Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 129421

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : LC06 - LC12 Full Version

Knowledge, Attitude, Practices and Risk of Psychological Distress among Frontline Healthcare Workers Towards COVID-19 in Second Wave

Published: September 1, 2022 | DOI:
Ram Milan Prasot, Malik Faizan Ahmad, Anand Bihari, Ankit Srivastava, Madhu Khan

1. Assistant Professor, Department of Community Medicine, Government Medical College, Chakrapanpur, Uttar Pradesh, India. 2. Associate Professor, Department of Community Medicine, Government Medical College, Chakrapanpur, Uttar Pradesh, India. 3. Statistician Cum Assistant Professor, Department of Community Medicine, Government Medical College, Chakrapanpur, Uttar Pradesh, India. 4. Assistant Professor, Department of Anatomy, Government Medical College, Chakrapanpur, Uttar Pradesh, India. 5. Nursing Staff, Department of Community Medicine, Government Medical College, Chakrapanpur, Uttar Pradesh, India.

Correspondence Address :
Dr. Anand Bihari,
Statistician Cum Assistant Professor, Department of Community Medicine,
Government Medical College, Chakrapanpur, Uttar Pradesh, India.


Introduction: Frontline Healthcare Workers (F-HCWs) are at the front position for medical care against Coronavirus Disease 2019 (COVID-19) pandemic which has life-threatening potentials. Poor level of knowledge, practices and negative attitudes as well as high-risk of psychological distress among F-HCWs can directly lead to delayed diagnosis, treatment and poor infection control practices.

Aim: To assess the level of Knowledge, Attitude and Practices (KAP) as well as risk of psychological distress among F-HCWs for COVID-19 pandemic.

Materials and Methods: This descriptive, hospital-based, cross-sectional study was conducted at Government Medical College, Azamgarh, Uttar Pradesh, India, located in tertiary care centre in rural area) from October 2021 to December 2021 among 223 F-HCWs using convenient sampling technique. To assess the level of KAP as well as risk of psychological distress among F-HCWs a prevalidated structured questionnaire was used consisting 15 knowledge questions, six attitude questions, 15 practices questions and six questions on risk of psychological distress. Chi-square test was performed to examine the association between risk of psychological distress and level of KAP as well as with demographic characteristics of F-HCWs.

Results: Out of total 223 participants more than half of physicians (52.9%) and one-third of staff nurses (35.9%) were from age group of 25-35 years, respectively. Majority of both physicians (57.1%) and staff nurses (87.6%) were married and had nuclear type of family as of 64.3% and 74.5%, respectively. Most of the physicians (92.9%) had good level of knowledge but they had less positive attitude (84.3%) compare to staff nurses (92.8%). Majority of both physicians (64.3%) and staff nurses (58.2%) had no or low risk of psychological distress while only few of them had its high level.

Conclusion: In this study majority of F-HCWs reported overall ‘good’ level of knowledge, attitude and practices for prevention of COVID-19. As for as risk of psychological distress was concerned, majority of F-HCWs had its no or low risk.


Feeling nervous, Low risk, Mental health, Pandemic, Physicians, Staff nurses

World Health Organisation (WHO) declared Coronavirus Disease 2019 (COVID-19) a global pandemic on 11th March 2020 (1). As per WHO, till now, prevention is the only strategy to protect people’s health and prevent the spread of this outbreak. The World Health Organisation (WHO) has issued many guidelines on COVID-19 for various sectors of society, and has provided a range of education and training materials to Healthcare Workers (HCWs) to increase their awareness and preparedness for COVID-19 control and prevention (2). Standard recommendations to prevent the spread of COVID-19 include; wearing facemask, frequent cleaning of hands using alcohol-based hand-rub or soap and water, covering the nose and mouth with a flexed elbow or with disposable tissue while coughing and sneezing and avoiding close contact with anyone that has a fever and cough (2).

Healthcare workers are at risk of contracting infectious diseases, caused by blood, body fluid, airborne pathogens and they are exposed to highest level of risk when there has been sustained, close contact with a case of Severe Acute Respiratory Syndrome (SARS) or in high-risk transmission settings (3),(4). Healthcare workers are the main persons involved in the management of patients hence amongst the high-risk groups of acquiring the infection therefore, these at-risk groups should also be given adequate social and mental health supports (5). It was reported that statistical significantly higher levels of psychological distress (p-value <0.001), burnout (p-value=0.019) fear, stress, emotional, ethical, and social conflicts and tension in healthcare providers at workplace those who were providing direct patient care to infected patients or those who have survived infection (6),(7). HCWs play a very big role to control the spread of any communicable or non-communicable diseases as well as the impact of unintended consequences of any future pandemic.

