Study setting, design, and period
A hospital-based cross-sectional survey was conducted from 3 to 28 August 2020 in Wollega zones, Western Ethiopia. The main town of Western Ethiopia is located in the Western part of Oromia National Regional State, 330 km away from Ethiopia’s capital city, Addis Ababa. There are 13 public hospitals in the study area. Among these hospitals there are one specialized (Nekemte Hospital) and one referral hospital (Wollega University Referral Hospital), both located in Nekemte town. In this study, seven public hospitals were included: Nedjo, Mendi, Arjo Jimma, Nekemte specialized, Sire, Shambu, and Guduru. These hospitals were involved in the study because they were identified as COVID-19 referral centers.
Study population is formed by all the HCWs working in the above-mentioned seven public hospitals located in Western Ethiopia.
Sample size determination and sampling procedure
The required sample size was determined by using a single population proportion formula assuming the proportion was 50% (p = 0.5) to have a larger sample size. By using a 5% margin of error, we obtained a sample size of 384. Adding a non-response rate of 10%, the final sample became 422.
The total sample was allocated to the selected seven hospitals in proportion to the number of their HCWs. Then, a simple random sampling technique was adopted to draw the study participants after they were proportionally allocated to the selected hospitals, on the base of the staff list obtained from their respective hospitals.
Data collection tool and procedures
An English language version of a pretested and structured self-administered questionnaire was employed to collect data from the participants. The study tool was adopted from previously published articles and CDC guidelines [15,16,17].
The self-administered questionnaire used for data collection consists of three parts (Additional file 1). The first one includes demographic and professional characteristics of HCWs (independent variables) such as sex, age, marital status, having child or old family, hospital level, professional type, level of education, work experience, past attendance of training about infection prevention/COVID-19, reading of materials on COVID-19, and whether HCWs’ got support from their hospital management.
The second part of the data collection tool contains 14 items aimed to test HCWs’ compliance with COVID-19 prevention. The reliability of these items had the Cronbach alpha of 0.85. Three experienced research experts, academic health science staff, and hospital staff checked the validity of these items. They were measured on a 3-point Likert scale (1 = seldom, 2 = sometimes, and 3 = always). The final answers were coded ‘1’ for the always answers, and ‘0’ for the sometimes and rarely answers. The score ranges from 0 (the minimum) to 14 (the maximum). HCWs who scored ≥75% were grouped as “good compliance”, and those who scored < 75% were grouped as “poor compliance”. These categories were in line with previously published works [15, 18].
The third part of the questionnaire aimed to identify the perceived barriers to COVID-19 prevention, assessed by a five Likert Scale which assigned ‘1’ for strongly disagree up to ‘5’ for strongly agree.
Two data collection facilitators were recruited for each hospital. Training about COVID-19 prevention and control was given to data facilitators. The packets of questionnaires were distributed to the seven public hospitals by the research team. The study participants were given an oral explanation on the purpose and procedures of the study, the confidentiality of data, a guarantee of voluntary and anonymous participation, and that they could withdraw from the study at any time without fear or prejudice. All HCWs who gave consent were asked to fill in the questionnaire and return it to the data facilitators after compilation. Based on the pretest result from 5% of the estimated sample size at Bako General Hospital located in West Shoa Zone, modifications have been made to avoid ambiguity in the questionnaire.
Data processing and analysis
Data were entered into EPI data version 3.1 and analyzed by Statistical Package for Social Sciences (SPSS) version 20.0. The descriptive statistics were summarized using tables, figures, and texts, while continuous variables were presented by mean and the standard deviation. To assess the association between independent variables and outcome, we employed binary logistic regression. Odds ratio (OR) with 95% CI was used to determine the strength of association, and p-value < 0.05 for statistical significance of compliance with COVID-19 prevention.