Assessing Knowledge, Attitude and Practice of Infection Prevention/control and Their Determinents Among Student Nurses on Clinicl Practicum in Ashanti Region, Ghana

Assessing Knowledge, Attitude and Practice of Infection Prevention/control and Their Determinents Among Student Nurses on Clinicl Practicum in Ashanti Region, Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing Knowledge, Attitude and Practice of Infection Prevention/control and Their Determinents Among Student Nurses on Clinicl Practicum in Ashanti Region, Ghana ABU TIA DIMONGSO, Bright Owusu-Afriyie, BURHANATU Hafiz, Felix Aayel, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8052359/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Healthcare-associated infections (HAIs) remain a major global challenge, particularly in resource-limited settings. Effective infection prevention and control (IPC) relies on healthcare workers’ knowledge, attitudes, and practices (KAP). This study assessed KAP regarding IPC among student nurses in the Ashanti Region, Ghana. Methods A descriptive cross-sectional study was conducted among 964 student nurses from health institutions across Ashanti region, Ghana. Data were collected using a structured, pretested questionnaire covering demographics and KAP domains. Descriptive statistics summarized variables, and Spearman's ranked examined associations between sociodemographic factors and KAP scores. Results Overall, 88.9% of participants demonstrated good knowledge, 97.6% exhibited positive attitudes, and 91.9% reported good practices regarding IPC. Knowledge was associated with levels in school (F [5, 958] = 3.39, p = .005), explaining 1.7% of the variance, while attitude was associated with practice was associated with gender (p = 0.031), and year of study (p = 0.001). Attitudes did not significantly differ by demographic characteristics. Attitude was associated with previous work experience and higher academic levels. Knowledge was associated with high level in school only and practice was associated with age, school level and gender. Conclusions Student nurses in Ashanti Region generally possess good IPC knowledge and practices, although attitudes toward IPC remain suboptimal. Strengthening attitude-oriented interventions alongside continuous training may further enhance IPC adherence. BACKGROUND Nosocomial infections, also referred to as healthcare-associated infections (HAIs), are defined as infections that develop in patients during their stay in a healthcare facility and were not present or incubating at the time of admission ( 1 ). These infections typically occur 48 hours or more after hospital admission or within 30 days of a medical procedure, such as surgery. They are a significant global public health challenge, affecting patient outcomes and the healthcare system. The most common types of nosocomial infections include surgical site infections, urinary tract infections (UTIs), bloodstream infections (BSIs), and ventilator-associated pneumonia. The global prevalence of nosocomial infections varies widely, with high-income countries reporting rates of approximately 7%, while low- and middle-income countries (LMICs) report rates as high as 15% (WHO, 2020). Nosocomial infections are primarily caused by bacterial, viral, or fungal pathogens, with drug-resistant organisms posing significant challenges. Staphylococcus aureus and Escherichia coli are common pathogens that often exhibit antimicrobial resistance. Key risk factors for nosocomial infections include prolonged hospitalization, invasive procedures, immunocompromised conditions, and inadequate infection prevention practices. Inadequate infection control practices are responsible for most HAIs. Poor hand hygiene and improper sterilisations of instruments play a major role in acquiring HAIs. Higher rates of these infections could be prevented with strict adherence to infection prevention and control protocols. The use of invasive medical devices in the hospital is a key risk factor for nosocomial infection. The procedure for passing a urethral catheter involves rigorous hand washing and the use of sterilized gloves. HAIs prolong hospital stay, the need for additional diagnostic tests, and the need for specialized treatment. All of this leads to extra costs to the hospital and the patient. The United States alone estimates $ 9.8 billion annually for the cost of treating infectious diseases. Poor countries and middle-income countries will spend more money on HAIs, ignoring other critical areas in health. Beyond financial costs, HAIs contribute to increased morbidity and mortality, resulting in prolonged recovery times and diminished quality of life. Healthcare workers with insufficient knowledge of IPC measures are less likely to adhere to standard protocols ( 2 , 3 ). Healthcare workers who perceive IPC protocols as burdensome or unnecessary are less likely to follow them consistently ( 3 ). Inadequate knowledge and positive attitudes, poor implementation of IPC practices contribute significantly to the high prevalence of nosocomial infections ( 3 , 4 ). Inadequate hand hygiene, improper disposal of medical waste, and failure to clean and sterilize medical equipment are associated with increased nosocomial infection ( 5 , 6 ). Low compliance with hand hygiene practices has been identified as a major cause of HAIs, with studies estimating that effective hand hygiene alone could reduce the incidence of nosocomial infections by up to 50% ( 7 ). Several studies have been conducted to test the knowledge, attitude and practice of infection prevention and control among healthcare workers and other disciplines, however, little is known about student nurses who are aspiring to become registered nurses in the future, knowledge, practice and attitude towards infection prevention and control in the Ashanti region of Ghana ( 8 ). This research, therefore, seeks to investigate the knowledge, attitude, and practice towards infection prevention and control and the influencing factors of these among student nurses carrying out their clinical practicum in the Ashanti Region of Ghana. Methodology Ashanti Region is one of the sixteen ( 16 ) administrative regions in Ghana, located in the middle belt of the country and shares boundaries with Bono, Ahafo, and Bono East to the north, Eastern Region to the south-east, Central Region to the south, and Western North Region to the south-west. The region lies between longitudes 0.150°W and 2.250°W, and latitudes 5.500°N and 7.460°N. It occupies a total land surface area of 24,389 square kilometres, constituting approximately 10.2% total land area of Ghana ( 9 ). The region is the second most populous region in Ghana, with a projected population of approximately 5.43 million people (2021 estimates) ( 10 ). It has 1,654 health facilities, comprising 1,120 Community-Based Health Planning and Services (CHPS) compounds, 165 health centres, 29 clinics, 71 maternity homes, 5 polyclinics, 26 district hospitals, 125 other hospitals, one regional hospital, one university hospital, and one teaching hospital located in Kumasi. Among the 170 facilities operated by GHS, 71, mission organizations, 281 are by private operators, and 8 are by quasi-government entities. Preceptors at the health institutions are responsible for the supervision of student nurses on practicum on the wards and liaise with training institutions. The target population comprised all student nurses who were on clinical practicum in the Ashanti Region during the data-collection period and who had completed at least a short rotation on the wards where infection prevention and control (IPC) procedures are routinely practiced. The sampling frame was constructed from lists of students on placement obtained via the Regional Coordinator for Clinical Preceptorship and the network of hospital preceptors. Students were eligible if they were currently on a clinical practicum, enrolled in a recognised nursing or midwifery training programme, and consented to participate. Students not on placement during the study window or who declined consent were excluded. The minimum required sample size was estimated with Cochran’s formula for cross-sectional surveys. At a 95% confidence level and an assumed proportion for adequate KAP (knowledge, attitude, and practice) of IPC, with allowance for non-response, the sample size was calculated. This yielded the target sample size against which recruitment progress was monitored. We used district hospitals, the regional hospital, and the teaching hospital. Private hospitals, Community-Based Health