KNOWLEDGE, ATTITUDE AND PERCEPTION OF HEALTHCARE WORKERS ON

HEPATITIS E VIRAL INFECTION AT THE ANTENATAL UNIT OF PENTECOST

HOSPITAL-MADINA.
INTRODUCTION

1.0 Background of the Study

Hepatitis E viral (HEV) infection is a liver disease caused by the hepatitis E virus, a non-
enveloped, positive-sense RNA virus belonging to the family Hepeviridae (World Health
Organization, 2020). It is primarily transmitted through contaminated water in regions with poor
sanitation. Infection with hepatitis E virus (HEV) is a significant cause of morbidity and
mortality, representing an important global health problem. Our understanding of HEV has
changed completely over the past decade. Hepatitis E viral (HEV) infection is a significant
public health concern, particularly among pregnant women, due to its high mortality rate,
ranging from 20% to 30% (Sayed et al., 2015). The risk of complications, such as stillbirth,
premature labor, and neonatal death, is significantly higher in pregnant women (Jothimani et al.,
2020). HEV infection has a generally benign course in most individuals, but pregnant women,
especially in their third trimester, are at a significantly higher risk of severe disease and
mortality, with case fatality rates reaching as high as 20-25% (World Health Organization, 2021)
According to the World Health Organization (WHO), HEV infection is responsible for
approximately 70,000 deaths annually, with pregnant women being disproportionately affected
(WHO, 2020). The virus is primarily transmitted through the fecal-oral route, often due to
contaminated water or food, and is commonly associated with outbreaks in areas with poor
sanitation and hygiene (Sayed et al., 2015)..The virus is highly contagious and can cause acute
hepatitis, which may lead to severe complications, particularly in pregnant women, who are at
increased risk of mortality (Li et al., 2020).

Previous studies on healthcare workers’ knowledge, attitudes, and perceptions (KAP) regarding
infectious diseases highlight the critical role of these professionals in preventing and managing
outbreaks. Healthcare workers (HCWs) play a crucial role in preventing and controlling HEV
infection, particularly in high-risk settings such as antenatal units (Olowookere et al., 2019).
However, studies have shown that HCWs often have inadequate knowledge and misconceptions
about HEV infection, which can compromise their ability to provide effective care and
prevention strategies (Sayed et al., 2015; Li et al., 2020). A study conducted by Al-Dossary et al.
(2021) on healthcare workers’ knowledge of viral hepatitis in Saudi Arabia revealed significant
gaps in knowledge, underscoring the importance of ongoing training programs.

The knowledge and attitudes of antenatal healthcare workers play a critical role in both the
prevention and management of HEV, particularly in high-risk populations. Despite the
significance of this issue, there is a lack of comprehensive studies examining the level of
awareness and perceptions of antenatal healthcare workers regarding HEV infection in pregnant
women.

1.1 Problem Statements

Hepatitis E virus (HEV) infection has a high mortality rate of 20% to 30%, making it a serious
public health problem, especially for pregnant women(Sayed et al., 2015). Despite its
importance, studies have shown that healthcare workers (HCWs) at antenatal units often have
inadequate knowledge, misconceptions, and negative attitudes towards HEV infection (Li et al.,
2020). The knowledge level, attitudes toward managing patients with Hepatitis E, and
perceptions of its transmission, diagnosis, and treatment may be insufficient, leading to delayed
diagnoses, inappropriate care, and ineffective prevention efforts. This knowledge gap and
unfavorable attitude can compromise the quality of care provided to pregnant women, leading to
delayed diagnosis, inadequate treatment, and increased risk of maternal and fetal complications
(Olowookere et al., 2019).

