Knowledge, attitudes, and practices regarding COVID-19 among university students and employees in Massachusetts, USA: A qualitative study

Figures & data

Figure 1. Epidemic curve of SARS-CoV-2 positive tests, University of Massachusetts-Amherst, Fall semester, 2020..

Table 1. Demographics for focus group and interview participants, COVID-KAP study, 2020–2021.

	Undergraduate focus groups (N = 13)	Employee focus groups (N = 9)	Interviews (N = 14)
Age (mean)	19.9 (N = 8)	49.8 (N = 5)	24.9 (N = 10)
Missing	N = 5	N = 4	N = 4
Gender
Female	5	3	8
Male	4	3	3
Gender Diverse/Prefer not to answer/No response	4	3	3
Race*
American Indian/Alaska Native	0	0	0
Asian	2	0	2
Black	0	1	1
White	8	6	8
Other	0	1	1
Prefer not to answer	0	0	0
Missing	3	3	3
Ethnicity
Hispanic	2	1	0
Non-Hispanic	8	5	11
Missing	3	3	3

*Note: Participants were able to choose multiple categories.

Table 2. Themes, codes, and their representative quotes for the focus group and interview analyses, COVID-KAP study, 2020–2021.

Themes	Codes	Representative Quotes
COVID-19 Knowledge	Misinformation and Confusion	“I feel like everybody has their own sort of definition of quarantine… for some people quarantine can mean maybe you don’t go to work but you can…go out to eat or go to the grocery store.” (Focus Group, Undergraduate, Non-Hispanic White, Female) “Our friends, like wouldn’t come back to our room because they were also worried like, she’s still technically positive. Like, how do we know she can’t still spread it to us, like we didn’t really know how that worked.” (Interview, Undergraduate, Quarantine, Non-Hispanic Asian, Female)  “So my anxiety it’s tough, you know, because oh how can I, how can I stay at home for three months?” (Interview, Faculty/Librarian, Isolation).
	Information Sources	“That’s the funny thing about news is that there’s really no way to kind of verify if it’s a trusted source…if you look at 10 different news channels that were all talking about COVID, they would each explain the severity and the symptoms and stuff different…it’s really hard to trust anything honestly.” (Focus Group, Undergraduate, Non-Hispanic White, Female) “There’s people out there, they don’t even believe that it’s a thing you know because of all the mixed messages.” (Interview, Staff, Quarantine, Non-Hispanic White, Male)
Stress and Coping	Direct Stressors from COVID-19	“I woke up and I had a cough from hell” (Interview, Staff, Isolation, Non-Hispanic White, Male) “I had no energy whatsoever. I was destroyed. And the other thing was, you know, train of thought. It was crazy. I was losing my train of thought.” (Interview, Staff, Isolation, Non-Hispanic White, Male) “I think the food you know food side of it is, was the biggest, hardest toughest thing to kind of overcome” (Interview, Staff, Isolation, Non-Hispanic White, Male) “I couldn’t be in my room anymore. So I would just run up and down the hallway” (Interview, Undergraduate, Quarantine, Non-Hispanic Asian, Female) “No one wanted to meet, you know, even within a six feet, social distance… So even the spouse didn’t want to come, oh, stay, something like that. That was so hard” (Interview, Faculty/Librarian, Isolation)
	Indirect Stressors from COVID-19	“In my head like working is huge. I need like, I need money. Like I need to pay rent and stuff.” (Interview, Undergraduate, Isolation, Non-Hispanic White, Female) “How much can you squeeze people, and squeeze people, and squeeze people before they just say, screw it. I’m not. I can’t deal with it.” (Interview, Staff, Quarantine, Non-Hispanic White, Male) “What’s going to happen is students are going to come in and you’re going to have staff members, many of whom are in older age brackets or student staff, having to police the behavior of students… student workers, are going to have to be monitoring the behavior of their fellow students and telling them put their masks back on” (Focus Group, Faculty/Librarian, Non-Hispanic White, Female)
	Social Support	“This is weird, but like my bathroom was next to this other guy’s bathroom and we could like, hear each other pee, and like the walls were really thin then we would like, say hi to each other through the wall… I need to do this… just to know that on the other side of the wall there, there’s another human.” (Interview, Undergraduate, Quarantine, Non-Hispanic Asian, Female) “People like that I grew up with, like are going to get tested and make the right choices… that’s also part of the routine but isolating and not hanging out is not” (Focus Group, Undergraduate).
Trust	Science, Government, and Healthcare Trust	“Tend to trust Anthony Fauci and others that have little by little, built a reputation for being careful.” (Focus Group, Faculty/Librarian, Multi-ethnic, Male)
