A Study of Knowledge, Attitude, and Practice of Nasal Irrigation During the COVID-19 Pandemic

COVID-19 is a respiratory tract infection caused by the novel coronavirus (nCov). Nasal irrigation is one of the efforts to prevent COVID-19. Nasal irrigation is an act of flushing saline solution into the nasal cavity. This research aims to determine level of knowledge, attitudes, and practices of the community regarding nasal irrigation during the COVID-19 pandemic. This study was a descriptive observational study. The sample of this research was the people of Palembang who were eligible for the inclusion and exclusion criteria with the consecutive sampling technique as many as 398 respondents. Data were obtained through primary data in the form of questionnaires, processed using the SPSS program, and analyzed using univariate analysis. The majority of respondents were aged 18-25 years old (65.5%) and had senior high school 58.0%. The level of public knowledge about nasal irrigation during the COVID-19 pandemic was in the moderate category of 36.2%. The level of public attitudes regarding nasal irrigation during the COVID-19 pandemic was in the good category at 83.4%. The level of nasal irrigation practice was included in the bad category of 75.6%. In conclusion, the community of Palembang had moderate level of knowledge, a good level of attitude, and a bad level of practice regarding nasal irrigation during COVID-19 pandemic.

These cases are constantly increasing so that efforts needed to take prevent the spread and reduce the case fatality rate.One of the measures that can be done is regular nasal irrigation.Nasal irrigation is useful for maintaining nasal health, such as for removing mucous, infective pathogens, and inflammatory mediators.Nasal irrigation is defined as a procedure of spraying saline solution in to the nasal cavity. 7The most commonly used saline solution is isotonic saline solution, for example NaCl 0.9%.
However, there were studies which stated that the use of hypertonic saline solution, povidone iodine (PVI), has a superior virusidal activity and thus reduce viral load. 7,8This study aims to determine level of knowledge, attitude, and practice of the community regarding nasal irrigation during COVID-19 pandemic.

Methods
This study used a descriptive observational design with the population of Palembang, Indonesia.

Results and Discussion
Figure   It is implied that the higher their education will be, the higher an individual will in pursuing information regarding new knowledge and the easier it is to receive the knowledge they get.The factor that can affect the level of knowledge of an individual is an information source.Information sources regarding health can be obtained from various parties, such as a doctor, healthcare workers, friends, teachers, and also social media. 9Attitudes are formed by personal experience or the people around them, which cause an individual's urge to stay away from an object or a disease by preventing the risk of developing the disease. 10In the study, the people showed a good attitude, meaning that the people supported COVID-19 prevention.
According to the Green theory, there are three main factors that affect a person's health behavior.The first is a predisposing factor regarding the individual's knowledge.Judging from the result of the level of knowledge, the majority of the people show a moderate level of knowledge regarding nasal irrigation.The second factor is enabling factor, which means the availability of facilities and health care materials, including the materials used for nasal irrigation (NaCl 0.9% solution), which probably is not available in every household, and the majority of people do not know how to make a saline solution at home. 11,12The third factor is the reinforcing factor, which means there is a relationship between the healthcare workers and other community leaders around them who never perform nasal irrigation. 13e three factors are interrelated and form health behavior. 14In this case, one of the factors that cause people never to perform nasal irrigation can be because they never see their close relatives perform it, so it is not emulated.Nasal irrigation is a procedure of spraying the saline solution into the nasal cavity. 7,8An incorrect nasal irrigation method may cause pain due to the water flow or the syringe tip nudging the nasal septum, which then elicits a negative response in the individual.This negative response can take the form of avoiding performing nasal irrigation procedures due to discomfort.This can also be a factor for someone to be reluctant to perform nasal irrigation.Usually, nasal irrigation is performed by individuals with nasal disease symptoms such as rhinosinusitis because it is advised by a doctor as adjuvant therapy.They are more compliant and more pleased to perform nasal irrigation because they can have more control of their health, effective in reducing chronic rhinosinusitis symptoms, and may reduce the need to use the medicine.To adapt to new health habits, people need to see and hear the correct information.Similarly, with hand washing and using a mask, currently, people are more obedient in doing so as a preventive measure against COVID-19. 12,14

Conclusion
The community of Palembang had a moderate level of knowledge, a good attitude, and a bad level of practice regarding nasal irrigation during the COVID-19 pandemic era.

Figure 1 .
Figure 1.Distribution of respondents according to the districts in Palembang.

Table 1 .
Sociodemographic distribution of respondents.

Table 2 .
Knowledge, attitude, and practice level regarding nasal irrigation.