Knowledge, Attitudes, and Practices of Students Towards COVID-19 Guidelines in Bushbuckridge Local Municipality, Mpumalanga Province

Abstract

The level of knowledge, positive attitudes, and adherence to preventive practices among students towards COVID-19 guidelines is essential in minimising transmission and ensuring the maintenance of safe and healthy learning environments. The present study aimed to investigate students’ knowledge, attitudes, and practices towards COVID-19 guidelines at Bushbuckridge Local Municipality, Mpumalanga Province. A quantitative, cross-sectional, descriptive design was employed. Two-stage cluster sampling and systematic sampling were used to select respondents from each sampled school cluster. A total sample size of n = 364 was determined using the Raosoft sample size calculator, with a margin of error (e) of 5% and a confidence level of 95%. Out of the total, 357 respondents who returned the assent forms participated in the study. Data was collected through a questionnaire administered to selected respondents. The findings indicated that the majority of secondary school students possess a good level of knowledge regarding COVID-19 guidelines. Furthermore, 78% of these students have positive attitudes toward COVID-19 guidelines, and 72% exhibit proactive practices in adhering to these guidelines. The Department of Basic Education should emphasise the integration of health education in schools to enhance students’ understanding of COVID-19 guidelines and the virus itself. Continuous education on hygiene practices and COVID-19 guidelines is essential to ensure that students are prepared and able to comply during future pandemics.

1. Introduction

The coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, emerged in December 2019 in Wuhan, China, and rapidly spread globally, becoming a significant public health crisis [1]. COVID-19 is highly contagious and can lead to severe respiratory illness, particularly in vulnerable individuals, such as the elderly and those with underlying health conditions, including cardiovascular diseases, diabetes, and respiratory disorders [2,3]. Symptoms of COVID-19 can range from mild respiratory discomfort to severe illness, including pneumonia, fever, cough, and loss of smell or taste [3]. In many cases, individuals may recover with or without medical attention, but some experience life-threatening complications, necessitating hospitalisation [4].

In South Africa, the pandemic has had a profound impact, with the country ranking first among the most affected in Africa [5]. As part of efforts to curb the spread of the virus, the South African government imposed a national lockdown on March 26, 2020, resulting in the closure of schools and affecting over 14 million students [6]. This disruption to education has been particularly challenging for students in rural areas, such as Bushbuckridge in Mpumalanga Province, where access to resources like information, technology, and healthcare is often limited [7]. Students in this region have faced not only the direct health risks of COVID-19 but also emotional challenges such as social isolation, fear, and uncertainty, which have impacted their adherence to public health guidelines [7].

Adherence to COVID-19 preventive measures, such as wearing masks, practising physical distancing, and following hygiene protocols, depends on the knowledge, attitude, and practices (KAP) of individuals. Knowledge includes understanding the symptoms, transmission modes, and effective preventive measures for COVID-19, such as the importance of hand hygiene, mask-wearing, and social distancing [8,9]. Research shows that people who understand the virus and how it spreads are more likely to take protective actions [10,11]. When individuals have a positive attitude toward safety guidelines, seeing them as vital for health, they tend to follow those guidelines more closely [12]. However, the true test comes down to behaviours like wearing masks, keeping a distance, and washing hands regularly, which depend on how well people can put their knowledge and positive mindset into practice [13,14]. It is particularly important to understand these factors among students in rural areas like Bushbuckridge to improve adherence to COVID-19 preventive measures in schools and communities [15]. By situating the current study within the broader literature on KAP, we can gain a better understanding of how these factors influence behaviour and contribute to the broader public health efforts to control the spread of COVID-19.

However, while the pandemic’s impact on education has been widely studied [6,7,15], limited research has been conducted on the KAP towards COVID-19 guidelines among students in rural South African communities. This study seeks to fill this gap by assessing students’ knowledge, attitudes, and practices in the Bushbuckridge local municipality, Mpumalanga Province, towards COVID-19 guidelines. By understanding how students in this region engage with public health measures, this research will provide valuable insights into the effectiveness of existing interventions and help inform future strategies for reducing the spread of the virus in schools and communities.

2. Materials and Methods

2.1. Study Setting, Design and Sampling

This descriptive cross-sectional study assessed students’ knowledge, attitudes, and practices regarding COVID-19 guidelines in public secondary schools within the Mkhuhlu Circuit.

