needs even when using a PPE

(Personal Protective Equipment), because

of time mangement cycle; 74,1% stated

“frequently” using the same mask more

than once; <45% stated “rarely” washing

hands with the right duration; and 31,5%

stated “never” maintain the distance when

doing activities outside table 6.

Table 6. Distribution of Respondents Based on Prevention Practices (5M) (n=232)

Items

Responses

Constantly

Frequently

Rarely

Never

n

%

n

%

n

%

n

%

Washing hands according to 6 steps

168

72,4

45

19,4

12

5,2

7

3,0

Bringing and washing the hands with

hand sanitizer when no facilities are

available

141

60,8

65

28,0

22

9,5

4

1,7

Washing hands with handsanitizer in

20-40 seconds

105

45,3

20

8,6

101

43,5

6

2,6

Washing hands with soap and running

water in 40-60 seconds

125

53,9

12

5,2

95

40,9

0

Using hand sanitizer before and after

touching the patient even when using a

handscoon

169

72,8

63

27,2

0

Do not touch the face area during

working time

126

54,3

82

35,3

10

4,3

14

6,0

Minimizing direct contact with patients

even when using a PPE.

8

3,4

59

25,4

165

71,1

0

Do not take off the mask while outside

41

17,7

135

58,2

46

19,8

10

4,3

Sometimes take off the mask during

work

9

3,9

5

2,2

59

25,4

159

68,5

Using the same mask more than once

33

14,2

172

74,1

6

2,6

21

9,1

Change the mask when it feels tight,

wet/humid, or dirty

0

98

42,2

134

57,8

0

Change the mask when it has been

used >4-5 hours except during working

times (8 hours)

98

42,2

97

41,8

31

13,4

6

2,6

The mask is removed only when eating.

55

23,7

112

48,3

51

22,0

14

6,0

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 1996

Items

Responses

Constantly

Frequently

Rarely

Never

n

%

n

%

n

%

n

%

Always using mask when going outside

114

49,1

49

21,1

53

22,8

16

6,9

Maintain the distance (1-2 meters) with

others

7

3,0

140

60,3

12

5,2

73

31,5

Adjusting the distance from the patient

at work and during the treatment

process.

101

43,5

73

31,5

43

18,5

15

6,5

Standing back to back in the elevator.

32

13,8

200

86,2

0

Do not hold meetings or swarming

activities in the park if it's not necessary

118

50,9

95

40,9

19

8,2

0

Maximizing online platform to reduce

social activities outside

145

62,5

27

11,6

49

21,1

11

4,7

Minimize activities outside the

hospital/mess area

177

76,3

54

23,3

1

0,4

0

Factors Associated With COVID-19

Prevention Practice (5M)

Through the results of multiple logistic

regression analysis, it is known that attitude

and knowledge are variables that

significantly influence the implementation

of prevention practices (5M) with a p value

<0.05 (0.014 and 0,017). The results of R

square showed 0.630, which means that the

attitude and the knowledge variables had

an effect of 63% on the implementation of

prevention practices (5M) and the

remaining (37%) is influenced by other

variables outside the variables studied. The

attitude variable was tested as the most

dominant (OR = 4.840) variable that

influencing the practice of prevention (5M)

(Table 7,10).

On the other hand, the results of the chi

square test, were also carried out to see the

relationship between others variables. It

was found that the variable of the length of

work as a volunteers and the variable of the

knowledge were significantly corellated to

attitude which were assessed from a p

value <0.05 (0.026 and 0.045) (Table 9).

Judging from the RR value, it is known

that volunteers (HCPs) who working <6

months were possibility having positive

attitude towards the implementation of

prevention practices (5M) 7.59 times

greater than the volunteers (HCPs) who

working ≥6 months. As for the knowledge

variable, it is known that the value of

volunteers (HCPs) with adequate

knowledge were 7.89 times more possible

to have a positive attitude towards

prevention practices than the volunteers

(HCPs) who having inadequate knowledge.

Likewise, volunteers (HCPs) who had a

positive attitude were 8.01 times more

possible to have adequate knowledge than

volunteers (HCPs) who having a negative

attitude (Table 8, 9,10).