Planning and Services (CHPS) compounds, and selected health centres were excluded from the sampling frame. Hospital preceptors shared the study information sheet and the link to the self-administered Google Form via WhatsApp to all eligible students under their supervision. Data collection targeted nursing students who were nearing the completion of their full clinical practicum at each facility. The data collection period commenced in December 2024 and concluded in August 2025. The form was designed to allow a single submission. The questionnaire comprised four sections: (A) demographics (e.g., facility, age, level of study), (B) IPC knowledge (17 yes/no items), (C) attitudes toward IPC (five-point Likert scale from “strongly agree” to “strongly disagree”), and (D) IPC practices (five-point Likert scale from “always” to “never”). Items were adapted from CDC/WHO-aligned KAP tools and prior studies ( 11 – 14 ), then revised to reflect the Ghanaian clinical context. The tool was piloted among students outside the main sample; items with comprehension or reliability issues were rephrased to meet acceptable internal consistency (Cronbach’s alpha) before field deployment. Permission to conduct the study was obtained through the Principal of the Nursing and Midwifery Training College, Tepa, and the Ghana Health Service. Participation was voluntary; the first page of the Google Form included the study information, eligibility criteria, and an electronic consent statement. Results Table 1 Descriptive Statistics for Participant Characteristics and Study Variables (N = 964) Variable N % M SD Variance Age (years) 964 — 24 4.01 — Gender — 0.39 0.15 Male 177 18 Female 787 82 Profession — 1.59 2.513 RM 190 20 RMN 120 12 RGN 358 37 RNAC 236 25 CHN 48 5 Others 12 1.2 Working experience — 0.36 0.132 No 813 84 Yes 151 16 Level in school — 0.79 0.616 Level 100 532 55 Level 200 281 29 Level 300 135 14 Level 400 16 1.7 Knowledge — 0.31 0.098 Poor 106 11 Good 857 89 Attitude — 0.15 0.023 Negative 23 2.4 Positive 941 98 Practice — 0.27 0.074 Bad 78 8.1 Good 886 92 Source: field data in August, 2025 (dup: abstract ?) Note M = Mean; Mdn = Median; SD = Standard deviation; SE = Standard error. A total of 964 participants took part in the study, with ages ranging from 18 to 46 years ( M = 23.90, SD = 4.01). The sample was predominantly female (81.6%, n = 787), with males representing 18.4% ( n = 177). Registered General Nurses were the most (37.1%, n = 358), and registered nurse assistant clinic followed with 24.5%, ( n = 236), midwife (19.7%, n = 190), mental health nurse (12.4%, n = 120), community health nurse (5.0%, n = 48), and other professionals not specified were 1.2%, ( n = 12) of the participants. Most participants had no working experience (84.3%, n = 813), while 15.7% ( n = 151) reported prior work experience. Most of the students were in Level 100, that is first year students (55.2%, n = 532). Level 200 were 29.1%, (281), Level 300 14.0%, (135), and Level 400 1.7%, ( 16 ). Knowledge levels were mostly good with 88.9%, (857), demonstrating good knowledge, and the remaining 11.0% (106) lack of knowledge. About 97.6%, (941) of the participants showed positive attitude towards infection prevention and control and finally 91.9%, (886) practice proper infection protocol. Correlation studies Spearman’s rank-order correlations were first computed to examine the relationships between age, mean attitude, mean knowledge, and mean practice scores (see Table 1 ). Age was positively correlated with knowledge, rs = .102, p = .002, 95% CI [.037, .166], but showed no significant association with attitude or practice scores. Attitude participants was positively correlated with knowledge levels, rs = .082, p = .011, and strongly correlated with level of practice, rs = .290, p < .001. However, knowledge had a small positive correlation with practice, rs = .107, p = .001. Mann–Whitney U tests were then conducted for group comparisons. For gender, there were no significant differences in attitude between males ( Mdn = 4.20, M rank = 486.17) and females ( Mdn = 4.20, M rank = 481.67), U = 69,000.00, p = .843. Similarly, level of knowledge did not differ significantly between males ( Mdn = 6.00, M rank = 498.71) and females ( Mdn = 6.00, M rank = 478.85), U = 66,779.50, p = .380. However there was a slightly closed significance of the practice, the difference between males ( Mdn = 4.40, M rank = 517.94) and females ( Mdn = 4.20, M rank = 474.53) approached significance, U = 63,376.50, p = .060. A significant difference was found in attitudes between participants with and without prior working experience, U = 51,930.50, p = .002. Participants without working experience reported significantly higher attitude scores ( Mdn = 4.20, M rank = 494.12) than those with working experience ( Mdn = 4.00, M rank = 419.91). However, there were no significant differences in knowledge ( Mdn = 6.00 for both groups) or practice ( Mdn = 4.20 for both groups) scores based on work experience. The Kruskal–Wallis H test revealed significant differences across student levels. For mean attitude, χ²(3, N = 964) = 18.50, p < .001, Level 100 ( Mdn = 4.40, M rank = 513.20) was highest, while Level 400 ( Mdn = 4.00, M rank = 360.84) was lowest. For mean knowledge, χ²(3, N = 964) = 13.06, p = .005, Level 300 ( Mdn = 6.00, M rank = 540.01) was highest, and Level 100 ( Mdn = 5.67, M rank = 456.13) lowest. For mean practice, χ²(3, N = 964) = 12.54, p = .006, Level 400 ( Mdn = 4.40, M rank = 532.69) was highest, and Level 300 ( Mdn = 4.00, M rank = 418.91) lowest. Table 2 Correlations and Group Comparisons for Attitude, Knowledge, and Practice Scores ( N = 964) Analysis DV Groups / Variables Median (Mdn) Mean Rank Test Statistic df N p Spearman’s ρ Age–Knowledge – – – ρ = .102 – – 0.002 Spearman’s ρ Age–Attitude – – – ρ = –.057 – – 0.843 Spearman’s ρ Age–Practice – – – ρ = .036 – – 0.38 Spearman’s ρ Attitude–Knowledge – – – ρ = .082 – – 0.011 Spearman’s ρ Attitude–Practice – – – ρ = .290 – – < .001 Spearman’s ρ Knowledge–Practice – – – ρ = .107 – – 0.001 Mann–Whitney U Attitude Male 4.2 486.17 U = 69,000.00 – 964 0.843 Female 4.2 481.67 Mann–Whitney U Knowledge Male 6 498.71 U = 66,779.50 – 964 0.38 Female 6 478.85 Mann–Whitney U Practice Male 4.4 517.94 U = 63,376.50 – 964 0.06 Female 4.2 474.53 Mann–Whitney U Attitude W. Exp: No 4.2 494.12 U = 51,930.50 – 964 0.002 W. Exp: Yes 4 419.91 Mann–Whitney U Knowledge W. Exp: No 6 483.31 U = 60,719.00 – 964 0.829 W. Exp: Yes 6 478.11 Mann–Whitney U Practice W. Exp: No 4.2 479.17 U = 58,676.50 – 964 0.388 W. Exp: Yes 4.2 500.41 Kruskal–Wallis Attitude L 100 4.4 513.2 χ² = 18.50 3 964 < .001 L 200 4.2 – L 300 4.2 – L 400 4 360.84 Kruskal–Wallis Knowledge L 100 5.67 456.13 χ² = 13.06 3 964 0.005 L 200 6 – L 300 6 540.01 L 400 6 – Kruskal–Wallis Practice L 100 4.2 – χ² = 12.54 3 964 0.006 L 200 4.2 – L 300 4 418.91 L 400 4.4 532.69 Source: field data in August, 2025 Age is associated with knowledge but not attitudes or practices. Attitudes are positively related to both knowledge and practice, with the strongest association observed between attitude and practice. Gender was unrelated to the three dependent variables. Working experience was associated with lower attitude scores but unrelated to knowledge or practice. The level of students in school showed meaningful differences: first-year students had the most positive attitudes, third-year students had the highest knowledge, and final-year students reported the highest practice scores. Rank-Based Multiple Regression Analyses with Bootstrapping Three separate rank-based multiple regression analyses were conducted to determine the combined influence of demographic factors, attitude, knowledge, and practice scores. Kolmogorov–Smirnov and Shapiro–Wilk tests ( p < .001) were significant for all variables. Attitude was statistically significant, F (5, 958) = 6.19, p < .001, explaining 3.1% of the variance ( R² = .031, Adjusted R² = .026). Significant predictors were working experience ( B = -54.01, p = .041, BCa 95% CI [-103.42, -4.21]) and level in school ( B = -45.36, p < .001, BCa 95% CI [-67.97, -23.82]). Work experience and higher levels in school had lower-ranked attitude scores. The rest were not significant. Ranked knowledge was statistically significant, F (5, 958) = 3.39, p = .005, explaining 1.7% of the variance ( R² = .017, Adjusted R² = .012). Level in school was the only significant predictor ( B = 34.98, p = .003, BCa 95% CI [8.51, 58.63]). The rest of the predictors were not related. Mean practice was statistically significant, F (5, 958) = 4.45, p = .001, explaining 2.3% of the variance ( R² = .023, Adjusted R² = .018). Significant predictors were age ( B = 6.39, p = .013, BCa 95% CI [0.97, 11.20]), gender ( B = -57.94, p = .013, BCa 95% CI [-102.01, -11.75]), and level in school ( B = -45.67, p < .001, BCa 95% CI [-69.26, -23.60]). Table 3 Rank Regression with Bootstrapping Predicting Ranked Mean Attitude, Knowledge, and Practice Predictor Attitude B (BCa 95% CI) p Knowledge B (BCa 95% CI) P Practice B (BCa 95% CI) p Constant 668.89 (523.44, 807.92) < .001 334.14 (175.30, 488.35) < .001 530.11 (392.09, 678.21) < .001 Age -1.18 (-6.10, 4.66) 0.636 4.15 (-1.07, 9.62) 0.098 6.39 (0.97, 11.20) 0.013 Gender (Male = 1) -24.44 (-63.80, 17.13) 0.283 -7.81 (-55.48, 36.90) 0.733 -57.94 (-102.01, -11.75) 0.013 Profession -10.00 (-20.27, 0.03) 0.07 3.80 (-6.38, 15.21) 0.503 -6.78 (-19.17, 6.10) 0.24 Working experience -54.01 (-103.42, -4.21) 0.041 -34.70 (-90.30, 17.75) 0.19 2.67 (-46.48, 52.46) 0.921 Level in school -45.36 (-67.97, -23.82) < .001 34.98 (8.51, 58.63) 0.003 -45.67 (-69.26, -23.60) < .001 Source: field data in August, 2025 Note BCa = Bias-Corrected and Accelerated bootstrap confidence interval based on 964 samples. R² values for Attitude, Knowledge, and Practice models were .031, .017, and .023, respectively. Across all three regression models, level in school consistently emerged as a significant predictor, although its direction varied: higher academic levels were associated with lower ranked attitude and practice scores, but higher ranked knowledge scores. Working experience was a significant negative predictor for attitude but unrelated to knowledge or practice, indicating that professional exposure may shape outlooks differently than it influences competence or behavior. Age was unrelated to attitude and knowledge but positively associated with practice, while gender only predicted practice scores, with males reporting lower scores than females. Discussion The knowledge, attitude, and practice (KAP) of infection prevention and control (IPC) among student nurses during their clinical practicum was generally good despite the fact that we use a high cut point 75% as a pass for knowledge, and 70% for both attitude and practice. Our findings revealed predominantly good levels of knowledge (88.9%) ( 14 – 16 ), overwhelmingly positive attitudes (97.6%) ( 17 ), and generally good IPC practices (91.9%) ( 17 ) among the 964 nursing students. Al-Ahmari et al., (2021) assessed the knowledge and attitude of health care workers in an urban city hospital at Saudi Arabia and came out with the findings that, about 88.2% of the health workers has good attitude towards IPC, however they had little above 60% who had good knowledge of infection prevention and control. Our study also showed high proportion of the clinical students (97.6%) with positive attitudes toward IPC. The findings aligns with other studies ( 14 , 16 , 17 ) and however contradicts with the findings of from a study in Tamale, Ghana among healthcare workers ( 19 ). They reported that 55.1% of the participants had good attitude towards IPC. This disparity may reflect the type of population used for the study. Our study involved only students nurses however, Alhassan et al. (2021) involve all healthcare work which might not involve in direct patient care. Also, cultural and institutional differences, where heightened awareness campaigns and stringent IPC policies in our clinical settings promote more favorable perceptions of infection control. Our study looked at all Ashanti region of Ghana and Tamale is from the northern part of Ghana. Regarding IPC practices, 91.9% of participants reported good adherence, a figure notably higher than the 70–80% range documented by several recent studies ( 17 – 20 ). However, self-reported practices may be subject to social desirability bias, potentially inflating adherence rates. The clinical supervision and practical exposure during the students’ hospital placements in Ghana likely reinforce correct IPC behaviors. Conversely, other studies from other places recorded very low attitude ( 19 ). Variations observed across studies can also be partly explained by differences in study design, sample characteristics, and healthcare infrastructure. Our study was predominantly females, sample (81.6%) may reflect gender-related differences in IPC compliance, as prior research suggests females tend to report higher IPC adherence ( 21 ). Furthermore, the majority of participants were Level 100 students (55.2%) and novices without prior work experience (84.3%), which might influence familiarity and confidence in IPC measures compared to more advanced students or practicing nurses. Infection prevention and control is taught in the first year and first semester. The results demonstrated a significant positive correlation between age and knowledge (rs = .102, p = .002). This findings align with previous studies reporting that knowledge increases with age due to greater exposure and experience over time ( 11 ). However, age showed no significant association with attitude or practice scores, which contrasts with some prior research indicating positive associations between age and practice behaviors ( 11 ). The discrepancy may be attributable to the relatively narrow age range and homogeneity of the current sample, as well as contextual factors that limit the translation of knowledge into practice across age groups in this population. Consistent with theoretical frameworks such as the Theory of Planned Behavior ( 22 ) attitude was positively correlated with both knowledge (rs = .082, p = .011) and practice (rs = .290, p < .001). The strong attitude-practice association underscores the critical role of positive attitudes in fostering adherence to recommended practices, a finding echoed in prior infection control studies ( 11 ). Knowledge also exhibited a small but significant correlation with practice (rs = .107, p = .001), suggesting that knowledge alone is insufficient to drive behavior change without supportive attitudes ( 13 ). Gender comparisons revealed no significant differences in attitude or knowledge scores. The findings contradict that males were more likely to comply to IPC practices compared to females ( 12 ). This could be due to different population of study. Participants without prior work experience reported significantly higher attitude scores than those with experience (p = .002), while knowledge and practice scores did not differ significantly by experience status. This finding is consistent with reports that real-world experience can temper idealistic attitudes due to exposure to practical challenges. The absence of differences in knowledge and practice suggests that prior experience alone may not enhance these measures without relevant or recent training. Contrasting results in some studies reporting experience-related improvements in practice may stem from varying definitions and quality of experience. Significant differences across student levels were observed for attitude, knowledge, and practice. Attitude scores were highest among first-year students and lowest among seniors (p < .001), possibly reflecting initial enthusiasm diminishing over time due to academic or environmental stressors. Knowledge peaked at the third-year level (p = .005), consistent with curricular progression and increased theoretical learning. Practice scores were highest among final-year students (p = .006), likely reflecting greater practical exposure through internships or clinical placements. These patterns underscore the influence of academic stage on the development of knowledge, attitudes, and behaviors relevant to infection control. Recommendation The study recommends that infection prevention and control (IPC) education be strengthened across all levels of nursing training to sustain positive attitudes and good practices. Continuous refresher training, simulation-based learning, and close clinical supervision should be implemented to bridge the gap between knowledge and practice. Curriculum developers should integrate IPC competencies and assessment into all stages of training. Additionally, regular monitoring and institutional research on IPC compliance are essential to guide evidence-based improvements in nursing education and practice. Limitations include the cross-sectional design, which limits causal inference, and the reliance on self-reported data, which may be subject to social desirability bias. Future longitudinal research is warranted to track changes over time and evaluate the impact of targeted interventions. Declarations The research committee of the school of nursing and midwifery, University of Cape Coast, Ghana, approved the study before data was collected. Declaration of generative AI and AI-assisted technologies in the writing process During the preparation of this work, the author(s) used Medley, chagpt to enhance my language to make reading easier. