Journal of Modern Medical

Introduction
The novel coronavirus disease named “COVID-19” as an acute respiratory disease was first reported in Wuhan, China in late December 2019 and spread to all countries in the world, and it has not completely disappeared yet. The cause of this disease is very similar to the previous corona viruses, but it is more contagious. In general, the transmission of droplets spread through coughing, sneezing, or even talking from an infected person to other people, plays a major role in the spread of this respiratory disease. Most cases of early death due to COVID-19 were observed in the elderly due to having a weak immune system or underlying diseases (at different ages). To reduce transmission, special attention should be paid to sensitive groups such as children, pregnant women, the elderly, and healthcare providers. Vaccination in different periods of time is recommended to have a strong immune response, but vaccination alone is not enough. Raising people’s awareness and attitude regarding the continued observance of health measures (such as social distancing and washing hands) by educational videos and through social media is also needed to control the disease and prevent its transmission. This study aims to determine the level of knowledge, attitude and practice of students in Isfahan University of Medical Sciences (IUMS) regarding the COVID-19.

Methods
This cross-sectional study was conducted on 260 students of IUMS who were selected by simple random sampling method. The data collection tool was a researcher-made questionnaire, which was made after conducting a literature review and consulting with experts and receiving their comments. Finally, the reliability of the questionnaire was investigated by conducting a pilot study and Cronbach’s α coefficient for the components of knowledge, attitude, and practice was reported 0.74, 0.73, and 0.82, respectively. This final draft had three subscales of “knowledge” with 12 and a score from 0 to 24 (rated on a scale from 2=agree, 1=no idea, 0=disagree), “attitude” with 14 items and a score of 14-70 (rated on a five-point Likert scale from 1=completely disagree to 5=completely agree), and “practice” with 11 items with a score from 0 to 11 answered by yes (1 point) or no (zero point). The demographic section had two items (gender, educational level). At the end of the knowledge section, there was a question “from what source did you get your information about COVID-19?”. Data were analyzed in SPSS software, version 26 using descriptive and inferential statistics.

Results
The participants were 189(75%) girls and 63(25%) boys. In terms of education level, most of them were undergraduate students (42%) while a few of them were doctorate students (10%). The mean scores of knowledge, attitude, and practice are presented in Table 1.


The awareness level of 174 students (69%) was satisfactory. Respectively, 154(61%) and 182(72%) students completely agreed with the use of masks and the effect of education on reducing contagion and disease transmission. Moreover, 227(90%) agreed to refrain from non-essential gathering in crowded places. About 237(94%) and 241(96%) of students wore masks and complied with social distancing practice, respectively. Moreover, 210 students (83%) obtained the information related to COVID-19 from radio and TV programs, social networks, newspapers and magazines, respectively. The results of the independent t-test showed that the sex variable had a significant relationship with students’ knowledge, attitude and practice, where females had higher scores in total; however, their knowledge and attitude had was no significant relationship with their educational level.

Conclusion
Knowledge of COVID-19 is a determining factor in how to respond to it and participate in preventive behaviors, despite getting vaccinated. The knowledge, attitude and practice of students regarding COVID-19 prevention methods can reduce the rate of infection among them. Considering the important role of medical universities during the pandemic, they should hold training courses for students on the control and prevention of COVID-19 for increasing their knowledge and attitude.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Isfahan University of Medical Sciences (Code: IR.MUI.RESEARCH.REC.1400.029).

Funding
This study is the result of a research project approved by Isfahan University of Medical Sciences (Code:199549). 

Authors' contributions
Conceptualization and study design: Mahnaz Nikaeen and Sepideh Sadeghi; Data collection: Fatemeh Hajialikhani; Data analysis: Farzaneh Mohammadi; Writing the initial draft: Sepideh sadeghi and Fatemeh Hajialikhani; Reviewing and final approval: All authors.

Conflicts of interest
The authors declared no conflicts of interests

Acknowledgements
The authors would like to thank the student research committee of Isfahan University of Medical Sciences for their support and cooperation. 
The authors would like to appreciate the Vice Chancellor for Research of Isfahan University of Medical Sciences for financial support.

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