ABSTRACT

A cross-sectional study was carried out to determine the teachers’ attitudes and knowledge about the COVID-19 pandemic in the Canary Islands region in Spain, between May 14 - 18, 2020. A virtual questionnaire based on a validated instrument was applied. We included 1,503 surveys, which showed that teachers are unwilling to work if there is risk of infection at the school (76.6%). However, they state that they would go to work if they had the appropriate hygiene (69.2%) and protection (67.0%) measures. In conclusion, it is important to guarantee the necessary preventive measures to avoid contagion in educational centers, promoting specific training of teachers in primary prevention.

Keywords:
Communicable Diseases; Coronavirus Infections; Hygiene; Faculty; Occupational Health; Surveillance; Health Education; Health Promotion

INTRODUCTION

As of September 21, 2020, Spain was the ninth country in the world with the most cases of COVID-19 ¹1. World Health Organization (WHO). Coronavirus disease (COVID-19) Dashboard. [Internet]. Ginebra: WHO; 2020 [citado el 21 de septiembre de 2020]. Disponible en: https://covid19.who.int/table., with a total of 671,468 infected persons and 30,663 deaths ²2. Centro de Coordinación de Alertas y Emergencias Sanitarias. Actualización nº 211. Enfermedad por el coronavirus (COVID-19). 21 de septiembre de 2020. [Internet]. Madrid: Ministerio de Sanidad; 2020 [citado el 21 de septiembre de 2020]. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_211_COVID-19.pdf.
https://www.mscbs.gob.es/profesionales/s... . The first measure taken by most countries to curb the pandemic was the suspension of face-to-face activities ³3. The World Bank. World Bank Education and COVID-19 [Internet]. Washington: TWB; 2020 [citado el 11 de julio de 2020]. Disponible en: https://www.worldbank.org/en/data/interactive/2020/03/24/world-bank-education-and-covid-19.. In Spain, more than 840,000 teachers have had to use information and communication technologies (ICT) in an improvised and hurried manner to avoid slowing down the educational process ⁴4. García-Peñalvo F, Corell A, Abella-García V, Grande M. La evaluación online en la educación superior en tiempos de la COVID-19. Education in the Knowledge Society. 2020; 21,12-26. doi: 10.14201/eks23013.
https://doi.org/10.14201/eks23013.... .

The World Health Organization (WHO) establishes recommendations for the reopening of educational centers, including hand hygiene, cleaning and ventilation of classrooms, and the use of masks. As well as the evaluation and management of students, teachers, other school personnel, tele-training facilities, etc. ⁵5. World Health Organization (WHO). Considerations for school-related public health measures in the context of COVID-19 [Internet]. Ginebra: WHO; 2020 [citado el 1 de agosto de 2020]. Disponible en: https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19.

Planning for reopening should begin as soon as possible, establishing mechanisms to guarantee the continuity of learning in a safe manner, both for staff and students ⁶6. UNICEF. La educación frente al COVID-19: Propuestas para impulsar el derecho a la educación durante la emergencia [Internet]. Nueva York: UNICEF; 2020 [citado el 25 de mayo de 2020]. Disponible en: https://www.unicef.es/sites/unicef.es/files/educa/unicef-educa-covid19-propuestas-proteger-derecho-educacion-emergencia-0.pdf.. However, the possibility of contagion among students and teachers during the reopening process, and the consequent closure of the educational center, cannot be ignored ⁷7. Fundación Cotec. COVID-19 y educación I: Problemas, respuestas y escenarios. [Internet]. Madrid: COTEC; 2020 [citado el 6 de mayo de 2020]. Disponible en: https://cotec.es/media/COTEC_COVID19_EDUCACION_problemas_respuestas_escenarios.pdf.. Therefore, the establishment of socio-health protocols, contingency educational plans and a digitalization plan in the center are some of the proposals that could minimize the impact of COVID-19 in the educational environment ⁷7. Fundación Cotec. COVID-19 y educación I: Problemas, respuestas y escenarios. [Internet]. Madrid: COTEC; 2020 [citado el 6 de mayo de 2020]. Disponible en: https://cotec.es/media/COTEC_COVID19_EDUCACION_problemas_respuestas_escenarios.pdf..