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication. Author Contribution Author Contributions1. Abu Tia Dimongso – Conceptualization, study design, data analysis, interpretation of results, supervision, and manuscript drafting. He is the major contributor to the development and completion of this work.2. Bright Owusu-Afriyie – Data collection coordination, literature review, and drafting of the methodology section.3. Burhanatu Hafiz – Assisted with data entry, analysis, and interpretation of findings.4. Felix Aayel – Contributed to the literature review, formatting of the manuscript, and preparation of tables and figures.5. Dorcas Aba Engmann – Assisted in data collection and validation, as well as in the review of the discussion section.6. Peter Namtibil Wanaba – Contributed to data curation, referencing, and critical revision of the manuscript for important intellectual content.7. Dorcas Owusu – Assisted in proofreading, manuscript editing, and ensuring adherence to journal submission guidelines.All authors read and approved the final manuscript prior to submission. References Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections – An overview. Infect Drug Resist [Internet]. 2018;11:2321–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30532565 Khatrawi EM, Prajjwal P, Farhan M, Inban P, Gurha S, Al-ezzi SMS et al. 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Available from: https://www.jidc.org/index.php/journal/article/view/14746 Mutaru AM, Balegha AN, Kunsu R, Gbeti C. Knowledge and determinants of infection prevention and control compliance among nurses in Yendi municipality, Ghana. PLoS One [Internet]. 2022;17(7):e0270508. Available from: http://www.ncbi.nlm.nih.gov/pubmed/35857742 Ajzen I. The Theory of Planned Behavior: Organizational Behavior and Human Decision Processes. Univ Mass Amherst. 1991;179–211. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Nov, 2025 Editor assigned by journal 24 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 06 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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07:49:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1025703,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8052359/v1/f3570cfb-25d1-4baf-a99e-d04da7518647.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessing Knowledge, Attitude and Practice of Infection Prevention/control and Their Determinents Among Student Nurses on Clinicl Practicum in Ashanti Region, Ghana\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eNosocomial infections, also referred to as healthcare-associated infections (HAIs), are defined as infections that develop in patients during their stay in a healthcare facility and were not present or incubating at the time of admission (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These infections typically occur 48 hours or more after hospital admission or within 30 days of a medical procedure, such as surgery. They are a significant global public health challenge, affecting patient outcomes and the healthcare system.\u003c/p\u003e\u003cp\u003eThe most common types of nosocomial infections include surgical site infections, urinary tract infections (UTIs), bloodstream infections (BSIs), and ventilator-associated pneumonia. The global prevalence of nosocomial infections varies widely, with high-income countries reporting rates of approximately 7%, while low- and middle-income countries (LMICs) report rates as high as 15% (WHO, 2020).\u003c/p\u003e\u003cp\u003eNosocomial infections are primarily caused by bacterial, viral, or fungal pathogens, with drug-resistant organisms posing significant challenges. \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eEscherichia coli\u003c/em\u003e are common pathogens that often exhibit antimicrobial resistance. Key risk factors for nosocomial infections include prolonged hospitalization, invasive procedures, immunocompromised conditions, and inadequate infection prevention practices. Inadequate infection control practices are responsible for most HAIs. Poor hand hygiene and improper sterilisations of instruments play a major role in acquiring HAIs. Higher rates of these infections could be prevented with strict adherence to infection prevention and control protocols. The use of invasive medical devices in the hospital is a key risk factor for nosocomial infection. The procedure for passing a urethral catheter involves rigorous hand washing and the use of sterilized gloves. HAIs prolong hospital stay, the need for additional diagnostic tests, and the need for specialized treatment. All of this leads to extra costs to the hospital and the patient. The United States alone estimates \u003cspan\u003e$\u003c/span\u003e9.8\u0026nbsp;billion annually for the cost of treating infectious diseases. Poor countries and middle-income countries will spend more money on HAIs, ignoring other critical areas in health. Beyond financial costs, HAIs contribute to increased morbidity and mortality, resulting in prolonged recovery times and diminished quality of life.\u003c/p\u003e\u003cp\u003eHealthcare workers with insufficient knowledge of IPC measures are less likely to adhere to standard protocols (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Healthcare workers who perceive IPC protocols as burdensome or unnecessary are less likely to follow them consistently (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Inadequate knowledge and positive attitudes, poor implementation of IPC practices contribute significantly to the high prevalence of nosocomial infections (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Inadequate hand hygiene, improper disposal of medical waste, and failure to clean and sterilize medical equipment are associated with increased nosocomial infection (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Low compliance with hand hygiene practices has been identified as a major cause of HAIs, with studies estimating that effective hand hygiene alone could reduce the incidence of nosocomial infections by up to 50% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Several studies have been conducted to test the knowledge, attitude and practice of infection prevention and control among healthcare workers and other disciplines, however, little is known about student nurses who are aspiring to become registered nurses in the future, knowledge, practice and attitude towards infection prevention and control in the Ashanti region of Ghana (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This research, therefore, seeks to investigate the knowledge, attitude, and practice towards infection prevention and control and the influencing factors of these among student nurses carrying out their clinical practicum in the Ashanti Region of Ghana.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eAshanti Region is one of the sixteen (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) administrative regions in Ghana, located in the middle belt of the country and shares boundaries with Bono, Ahafo, and Bono East to the north, Eastern Region to the south-east, Central Region to the south, and Western North Region to the south-west. The region lies between longitudes 0.150\u0026deg;W and 2.250\u0026deg;W, and latitudes 5.500\u0026deg;N and 7.460\u0026deg;N. It occupies a total land surface area of 24,389 square kilometres, constituting approximately 10.2% total land area of Ghana (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe region is the second most populous region in Ghana, with a projected population of approximately 5.43\u0026nbsp;million people (2021 estimates) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It has 1,654 health facilities, comprising 1,120 Community-Based Health Planning and Services (CHPS) compounds, 165 health centres, 29 clinics, 71 maternity homes, 5 polyclinics, 26 district hospitals, 125 other hospitals, one regional hospital, one university hospital, and one teaching hospital located in Kumasi. Among the 170 facilities operated by GHS, 71, mission organizations, 281 are by private operators, and 8 are by quasi-government entities.