Knowledge about disease may affect HCWs’ attitudes and practices, and incorrect attitudes and practices directly increase the risk of infection (8). Second wave of COVID-19 pandemic had very high infection and high mortality rate (9) therefore, it is necessary to ascertain and improve the level of knowledge, attitude and practices as well as to reduce the risk of psychological distress among Frontline Healthcare Workers (F-HCWs) whereby, infection and mortality rate due to it can be prevented in future. Therefore, this study aimed to assess the level of knowledge, attitude, practices and risk of psychological distress among F-HCWs regarding COVID-19 as well as to look for association between their socio-demographic characteristics and risk of psychological distress among them.

Material and Methods

This descriptive, hospital-based, cross-sectional study was conducted at Government Medical College, Azamgarh, Uttar Pradesh, India, located in tertiary care cntre in rural area) from October 2021 to December 2021 among 223 F-HCWs using convenient sampling technique. The studied healthcare workers were assured of maintaining anonymity and confidentiality of collected data and they were informed that they had the right to withdraw from the study at any time, in despite of having given consent. Helsinki declaration of 1975, revised in 2013 was considered for the study (10). Approval was obtained from Ethical Committee of Institute (letter no.:1663/GMCA/IEC/2021 dated:19/9/2021). An informed written consent was taken from all the eligible participants prior to inclusion critera in the study.

Non probability method of convenient sampling technique was used to select 223 study subjects. Out of total 186 physicians and 202 staff nurses working at Government Medical College, only 70 physicians and 153 staff nurses participated in this study. Rest of the healthcare providers was on the duty in COVID-19 and non COVID-19 wards.

Inclusion criteria: F-HCWs who already had done their duty in COVID-19 ward and also had willingness to participate in the study.

Exclusion criteria: F-HCWs with severe illness and who were non willing to participate in the study.


Data on KAPs were collected by using predesigned, pretested and structured questionnaires. It was developed by researchers on the basis of a literature review of previously published relevant questionnaires, in keeping with the World Health Organisation (WHO) and Center for Disease Control and Prevention (CDC) recommendations (11),(12),(13). To assess the risk of psychological distress among F-HCWs, Kessler (K6) scale was used (14). Questionnaire was validated by expert and pretested on a sample of 15 F-HCWs who worked in COVID-19 ward and they were excluded from the final sample selection process. The cronbach’s alpha coefficient of knowledge, attitude and practices as well as questionnaire on psychological distress was 0.71, 0.80 and 0.70 as well as 0.81, respectively, indicating acceptable internal consistency. The results of the pilot survey were not included in the samples used for the actual study. The questionnaire used for collecting data to meet the purpose of the study, comprised of five parts.

Part-1 (Socio-demographic characteristics)

Included the socio-demographic characteristics of F-HCWs such as- age, gender, marital status, types of family, religion and caste.

Part-2 (Knowledge)

The participants’ knowledge (15-items) was assessed about COVID-19.

• The 1st question allowed for multiple responses where they were asked for the most common symptoms of COVID-19 with a listed option assigned a score of one and zero. For this assessment, a participant was scored one who responded atleast three main symptoms of fever, dry cough and difficulty in breathing, otherwise zero.
• Remaining 14 questions were assigned a score of zero if the response was incorrect or ‘don’t know’ and one if the response was correct. Hence, the cumulative score for all 15 questions ranged from 0 to 15 points for each participant. Participants’ overall knowledge was graded using Bloom’s cut-off point as ‘good’ if the score was ≥80% (≥12 points) (15).

Part-3 (Attitude)

The participants’ attitude (6-items) was assessed which included questions about attitudes towards COVID-19 control, its threat to community, Importance of lockdown and responsibility of government, individual and community to prevent COVID-19. Each correct answer was given one point but an incorrect or do not know answer, given a score zero. Thus, total score of attitude of a participant was from zero to six. Participants’ overall attitude level was categorised, using Bloom’s cut-off point as ‘positive’ if the score was ≥80% (≥5 points) (15).

