INTRODUCTION

COVID-19 pandemic has created a crisis in health systems worldwide. In recent days we have been witnesses of the fast increase of infections caused by this disease, whose prevalence and incidence has become a worldwide public health problem, where high mortality and morbidity have been evidenced¹. COVID-19 has a high spread, thus resulting in the appearance of a large number of cases and causing the collapse of health systems in developed countries, being even more alarming in national health systems of middle- and low-income countries².

When facing this pandemic, immediate attention is needed; so that the emergence of this pandemic forced the confinement of the world's population³. Several measures have been implemented to reduce the impact of COVID-19, such as physical isolation or temporary closure of territorial boundaries, academic institutions and public places⁴, but everyone must take the necessary precautions, with an aware and responsible commitment, either individually or collectively, to control and adapt to the new routine; which requires awareness and responsibility from everyone, to deal with the pandemic⁵.

Therefore, the World Health Organization (WHO) insisted on the strengthening of the effective monitoring of cases, early detection, isolation and management of such cases, follow-up of patients, and prevention of the spread of the virus⁶. In addition, the WHO⁷and various related organizations publish promotional preventive information about COVID-19, so that the population is well informed about the ways in which the disease is spread, becomes aware of it and adopts attitudes of individual and collective health self-care.

Global statistics state that the spread of COVID-19 results in significant psychological, economic, social and political consequences⁸. However, as mentioned by Peralta et al.⁹, this disease continues to spread due to factors such as lack of knowledge caused by the misinformation of citizens and their consequent negative attitudes; assuming that this disease does not arise from nature, but was created intentionally. Another factor also attributable to lack of knowledge is the negative attitude towards self-care practices.

Huanuco is a region with a high incidence of COVID-19 cases, reporting 28.990 confirmed cases and a fatality rate of 1.77% (May 5)¹⁰. Having been informed of these results, the media have been broadcasting specific measures for self-care, such as social distancing, compulsory social immobilization, frequent hand hygiene and the use of face masks. These recommendations are ignored and the population shows a lack of knowledge about this disease, so they act recklessly based on their negative attitudes.

In view of the problems aforementioned, a gap in the field of knowledge of COVID-19 prevention is recognized. This is due to a poor specialized and programmed communicational resource of national and local health authorities, being knowledge the main resource that individuals have to solve their problems or needs. Therefore, it is necessary to carry out research from the primary health care approach that allows us to analyze knowledge and attitudes, since there are currently no studies on this subject in Huánuco. Consequently, the objective of our study is to identify the perception of knowledge and the type of attitudes towards COVID-19 in citizens of the urban area of Huánuco, during the first wave, which took place during the first half of the year 2020.

METHODS

RESULTS

Regarding the sociodemographic characteristics of the sample of the study, 77.4% (130) were young adults from the ages of 20 to 39; 54.2% (91) were male; half of the sample were single; 44% (74) had completed higher education. The occupational group to which they belonged was professionals with 26.2 %: 73.8 % (124) were Catholics; 10.7 % (18) were living with their family during the quarantine period; 47 % (79) had children and, among them, 19.6 % (33) had three or more children (Table 1).

When analyzing the perception of knowledge towards COVID-19 of the citizens in study, it was found that 55.4 % (93) perceived that they knew the complications of COVID-19, 52.4 % (88) the diagnostic methods, 42.9 % (72) the risk factors and the preventive measures, respectively. In contrast, 81 % perceived that they did not know the notion of this disease, 76.8 % (129) did not know the symptoms and 75 % (126) were unaware of the meaning of being an asymptomatic carrier; thus, there was a higher proportion in the category "perceives that they do not know" (Table 2). In general and descriptively, 62.5 % (105) of the sample in this study were in the category "perceives that they do not know".

When assessing attitudes towards COVID-19, it was evident that 45.8 % (77) never comply with the regulations imposed by the government, compared to 42.3 % (71) who consider that being healthy is never a result of the individual's self-care responsibility. On the other hand, 35.1 % (59) of the study sample always opted for self-care, since health services are hardly ever available (Table 3).

When analyzing the type of global attitudes, it was found that 63.1% (106) of the participants showed negative attitudes, compared to 36.9% (62) with positive attitudes. An association was found between the perception of knowledge and attitudes towards COVID-19, obtaining a chi-square value of 7.423, with p=0.005 (Table 4), which indicates that the lower perception of knowledge, results in a better attitude.