Mkhuhlu Circuit is situated within the Bushbuckridge local municipality in Mpumalanga province, South Africa, a predominantly rural area known for its rich cultural heritage and natural beauty [16]. Geographically, it lies in the eastern part of Mpumalanga, nestled between the Lowveld and the scenic Drakensberg mountains [17]. This circuit is home to several public secondary schools catering to a diverse student population, predominantly black South Africans. The area faces socio-economic challenges such as high unemployment rates, limited access to resources, and a reliance on agriculture as the primary source of income for many households [18].

The educational landscape in Mkhuhlu Circuit is marked by efforts to improve literacy and academic performance, despite challenges such as overcrowded classrooms, insufficient teaching materials, and limited access to digital resources [19]. Public secondary schools in the area have become essential community institutions, striving to provide quality education despite these barriers. The students, often coming from disadvantaged backgrounds, face unique health and social challenges, which the COVID-19 pandemic has exacerbated [20].

A two-stage cluster sampling method was employed due to the geographical spread of the schools, which made it logistically challenging to use a simple random sample. First, six out of ten secondary school clusters in the Mkhuhlu Circuit were randomly selected. Second, within each selected cluster, systematic random sampling was used to select every 23rd learner from the cluster’s pre-existing list of students, which was randomly ordered. This ensured a proportional representation of the learner population from each cluster.

A total of 364 students (aged 15–20) were initially sampled based on this sampling method. The sample size was determined using a Raosoft sample size calculator, with a population size of 6648, a margin of error of 5%, and a 95% confidence level. The optimal number calculated to ensure sufficient statistical power for the study was 364 students. Of the 364 students, 357 provided written informed assent or consent to participate, while 7 students were excluded for not returning their assent or consent forms. Data were collected using a structured questionnaire between July and August 2023.

2.2. Ethical Considerations

Ethical approval for the study was granted by the Human and Clinical Trials Research Ethics Committee (HCTREC) at the University of Venda under the ethical clearance number FHS/23/PH/07/0707. To ensure the integrity of our research, we obtained formal permission from the Mpumalanga Department of Basic Education, along with authorisation from the principals of each participating school.

To protect the rights of all participants, we provided detailed information sheets that clearly outlined the study’s purpose, processes, and potential implications. We obtained assent or consent from each participating learner. For participants under 18, we diligently secured consent from their parents or guardians to ensure their involvement was ethical and appropriate.

Throughout the research process, we maintained the highest standards of confidentiality and anonymity. All responses collected were anonymised, and the data were stored securely to protect participants’ identities. Our data handling and storage strictly adhered to established ethical guidelines, reflecting our commitment to responsible research practices.

2.3. Data Collection

2.3.1. Materials and Measurements

The research instrument was developed following an extensive literature review, ensuring it captured the essential data on students’ demographic details and their knowledge, attitudes, and practices regarding COVID-19 guidelines. The questionnaire consisted of several sections explained below:

2.3.2. Demographic Data

The demographic section of the questionnaire collected basic data about the participants, including age, gender and school name.

2.3.3. Knowledge of Students Towards COVID-19 Guidelines

The respondents’ knowledge of COVID-19 guidelines was assessed using 20 variables. These variables tested their understanding of various aspects of COVID-19, including symptoms, transmission, prevention, and the virus’s general characteristics.

Sample Knowledge Items:

• Have you heard of COVID-19? (Yes = 1; No = 2)
• From where did you hear about COVID-19? (Radio = 1; Internet = 2; Newspaper = 3; Friends/Family = 4; Television = 5; Government Enlightenment Campaign = 6)
• What causes COVID-19? (Bacteria = 1; Fungi = 2; Virus = 3; I don’t know = 4)
• Does eating or contacting wild animals result in COVID-19 infection? (Yes = 1; No = 2; I don’t know = 3)
• Which of the following diseases is similar to COVID-19? (Typhoid = 1; Malaria = 2; Ebola = 3; HIV/AIDS = 4; SARS = 5; All of the above = 6; None of the above = 7)

Participants were asked these questions to evaluate their understanding of COVID-19, with possible answers on a binary or multiple-choice scale.

2.3.4. Attitudes Towards COVID-19 Guidelines

The study’s second objective was to determine the students’ attitudes toward implementing COVID-19 guidelines. This section contained six statements, and respondents rated their level of agreement using a three-point Likert scale.

Sample Attitude Items:

• It is important to report suspected COVID-19 cases to health authorities. (Agree = 1; Disagree = 2; Undecided = 3)
• It is important to use a face mask while indoors and in crowded spaces. (Agree = 1; Disagree = 2; Undecided = 3)
• COVID-19 can be treated at home. (Agree = 1; Disagree = 2; Undecided = 3)

The scale was designed to measure whether respondents held positive, negative, or neutral attitudes toward specific COVID-19 guidelines and preventive measures.