Part-4 (Practices)

The participants’ practices (15-items) for prevention of COVID-19 were assessed by using Likert scale on frequency based questions. Responses of questions from 1 to 11 were very frequently, frequently, occasional, rarely and never where each weighing 4, 3, 2, 1 and 0 but questions number 12 to 15 were weighed 0, 1, 2, 3 and 4, respectively. Thus, the cumulative score for all 15 questions ranged from 0 to 60 points for each participant. Participants’ overall practices were categorised, using Bloom’s cut-off point as ‘good’ if the score was ≥80% (≥48 points) (15).

Part -5 (Psychological distress)

Included questions on the participants’ risk of psychological distress, which was assessed by using Kessler Psychological distress Scale K6 (14). It was developed to detect the general psychological distress, and has demonstrated good reliability and validity. It has six questions about their feelings during the past 4 weeks. It includes; so sad nothing could cheer you up, nervous, restless, hopeless, that everything was an efforts and worthless. There were five responses option for each question, ranging from “none of the time, a little of the time, some of the time, most of the time and all of the time, scoring; 0 ,1, 2, 3 and 4, was assigned to each response, respectively. Total score ranging 0-24, was calculated by summing up the responses to each question. Participants were classified for risk of psychological distress scoring (14):

• No or low risk: <5
• Mild/moderate risk: 5≤K6<13
• Hgh/severe risk: ≥13

All the preventive measures were taken during the course of study as per recommended guidelines (12),(13).

Statistical Analysis

After compilation of data, analysis was done using Statistical Package for Social Sciences (SPSS) version 16.0, trial version. Descriptive statistics was used in the study to analyse the basic information regarding study. Mean, standard deviation and Chi-square test were used for data analysis. A p-value <0.05 was considered as statistically significant.


Out of total 70 physicians and 153 staff nurses; 37 (52.9%) and 55 (35.9%) were from age group of 25-35 years. As per gender, majority 58 (82.9%) of physicians were male whereas most of the staff nurses 144 (94.1%) were female. Majority of physicians 40 (57.1%) and staff nurses 134 (87.6%) were married and had nuclear type of family as of 45 (64.3%) and 114 (74.5%), respectively. Religion wise, most of physicians 62 (88.6%)as well as staff nurses 138 (90.2%) were Hindu while as per caste, majority 102 (66.7%) of staff nurses were from general category (Table/Fig 1).

Overall knowledge, attitude and preventive practices of physicians was 65 (92.9%), 59 (84.3%), 62 (88.6%), respectively. Overall knowledge, attitude and preventive practices of staff nurses was 134 (87.6%), 142 (92.8%) and 121 (79.1%), respectively. The mean of physicians’ knowledge (12.5±0.9) and practices (53.7±3.3) were higher than the mean of staff nurses’ knowledge (11.9±1.4) and practices (48.8±5.3). However, the mean level of attitude among staff nurses (5.1±0.7) was little higher than the physicians (4.9±0.6).The data shows that attitude of F-HCWs was found to be significantly associated (p-value=0.048) with type of F-HCWs (Table/Fig 2).

About two-third of physicians 45 (64.3%) and more than half of staff nurses 89 (58.2%) had no or low risk of psychological distress where its mean level among physicians was low (6.3±3.4) compare to staff nurses (6.5±3.8). Only few of them had high/severe risk of psychological distress where staff nurses 17 (11.1%) were affected more than physicians 5 (7.1%).The data shows that risk of psychological distress was found to be insignificantly associated (t-value=0.38, p-value=0.70) with type of F-HCWs (Table/Fig 3).

(Table/Fig 4), shows that majority of physicians and staff nurses who had ‘good’ level of KAP as of 44 (67.7%), 40 (67.8%), 40 (64.5%) and 76 (56.7%), 81 (57.0%) 70 (57.9%), respectively they also had low or no risk of psychological distress and only few of them had its high-risk. Statistically a significant (p-value <0.001) association was found between the level of knowledge and risk of psychological distress among physicians.

