Associations among Knowledge, Attitudes, Health Behaviors, and Stress of Pregnant Women in Thailand during the New Coronavirus-2019

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Pairin Sukontrakoon
Srisamorn Phumonsakul
sailom Gerdprasert
Shuleeporn Prohm
Arissara Sawatpanich


  A descriptive correlational study aimed to examine the associations among knowledge about COVID-19, attitudes toward COVID-19, health behaviors, and stress of pregnant women in Thailand during the COVID-19 pandemic. A sample of 283 pregnant women who met the inclusion criteria was recruited and participated via self-administered online questionnaires. The questionnaires requested personal information, knowledge about COVID-19, attitudes toward COVID-19, health behaviors related to COVID-19 in pregnancy, and stress. Descriptive statistics and Spearman’s rank correlations were applied for data analysis. The results showed that most pregnant women had a high level of knowledge about COVID-19 and good health behaviors (75.62% and 88.34%, respectively), a neutral attitude, and a moderate stress level (78.09% and 76.32%, respectively). Also, findings revealed a significant positive association between knowledge and health behaviors, negative attitudes toward COVID-19 and health behaviors, and negative attitudes toward COVID-19 and stress. However, significant associations were not found between knowledge and attitudes,knowledge and stress, and health behaviors and stress. Therefore, pregnant women should receive reliable health information about the novel coronavirus disease, which may influence attitudes toward this disease, to help them engage in health behaviors and prevent such infections. Importantly, accurate information should make the pregnant women gain more understanding of COVID-19. Psychological support is needed to help pregnant women manage their stress appropriately.
Keywords: Knowledge, Attitude, Health behaviors, Stress, Pregnant women, COVID-19

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How to Cite
Sukontrakoon P, Phumonsakul S, Gerdprasert sailom, Prohm S, Sawatpanich A. Associations among Knowledge, Attitudes, Health Behaviors, and Stress of Pregnant Women in Thailand during the New Coronavirus-2019. Nurs Res Inno J [Internet]. 2022 Aug. 23 [cited 2024 Feb. 22];28(2). Available from:



Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3. doi: 10.1016/S0140-6736(20)30185-9

Royal College of Obstetricians & Gynaecologists.Coronavirus (COVID-19) infection in pregnancy: Information for healthcare professionals. Version 12: 14 October 2020. [cited 2021 Feb 5]. Available from: inpregnancy-v12.pdf

Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y,Cabaraux P, Mat Q, et al. Clinical and epidemiological characteristics of 1420 European patients with mild-tomoderate coronavirus disease 2019. J Intern Med. 2020;288(3):335-44. doi: 10.1111/joim.13089.

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T,et al. Clinical manifestations, risk factors, and maternal and

perinatal outcomes of coronavirus disease 2019 in pregnancy:living systematic review and meta-analysis. BMJ. 2020;

:m3320. doi: 10.1136/bmj.m3320.

Ayed A, Embaireeg A, Benawadh A, Al-Fouzan W,Hammoud M, Al-Hathal M, et al. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth.2020;20:754. doi:10.1186/s12884-020-03461-2.

Griffiths LJ, Johnson RD, Broadhurst K, Bedston S,Cusworth L, Alrouh B, et al. Maternal health, pregnancy and birth outcomes for women involved in care proceedings in Wales: a linked data study. BMC Pregnancy Childbirth.2020;20:697. doi: 10.1186/s12884-020-03370-4.

Boekhorst MGBM, Muskens L, Hulsbosch LP, Deun KV,Bergink V, Pop VJM, et al. The COVID-19 outbreak increases maternal stress during pregnancy, but not the risk for postpartum depression. Arch Womens Ment Health.2021;24(6):1037-43. doi: 10.1007/s00737-021-


Coussons-Read ME. Effect of prenatal stress on pregnancy and human development: mechanisms and pathways.

Obstet Med. 2013;6:52-7. doi: 10.1177/1753495X12473751

Thornton CA. Immunology of pregnancy. Proc Nutr Soc.2010; 69:357-65. doi:10.1017/S0029665110001886

Fransson E, Ortenstrand A, Hjelmstedt A. Antenatal depressive symptoms and preterm birth: a prospective study of a Swedish national sample. Birth. 2011;38(1):10-6.doi: 10.1111/j.1523-536X.2010.00441.x.

de Paz NC, Sanchez SE, Huaman LE, Chang GD, Pacora PN, Garcia PJ, Neal Jret al. Risk of placental abruption in relation to maternal depressive, anxiety and stress symptoms. J Affect Disord. 2011;130(1-2):280–4.doi: 10.1016/j.jad.2010.07.024

Marcus S, Lopez JF, McDonough S, Mackenzie MJ, Flynn H, Neal Jr CR, et al. Depressive symptoms during pregnancy:impact on neuroendocrine and neonatal outcomes. Infant Behav Dev. 2011;34(1):26–34. doi: 10.1016/j.infbeh.2010.07.002

Glover V, O’Connor TG, Heron J, Golding J, ALSPAC Study team. Antenatal maternal anxiety is linked with atypical handedness in the child. Early Hum Dev. 2004;79(2):107–18. doi:10.1016/j.earlhumdev.2004.04.012.