\u003c/p\u003e\u003cp\u003ePreceptors at the health institutions are responsible for the supervision of student nurses on practicum on the wards and liaise with training institutions. The target population comprised all student nurses who were on clinical practicum in the Ashanti Region during the data-collection period and who had completed at least a short rotation on the wards where infection prevention and control (IPC) procedures are routinely practiced.\u003c/p\u003e\u003cp\u003e The sampling frame was constructed from lists of students on placement obtained via the Regional Coordinator for Clinical Preceptorship and the network of hospital preceptors. Students were eligible if they were currently on a clinical practicum, enrolled in a recognised nursing or midwifery training programme, and consented to participate. Students not on placement during the study window or who declined consent were excluded.\u003c/p\u003e\u003cp\u003eThe minimum required sample size was estimated with Cochran\u0026rsquo;s formula for cross-sectional surveys. At a 95% confidence level and an assumed proportion for adequate KAP (knowledge, attitude, and practice) of IPC, with allowance for non-response, the sample size was calculated. This yielded the target sample size against which recruitment progress was monitored.\u003c/p\u003e\u003cp\u003e We used district hospitals, the regional hospital, and the teaching hospital. Private hospitals, Community-Based Health Planning and Services (CHPS) compounds, and selected health centres were excluded from the sampling frame. Hospital preceptors shared the study information sheet and the link to the self-administered Google Form via WhatsApp to all eligible students under their supervision. Data collection targeted nursing students who were nearing the completion of their full clinical practicum at each facility. The data collection period commenced in December 2024 and concluded in August 2025. The form was designed to allow a single submission.\u003c/p\u003e\u003cp\u003eThe questionnaire comprised four sections: (A) demographics (e.g., facility, age, level of study), (B) IPC knowledge (17 yes/no items), (C) attitudes toward IPC (five-point Likert scale from \u0026ldquo;strongly agree\u0026rdquo; to \u0026ldquo;strongly disagree\u0026rdquo;), and (D) IPC practices (five-point Likert scale from \u0026ldquo;always\u0026rdquo; to \u0026ldquo;never\u0026rdquo;). Items were adapted from CDC/WHO-aligned KAP tools and prior studies (\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), then revised to reflect the Ghanaian clinical context. The tool was piloted among students outside the main sample; items with comprehension or reliability issues were rephrased to meet acceptable internal consistency (Cronbach\u0026rsquo;s alpha) before field deployment.\u003c/p\u003e\u003cp\u003e Permission to conduct the study was obtained through the Principal of the Nursing and Midwifery Training College, Tepa, and the Ghana Health Service. Participation was voluntary; the first page of the Google Form included the study information, eligibility criteria, and an electronic consent statement.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistics for Participant Characteristics and Study Variables (N\u0026thinsp;=\u0026thinsp;964)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVariance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.513\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRMN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRGN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRNAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel in school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.616\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel 200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel 300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel 400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAttitude\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e941\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePractice\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e886\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSource: field data in August, 2025 (dup: abstract ?)\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003cp\u003eM\u0026thinsp;=\u0026thinsp;Mean; Mdn\u0026thinsp;=\u0026thinsp;Median; SD\u0026thinsp;=\u0026thinsp;Standard deviation; SE\u0026thinsp;=\u0026thinsp;Standard error.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eA total of 964 participants took part in the study, with ages ranging from 18 to 46 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23.90, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.01). The sample was predominantly female (81.6%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;787), with males representing 18.4% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;177). Registered General Nurses were the most (37.1%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;358), and registered nurse assistant clinic followed with 24.5%, (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;236), midwife (19.7%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;190), mental health nurse (12.4%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120), community health nurse (5.0%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;48), and other professionals not specified were 1.2%, (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12) of the participants. Most participants had no working experience (84.3%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;813), while 15.7% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;151) reported prior work experience. Most of the students were in Level 100, that is first year students (55.2%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;532). Level 200 were 29.1%, (281), Level 300 14.0%, (135), and Level 400 1.7%, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Knowledge levels were mostly good with 88.9%, (857), demonstrating good knowledge, and the remaining 11.0% (106) lack of knowledge. About 97.6%, (941) of the participants showed positive attitude towards infection prevention and control and finally 91.9%, (886) practice proper infection protocol.\u003c/p\u003e\n\u003ch3\u003eCorrelation studies\u003c/h3\u003e\n\u003cp\u003eSpearman\u0026rsquo;s rank-order correlations were first computed to examine the relationships between age, mean attitude, mean knowledge, and mean practice scores (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Age was positively correlated with knowledge, \u003cem\u003ers\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.102, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002, 95% CI [.037, .166], but showed no significant association with attitude or practice scores. Attitude participants was positively correlated with knowledge levels, \u003cem\u003ers\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.082, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.011, and strongly correlated with level of practice, \u003cem\u003ers\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.290, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001. However, knowledge had a small positive correlation with practice, \u003cem\u003ers\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.107, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001.\u003c/p\u003e\u003cp\u003eMann\u0026ndash;Whitney U tests were then conducted for group comparisons. For gender, there were no significant differences in attitude between males (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.20, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;486.17) and females (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.20, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;481.67), \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;69,000.00, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.843. Similarly, level of knowledge did not differ significantly between males (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.00, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;498.71) and females (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.00, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;478.85), \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;66,779.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.380. However there was a slightly closed significance of the practice, the difference between males (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.40, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;517.94) and females (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.20, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;474.53) approached significance, \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;63,376.