The physicians 26 (57.8%) and staff nurses 35 (39.3%) who had low or no risk of psychological distress were from age< 35 years (Table/Fig 5). As per gender, majority of physicians 38 (84.4%) and staff nurses 83 (93.3%) who had no or low risk of psychological distress were male and female, respectively. More than half of the physicians 25 (55.6%) and majority of staff nurses 80 (89.9%) who had low or no risk of psychological distress were married. It was also found that risk of moderate to severe psychological distress was more among married subjects compare to unmarried subjects. More than half of the physicians 27 (60.0%) and more than two third of staff nurses 62 (69.7%), who had low or no risk of psychological distress were belonged to nuclear family. All of the physicians 5 (100%) and most of the staff nurses 16(94.1%) who had high/severe risk of psychological distress were Hindu and it was also observed that most of the staff nurses 14 (82.4%) of general category had high/severe risk of psychological distress.

[Tables/Fig-6]a-c shows a prevalidated structured questionnaire was used consisting fifteen knowledge questions, six attitude questions, 15 practices questions and six questions on risk of psychological distress.


In current study, out of 223 F-HCWS (70 physicians and 153 staff nurses); more than half (52.9%) of physicians and above one third (35.9%) of staff nurses were from younger age group of 25-35 years, respectively. As per gender, majority of physicians (82.9%) were male where as most of the staff nurses (94.1%) were female. More than half of the physicians (57.1%) and majority of staff nurses (87.6%) were married and had nuclear type of family as of (64.3%) and (74.5%), respectively.

In this study, overall levels of knowledge, attitude and practices of 223 F-HCWs found to be 89.2%, 90.1% and 82.1%, respectively. Out of total subjects more than three fourth of them were assessed as ‘good’ where majority of physicians’ and staff nurses had KAP of 92.9%, 84.3%, 88.6% and 87.6%, 92.8%, 79.1%, respectively which is accordance to findings of previous study conducted by Elbqry MG et al., at Suez Canal University hospitals among 364 medical and paramedical staffs, and reported that most of them had satisfactory level of KAP as of 94.6%, 100%, 87.5% and 91.3, 94.4%, 91.7%, respectively (16). In similar study, conducted by Maurya VK et al., among 260 F-HCWs in Uttar Pradesh, reported that the knowledge (mean score: 9.77 out of 12 points), attitudes (mean score: 7.38 out of 10 points), and practices (mean score: 4.05 out of 5 points) among F-HCWs were relatively high (17).

As per study most of the physicians (92.9%) had good level of knowledge but they had less positive attitude (84.3%)compare to staff nurses (92.8%) and it was significantly (p-value=0.048) associated with type of F-HCWs which is comes in accordance with the study conducted in north India by Goel N et al., among 587 F-HCWs who revealed that overall knowledge (mean: 9.71 out of 12 points) among them was on higher side and positive attitude score in paramedical staff was significantly higher (mean: 1.8 out of 4 points) as compared to junior residents (mean: 1.7 out of 4 points) and specialists (mean: 1.6 out of 4) (18). Findings of current study are inconsistent with the findings of study conducted by Olum R et al., in Uganda who reported that overall mean levels of knowledge, attitude and practices among 136 HCWs were 82.4, 3.4 and 2.5, respectively where 69% and 74% HCWs had sufficient level of knowledge and practices but poor level of attitude (21%) (19). Another web based study conducted by Bhagavathula AS et al., among 453 HCWs, globally, revealed that healthcare workers had insufficient knowledge about COVID-19 pandemic but showed positive perceptions (78%) of COVID-19 transmission prevention (20). Sample size, timing and period of study and geographical variations might be responsible for the discrepancies in the findings. Some of the similar studies have been tabulated in (Table/Fig 7) (16),(17),(18),(19),(20),(21),(22).

In current study majority of the physicians (64.3%) had low or no risk of psychological distress compare to staff nurses (58.2%) and majority of physicians and staffs nurses who had ‘good’ level of KAP, they also had low or no risk of psychological distress which was much higher than the findings of previous study conducted at Suez Canal University hospitals (PHQ-4 scale was used) and reported that only 19.1% medical and 7.5% paramedical staffs had very low level of psychological stress (16). The findings of this study suggest that staff nurses had considerably greater levels of risk of psychological distress than physicians which might be explained by the fact that they were in closer contact with sick patients.