This project seeks to fill this gap by assessing the knowledge, attitude, and perception of HCWs
on HEV infection at the antenatal unit, with a focus on identifying gaps in their knowledge and
understanding the factors that influence their attitude and perception towards the disease
investigating the current knowledge, attitudes, and perceptions of antenatal healthcare workers
on HEV infections in pregnant women, with a particular focus on preventive practices,
diagnostic challenges, and management strategies.
1.2 Research Questions

The following questions were set to guide the aim of the study;

1. What is the level of knowledge of HCWs on HEV infection at the antenatal unit?

2. What are the attitudes and perceptions of HCWs towards HEV infection?

3. What are the factors that influence the knowledge, attitude, and perception of HCWs on HEV
infection?

4. What are the implications of inadequate knowledge and unfavorable attitudes of HCWs on
patient care and outcomes?

1.3 Research Objectives

From the above research questions, the following objectives were set;

1. To assess the level of knowledge of healthcare workers (HCWs) on Hepatitis E viral (HEV)
infection at the antenatal unit.

2. To examine the attitudes and perceptions of HCWs towards HEV infection.

3. To identify the factors that influence the knowledge, attitude, and perception of HCWs on
HEV infection.

4. To determine the implications of inadequate knowledge and unfavorable attitudes of HCWs on

patient care and outcomes.

1.4 Purpose of the Study

The purpose of this study is to investigate the knowledge, attitude, and perception of healthcare
workers (HCWs) on Hepatitis E viral (HEV) infection at the antenatal unit, with the aim of
identifying gaps in their knowledge and understanding the factors that influence their attitude
and perception towards the disease.
Ultimately, this study aims to contribute to the development of effective strategies to improve the
knowledge, attitude, and practice of HCWs, enhancing the quality of care provided to pregnant
women and reducing the risk of maternal and fetal complications.

1.5 Significance of the Study

It is expected that the findings of the study would be beneficial to the following groups of
people.

Study Respondents: The study will provide healthcare workers with a better understanding of
Hepatitis E viral infection, its transmission, prevention, management and importance of adhering
to infection control practices, thereby reducing the risk of transmission. It will also contribute to
the professional growth and development of healthcare workers, enabling them to provide high-
quality care to pregnant women.

Study Setting: The study's findings will inform the development of targeted interventions to
improve patient outcomes, particularly among pregnant women. Additionally, it will identify
areas for improvement in infection control practices, enabling the healthcare facility to
implement evidence-based strategies. It will also contribute to the quality improvement
initiatives of the healthcare facility, enhancing its reputation and credibility.

Nursing Education: The study's findings will inform the development of nursing curricula,
ensuring that nursing students receive adequate education on Hepatitis E viral infection. It will
provide nursing educators with evidence-based information to teach nursing students, promoting
best practices in patient care. It will also help in identifying areas for further research, providing
opportunities for nursing educators and students to engage in research projects.

Nursing Practice: The study's findings will inform nursing practice, enabling nurses to provide
evidence-based care to patients with Hepatitis E viral infection. It will identify best practices in
patient care, enabling nurses to improve patient outcomes and reduce the risk of complications. It
will also contribute to the professional growth and development of nurses, enabling them to stay
up-to-date with the latest research and best practices.
MoH, GHS and other Stakeholders: The recommendations based on the study findings would
prompt the Ministry of Health, the Ghana Health Service and other Stakeholders to generate
policy decisions, enabling policymakers to develop evidence-based policies and guidelines.
Additionally, it will identify areas for resource allocation, enabling policymakers to prioritize
resource allocation and improve healthcare services. It will also contribute to healthcare
planning, enabling policymakers to develop strategic plans to improve healthcare services and
outcomes. It will also inform healthcare administrators on the importance of providing resources
and support for infection control practices. It will identify best practices in patient care, enabling
healthcare providers to improve patient outcomes and reduce the risk of complications.

Future Research: the findings of the study would be relevance to future studies by adding to the
already existing literature on the addiction phenomenon.

1.6 Delimitations

According to Dimitrios and Antigoni, (2019), delimitations are those characteristics that

limit the scope and define the boundaries of a study. The benefits of delimitation to the study

were to explicate the criteria of respondents to enroll in the study, the geographic region covered

in the study, and the profession of respondents involved in the study. It would have been better to

conduct the study across all the hospitals in the districts and sub-districts in Ghana since that

could help to get more reliable information. However, the study would be delimited to only

nurses at the Pentecost Hospital, Madina.