1997 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

Table 7. Distribution of Respondents Based on Sex, Age, Education Categories, Length of

Work, Previous Work Experience, Knowledge, and Attitude of Volunteers’ (HCPs) Prevention

Practices (5M) (n=232)

Variables

Prevention Practice of 5M

n

p-

Value

OR

(95%

CI)

Good

prevention

practices

Poor

prevention

practices

n

%

n

%

Sex

Male

Female

24

51

26,1

36,4

68

89

73,9

63,6

92

140

0,099

0,910 –

2,896

Age

19 – 32

33 – 45

62

13

32,6

31,0

128

29

67,4

69,0

190

42

0,833

0,450 –

1,903

Education

categories

Medical

Non

medical

36

68

44,4

45,0

45

83

55,6

55,0

81

15

1

0,932

0,595 –

1,763

Continue Table

Length of

Work

<6

months

≥6

months

82

22

49,4

33,3

84

44

50,6

66,7

16

6

66

0,026

0,282 –

0,929

Experienc

e

Ever

Never

58

46

44,6

45,1

72

56

55,4

54,9

13

0

10

2

0,942

0,582 –

1,652

Knowledg

e

Adequate

Inadequat

e

36

68

37,1

50,4

61

67

62,9

49,6

97

13

5

0,045

0,341 –

0,990

1999 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

Tabel 10. The Final Results of The Chi Square and Multivariate Tests (n=232)

Test Type

X Variable

Y Variable

P

value

RR

CI 95%

Chi square

Knowledge

Attitude

0,045

7,590

0,341 –

0,990

Length of

Work

0,026

7,890

0,282 –

0,929

Attitude

Knowledge

0,045

8,010

0,341 –

0,990

Multivariate

Attitude

Prevention Practice

(5M)

0,014

4,840

0,269 –

0,865

0,630

(63%)

Knowledge

0,017

4,820

0,267 –

0,876

Discussion

This study assessed KAP among

volunteers (HCPs) and identified factors

associated with COVID-19 prevention

practices in hospitals. Thus, it was found

that the proportion of “inadequate

knowledge”, “negative attitudes” and “poor

prevention practices (5M)” towards COVID-

19 among volunteers were 58,2%, 55,2%,

and 67,7% respectively. This shows that

volunteers (HCPs) do not yet competent

enough in the knowledge, attitude and

prevention practice about prevention

behavior of COVID-19 that means 5M.

This study have a different result of the

other research at two hospitals at once,

namely Hospitals in Ankara and Bingol,

Turkey, where it was found that volunteers

(HCPs) had a high level of knowledge (85%)

with a positive attitude (87%) and had a

high level of prevention practice (89%) with

a correlation value between knowledge and

behavior through p value =0.001 (<0.05)

(Yasin Uzuntarla and Sumeyra Ceyhan,

2021). But, the result of this study is

supported by the research about HCPs in

Tanzania which concludes that adherence

to prevent behavior during the pandemic is

still inadequate (Powell-Jackson T, King JJC,

Makungu C, Spieker N, Woodd S, Risha P,

et al, 2020), that probably due to time

constraints when conducting research with

observational techniques that have not

been maximized. That study was conducted

by measuring compliance based on

observations, so the level of validity still

tends to be more valid (Xiong Y, Zhang Q,

Sun D, Zhu W, 2020).

According to the research above, would

like to emphasize that the differences in the

results of this research of KAP (HCPs) may

differ from the research technique and the

time of the study, which was adjusted to the

escalation of the case. If this research can

be confirmed by observation over a certain

period of time with a high case escalation,

it will give better results.

This research found that there was

58,2% (135 respondents) volunteers (HCPs)

have inadequate knowledge of prevention

practice (5M) strongly conclude that

volunteers (HCPs) do not fully understand

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 2000

their duties and roles in their field, while the

the remaining amount that 41,8% (97

respondents) volunteers (HCPs) having an

adequate knowledge. So, in this case will be

proved the Bloom’s theory which states

that knowledge is a domain that very

important to shape one's actions (over

behavior). The higher knowledge of HCPs

about their field, the higher participation in

high healthy behavior (Dewi, Adawiyah and

Rujito, 2019).