Because of what was previously mentioned, and due to the limited number of studies carried out on teaching personnel, we set ourselves the objective of describing the attitudes and knowledge about the COVID-19 pandemic among teaching personnel in the Canary Islands.

THE STUDY

We conducted a cross-sectional study in the Autonomous Community of the Canary Islands in Spain, between May 14 and 18, 2020. The target population was teachers from any public or private educational institution, that is, from primary school teachers to university professors. Teachers who signed the informed consent form and answered all the questions in the questionnaire were included.

The recollection instrument is based on a study published by the research team in 2019 to learn about the attitudes and beliefs of healthcare personnel during a hypothetical influenza pandemic ⁸8. Santana-López BN, Santana-Padilla YG, Martín-Santana JD, Santana-Cabrera L, Escot-Rodríguez C. Creencias y actitudes de trabajadores sanitarios y estudiantes de enfermería de una región de España ante una pandemia de gripe. Rev Peru Med Exp Salud Pública. 2019; 36:481-6. doi: 10.17843/rpmesp.2019.363.4371.
https://doi.org/10.17843/rpmesp.2019.363... . Because it is an ad hoc questionnaire, we made an adaptation for the educational sector; the research team reviewed that the questions were not ambiguous or difficult to understand, and that they correlated to the objective of the study.

To validate the instrument, we used the Delphi technique with 19 experts from different levels of the educational sector, guaranteeing at least two participants for each level (nursery school, kindergarten, primary school, secondary school, special education center, vocational training center, university, others). These experts assessed the suitability of each of the items by means of a Likert scale score of 1 to 7 points, where 1 represented disagreement and 7 represented agreement. The consensus of the experts was reached when the score for each item reached a mean greater than 5 and a standard deviation less than 2; thus, three questions were excluded from the initial questionnaire. Subsequently, to assess the level of reliability, Cronbach’s alpha was calculated using the experts’ scores, which resulted in a value of 0.943.

The questionnaire had 16 questions, divided into 4 sections: attitudes (3), knowledge (6), sociodemographic information (5) and employment information (2). The virtual questionnaire was created in a Google form and disseminated through social networks. Informed consent was requested from each participant, which guaranteed their anonymity at all times.

Statistical analysis was performed with R Core Team 2020 version 4.0.0. The descriptive analysis of the data was presented with frequencies and percentages. From a population of approximately 25,000 teachers, a sample size of 587 was calculated for the data to be significant at 95%, with a sampling error of 4%. Finally, 1,509 surveys were obtained, which allowed us to perform a statistical analysis with a sampling error of less than 2%, for a confidence level of 99%.

This study has been approved by the Ethics Committee for Research with Drugs of the University Hospital of Gran Canaria Dr. Negrín (CEI/CEIm HUGCDN).

FINDINGS

Teaching staff profile

A total of 1,503 correctly completed surveys were received. Most were women (75.6%), more than half (52.5%) were between 31 and 50 years old and lived with their partner and children (50.8%). Most were secondary school teachers (48.0%), and almost all belonged to the public education sector (91.2%) (Table 1).

Teaching staff attitudes

The majority of teachers do not believe that adequate protection and hygiene measures against COVID-19 will be available at the school (73.3%). This fact is related to their own attitudes where they state that they would not be willing to work if there were a higher than usual risk of becoming infected at the school (76.6%) (Table 2). In addition, if there was an added risk of infecting their family members (85.0%), they would probably not go to work either. However, 69.2% would go to work under hygienic measures and 67.0% if they had adequate protective measures.

The teachers also stated that they would not be willing to work if there was no possibility of maintaining the physical safety distance (77.4%), if the students did not have personal protection material (68.7%), if there was no hydroalcoholic solution inside the classroom (65.0%), or if they were asked to teach in groups with higher ratios of students(80.0%) (Table 2).

Overall, teachers do not agree with teaching at a classroom when there is a high risk of infecting themselves or their family (94.9%); this fact is relevant since this population lives in families with partners and children. It is noted that teachers put their responsibility to their families before their work duties (92.5%) (Table 3).