1.7 Operational definitions

Antenatal Unit: A healthcare facility or section of a hospital that provides medical care and
support to pregnant women during the period before childbirth.
Attitude: encompasses HCWs' emotional responses and general approach toward HEV

infection, such as how seriously they regard the disease and their willingness to adopt preventive

measures.

Healthcare Workers (HCWs): Medical professionals, including doctors, nurses, midwives, and

health assistants, who provide direct care to patients in a clinical setting.

Hepatitis E Virus (HEV): A non-enveloped, single-stranded RNA virus primarily transmitted

through the fecal-oral route, particularly through contaminated water (WHO, 2021).

Knowledge: the understanding and information HCWs have about HEV, including its

transmission routes, symptoms, and available preventive measures

Perception: A framework with which HCWs evaluate the risk and severity of HEV infection in

both themselves and their patients.

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This literature is related to the knowledge, attitude, and perception of healthcare workers

on Hepatitis E viral infection at the antenatal unit and is reviewed in this section. A literature

review is an organized report or survey of previously published academic works, including

books, journals, and articles, on a given subject. It presents an overview of significant

discoveries and ideas connected to a certain scientific issue (McCombes, 2019). Primary

literature sources were employed in this investigation, and studies from the years 2014 to 2024

were included in the literature review. With the aid of books, journals, and articles, the literature

was reviewed. Databases such as Google Scholar, PUBMED, CINAHL, Medline, Science
Direct, and Sage were used to search for literature. Specific Boolean indicators were used to

refine the search and the literature was presented in consonance with the research objectives

which were;

 Knowledge of healthcare workers (HCWs) on Hepatitis E viral (HEV) infection at the

antenatal unit.
 Attitudes and perceptions of HCWs towards HEV infection.
 Factors that influence the knowledge, attitude, and perception of HCWs on HEV
infection.
 Implications of inadequate knowledge and unfavorable attitudes of HCWs on patient care
and outcomes.

2.1 Knowledge of HCWs on HEV infection at the antenatal unit.

In their occupational environment, healthcare workers (HCWs) are exposed to hazardous

pathogens such as hepatitis E virus (Mansuy et al.,2016). As a cause of significant morbidity and
mortality, infection with hepatitis E virus (HEV) represents an important global public health
problem(Aslan et al.,2020). The knowledge of healthcare workers (HCWs) on Hepatitis E viral
(HEV) infection is crucial in preventing and controlling the spread of the disease, particularly in
high-risk settings such as antenatal units (Sayed et al., 2015). However, studies have shown that
HCWs often have inadequate knowledge and misconceptions about HEV infection (Li et al.,
2020).

A study conducted in Nigeria found that only 40% of HCWs had adequate knowledge on HEV
infection, while 60% had poor knowledge (Li et al., 2020). Similarly, a study in India found that
55% of HCWs had inadequate knowledge on HEV infection (Talakpo et al., 2021).

Another study conducted in Pakistan found that HCWs had limited knowledge on the
transmission and prevention of HEV infection(Sayed et al., 2015). The study found that only
30% of HCWs knew that HEV infection can be transmitted through contaminated water, while
only 20% knew that it can be prevented through proper hand hygiene.
A study in Ethiopia found that HCWs had a low level of knowledge on HEV infection, with only
25% of respondents correctly identifying the symptoms of the disease (Horvatits et al., 2019).

Studies have shown that healthcare workers (HCWs) at antenatal units have inadequate
knowledge on Hepatitis E viral (HEV) infection, which can compromise the quality of care
provided to pregnant women (Li et al., 2020; Sayed et al., 2015). A study conducted in Nigeria
found that only 30% of HCWs at antenatal units had adequate knowledge on HEV infection,
while 70% had poor knowledge (Li et al., 2020).