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.060.\u003c/p\u003e\u003cp\u003eA significant difference was found in attitudes between participants with and without prior working experience, \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;51,930.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002. Participants without working experience reported significantly higher attitude scores (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.20, \u003cem\u003eM\u003c/em\u003e rank\u0026thinsp;=\u0026thinsp;494.12) than those with working experience (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.00, \u003cem\u003eM\u003c/em\u003e rank\u0026thinsp;=\u0026thinsp;419.91). However, there were no significant differences in knowledge (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.00 for both groups) or practice (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.20 for both groups) scores based on work experience.\u003c/p\u003e\u003cp\u003eThe Kruskal\u0026ndash;Wallis H test revealed significant differences across student levels. For mean attitude, χ\u0026sup2;(3, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;964)\u0026thinsp;=\u0026thinsp;18.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, Level 100 (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.40, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;513.20) was highest, while Level 400 (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.00, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;360.84) was lowest. For mean knowledge, χ\u0026sup2;(3, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;964)\u0026thinsp;=\u0026thinsp;13.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005, Level 300 (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.00, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;540.01) was highest, and Level 100 (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.67, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;456.13) lowest. For mean practice, χ\u0026sup2;(3, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;964)\u0026thinsp;=\u0026thinsp;12.54, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006, Level 400 (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.40, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;532.69) was highest, and Level 300 (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.00, \u003cem\u003eM rank\u003c/em\u003e\u0026thinsp;=\u0026thinsp;418.91) lowest.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelations and Group Comparisons for Attitude, Knowledge, and Practice Scores (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;964)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnalysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroups / Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian (Mdn)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean Rank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u0026ndash;Knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eρ\u0026thinsp;=\u0026thinsp;.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u0026ndash;Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eρ = \u0026ndash;.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u0026ndash;Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eρ\u0026thinsp;=\u0026thinsp;.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude\u0026ndash;Knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eρ\u0026thinsp;=\u0026thinsp;.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude\u0026ndash;Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eρ\u0026thinsp;=\u0026thinsp;.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge\u0026ndash;Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eρ\u0026thinsp;=\u0026thinsp;.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e486.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eU\u0026thinsp;=\u0026thinsp;69,000.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e481.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e498.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eU\u0026thinsp;=\u0026thinsp;66,779.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e478.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e517.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eU\u0026thinsp;=\u0026thinsp;63,376.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e474.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eW. Exp: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e494.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eU\u0026thinsp;=\u0026thinsp;51,930.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eW. Exp: Yes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e419.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eW. Exp: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e483.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eU\u0026thinsp;=\u0026thinsp;60,719.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.829\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eW. Exp: Yes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e478.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eW. Exp: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e479.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eU\u0026thinsp;=\u0026thinsp;58,676.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.388\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eW. Exp: Yes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e500.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKruskal\u0026ndash;Wallis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e513.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ\u0026sup2; = 18.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e360.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKruskal\u0026ndash;Wallis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e456.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ\u0026sup2; = 13.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e540.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKruskal\u0026ndash;Wallis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ\u0026sup2; = 12.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e418.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL 400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e532.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSource: field data in August, 2025\u003c/h3\u003e\n\u003cp\u003eAge is associated with knowledge but not attitudes or practices. Attitudes are positively related to both knowledge and practice, with the strongest association observed between attitude and practice. Gender was unrelated to the three dependent variables. Working experience was associated with lower attitude scores but unrelated to knowledge or practice. The level of students in school showed meaningful differences: first-year students had the most positive attitudes, third-year students had the highest knowledge, and final-year students reported the highest practice scores.\u003c/p\u003e\n\u003ch3\u003eRank-Based Multiple Regression Analyses with Bootstrapping\u003c/h3\u003e\n\u003cp\u003eThree separate rank-based multiple regression analyses were conducted to determine the combined influence of demographic factors, attitude, knowledge, and practice scores. Kolmogorov\u0026ndash;Smirnov and Shapiro\u0026ndash;Wilk tests (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) were significant for all variables.\u003c/p\u003e\u003cp\u003eAttitude was statistically significant, \u003cem\u003eF\u003c/em\u003e(5, 958)\u0026thinsp;=\u0026thinsp;6.