Teaching staff knowledge

We found high percentages of knowledge about adequate measures to protect against COVID-19 (Table 4). However, 52.0% still considered that the use of gloves is an adequate measure of protection, 91.6% knew that not all masks serve to protect against infection and that not only the mouth should be covered (89.9%). Likewise, 68.4% were of the opinion that these protective measures should be maintained throughout the workday.

On the other hand, 63.1% knew that they had to disinfect their hands with hydroalcoholic solution for 20-30 seconds. However, 89.2% are of the opinion that to avoid contamination of the hands it is necessary to wash with soap and water for 40-60 seconds. In addition, 44.3% believe that it is necessary to wash hands with hydroalcoholic solution whenever they are visibly dirty. Teachers know that the physical safety distance must be maintained throughout the workday (96.3%).

As measures to be improved, only 54.7% of the teachers stated that the mask should cover the nose, mouth and chin, and only 26.8% indicated that the most effective measure to avoid contaminating the hands is the hydroalcoholic solution.

DISCUSSION

In general, the teaching staff do not believe that they have the protection and hygiene measures in place in their workplaces and are not willing to work if there is a risk of infection. However, they state that they would be willing to work if they were provided with the appropriate hygiene and safety measures. Regarding knowledge, we observed that they are aware of the measures to protect themselves from infection, however, they need training in hygiene and infection prevention.

Regarding attitudes, we observed a general belief of lack of protection, since most of them expressed that they do not have protection and hygiene measures in their workplaces. This impression is not unique to this guild; similar results were described in a national survey on the working conditions of nurses in Spain, during the COVID-19 health crisis ⁹9. Sindicato de Enfermería SATSE. 5.500 enfermeras y enfermeros graves por la Covid 19. [Internet]. Madrid; 2020 [citado el 3 de septiembre de 2020]. Disponible en: http://www.satse.es/comunicacion/sala-de-prensa/notas-de-prensa/5.500-enfermeras-y-enfermeros-graves-por-la-covid-19.
http://www.satse.es/comunicacion/sala-de... .

Currently, children represent a low proportion of all reported cases, as they remain mostly asymptomatic or develop mild disease ¹⁰10. Viner RM, Russell SJ, Croker H, Packer J, Ward J, Stansfield C, et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolesc Health. 2020;4(5):397-404. doi: 10.1016/S2352-4642(20)30095-X.
https://doi.org/10.1016/S2352-4642(20)30... . Teachers’ concern about COVID-19 transmission could lead to absenteeism under certain circumstances described in the items explored; similar findings have been described in a similar study ⁸8. Santana-López BN, Santana-Padilla YG, Martín-Santana JD, Santana-Cabrera L, Escot-Rodríguez C. Creencias y actitudes de trabajadores sanitarios y estudiantes de enfermería de una región de España ante una pandemia de gripe. Rev Peru Med Exp Salud Pública. 2019; 36:481-6. doi: 10.17843/rpmesp.2019.363.4371.
https://doi.org/10.17843/rpmesp.2019.363... .

Teachers should use hygienic masks that comply with the specific quality standards UNE 0064 and 0065 ¹¹11. Ministerio de Consumo. ¿Qué debes tener en cuenta al comprar una mascarilla? [Internet]. Madrid: MIC; 2020. [citado el 3 de septiembre de 2020]. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/030520_GUIA_COMPRA_MASCARILLAS.pdf.
https://www.mscbs.gob.es/profesionales/s... . However, the WHO states that inadequate use of the masks, far from reducing the risk of contagion, could even increase it ¹²12. World Health Organization (WHO). Advice on the use of masks in the community setting in Influenza A (H1N1) outbreaks. [Internet]. Ginebra: WHO; 2020 [citado el 3 de septiembre de 2020] Disponible en: https://www.who.int/influenza/preparedness/measures/Adviceusemaskscommunityrevised.pdf.. In addition, all measures should be applied to prevent the spread of the pandemic ¹³13. Santana-Cabrera L, Santana-Cabrera EG, Santana-López BN. Medidas a implantar en la vuelta a la escuela en período Covid-19. Rev Esp Salud Pública. 2020;94:e1-e2.. According to Law 31/1995 on Occupational Risk Prevention, the Spanish public administration must guarantee workers effective protection in terms of occupational health and safety, in addition to training them in the correct use of protective equipment ¹⁴14. Ley 31/1995, de 8 de noviembre, de prevención de Riesgos Laborales [Internet]. Boletín Oficial del Estado. num. 269, de 10 de noviembre de 1995 [citado el 7 de marzo de 2020]. Disponible en: https://www.boe.es/buscar/pdf/1995/BOE-A-1995-24292-consolidado.pdf.
https://www.boe.es/buscar/pdf/1995/BOE-A... .