DISCUSSION SECTION

To take preventive measures in response to the health emergency, it is necessary to acquire knowledge gradually in order to implement more effective measures to deal with the situation¹⁴. As Muñoz states¹⁵, COVID-19 is a disease that demands a supportive attitude from the entire population, since this is the best measure to deal internationally with the coronavirus. As Ubillús states¹⁶,"overcoming the pandemic shall depend on the health vocation and social responsibility of citizenship".

According to the findings of this research, it was found that most of the citizens who considered themselves to be aware of the disease, in turn, showed negative attitudes towards the COVID-19. A result that brings out the risk of spreading the infection among the members of the family, society and communities, since an incorrect perception of the knowledge leads to inadequate actions. This is a situation to which, unfortunately, a large part of the population is exposed when faced with a disease that is more uncertain than certain, which leads to the easy spread of rumors or myths about COVID-19.

This finding is based on the analysis of Llanos et al.¹⁷, when considering that knowledge influences the thinking or believing and the attitudes that a person has about the COVID-19 pandemic. In addition, in the behavioral component, the current behavior of the person is reflected and, depending on the knowledge the person may have, he/she shall show more or less correct attitudes. In a similar vein, Perez¹⁸states that preventive attitudes towards the pandemic are characterized by knowledge, responsibility and control. Moreover, the control of the COVID-19 pandemic lies in the people themselves, through individual and collective self-care.

On the other hand, WHO⁷explains that, during the health emergency, media provide information related to COVID-19 so that the population acquires knowledge about the transmission routes of this disease in order to become aware of its incidence worldwide; otherwise, it is analyzed that misinformation leads to incorrect behaviors. Ruiz et al.¹⁹noted a significant direct correlation between insufficient cognitive aspects and negative attitudes towards COVID-19. On the other hand, Ríos et al²⁰analyzed in their study the correspondence between attitudes and practices, being the first ones adequate, but not the second one. Therefore, it is necessary to promote health education to enhance knowledge about COVID- 19 and thus generate positive attitudes towards prevention.

According to our findings, in the presence of perception of lack of knowledge, attitudes towards COVID-19 improve, which may be related to the fact that people with a lower level of education, poor access to a variety of information about the disease or simply within timely and appropriate information about it, only get basic practical knowledge about basic measures to ensure effective control of the spread of COVID-19.

Among the studies that differ from our findings, we find the study of Azlan et al.²¹, who concluded that the Malaysian population has an acceptable level of knowledge and, therefore, a positive attitude in their perspective to overcome the crisis caused by the COVID-19 pandemic. These studies must also take into account the educational, cultural and social differences of the community studied.

Furthermore, our result also contradicts the findings of Montaño et al.²²who identified that 100% of the sample studied showed a high level of knowledge about the causative agent of COVID-19, 80% knew the incubation period of the virus, and 95% had an excellent knowledge about the main symptoms of this disease.

It is recommended to implement targeted, more vigorous measures and to strengthen communication strategies to the population by means of professionals with skills in the area, to continue with social awareness campaigns starting with primary health care through coordinated work, preventive actions and health promotion, diffused in different networks and media (advertising spots on television, radio, loudspeakers, billboards, social networks, etc.) that are accessible to citizens, making sure to use messages with clear and precise information, in order to promote responsible behavior that prevents the spread of COVID-19.

The first limitation of our study was that the online survey could have generated response bias; however, we used a self-administered and standardized instrument that was easy to understand. On the other hand, non-random sampling resulted in the increase in selection bias; however, the study described and evaluated knowledge and attitudes in a limited spatial context, so the data obtained in this study cannot be generalized to the urban population of Huánuco. Despite these limitations, this research provides results for future studies, since it is the first one of this type to be reported in our region, and therefore its results should be taken as initial references for future research.

CONCLUSION

There is an inverse association between the perception of knowledge and the type of attitudes towards COVID-19 in a group of citizens from the urban area of Huánuco. In view of this, it is important to provide the population with an adequate and correct level of knowledge that allows them to be oriented towards favorable attitudes of prevention, recognizing the possible damages or consequences that affect the most vulnerable groups, in order to avoid serious complications in their health.