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, explaining 3.1% of the variance (\u003cem\u003eR\u0026sup2;\u003c/em\u003e = .031, Adjusted \u003cem\u003eR\u0026sup2;\u003c/em\u003e = .026). Significant predictors were working experience (\u003cem\u003eB\u003c/em\u003e = -54.01, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.041, BCa 95% CI [-103.42, -4.21]) and level in school (\u003cem\u003eB\u003c/em\u003e = -45.36, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, BCa 95% CI [-67.97, -23.82]). Work experience and higher levels in school had lower-ranked attitude scores. The rest were not significant. Ranked knowledge was statistically significant, \u003cem\u003eF\u003c/em\u003e(5, 958)\u0026thinsp;=\u0026thinsp;3.39, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005, explaining 1.7% of the variance (\u003cem\u003eR\u0026sup2;\u003c/em\u003e = .017, Adjusted \u003cem\u003eR\u0026sup2;\u003c/em\u003e = .012). Level in school was the only significant predictor (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;34.98, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003, BCa 95% CI [8.51, 58.63]). The rest of the predictors were not related. Mean practice was statistically significant, \u003cem\u003eF\u003c/em\u003e(5, 958)\u0026thinsp;=\u0026thinsp;4.45, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001, explaining 2.3% of the variance (\u003cem\u003eR\u0026sup2;\u003c/em\u003e = .023, Adjusted \u003cem\u003eR\u0026sup2;\u003c/em\u003e = .018). Significant predictors were age (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.39, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013, BCa 95% CI [0.97, 11.20]), gender (\u003cem\u003eB\u003c/em\u003e = -57.94, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013, BCa 95% CI [-102.01, -11.75]), and level in school (\u003cem\u003eB\u003c/em\u003e = -45.67, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, BCa 95% CI [-69.26, -23.60]).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRank Regression with Bootstrapping Predicting Ranked Mean Attitude, Knowledge, and Practice\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttitude B (BCa 95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowledge B (BCa 95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePractice B (BCa 95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConstant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e668.89 (523.44, 807.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e334.14 (175.30, 488.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e530.11 (392.09, 678.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.18 (-6.10, 4.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.15 (-1.07, 9.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.39 (0.97, 11.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender (Male\u0026thinsp;=\u0026thinsp;1)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-24.44 (-63.80, 17.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-7.81 (-55.48, 36.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.733\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-57.94 (-102.01, -11.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-10.00 (-20.27, 0.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.80 (-6.38, 15.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-6.78 (-19.17, 6.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-54.01 (-103.42, -4.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-34.70 (-90.30, 17.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.67 (-46.48, 52.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel in school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-45.36 (-67.97, -23.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.98 (8.51, 58.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-45.67 (-69.26, -23.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSource: field data in August, 2025\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003cp\u003eBCa\u0026thinsp;=\u0026thinsp;Bias-Corrected and Accelerated bootstrap confidence interval based on 964 samples. R\u0026sup2; values for Attitude, Knowledge, and Practice models were .031, .017, and .023, respectively.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eAcross all three regression models, level in school consistently emerged as a significant predictor, although its direction varied: higher academic levels were associated with lower ranked attitude and practice scores, but higher ranked knowledge scores. Working experience was a significant negative predictor for attitude but unrelated to knowledge or practice, indicating that professional exposure may shape outlooks differently than it influences competence or behavior. Age was unrelated to attitude and knowledge but positively associated with practice, while gender only predicted practice scores, with males reporting lower scores than females.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe knowledge, attitude, and practice (KAP) of infection prevention and control (IPC) among student nurses during their clinical practicum was generally good despite the fact that we use a high cut point 75% as a pass for knowledge, and 70% for both attitude and practice. Our findings revealed predominantly good levels of knowledge (88.9%) (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), overwhelmingly positive attitudes (97.6%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and generally good IPC practices (91.9%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) among the 964 nursing students. Al-Ahmari et al., (2021) assessed the knowledge and attitude of health care workers in an urban city hospital at Saudi Arabia and came out with the findings that, about 88.2% of the health workers has good attitude towards IPC, however they had little above 60% who had good knowledge of infection prevention and control.\u003c/p\u003e\u003cp\u003eOur study also showed high proportion of the clinical students (97.6%) with positive attitudes toward IPC. The findings aligns with other studies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and however contradicts with the findings of from a study in Tamale, Ghana among healthcare workers (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). They reported that 55.1% of the participants had good attitude towards IPC. This disparity may reflect the type of population used for the study. Our study involved only students nurses however, Alhassan et al. (2021) involve all healthcare work which might not involve in direct patient care. Also, cultural and institutional differences, where heightened awareness campaigns and stringent IPC policies in our clinical settings promote more favorable perceptions of infection control. Our study looked at all Ashanti region of Ghana and Tamale is from the northern part of Ghana.\u003c/p\u003e\u003cp\u003eRegarding IPC practices, 91.9% of participants reported good adherence, a figure notably higher than the 70\u0026ndash;80% range documented by several recent studies (\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, self-reported practices may be subject to social desirability bias, potentially inflating adherence rates. The clinical supervision and practical exposure during the students\u0026rsquo; hospital placements in Ghana likely reinforce correct IPC behaviors. Conversely, other studies from other places recorded very low attitude (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVariations observed across studies can also be partly explained by differences in study design, sample characteristics, and healthcare infrastructure. Our study was predominantly females, sample (81.6%) may reflect gender-related differences in IPC compliance, as prior research suggests females tend to report higher IPC adherence (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Furthermore, the majority of participants were Level 100 students (55.2%) and novices without prior work experience (84.3%), which might influence familiarity and confidence in IPC measures compared to more advanced students or practicing nurses. Infection prevention and control is taught in the first year and first semester.\u003c/p\u003e\u003cp\u003eThe results demonstrated a significant positive correlation between age and knowledge (rs\u0026thinsp;=\u0026thinsp;.102, p\u0026thinsp;=\u0026thinsp;.002). This findings align with previous studies reporting that knowledge increases with age due to greater exposure and experience over time (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, age showed no significant association with attitude or practice scores, which contrasts with some prior research indicating positive associations between age and practice behaviors (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The discrepancy may be attributable to the relatively narrow age range and homogeneity of the current sample, as well as contextual factors that limit the translation of knowledge into practice across age groups in this population.