The items of knowledge in detail

explains the understanding of volunteers

(HCPs), having added three times through

previous studies, namely from 3M

protocols, 5M to 6M which have been

summarized in the Circular of the COVID-

19 Handling Task Force No. 16, 2021.

From this reseach was found that there

were only about 9.5% of the volunteers still

do not understand the indicators in doing

5M, while just about 28-40% do not

understand the right steps in washing

hands, the duration needed to wash hands

and the correct technique of using masks.

On the other side, there were found that

still 6% of volunteers do not understand the

difference between social and physical

distancing, 14.2% do not knew the correct

distance measure in avoiding COVID-19

transmission, 12.5% do not understand the

procedure for adjusting positions while in

an elevator in a pandemic situation, 40.5%

do not understand what is meant by

avoiding crowds, and 15.5% do not

understand how to minimize mobility.

The results of this study show in detail

that the lack of knowledge of volunteers

(HCPs) adjusted for the time of the study

which lasted approximately a month, after

going through a year of adaptation to the

COVID-19 condition, was still at the first

level (know) of knowledge, which should

have entered the third level (application) of

knowledge is in accordance with

Notoadmodjo's theory (2010).

In this case, it is necessary to note that

volunteers (HCPs) who will be accepted as

part of the health workforce to assist the

process of treating COVID-19 patients must

be facilitated in increasing volunteers’

knowledge regarding COVID-19

prevention, so that the on going treatment

process is not necessarily about the

routines and the cycle of cares, but

volunteers (HCPs) will able to serve as a

source of information for patients and also

as a basis for taking academically capable

in treatment actions regarding the health

problems being treated.

Turning to description the attitude of

volunteers (HCPs) in implementing

prevention practices (5M), 55.2% of

volunteers (HCPs) have a negative attitude

category. This is similar to a study in

Uganda, which stated that most HCPs has a

negative attitude towards prevention

practice of COVID-19 (Olum, et al., 2020).

It is clearly relate with the chi square

test results that showed a significant

relationship between attitudes and

prevention pracrice (5M) through p-value

0.014 (<0.05). This study have the same

result by Wiranti, et al (2020) and the

research about COVID-19 for the HCPs in

Nepal and Pakistan which states that there

was a significant relationship between

attitude and prevention practice with a p

value < 0.05 (Saqlain et al. 2020).

Attitude is a predisposing factor for a

person to perform certain behaviors. This

study shows that the attitude of volunteers

2001 | Knowledge, Attitude and Prevention Practice Among the Volunteers (HCPS) in

Implementing 5M

(HCPs) is still in the negative category with

the standard provided by Bloom. A positive

attitude is a sign in a person to be able to

do work, so that they are able to behave

well. According to (Garner et al., 2020), this

means that not all respondents are able to

accept, respond, and responsible for the

stimulus which in this case is COVID-19.

Other results studied was found that in

addition to attitude affect prevention

practices, was also influenced by length of

work and knowledge. In this regard, there

is no research that discusses the

relationship between attitude and length of

work (as volunteers). Then for the attitudes

and the knowledge, known as variables was

influence each other. This is equivalent to

the theory which states that knowledge is

one of the factors that influence the

formation of individual’s attitude. Based on

theory and research, if someone has a good

knowledge will have a good attitude as well

(Jing et al., 2019).

The description of preventive practices

(5M) of volunteers (HCPs) in this study was

categorized as a "poor practice" (67.7%),

which contrary to the results of a study in

the Amhara Region, Northern Ethiopia that

HCPs had good prevention practices

(79.5%) (Tsehay et al., 2021). The results of

the study showed that the practice of

prevention (5M) in this case that means the

indicators, summarized in the 5M is not

fully implemented properly and correctly.

Several factors that significantly

influence prevention practice (5M) are

attitude and knowledge with a p value

=0.014 and 0,017 (< α). R square states that

attitude and knowledge 63% had a positive

effect on the implementation of prevention

practices (5M). This relates to research on

HCPs in the cities of Medan and Batam in

the research by (Kim et al., 2022), where

attitude had a significant relationship

based on a p value (0.036) and the research

of (Assefa et al., 2020) about KAP on HCPs

in Silte Zone, Southern Ethiopia that

significantly related with prevention

practices that based on a p value (0.039).