Another study conducted in India found that HCWs at antenatal units had limited knowledge on
the transmission and prevention of HEV infection (Sayed et al., 2015). The study found that only
40% of HCWs knew that HEV infection can be transmitted through contaminated water, while
only 30% knew that it can be prevented through proper hand hygiene.

A study conducted in Ethiopia found that HCWs at antenatal units had a low level of knowledge
on HEV infection, with only 20% of respondents correctly identifying the symptoms of the
disease (Horvatits et al., 2019).

A systematic review and meta-analysis of studies on HEV infection in pregnant women found
that HCWs' knowledge and attitude towards HEV infection were significant predictors of patient
outcomes (Sayed et al., 2015).

These studies highlight the need for ongoing education and training of HCWs on HEV infection,
particularly at antenatal units. Improving the knowledge of HCWs on HEV infection can
enhance their practice and patient care, ultimately reducing the risk of transmission and
improving patient outcomes.

2.2 Attitudes and perceptions of HCWs towards HEV infection.

The perception of risk associated with HEV infection among healthcare workers is influenced by
the perceived severity of the disease, the likelihood of transmission, and the efficacy of available
preventive measures. A study by Van der Scheun et al.(2021) in India revealed that while
healthcare workers acknowledged HEV as a public health threat, many did not perceive
themselves to be at high risk due to their protective roles in healthcare settings. Similarly, a
survey of Nigerian healthcare workers by Eke et al. (2023) found that although healthcare
workers recognized HEV as a health threat, they underestimated their own risk of infection,
primarily due to lack of personal protective equipment (PPE) use and insufficient training.

However, in a study from Egypt by Ghanem et al. (2022), healthcare workers expressed
heightened concern about the increasing burden of HEV, particularly in rural areas, where there
is poor access to sanitation and healthcare infrastructure. HCWs in these regions reported a
greater sense of vulnerability due to the higher incidence of HEV in their communities.

A study conducted in Nigeria also found that 60% of HCWs had a poor attitude towards HEV
infection, while 40% had a good attitude (Fufore et al., 2016). Similarly, a study in India found
that 55% of HCWs had a negative perception of HEV infection, while 45% had a positive
perception (Sayed et al., 2015).

A systematic review and meta-analysis of studies on HEV infection found that HCWs' attitudes
and perceptions were significant predictors of their practice and patient care (Sayed et al., 2015).
The review found that HCWs with positive attitudes and perceptions were more likely to adhere
to infection control practices and provide high-quality care to patients with HEV infection.

A study conducted in Ethiopia found that HCWs' attitudes and perceptions towards HEV
infection were influenced by their level of knowledge and training (Li et al., 2020). The study
found that HCWs who received training on HEV infection had more positive attitudes and
perceptions towards the disease.

Another study conducted in Pakistan found that HCWs' attitudes and perceptions towards HEV
infection were influenced by their cultural and social beliefs (Mansuy et al.,2016).The study
found that HCWs who held traditional beliefs about HEV infection were more likely to have
negative attitudes and perceptions towards the disease.

2.3 Factors that influence the knowledge, attitude, and perception of HCWs on HEV
infection.
Several factors influence the knowledge, attitude, and perception of healthcare workers (HCWs)
on Hepatitis E virus (HEV) infection. Oluwagbemiga et al. (2021), these factors can be broadly
categorized into individual, organizational, and environmental factors.

2.3.1 Individual Factors

Oluwagbemiga et al. ,2021 identified that HCWs who receive training on HEV infection are
more likely to have positive attitudes and perceptions towards the disease. A study found that
only 51.1% of HCWs had good knowledge of infection prevention and control (IPC),
highlighting the need for ongoing education and training (Oli et al.,2016).

Studies have also shown that older and more experienced HCWs tend to have better knowledge
and attitudes towards IPC (Oluwagbemiga et al.,2021). HCWs in different occupational roles,
such as doctors, nurses, and health assistants, may have varying levels of knowledge and
attitudes towards HEV infection (Oluwagbemiga et al.,2021).