2.3.5. Practices Towards COVID-19 Guidelines

This section assessed the practices of students regarding COVID-19 preventive measures. A 7-item scale was used to evaluate hand hygiene, face mask usage, and social distancing behaviours.

Sample Practice Items:

• Do you use a handkerchief during coughing or sneezing? (Yes = 1; No = 2; Sometimes = 3)
• Do you wash your hands with water and soap regularly? (Yes = 1; No = 2; Sometimes = 3)
• Do you maintain social distancing? (Yes = 1; No = 2; Sometimes = 3)

The Likert scale in this section categorised responses as proactive practices (Yes = 1), bad practices (No = 2), or inconsistent practices (Sometimes = 3).

2.3.6. Data Collection Procedure

Data collection took place during break times and after-school hours at participating schools. This approach ensured minimal disruption to the students’ academic schedules. The researcher distributed the questionnaires to the students, who were instructed to complete them independently. Assistance was available from the researcher if respondents required clarification on any items.

Before administering the questionnaire, the researcher obtained informed consent and assent from the students and their guardians. All participants were informed of the study’s objectives, and their participation was voluntary.

The completed questionnaires were collected, digitally entered into a database, and coded for further analysis.

3. Results

3.1. Demographic Data

The study included 357 respondents, primarily young individuals aged 15–20 years, who comprised 65% of the respondents, and the remaining percentage of respondents were aged 20 years or older, rounding out the age distribution. Gender representation within the study was relatively balanced, with 53% of respondents identifying as female and 47% as male. This parity is essential, as it allowed for a comprehensive exploration of varying perspectives and insights on health issues from both genders, enriching the study’s overall findings.

3.2. Knowledge of COVID-19

Overall, students demonstrated a high level of awareness (87%) regarding the symptoms, transmission, and preventive measures of COVID-19 (Figure 1). However, there were gaps in their knowledge in certain areas, indicating that further education may be necessary. Notably, 17% of respondents were uncertain about the causes of COVID-19, highlighting a knowledge gap that could be addressed through educational initiatives. Additionally, 62% of respondents compared COVID-19 to the flu, suggesting a tendency to view the virus as similar to other familiar respiratory illnesses. Interestingly, only 2% of respondents disagreed with the idea that handwashing is an effective preventive measure, demonstrating a general acknowledgement of hygiene practices in combating the spread of illness.

Television (TV) emerged as the most frequently accessed source for COVID-19 information, with 73% of individuals reporting it as a reliable medium. In contrast, radio was the least accessed, with only 1% of people turning to it for information, while newspapers garnered even less attention, accounting for just 0%. Both radio and newspapers were generally considered unreliable sources during the pandemic; this might have been due to the fact that students watched more TV and were on the internet most of the time during the lockdown (see Figure 2).

Symptoms: Most students demonstrated a solid understanding of COVID-19 by correctly identifying some of its most commonly recognised symptoms, such as fever, reported by 70%, and shortness of breath, noted by 61%. However, it is concerning that more than half of the respondents (>50%) failed to identify other prevalent symptoms like coughing, runny nose, and fatigue. Additionally, they were unaware of less common manifestations, such as the loss of taste or smell (refer to

Table 1. Knowledge of COVID-19 symptoms.

COVID-19 Symptoms	Selected		Not Selected
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
High Fever	250	70.03%	107	29.97%
Shortness of Breath	219	61.34%	138	38.66%
Coughing	175	49.02%	182	50.98%
Runny Nose	111	31.09%	246	68.91%
Muscle Pain	63	17.65%	294	82.35%
Fatigue	58	16.25%	299	83.75%
Bleeding	28	7.84%	329	92.16%

). This knowledge gap suggests that while specific core symptoms have gained wide acknowledgement, a significant misunderstanding or lack of awareness about the full spectrum of COVID-19 symptoms exists, particularly among younger individuals. This highlights the need for improved education and awareness campaigns to ensure everyone is well-informed about the various signs of the virus.

Transmission: Most students (64%) correctly understood that COVID-19 spreads through respiratory droplets. Nearly 10% of the participants were unaware of how COVID-19 is transmitted, while 13% incorrectly believed it could be spread through insects (see

Table 2. Students’ knowledge of modes for spreading COVID-19.