	Science, Government, and Healthcare Mistrust	“I felt like the CDC information was clearly being politicized, was being whitewashed, was being struck through what could and couldn’t be said and those decisions were not motivated by protecting-people protecting people’s health and making accurate recommendations.” (Focus Group, Staff, Non-Hispanic White, Female) “My roommates, like, we try to be safe but when we go home, none of our families really believe in COVID so it’s kind of hard to actually be safe because half the people we see don’t care.” (Focus Group, Undergraduate, Non-Hispanic White, Male) “My personal beliefs, out of work… I thought things were, you know, kind of overblown” (Interview, Isolation, Staff, Non-Hispanic White, Male)
	Institutional Trust	“I trust like the university’s decisions. I think that they’re doing like the best they can in the situation. And also comparing them to other universities, because I do that too, I think that we are like heads above other schools.” (Focus Group, Undergraduate, Non-Hispanic White, Female) “[the university] I think did a really good job. Like unbelievable with like checking up every day like it was almost like annoying, but it was like a good annoying because obviously you know you need that kind of like accountability.” (Interview, Undergraduate, Quarantine, Non-Hispanic, Female)
	Institutional Mistrust	“Just like blare out loud that it’s confidential in a way that it’s like not being published and stuff, just because I think the biggest motivator for not doing it is the fact that, like, oh, like who’s finding this out? Are they gonna know? Like they’re who are they tracing it back to? And is that person’s name not going to get everywhere, there’s like a rumor about it, not that this high school, but just the idea that people like their confidentiality and privacy, especially when you’re talking about COVID just because, like, oh, COVID, shun them away.” (Focus Group, Undergraduate, Non-Hispanic White, Male) “We have these levels of what’s open and what’s not. But it is really opaque what triggers those changes and that really reduces my faith in campus administration… they might just disregard them because they see dollar signs or they see the budget deficit and that overrides their health and safety concerns.” (Focus Group, Faculty/Librarian, Non-Hispanic White, Female) “If I was a contact of somebody right now and I had – and they asked me the question, were you a contact with somebody? I don’t know if I would, if I would be truthful” (Interview, Quarantine, Staff, Non-Hispanic White, Male)
Decision-Making	Testing Choices	“I look at testing as just one of the tools in our arsenal to help prevent the spread as well as help to keep myself and my colleagues and family safe.” (Focus Group, Staff, Non-Hispanic White, Male) “Maybe you’re preparing to see some people over the weekend. That’s smart, you should get tested then” (Focus Group, Undergraduate, Non-Hispanic White, Gender Diverse) “I’d probably like get tested on Monday, like at the end of the weekend so I know like I’m safe for the week, nothing happened over the weekend” (Focus Group, Undergraduate, Non-Hispanic White, Male)
	Safer Social Behaviors	“I think like the most aggressive change that I made would be like, no one’s going to like typical college house parties.” (Focus Group, Undergraduate) Employee, Focus group: “Think of a health budget and where do you want to spend it, on what chances you want to take and where you want to minimize, that type of thing.” (Focus Group, Faculty/Librarian, multi-ethnic, Male) “We’re careful but we’re not psychotic about it… Saturday I had done a huge meal and I threw it out there and some people were frequently stopping in throughout that day. So in grand total on that day I probably had 17 people that had kind of gone through the system” (Interview, Staff, Isolation, Non-Hispanic White, Male).
	Negotiation and Peer Pressure	“I would just like cancel, make an excuse or something because I don’t feel comfortable suggesting something else, because I know like they would think it’s weird.” (Focus Group, Undergraduate, Non-Hispanic White, Male) “We put our foot down. ‘No, we’re not traveling and no, you can’t come up.” (Focus Group, Staff, Non-Hispanic White, Male) “When we found out that we might test positive… I wanted to lock myself in my room. My friends didn’t want me to. They thought I was being silly. I wish I did.” (Interview, Undergraduate, Isolation, Non-Hispanic White, Female) “It’s an internal pressure. I mean, I felt the external pressure from [the university] because I had the classes on campus, but otherwise for them, it was definitely an internal like, ‘we don’t want COVID, be careful, get tested’” (Focus Group, Undergraduate, Non-Hispanic White, Gender Diverse)