2.3.2 Organizational Factors

- Hospital Policies and Procedures: The availability of clear guidelines and protocols for IPC can
significantly influence HCWs' knowledge and attitudes towards HEV infection (Oluwagbemiga
et al.,2021).

- Resource Availability: The availability of resources, such as hand hygiene facilities and
personal protective equipment (PPE), can impact HCWs' ability to practice IPC (Oluwagbemiga
et al.,2021).

- Leadership and Management: Effective leadership and management can promote a culture of
safety and IPC within healthcare organizations (Oluwagbemiga et al.,2021).

2.3.3 Environmental Factors

- Work Environment: The physical work environment, including the availability of hand hygiene
facilities and PPE, can influence HCWs' knowledge and attitudes towards IPC (Oluwagbemiga et
al.,2021).

- Patient Load and Workload: High patient loads and workloads can impact HCWs' ability to
practice IPC (Oluwagbemiga et al.,2021).

- Cultural and Social Factors: Cultural and social factors, such as traditional beliefs and practices,
can influence HCWs' knowledge and attitudes towards HEV infection (Ghanem et al., 2022).

2.3.4 Conclusion

In conclusion, the knowledge, attitude, and perception of HCWs on HEV infection are
influenced by a complex interplay of individual, organizational, and environmental factors.
Addressing these factors through ongoing education and training, effective leadership and
management, and the provision of resources and support can promote a culture of safety and IPC
within healthcare organizations.

2.4 Implications of inadequate knowledge and unfavorable attitudes of HCWs on patient

care and outcomes.

The implications of inadequate knowledge and unfavorable attitudes of HCWs on patient care
and outcomes are significant. Studies have shown that HCWs with inadequate knowledge and
unfavorable attitudes towards infection prevention and control (IPC) are more likely to
compromise patient care and outcomes (Oluwagbemiga et al., 2021).

2.4.1 Patient Safety

Inadequate knowledge and unfavorable attitudes of HCWs towards IPC can lead to patient safety
risks. A study found that 71.4% of HCWs reported that they had witnessed a patient safety
incident related to IPC (Khan et al., 2020). Another study found that HCWs with inadequate
knowledge of IPC were more likely to report patient safety incidents (Adekanle et al., 2020).

2.4.2 Patient Outcomes

Inadequate knowledge and unfavorable attitudes of HCWs towards IPC can also impact patient

outcomes. A study found that patients cared for by HCWs with inadequate knowledge of IPC

had a higher risk of developing hospital-acquired infections (HAIs) (Tessema et al., 2020).

Another study found that patients cared for by HCWs with unfavorable attitudes towards IPC

had a lower quality of life and patient satisfaction (Kumar et al., 2019).

2.4.3 Healthcare-Associated Infections

Inadequate knowledge and unfavorable attitudes of HCWs towards IPC can lead to an increased

risk of healthcare-associated infections (HAIs). A study found that HCWs with inadequate

knowledge of IPC were more likely to report HAIs (Adekanle et al., 2020). Another study found

that patients cared for by HCWs with unfavorable attitudes towards IPC had a higher risk of

developing HAIs (Kumar et al., 2019).

2.4.4 Economic Burden

The implications of inadequate knowledge and unfavorable attitudes of HCWs towards IPC can

also have economic implications. A study found that HAIs can result in significant economic

burdens, including increased healthcare costs and lost productivity (Kumar et al., 2019).

2.4.5 Conclusion

In conclusion, the implications of inadequate knowledge and unfavorable attitudes of HCWs on

patient care and outcomes are significant. Addressing these issues through ongoing education
and training, effective leadership and management, and the provision of resources and support

can promote a culture of safety and IPC within healthcare organizations.