In this study, the prevalence of mild/moderate to high/severe risk of psychological distress among physicians and staffs nurses was found to be 35.7% and 41.8%, respectively, that is nearly similar to findings of previous study conducted by Wang Y et al., among 4184 healthcare trainees at Sichuan University in China, and reported that 30.9% participants had clinically significant (k6≥5) risk of psychological distress (21). However, a study conducted by Altwaijri Y et al., among 1843 HCWs in Saudi Arabia (used K6 scale) and revealed that 80.0% of HCWs who were directly engaged (n=395) with the care of COVID-19 patients had high prevalence rate of mild/moderate and severe psychological distress (22). Findings of another study which is inconsistent to present study, revealed that 57.4% and 49.1% of medical and paramedical participants had moderate level of psychological stress and about one fourth of them had its severe form (16). There was a significant association between COVID-19 risk of psychological distress and good level of knowledge of physicians which is accordance to previous study (16). In current study, it was found that as age increases, the risk of mild/moderate and high level of psychological distress among F-HCWs also increases that was inconsistent to the findings of previous study which revealed, the older age groups (40-70 years old verses 20-29 years old) had decreased odds of experiencing higher distress (22). As per gender, female subjects (staff nurses) had higher level of moderate to high-risk of psychological distress compare to male (physicians) which is accordance to the previous study where women were more likely than men to experience increasing psychological distress (22). In this study demographic characteristics of F-HCWs were not associated significantly with risk level of psychological distress, which indicates that COVID-19 pandemic and its related national preventive policies affect the mental health of hospital workers non discriminatively.

In current study, decreased risk of psychological distress among F-HCWs might be due to improving level of KAPs, psychological supports and confidence level (after getting vaccine against COVID-19), effective communication and proper information dissemination as well as conduction of study in late phase of the pandemic when mortality and morbidity were reduced. These all conditions might have contributed to a significant difference in level of KAP and mental health of the F-HCWs.


There were some limitations in the present study. Firstly, it was a descriptive cross-sectional survey from a single centre with small study subjects. The data did not indicate changes in psychological distress from the pre-pandemic period; rather, they characterise its trouble during second wave of COVID-19. Secondly, the response rate was low among the F-HCWs, and those who did not participate might have been with highest stress levels at work. Thirdly, it was asked only about feelings of psychological symptoms once in the late phase of the pandemic, so longitudinal studies are needed in the future, as symptoms may change over time. Fourthly, there were no more researches that used this scale (k6) to assess the risk of psychological distress related to COVID-19 among healthcare workers. The generalizability of these findings to other hospitals and medical populations remains unclear and, therefore, needs more investigation.


In this study overall level of knowledge, attitude, and practices among majority of the physicians (92.9%, 84.3%, and 88.6%, respectively) and staff nurses (87.6%, 92.8%, and 79.1%, respectively) were as ‘good’ regarding COVID-19 infection prevention. As for as risk of psychological distress was concerned, more than half of the physicians (64.3%) and staff nurses (58.2%) had low or no risk and only few physicians (7.1%) and staff nurses (11.1%) had its high-risk. However, improvement is still required. Therefore, to improve the level of KAP and to reduce the risk of psychological distress among HCWs there must be conduction of educational professional programs time to time and continuous provision of psychological support to all of them.


Authors would like to thanks all participants, all faculty members who supported this research, junior residents, interns and non teaching staffs of Community Medicine Department, Government Medical College, Azamgarh, Uttar Pradesh, India.