Of each measured variable, attitude is

the most dominant variable. Likewise,

research by (Yanti et al., 2020) found that

the attitude was the most dominant in

influencing prevention practices

significantly (F[2.1164] = 76.546, p <0001)

with a strong effect (f = 0.36). In the analysis

at the level of the linear coefficient of the

regression model, if the attitude increases

by 1 point, the prevention practice will

increase by 0.287 points (Islam et al., 2020).

CONCLUSIONS

Volunteer knowledge about COVID-19

prevention is not evenly understood. Even

though COVID-19 has been going on for

more than entering 2 years, understanding

regarding COVID-19 is not only meant to

be known. This is sought so that there is

awareness and efforts to act healthy

towards oneself while also acting healthy

towards others or the environment.

This is further emphasized, because

HCPs are the main actors in implementing

healthy behavior.

Overall, this study concludes that from

a socio-demographic point of view, there

are no variables that affect prevention

practices (5M). Knowledge and attitude are

the factors that influence the

implementation of 5M. While crosswise, the

variables of attitude and knowledge are

Julia Christy Labetubun, Dian Ayubi, Tri Krianto

| 2002

interrelated and influencing factors. By

knowing the description of volunteers

(HCPs) in this case knowledge about 5M

and attitudes in implementing 5M, even the

implementation of 5M behavior itself,

actually it is still very minimal even among

professionals.

This is an important note, that even

though being a volunteer, actively

participating in health care based on the

field of health education requires being

academically and artistically capable of

doing care. IPC (Infection Prevention &

Control) as an institution that supports the

quality of the effectiveness of treatment

compliance in hospitals needs to pay

attention to SOP (standard operating

procedures) in order to enable volunteers

(HCPs) to know for sure and to carry out

correctly, procedures in care, especially in

the era of the COVID-19 pandemic which

has not subsided. Even though COVID-19

will eventually become endemic, this will

become a benchmark for the effectiveness

of handling infectious diseases specifically

in hospitals.

REFERENCES

Alajmi, J., Jeremijenko, A. M., Abraham, J. C.,

Alishaq, M., Concepcion, E. G., Butt, A.

A., & Abou-Samra, A.-B. (2020). COVID-

19 infection among healthcare workers

in a national healthcare system: The

Qatar experience. International Journal

of Infectious Diseases, 5(10), 386–389.

https://doi.org/10.1016/j.ijid.2020.09.0

27

Ashebir, W., Yimer, B., Alle, A., Teshome, M.,

Teka, Y., & Wolde, A. (2022). Knowledge,

attitude, practice, and factors

associated with prevention practice

towards COVID-19 among healthcare

providers in Amhara region, northern

Ethiopia: A multicenter cross-sectional

study. PLOS Global Public Health, 2(4),

171.

https://doi.org/https://doi.org/10.1371

/journal.pgph.0000171

Assefa, J., Diress, G., & Adane, S. (2020).

Infection prevention knowledge,

practice, and its associated factors

among healthcare providers in primary

healthcare unit of Wogdie District,

Northeast Ethiopia, 2019: a cross-

sectional study. Antimicrobial

Resistance & Infection Control, 9(1), 1–9.

Chen, Q., Lim, B., Ong, S., Wong, W.-Y., &

Kong, Y.-C. (2020). Rapid ramp-up of

powered air-purifying respirator (PAPR)

training for infection prevention and

control during the COVID-19 pandemic.

British Journal of Anaesthesia, 5(12),

e171–e176.

Garner, T. I., Safir, A., & Schild, J. (2020).

Receipt and use of stimulus payments

in the time of the Covid-19 pandemic.

Beyond the Numbers: Prices and

Spending, Bureau of Labor Statistics,

9(10), 1–18.