How COVID-19 Spreads	Selected		Not Selected
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Contact with an infected person	236	66.11%	121	33.89%
Air droplets	227	63.59%	130	36.41%
Contact with contaminated surfaces	94	26.33%	263	73.67%
Mosquitoes/flies	48	13.45%	309	86.55%
I do not know	35	9.80%	322	90.20%

). This reveals a misunderstanding about non-respiratory transmission routes, indicating a need for clearer public health messaging regarding modes of disease transmission.

Preventive Measures Adherence: A significant majority of participants (89%) demonstrated awareness of and adherence to the government’s COVID-19 preventive measures. Among these, the most widely followed measures included regular handwashing with soap and water (87%), maintaining social distancing (73%), and wearing face masks in public settings (71%), as illustrated in Figure 3. Over 80% of participants also identified avoiding crowded places and self-isolation as key strategies for preventing the spread of the virus.

However, a notable concern emerged regarding age-based misconceptions. Nearly 35% of participants believed that children and young adults did not need to adhere to preventive measures, which suggests a misunderstanding of the virus’s impact across different age groups (

Table 3. Steps to take to prevent COVID-19 infection or transmission.

	Agree		Disagree		Not concerned
Actions	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Adults with chronic diseases must take precautions	254	71.15%	26	7.28%	77	21.57%
Avoiding crowded places	303	84.87%	19	5.32%	35	9.80%
Self-isolation when infected	288	80.67%	30	8.40%	39	10.92%
Children and young adults do not need to be compliant.	124	34.73%	209	58.54%	24	6.72%
Wearing surgical mask	276	77.31%	77	21.57%	4	1.12%
Maintaining 2 feet distance	243	68.07%	72	20.17%	42	11.76%

).

Equally concerning was the finding that none of the participants recognised the importance of proper ventilation in minimising transmission risks. This lack of awareness represents a critical knowledge gap that could be addressed through targeted educational campaigns to improve public understanding of all aspects of COVID-19 prevention.

3.3. Attitudes Towards COVID-19 Guidelines

Students generally displayed positive attitudes toward COVID-19 prevention measures, although there was some variability based on personal experiences with the virus. Those who had experienced COVID-19 directly, whether through their own illness or by witnessing its effects on a family member or close friend, tended to have a more favourable view of these preventive measures. Their firsthand observations of the virus’s impact influenced their perspective on the importance of protecting against it.

Support for Guidelines: A majority of students (>70%) expressed strong support for key preventive measures, such as wearing masks (89%) and practising social distancing (68%). These results suggest that the students’ attitudes align with public health recommendations, a positive indicator of their potential adherence to guidelines.

Perceived Efficacy: Despite supporting the guidelines, there was some uncertainty regarding their effectiveness. Approximately 22% of students believed wearing a mask was less effective than staying at home and avoiding crowded places (5%), showing a lack of confidence in the protective benefits of masks. This could reflect misinformation or a lack of trust in health authorities, which could be addressed through more engaging and clear public health campaigns.

Social Responsibility: Students’ attitudes toward their social responsibility were mixed. While a majority agreed on the importance of following COVID-19 guidelines to protect others—such as reporting suspected cases (74%)—a significant number of students (59%) believed COVID-19 could be treated at home. Some participants felt that children and young adults were not at risk (35%) and considered restrictions like lockdowns and social distancing overly burdensome, particularly among older adolescents. This divergence suggests that while most students recognise the importance of the guidelines, some may feel fatigued by the prolonged nature of the pandemic and its restrictions.

Practices in Adhering to COVID-19 Guidelines: In terms of actual behaviour, students reported good adherence to some preventive measures (>68%). However, there were notable areas where practices were less consistent, such as wearing a mask (22%) and maintaining a 2-foot distance (20%).

Mask-Wearing and Social Distancing: Most students (77%) reported wearing masks in public places, and a similar proportion (68%) practised social distancing. These results suggest that students are mainly adhering to these basic protective measures. However, adherence was lower in social settings (21%), where some students felt masks were unnecessary, indicating that contextual factors influence compliance.

Hand Hygiene: A significant 98% of students acknowledged the vital role of handwashing in preventing the spread of the virus, underscoring its importance as a health measure. Despite this awareness, only 87% reported consistently practising hand hygiene, primarily through handwashing alone. Alarmingly, 24% admitted to neglecting to sanitise their hands after touching public surfaces, such as doorknobs, elevator buttons, and shopping carts. This reveals a critical gap between knowledge and practice; understanding the importance of these preventative measures does not ensure consistent adherence. To address this issue, implementing regular reminders and ongoing educational initiatives could significantly improve compliance and foster safer hygiene habits among students.