World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 e11 March 2020. Geneva: WHO; 2020. general-s-opening-remarks-at-the-mediabriefing-on-covid-19-11-march-2020.
World Health Organisation. Coronavirus disease (COVID-19) outbreak: rights, rolesand responsibilities of health workers, including key considerations for occupational safety and health, 2020. Available at: and responsibilities-of-healthworkers-including-keyconsiderations for-occupational-safety-and-health.
Shiao JS, Koh D, Lo LH, Lim MK, Guo YL. Factors predicting nurses’ consideration of leaving their job during the SARS outbreak. Nurs Ethics. 2007;14(1):5-17. Doi: 10.1177/0969733007071350. PMID:17334166. [crossref] [PubMed]
World Health Organization. Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). World Health Organization (2003)
Koh D. Occupational risks for COVID-19 infection. Occup Med (Lond). 2020;70(1):03-05. Doi:10.1093/occmed/kqaa036. PMID: 32107548; PMCID: PMC7107962. [crossref] [PubMed]
Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis. 2006;12(12):1924-32. Doi: 10.3201/eid1212.060584. PMID: 17326946; PMCID: PMC3291360. [crossref] [PubMed]
Almutairi AF, Adlan AA, Balkhy HH, Abbas OA, Clark AM. “It feels like I’m the dirtiest personin the world.”: Exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia. J Infect Public Health. 2018;11(2):187-91. Doi: 10.1016/j.jiph.2017.06.011. Epub 2017 Jul 1. PMID: 28676285; PMCID: PMC7102804. [crossref] [PubMed]
McEachan R, Taylor N, Harrison R, Lawton R, Gardner P, Conner M. Meta-analysis of the reasoned action approach (RAA) to understanding health behaviors. Ann Behav. Med. 2016;50(4):592-12. Doi: 10.1007/s12160-016-9798-4. PMID: 27169555; PMCID: PMC4933736. [crossref] [PubMed]
Ranjan R, Sharma A, Verma MK. Characterization of the second wave of COVID-19 in India medRxiv 2021.04.17.21255665. Doi: [crossref]
WMA - The World Medical Association-Declaration of Helsinki 1975.Available:
Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A Review. JAMA. 2020;324(8):782-93. Doi: 10.1001/jama.2020.12839. PMID: 32648899. [crossref] [PubMed]
World Health Organization. Q&a on Coronaviruses (Covid-19). Available online at: -hub/.
CDC. Centers for Disease Control and Prevention: Coronavirus (COVID-19) 2020. Available online at:
Prochaska JJ, Sung HY, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012;21(2):88-97. Doi: 10.1002/mpr.1349. Epub 2012 Feb 20. PMID: 22351472; PMCID:PMC3370145.15. [crossref] [PubMed]
Kamacooko O, Kitonsa J, Bahemuka UM, Kibengo FM, Wajja A, Basajja V, et al. Knowledge, attitudes, and practices regarding COVID-19 among healthcare workers in uganda: A cross- sectional survey. Int. J. Environ. Res Public Health. 2021;18(13):7004. Doi: PMID: 34208959. [crossref] [PubMed]
Elbqry MG, Elmansy FM, Elsayed AE, Mansour B, Tantawy A, Eldin MB, et al. Effect of COVID-19 stressors on healthcare workers’ performance and attitude at Suez Canal university hospitals. Middle East Curr Psychiatry. 2021;28(1):4. Doi: [crossref] [PubMed]
Maurya VK, Upadhyay V, Dubey P, Shukla S, Chaturvedi A. Assessment of front-line healthcare workers’ knowledge, attitude and practice after several months of COVID-19 pandemic. J Healthc Qual Res. 2022;37(1):20-27. Doi: 10.1016/j.jhqr.2021.07.004. Epub 2021 Jul 22. PMID: 34419379; PMCID: PMC8295023. [crossref] [PubMed]
Goel N, Kumar V, Kumar N, Hasija S, Sharma K, Singroha V, et al. Assessment of knowledge, attitude, practice, anxiety and perceived mental health care needs in frontline health care workers regarding COVID-19. India Int J Heal Clin Res. 2021;4(4):148-52.
Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus disease-2019: Knowledge, attitude, and practices of health care workers at makerere university teaching hospitals, Uganda. Front Public Health. 2020;8:181. Doi: 10.3389/fpubh.2020.00181. PMID: 32426320; PMCID: PMC7204940. [crossref] [PubMed]
Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and perceptions of COVID-19 among health care workers: Cross-sectional study. JMIR Public Health Surveill 2020;6(2):e19160. Doi: 10.2196/19160 PMID: 32320381 PMCID: 7193987. [crossref] [PubMed]
Wang Y, Li Y, Jiang J, Feng Y, Lu D, Zhang W, et al. COVID-19 outbreak-related psychological distress among healthcare trainees: A cross-sectional study in China. BMJ Open. 2020;10:e041671. Doi: 10.1136/bmjopen-2020-041671. [crossref] [PubMed]
Altwaijri Y, Bilal L, Almeharish A, BinMuammar A, DeVol E, Hyder S, et al. Psychological distress reported by healthcare workers in Saudi Arabia during the COVID-19 pandemic: A cross- sectional study. PLoS One. 2022;17(6):e0268976. Doi: pone.0268976. PMID: 35657938. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/58156.16880

Date of Submission: Jun 01, 2022
Date of Peer Review: Jun 10, 2022
Date of Acceptance: Aug 27, 2022
Date of Publishing: Sep 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jun 07, 2022
• Manual Googling: Aug 01, 2022
• iThenticate Software: Aug 25, 2022 (20%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)