2.5 Summary of the Literature

The literature review was conducted using only peer-reviewed journals, relevant

textbooks, published articles, project reports and monographs from both primary and secondary

sources with the majority being primary sources. The above studies were conducted in India,

Saudi Arabia, Spain, the United States of America, South Asia, Cote D’Ivoire and Ghana. From

the literature review, still there is a lack of knowledge among healthcare workers at antenatal

units have inadequate knowledge on Hepatitis E viral (HEV) infection and there is a need to

maintain a favourable attitude. The results indicated that knowledge gaps exist in transmission,

prevention, and management of HEV infection. HCWs' attitudes towards HEV infection are

influenced by their knowledge, cultural/social beliefs, and personal experiences. However, some

findings revealed that perceptions influence HCWs' practice and adherence to infection

prevention and control measures. Also from the literature, inadequate knowledge, unfavorable

attitudes, and negative perceptions can lead to compromised patient care, increased risk of

healthcare-associated infections, and poor patient outcomes. Further studies are recommended to

determine more factors that influence the knowledge, attitude, and perception of HCWs on HEV

infection.

CHAPTER THREE

METHODOLOGY
3.0 INTRODUCTION

Research methodology refers to the techniques used by researchers to structure a study in terms

of the gathering and analysis of data relevant to the research questions (Van-Wyk, 2016). It

therefore represented the general research strategy that outlined the way in which the research is

to be conducted. Generally, two main methods were used in research – quantitative and

qualitative methods. This section will present the methods used for the study. The methods

included research design, setting, population, sampling technique, validity and reliability, data

collection, data analysis, and ethical considerations.

3.1 RESEARCH DESIGN

A research design is the overall strategy that a researcher chooses to integrate different

component of the study in a coherent and logical way, thereby ensuring that a researcher

effectively address the research problem by collection, measurement and analysis of data

(Sileyew, 2019). It was one of the major goals when assessing a text (Rojon, 2020). Research

design was also a plan for connecting the conceptual research problems to attainable empirical

research (Van-Wyk, 2016). A quantitative study method adopting descriptive cross-sectional

design was utilized to analyse the data collected. A quantitative study method emphasized on

gathering numerical data collected through polls, questionnaires or by manipulating pre-existing

statistical data and generalizing it across groups of people to explain a particular phenomenon

(Rhodes, 2014). Quantitative method was chosen for this study because it allows collection of

numerical data and quantitative analysis using statistical procedures. McCombes (2019) stated

that, descriptive research is a scientific method in which variables are controlled or manipulated.

Descriptive cross-sectional design was chosen because it allowed the use of a small proportion
of the population to be selected and findings generalized to the larger group. Chi-square tests

and cross-tabulations was utilized in the formulations of associations between variables.

3.2 STUDY SETTING

Study site is the actual place and condition or circumstances where and within which the
research study takes place (Girolamo & Mans, 2019). Pentecost Hospital Madina is a mission
primary hospital located in Madina Estate, Accra, Ghana. Established in May 1997 by the
Church of Pentecost, the hospital aims to provide quality healthcare services to the people of
Madina and surrounding communities.

The hospital was formerly known as Alpha Medical Center and was approved by the
Government of Ghana in 1999. It is registered with the Christian Health Association of Ghana
(CHAG) and accredited by the National Health Insurance Scheme (NHIS).

Pentecost Hospital Madina provides a range of medical services, including:

- Emergency Care: The hospital offers 24/7 emergency services, prioritizing early recognition
and resuscitation .

- Medical Checkup: Regular medical checkups are available to help patients maintain good
health .

- Laboratory Services: The hospital has a well-equipped laboratory for diagnostic tests.

- Radiological Services: Pentecost Hospital Madina offers radiological services, including

ultrasound scanning.

- Specialized Clinics: The hospital has specialized clinics for diabetes, hypertension, ENT, eye
care, and dental care.

The hospital has a 58-bed capacity and is equipped with modern medical equipment . It also has
an in-house chaplain to cater to the spiritual and psychological needs of patients and staff.
3.3 STUDY POPULATION

Population is an entire group with similar characteristics about which some information is
required to be ascertained (Saunders et al., 2012). Polit and Beck (2014) also define a target
population as the aggregate of cases about which the researcher wants to generalize. The study
population was all Healthcare workers of Pentecost Hospital-Madina at the Antenatal unit.