Avoiding Crowded Spaces: Among students, there was a noticeable inconsistency in their efforts to steer clear of crowded areas. Approximately 5% admitted that they occasionally found themselves in these bustling environments. In comparison, a concerning 10% expressed a sense of indifference, even though they recognised that their actions heightened their risk of exposure to various health threats (Figure 4). This observation highlights that, while students may possess strong knowledge and awareness of the dangers, their ability to change behaviours is often compromised by external influences, such as societal pressures, to engage in social activities or a lack of enforcement of safety measures.

4. Discussion

This study assessed the knowledge, attitudes, and practices (KAP) of secondary school students in the Bushbuckridge Local Municipality, Mpumalanga Province, regarding COVID-19 guidelines. Overall, students demonstrated a strong awareness of COVID-19 and generally positive attitudes toward preventive measures. However, notable gaps were identified in their knowledge of specific symptoms and certain transmission aspects, highlighting areas for targeted educational interventions.

Students exhibited a high level of general COVID-19 awareness (87.11%), consistent with findings from other studies conducted during the pandemic [21,22]. Television emerged as the primary information source (73.11%), mirroring trends observed in India, where media outlets played a significant role in disseminating information [22]. This reliance on television underscores its potential as a key channel for future health communication efforts.

While students understood the primary modes of transmission, such as close contact (66.11%) and respiratory droplets (63.59%), significant knowledge gaps existed regarding specific symptoms. Over half of the respondents were unaware that symptoms like dry cough, runny nose, muscle pain, and fatigue are associated with COVID-19 [23]. This contrasts with other studies that have emphasised these symptoms [21,24]. This lack of awareness could hinder early detection and isolation efforts, potentially contributing to the virus’s spread. It is possible that the emphasis on fever and shortness of breath in initial public health campaigns overshadowed the importance of recognising these milder yet common symptoms.

The study revealed positive attitudes toward COVID-19 prevention measures, with a majority (91.32%) supporting mask-wearing in indoor and crowded spaces. This aligns with findings from Ferdous et al. [21], indicating a general acceptance of and willingness to comply with public health recommendations. Furthermore, most students recognised the crucial role of health education (79.27%) and hand hygiene (88.52%) in preventing the spread of the virus, reinforcing the need for continued educational initiatives.

In terms of practices, students reported actively following several COVID-19 guidelines. A significant proportion used handkerchiefs when coughing or sneezing (62.46%) and practised regular handwashing (87.11%), consistent with findings from studies in Bangladesh [21]. Mask-wearing at school was also prevalent (71.43%). However, a concerning number of students (64.87%) were inconsistent in avoiding touching their faces, a key behaviour for reducing viral transmission [25]. This highlights the challenge of translating knowledge and positive attitudes into consistent practice, suggesting that interventions should focus on behaviour reinforcement techniques.

Several specific knowledge gaps warrant attention. Only 46% of students were aware that asymptomatic individuals could transmit COVID-19, contradicting findings that highlight asymptomatic transmission as a major factor in the pandemic [25]. Additionally, only 52% correctly understood that contact with animals does not lead to COVID-19 infection, despite clear guidance from organisations like the WHO [26]. These misconceptions could be due to evolving scientific understanding during the pandemic or to the spread of misinformation. It is, therefore, crucial to run targeted educational campaigns to help fill the knowledge gaps about COVID-19 among students. These campaigns should deliver accurate and current information. Using interactive methods, peer-led initiatives, and visual media can help clarify misunderstandings and encourage good preventive practices. This way, students are more likely to follow health guidelines effectively.

This study has several limitations. The cross-sectional design restricts the ability to establish causality, and the reliance on self-reported data may introduce social desirability bias. The focus on a specific geographic area and sample may limit the generalisability of the findings. Future research could address these limitations by employing longitudinal designs, using more diverse sampling methods, incorporating observational data, and exploring psychological and cultural factors that influence behaviour.

In conclusion, this study underscores the importance of strengthening health education efforts to enhance COVID-19 prevention among secondary school students in Bushbuckridge Local Municipality. While students demonstrated good knowledge of preventive measures and positive attitudes towards health guidelines, notable gaps remain in their understanding of COVID-19 symptoms and the risks of asymptomatic transmission. Public health campaigns have made significant strides, particularly through media platforms like television, but targeted interventions are still needed to address these gaps. Knowledge of symptoms, correcting misconceptions about transmission, and promoting consistent preventive practices, particularly in social settings. By addressing these knowledge gaps and leveraging media outlets for wider reach, we can better protect students and the broader community from future outbreaks.