\u003c/p\u003e\u003cp\u003eConsistent with theoretical frameworks such as the Theory of Planned Behavior (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) attitude was positively correlated with both knowledge (rs\u0026thinsp;=\u0026thinsp;.082, p\u0026thinsp;=\u0026thinsp;.011) and practice (rs\u0026thinsp;=\u0026thinsp;.290, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The strong attitude-practice association underscores the critical role of positive attitudes in fostering adherence to recommended practices, a finding echoed in prior infection control studies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Knowledge also exhibited a small but significant correlation with practice (rs\u0026thinsp;=\u0026thinsp;.107, p\u0026thinsp;=\u0026thinsp;.001), suggesting that knowledge alone is insufficient to drive behavior change without supportive attitudes (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGender comparisons revealed no significant differences in attitude or knowledge scores. The findings contradict that males were more likely to comply to IPC practices compared to females (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This could be due to different population of study.\u003c/p\u003e\u003cp\u003eParticipants without prior work experience reported significantly higher attitude scores than those with experience (p\u0026thinsp;=\u0026thinsp;.002), while knowledge and practice scores did not differ significantly by experience status. This finding is consistent with reports that real-world experience can temper idealistic attitudes due to exposure to practical challenges. The absence of differences in knowledge and practice suggests that prior experience alone may not enhance these measures without relevant or recent training. Contrasting results in some studies reporting experience-related improvements in practice may stem from varying definitions and quality of experience.\u003c/p\u003e\u003cp\u003eSignificant differences across student levels were observed for attitude, knowledge, and practice. Attitude scores were highest among first-year students and lowest among seniors (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), possibly reflecting initial enthusiasm diminishing over time due to academic or environmental stressors. Knowledge peaked at the third-year level (p\u0026thinsp;=\u0026thinsp;.005), consistent with curricular progression and increased theoretical learning. Practice scores were highest among final-year students (p\u0026thinsp;=\u0026thinsp;.006), likely reflecting greater practical exposure through internships or clinical placements. These patterns underscore the influence of academic stage on the development of knowledge, attitudes, and behaviors relevant to infection control.\u003c/p\u003e\n\u003ch3\u003eRecommendation\u003c/h3\u003e\n\u003cp\u003eThe study recommends that infection prevention and control (IPC) education be strengthened across all levels of nursing training to sustain positive attitudes and good practices. Continuous refresher training, simulation-based learning, and close clinical supervision should be implemented to bridge the gap between knowledge and practice. Curriculum developers should integrate IPC competencies and assessment into all stages of training. Additionally, regular monitoring and institutional research on IPC compliance are essential to guide evidence-based improvements in nursing education and practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e include the cross-sectional design, which limits causal inference, and the reliance on self-reported data, which may be subject to social desirability bias. Future longitudinal research is warranted to track changes over time and evaluate the impact of targeted interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe research committee of the school of nursing and midwifery, University of Cape Coast, Ghana, approved the study before data was collected.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eDeclaration of generative AI and AI-assisted technologies in the writing process\u003c/h2\u003e\u003cp\u003eDuring the preparation of this work, the author(s) used Medley, chagpt to enhance my language to make reading easier. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.\u003c/p\u003e\u003c/div\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions1. Abu Tia Dimongso \u0026ndash; Conceptualization, study design, data analysis, interpretation of results, supervision, and manuscript drafting. He is the major contributor to the development and completion of this work.2. Bright Owusu-Afriyie \u0026ndash; Data collection coordination, literature review, and drafting of the methodology section.3. Burhanatu Hafiz \u0026ndash; Assisted with data entry, analysis, and interpretation of findings.4. Felix Aayel \u0026ndash; Contributed to the literature review, formatting of the manuscript, and preparation of tables and figures.5. Dorcas Aba Engmann \u0026ndash; Assisted in data collection and validation, as well as in the review of the discussion section.6. Peter Namtibil Wanaba \u0026ndash; Contributed to data curation, referencing, and critical revision of the manuscript for important intellectual content.7. Dorcas Owusu \u0026ndash; Assisted in proofreading, manuscript editing, and ensuring adherence to journal submission guidelines.All authors read and approved the final manuscript prior to submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHaque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections \u0026ndash; An overview. Infect Drug Resist [Internet]. 2018;11:2321\u0026ndash;33. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/pubmed/30532565\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/pubmed/30532565\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhatrawi EM, Prajjwal P, Farhan M, Inban P, Gurha S, Al-ezzi SMS et al. 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The Theory of Planned Behavior: Organizational Behavior and Human Decision Processes. Univ Mass Amherst. 1991;179\u0026ndash;211.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8052359/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8052359/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Healthcare-associated infections (HAIs) remain a major global challenge, particularly in resource-limited settings. Effective infection prevention and control (IPC) relies on healthcare workers’ knowledge, attitudes, and practices (KAP). This study assessed KAP regarding IPC among student nurses in the Ashanti Region, Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive cross-sectional study was conducted among 964 student nurses from health institutions across Ashanti region, Ghana. Data were collected using a structured, pretested questionnaire covering demographics and KAP domains. Descriptive statistics summarized variables, and Spearman's ranked examined associations between sociodemographic factors and KAP scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 88.9% of participants demonstrated good knowledge, 97.6% exhibited positive attitudes, and 91.9% reported good practices regarding IPC. Knowledge was associated with levels in school (F [5, 958] = 3.39, \u003cem\u003ep\u003c/em\u003e = .005), explaining 1.7% of the variance, while attitude was associated with practice was associated with gender (p = 0.031), and year of study (p = 0.001). Attitudes did not significantly differ by demographic characteristics. Attitude was associated with previous work experience and higher academic levels. Knowledge was associated with high level in school only and practice was associated with age, school level and gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudent nurses in Ashanti Region generally possess good IPC knowledge and practices, although attitudes toward IPC remain suboptimal. Strengthening attitude-oriented interventions alongside continuous training may further enhance IPC adherence.\u003c/p\u003e","manuscriptTitle":"Assessing Knowledge, Attitude and Practice of Infection Prevention/control and Their Determinents Among Student Nurses on Clinicl Practicum in Ashanti Region, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 10:15:55","doi":"10.21203/rs.3.rs-8052359/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T07:58:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-24T14:12:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-24T14:09:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-11-07T02:44:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"822b11e2-5960-4abe-adb1-cb2e2e711b82","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T08:38:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 10:15:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8052359","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8052359","identity":"rs-8052359","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}