Islam, M. S., Rahman, K. M., Sun, Y., Qureshi,

M. O., Abdi, I., Chughtai, A. A., & Seale,

H. (2020). Current knowledge of

COVID-19 and infection prevention and

control strategies in healthcare settings:

A global analysis. Infection Control &

Hospital Epidemiology, 4(10), 1196–

1206.

https://doi.org/https://doi.org/10.1017

/ice.2020.237

Jing, P., Huang, H., Ran, B., Zhan, F., & Shi,

Y. (2019). Exploring the factors affecting

mode choice Intention of autonomous

vehicle based on an extended theory of

2003  |  Knowledge,  Attitude  and  Prevention  Practice  Among  the  Volunteers  (HCPS)  in 
Implementing 5M 
 
planned  behavior—A  case  study  in 
China.  Sustainability,  4(11),  1155. 
https://doi.org/https://doi.org/10.3390
/su11041155 
 
Kim, H.-Y., Shin, S.-H., & Lee, E.-H. (2022). 
Effects of health belief, knowledge, and 
attitude  toward  COVID-19  on 
prevention  behavior  in  health  college 
students.  International  Journal  of 
Environmental  Research  and  Public 
Health,  9(3),  1898. 
https://doi.org/https://doi.org/10.3390
/ijerph19031898 
 
Lescure,  F.-X.,  Bouadma,  L.,  Nguyen,  D., 
Parisey,  M.,  Wicky,  P.-H.,  Behillil,  S., 
Gaymard,  A.,  Bouscambert-Duchamp, 
M., Donati, F., & Le Hingrat, Q. (2020). 
Clinical and virological data of the first 
cases  of  COVID-19  in  Europe:  a  case 
series.  The  Lancet  Infectious  Diseases, 
2(6),  697–706. 
https://doi.org/https://doi.org/10.1016
/S1473-3099(20)30200-0 
 
Miller, I. F., Becker, A. D., Grenfell, B. T., & 
Metcalf,  C.  J.  E.  (2020).  Disease  and 
healthcare burden of COVID-19 in the 
United  States.  Nature  Medicine,  2(8), 
1212–1217. 
 
Stangerup,  M.,  Hansen, M.  B.,  Hansen,  R., 
Sode, L. P., Hesselbo, B., Kostadinov, K., 
Olesen, B. S., & Calum, H. (2021). Hand 
hygiene  compliance  of  healthcare 
workers before and during the COVID-
19  pandemic:  a  long-term  follow-up 
study.  American  Journal  of  Infection 
Control,  4(9),  1118–1122. 
https://doi.org/https://doi.org/10.1016
/j.ajic.2021.06.014 
 
Tsehay,  A.,  Hareru,  H.  E.,  Molla,  W., 
Mengistu, N., Kaso, A. W., Ashuro, Z., & 
Soboksa,  N.  E.  (2021).  Factors 
associated with preventive practices of 
COVID-19  among  health  care  workers 
in  Dilla  University  Hospital,  Southern 
Ethiopia.  Environmental  Challenges, 
5(2),  100–128. 
https://doi.org/https://doi.org/10.1016
/j.envc.2021.100368 
 
Yang, C., Ke, C., Yue, D., Li, W., Hu, Z., Liu, W., 
Hu,  S.,  Wang,  S.,  &  Liu,  J.  (2020). 
Effectiveness  of  arbidol  for  COVID-19 
prevention  in  health  professionals. 
Frontiers  in  Public  Health,  8(2),  249. 
https://doi.org/https://doi.org/10.3389
/fpubh.2020.00249 
 
Yanti,  B.,  Mulyadi,  E.,  Wahiduddin,  W., 
Novika, R. G. H., Arina, Y. M. D., Martani, 
N. S., & Nawan, N. (2020). Community 
knowledge,  attitudes,  and  behavior 
towards  social  distancing  policy  as 
prevention transmission of COVID-19 in 
indonesia. Indonesian Journal of Health 
Administration  (Jurnal  Administrasi 
Kesehatan  Indonesia),  8(2),  4–14. 
https://doi.org/https://doi.org/10.2047
3/jaki.v8i0.2020.4-14 
 
 
© 2022 by the authors. Submitted  
for possible open access publication  
under  the  terms  and  conditions  of  the  Creative 
Commons  Attribution  (CC  BY  SA)  license 
(https://creativecommons.org/licenses/by-sa/4.0/). 
 