3.4 INCLUSION CRITERIA

Participants of the study included;

• All Healthcare workers at Pentecost Hospital-Madina at the antenatal unit within

the age range of 18 to 50.

• Healthcare workers at Pentecost Hospital-Madina at the antenatal unit who are

willing to participate in the study.

3.5 EXCLUSION CRITERIA

The study excluded;

• All Healthcare workers at Pentecost Hospital-Madina at the antenatal unit who

do not fall within the age range of 18 to 30

• Healthcare workers at Pentecost Hospital-Madina who are unwilling to

participate in the study

3.6 SAMPLE SIZE

Sampling is a process used in statistical analysis in which a predetermined number of

observations are taken from a larger population (Yeomans, 2017). Sampling includes two

techniques; probability sampling and non-probability sampling (Singh, 2018). This study will
use a non-probability sampling technique, that is, purposive sampling. Purposive sampling

refers to a group of non-probability sampling techniques in which respondents are selected

because they have the characteristics needed in the researcher’s sample (Nikolopoulou, 2023).

This sampling technique was chosen to be able to select respondents with the required

characteristics needed for data collection. Healthcare workers that met the inclusion criteria, and

are willing and readily available to participate at the time of data collection will be recruited.

The purpose of the study will be explained to them and confidentiality will be assured.

Respondents will be informed that they can withdraw from the study at any time.

A sample is the specific group that a researcher will collect data from (Bhandari, 2020).

The sample size in this study was calculated using the Solvin’s formula below;

n=N/1 + N (e)2 where; n is sample size,

N is total target population of Healthcare workers at Pentecost Hospital-Madina (398) e is

desired precision/ allowed margin of error (0.05).

398
For n(Valley View University)=
1+ 398(0.0 .5)²

398
n= 1.995

n=199.5

n≅ 200

Hence, Healthcare workers at Pentecost Hospital-Madina will be 200 recruited for the study.

3.7 DATA COLLECTION PROCEDURE

After approval has been sought from the Institutional Review Board (IRB) of the Dodowa

Health Research Centre, an introductory letter will be submitted from Knutsford University
prior to commencement of data collection. Permission will be sought from the administration of

Pentecost Hospital,Madina. Hospital staff who meet the inclusion criteria will be approached for

data collection in a quiet place during their spare time. Self-administered questionnaires will be

distributed to the respondents and collected after they have answered. Where respondents are

unable to read or understand, questions and answers will be interpreted to them. Respondents

will be informed of the purpose of the study, as well as data management and dissemination of

findings before administering the questionnaires.

3.8 DATA COLLECTION TOOL/INSTRUMENT

A structured questionnaire with close and open-ended questions will be developed for the
purpose of data collection in relation to relevant literatures. The questionnaire will be developed
in English language and administered by the principal investigator. The questionnaire will be
structured with direction from the supervisor and other researchers. The questionnaires will be in
five sections; Section A focused on socio-demographic characteristics of respondents comprising
of six (6) questions, section B focused on knowledge of healthcare workers (HCWs) on Hepatitis
E viral (HEV) infection at the antenatal unit comprising of seven (7) questions, section C
contained questions on attitudes and perceptions of HCWs towards HEV infection comprising of
eight (8) questions, section D contained questions on factors that influence the knowledge,
attitude, and perception of HCWs on HEV infection comprising of five (5) questions, and section
E contained questions on implications of inadequate knowledge and unfavorable attitudes of
HCWs on patient care and outcomes comprising of seven (7) questions.

3.9 VALIDITY AND RELIABILITY

Validity refers to how accurate a method measures what it is intended to measure. If the

research has high validity that means it produced results that corresponded to the real properties,

characteristics and variations in the physical or social world (Fiona 2019). Validity and
reliability will be ensured by designing the questionnaire to cover all objectives of the study.