O’Connor TG, Heron J, Golding J, Glover V, Team AS.Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis.J Child Psychol Psychiatry. 2003; 44(7):1025–36. doi:10.1111/1469-7610.00187.

Rogers LK, Velten M. Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular

disease. Life Sci. 2011;89:417–21. doi: 10.1016/j.lfs.2011.07.017.

Rav-Marathe K, Wan TTH, Marathe S. A systematic review on the KAP-O framework for diabetes education and research. Med Res Arch. 2016; 4(1):1-21.

Alavi SS, Dabbagh ST, Abbasi M, Mehrdad R. Radiation protection knowledge, attitude and practice (RP-KAP)as predictors of job stress among radiation workers in Tehran Province, Iran. Iran Red Crescent Med J. 2016; 18(10):e29394. doi: 10.5812/ircmj.29394.

Borjigen A, Huang C, Liu M, Lu J, Peng H, Sapkota C,Sheng, J. Status and factors of menstrual knowledge,attitudes, behaviors and their correlation with psychological stress in adolescent girls. J Pediatr Adolesc Gynecol. 2019;32(6): 584-9. doi:10.1016/j.jpag.2019.08.007.

Zaidi SMIH, Yagoob N, Naveed A, Gulshan N, Hussain S. Positive attitude and stress among adults with coronary

heart disease in Faisalabad. Khyber Med Univ J. 2018;10(3):146-9.

World Health Organization, Stop TB Partnership.Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys; 2008 [cited 2021 Feb 5]. Available from:

World Health Organization. Knowledge, attitudes, and practice (KAP) surveys during cholera vaccination campaigns:

guidance for oral cholera vaccine stockpile campaigns;2014 [cited 2021 Feb 5]. Available from: https://www.


Theppitak T. The KAP model and a study of behavior and attitude on prevention HIV/AIDS infection in Thai Seafarers.

Journal of Management Science Chiangrai Rajabhat University. 2013;8:84-102. (in Thai)

Calvo MG, Gutie’rrez-Garci’a A. Cognition and stress.In: Fink G, editor. Stress: concepts, cognition, emotion,and behavior. London: Elsevier; 2016. p. 139-44.

Glanz K, Schwartz MD. Stress, coping, and health behavior. In: Glanz K , Rimer BK, Visvanath K, editors.Health behavior and health education: theory, research,and practice. 4th ed. Jossey-Bass; 2008. p. 211-36.

Cohen J. Statistical power analysis for the behavioral sciences.2nd ed. New York: Lawrence Erlbaum Associates Publishers;

Grove SK. Sampling. In: Gray JR, Grove SK, Sutherland S,editors. Burns and grove’s the practice of nursing research:appraisal, synthesis, and generation of evidence. 8th ed. St.Louis: Elsevier; 2017. p. 329-62.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983; 24(4):385-96.

Wongpakaran N, Wongpakaran T. The Thai version of the PSS-10: an investigation of its psychometric properties. Biopsychosoc

Med. 2010;4:6. doi: 10.1186/1751-0759-4-6.

Al-Hanawi MK, Angawi K, Alshareef N, Qattan AMN,Helmy HZ, Abudawood Y, et al. Knowledge, attitude and practice toward COVID-19 among the public in the Kingdom of Saudi Arabia: a cross-sectional study. Front Public Health. 2020;8:217. doi:10.3389/fpubh.2020.00217.

Kamal D, Thakur VD, Swain SK, Vikneshram CR.Knowledge, attitude, and practice toward COVID‑19 among pregnant women in a tertiary care hospital during the COVID‑19 outbreak. J Mar Med Soc. 2020; 22:S66-71.

Peng Y, Pei C, Zheng Y, Wang J, Zhang K, Zheng Z, et al.A cross-sectional survey of knowledge, attitude and practice

associated with COVID-19 among undergraduate students in China. BMC Public Health. 2020; 20:1292. doi: 10.1186/s12889-020-09392-z.

Singh JP, Sewda A, Gupta SD. Assessing the knowledge,attitude and practices of students regarding the COVID-19

pandemic. J. Health Manag. 2020;22(2): 281–90. doi:10.1177/0972063420935669.

Hoque AM, Alam AM, Hoque M, Hoque ME, Van Hal G. Knowledge, attitudes, and practices towards COVID-19 of pregnant women at a primary health care facility in South Africa. Eur J Med Res. 2021;3(1):50-5. doi:

Moyer CA, Compton SD, Kaselitz E, Muzik M. Pregnancyrelated anxiety during COVID-19: a nationwide survey of 2740 pregnant women. Arch Womens Ment Health.2020;23(6):757-65. doi:

Parra-Saavedra M, Villa-Villa I, Pérez-Olivo J, Guzman-Polania L, Galvis-Centurion P, Cumplido- Romero A, et al.Attitudes and collateral psychological effects of COVID-19 in pregnant women in Colombia. Int J Gynecol Obstet.2020; 151(2): 203- 8. doi: 10.1002/ijgo.13348.

Dantzer R. Behavior: overview. In: Fink G, editor. Stress:concepts, cognition, emotion, and behavior. London:Elsevier; 2016. p. 57-63.

Lee M, Kang BA, You M. Knowledge, attitudes and practices (KAP) towards the COVID-19: a cross-sectional study in South Korea. BMC Public Health. 2021;21(1):295.doi: 10.1186/s12889-021-10285-y.