Teachers would probably not go to their place of work if they were at a higher risk of becoming infected and, therefore, of infecting their family members. This risk has been demonstrated in a study carried out by the University of Granada, where a group of students composed of 20 children would have contact with more than 800 people after only two days ¹⁵15. La Vanguardia. Un aula con 20 niños tendrá contacto con más de 800 personas en dos días. Ìnternet]. Granada: La Vanguardia; 2020 [citado el 18 de julio de 2020]. Disponible en: https://www.lavanguardia.com/vida/20200617/481822039593/aula-20-ninos-contacto-800-personas-inicio-escolar.html.
https://www.lavanguardia.com/vida/202006... .

Some gaps in knowledge among teachers have been described, so it will be necessary to implement training measures. We emphasize that they were aware of the basic hygiene and protection measures to be applied in the centers to prevent infection and spread of the coronavirus ¹³13. Santana-Cabrera L, Santana-Cabrera EG, Santana-López BN. Medidas a implantar en la vuelta a la escuela en período Covid-19. Rev Esp Salud Pública. 2020;94:e1-e2.. In addition, more than half of them consider the use of gloves as an effective protective measure against COVID-19. Therefore, it would be necessary to insist on infection prevention measures, such as proper hand hygiene, and to standardize this practice throughout the educational community ¹⁶16. Stone TE, Kunaviktikul W, Omura M, Petrini M. Facemasks and the Covid 19 pandemic: What advice should health professionals be giving the general public about the wearing of facemasks?. Nurs Health Sci. 2020; 22 (2):339-42. doi: 10.1111/nhs.12724.
https://doi.org/10.1111/nhs.12724... .

The teaching staff is key to promoting health promotion measures, so it is recommended to include health professionals in the educational environment to provide teachers with training in prevention, thus collaborating in the adequacy of hygiene and protection measures in the centers, in addition to helping to manage possible contagions ¹⁷17. Maughan ED. Building Strong Children: Why We Need Nurses in Schools. American Educator. 2020; 40(1):19-22. Disponible en: https://files.eric.ed.gov/fulltext/EJ1094215.pdf.
https://files.eric.ed.gov/fulltext/EJ109... .

The major limitation of this study is that the sample covers different types of educational population, from kindergarten teachers to university teachers, in spite of which, our general conclusions encourage further research on the different characteristics of each of the different educational levels. Furthermore, all the respondents belong to an autonomous community, which prevents the extrapolation of the data to other regions with different characteristics outside the Spanish educational sphere. On the other hand, since this is an anonymous and electronic questionnaire, it is assumed that some of the interviewees do not belong to the teaching profession.

In conclusion, teachers in the Canary Islands are willing to work in the classroom as long as there are guaranteed hygiene and safety measures in their workplace; however, they do not believe they have them at the moment. In terms of knowledge, there are certain educational gaps, which could be filled with adequate training in infection prevention.

Acknowledgements:

Multidisciplinary Educational Group EDUCACOVID: Manuel Montesdeoca Calderín (University of Las Palmas de Gran Canaria); José Javier Rodríguez Vega (Agustín Millares Sall Secondary School); Gladys M. Suárez González (Casas Nuevas Secondary School); Carmen Terrón Álvarez (Esteban Navarro Infant and Primary School); Juan José Gil Méndez (Las Huesas Secondary School); Rafaela Martel Ojeda (Amelia Vega Infant and Primary School); Santiago Ortigosa López (Universidad Complutense de Madrid); Ana Carlier Pérez (Centro de Educación Infantil y Primaria Santa Bárbara); Jovita Pérez Rosales (Centro de Educación Infantil y Primaria Claudio De la Torre).

References

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