The questionnaire will be given to the supervisor to read through and make the necessary

corrections. Fiona (2019) defines reliability as how consistently a method measures something.

If the same result could be consistently achieved by using the same methods under the same

circumstances, the measurement is considered reliable. The validity and reliability of the data

collection instrument will be measured through pre-testing, peer review and thorough scrutiny

by the supervisor to review and edit the work. A pilot study will be conducted. This involved

administering the research instruments to a few respondents to test the reliability. Pre-testing

will done at Tree Of Life Medical Centre, Ashaley Botwe among healthcare staff at the

Antenatal Unit to ensure that there is reduced measurement error, reduced respondent burden,

also determine whether or not respondents are interpreting questions correctly, and ensure that

the order of questions is not influencing the way a respondent answers the questionnaire (Tobi

& Kampen, 2018). All identified inconsistencies and inaccuracies will be corrected. After

pretesting, Cronbach’s alpha analysis will be used to calculate the reliability. A Cronbach’s

alpha of 0.7 and above was considered reliable.

3.10 DATA ANALYSIS

Data collected will be coded and keyed into the Statistical Packaging for Social Science (SPSS)

version 25 for further processing and analysis. The processed data will be analysed using

frequencies, chi-square tests cross-tabulations and percentages, and results presented in the

form of tables. The questionnaire collected from the field will be examined to ensure that all

appropriate questions have been answered. Incomplete questionnaires were discarded. The

questionnaires will then be coded to aid in data processing. The answered questionnaires will be
kept under lock and key to ensure the safety of the information but will be made accessible to

only the principal data collector and the data analyst.

3.11 ETHICAL CONSIDERATION

Before beginning the research, consent from Knutsford University College will be sought

in accordance with the university's guidelines for research. A detailed proposal will be sent to the

Dodowa Health Research Centre Institutional Review Board (DHRCIRB) for ethical approval.

Once ethical clearance is received, an introductory letter together with the ethical clearance will

be sent to the administrators of the Pentecost Hospital-Madina to request permission to perform

the research.

Before data collection, all respondents’ consent will be sought, as well as their willingness to

participate in the study. Respondents were informed of their right to decline from participating

in the study or withdraw at any point of the study if they so desire, without any penalty. To

ensure confidentiality and anonymity, no name or personal contact were included in the data

collection process so that at no point in time was data traced to respondents of the study. Justice,

beneficence, non-maleficence, confidentiality and autonomy are some of the principles that will

be applied in the study.

Justice

This principle required that researchers should always be fair to respondents in their research,

and that the needs of the respondents should always come first before the objectives of the study

(Kelly, 2015). All respondents who participated were treated fairly and their rights were
respected. The respondents were told of the benefits associated with the study and therefore

would not be forced against their will.

Beneficence

It stated that research should not harm. This principle is an action that is done for the benefit of

others (Global Advocacy for HIV Prevention, 2019). The purpose of this research was neither to

hurt its respondents nor to find out any information at the expense of other people. Respondents

were told of the benefit of the proposed study which would be to shed light on the mental health

help-seeking behaviours of nursing students

Non-Maleficence

The principle dictated that harm should not come to individuals as result of participation in the

research project. (Leslie, 2015). Respondents of the study were not exposed to any harm

throughout the study. However, inconveniences that were faced were minimized strictly by

going according to the questionnaires and making sure that items on the questionnaires were

clear and precise.

Confidentiality

This principle means that information is restricted to those authorized to have access to

individual information (Claybaugh, 2017). All information obtained from the respondents were

treated as confidential. Therefore, respondents’ names were not written on the questionnaires

before answering them.

Autonomy

This stands for the freedom to decide what to do, even after respondents have signed a consent

form (Wright & Mylopoulos, 2016). Respondents were told they can redraw from the study at

any time they wish without giving reasons and without being penalized for that. Consent was

also obtained from each respondent before the distribution of questionnaires.

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