	Protection of Family Members	“People like my grandparents, I have not gone to visit them at all, like I won’t get very near them.” (Focus Group, Undergraduate, Non-Hispanic White, Gender Diverse) “We have been extremely disciplined and I’m exhausted being the disciplinarian in terms of social interactions for my 10-year-old social butterfly daughter.” (Focus Group, Faculty/Librarian) “So, my concern, mostly was that I had gotten like the people that I love the most sick, more so than myself…”It was more than sadness.” (Interview, Graduate student, Isolation, Non-Hispanic White, Female)
Institutional Feedback	Institutional Pride	“I think the campus did like a really, really good job. I mean like probably like the best in this in the country.” (Interview, Undergraduate, Quarantine, Non-Hispanic, Female) “I’m continually impressed with just like health supports at UMass in general…I do feel like UMass as an organization does a great job like prioritizing them. Both like the physical and mental health of their students.” (Interview, Graduate student, Isolation, Non-Hispanic White, Female) “I’ve been pretty happy with how [the university] is relaying information. In terms of COVID, I do really like the website to just look at the numbers and everything of what’s happening and how many cases there are per day and how fast people are getting their results” (Focus Group, Undergraduate, Non-Hispanic White, Female) “from what I’ve seen, [the university] has done a pretty good job. Every time there’s a big COVID update, I see an Instagram, Facebook posts, etc. and there’s always information on websites. And then there’s almost always an email as well. I’m not sure what more they could be doing. I really, I do think it’s pretty comprehensive” (Focus Group, Undergraduate) “UHS was great, [the university] was great (Interview, Quarantine, Non-Hispanic White, Male)”
	Asymptomatic Testing Pros	“I think the Mullins Testing Center has been such a – such a blessing, we’re really lucky to have that.” (Focus Group, Undergraduate) “The ease definitely outweighs any potential challenges or negative components of the testing” (Focus Group, Graduate student)
	Asymptomatic Testing Cons	“We would go there and sometimes the line would be so long, we’d miss class like so then we’d have to leave midway through the line and just go back to class.” (Focus Group, Undergraduate, Non-Hispanic Asian, Female)
	Policy Disagreement or Confusion	“Let’s say you’re on campus and get tested positive like when you get tested positive, does someone come out like a hazmat suit and like drag me to like the [] Hall like that prison looking building or like, what- what’s the protocol for that?” (Focus Group, Undergraduate, Non-Hispanic White, Male) “I don’t care about this wellness check, regardless. So I just don’t know how beneficial it will be for like, as a data, data like collection resource to have it, try and push it on people that don’t really want to take it” (Focus Group, Undergraduate) “I don’t see how without a little stick rather than a carrot, people will comply” (Focus Group, Faculty/Librarian)
	Perception of Privileged Groups	“I also follow UMass athletics and it’s very difficult when I see them traveling and training and going to games and doing this and that.” (Focus Group, Undergraduate, Non-Hispanic White, Female) “One thing that I saw was that they reopened the gym at school before the library, which I think should not have been done.” (Focus Group, Undergraduate, Hispanic White, Female) “I think as a senior, it was just a little disappointing seeing that some freshman are going to be allowed on campus taking in person classes” (Focus Group, Undergraduate, Non-Hispanic White, Female) “…there’s like a few like frat houses and stuff who are not taking it seriously. I am also involved in Greek life so I’m not out here to like bash Greek life at all, but like, I just happen to know of like different fraternities who have been having parties and not getting tested” (Focus Group, Undergraduate, Non-Hispanic White, Female)

Figure 2. Overview of main themes related to university COVID-19 pandemic response. 

Data availability statement

The datasets generated and analyzed during the current study are not publicly available in order to preserve participant confidentiality. Data may be available from the corresponding author upon reasonable request.