The infectious coronavirus disease (COVID-19) was first reported in December 2019 in the Chinese city of Wuhan [1] and later spread worldwide [2]. It is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 is genetically distinguishable from coronavirus, which causes severe acute respiratory syndrome or Middle East Respiratory Syndrome (MERS) [3]. However, similar to other types of coronaviruses, SARS-CoV 2 is spread between humans [2]. Hence, the World Health Organization (WHO) has recommended that people should avoid direct contact with those infected with COVID-19 and comply with hand hygiene and respiratory/cough etiquette [2].

In South Korea, the first confirmed COVID-19 cases were identified in January 2020 among individuals who had arrived from Wuhan, and the number of confirmed cases accelerated owing to its spread in local communities [4]. The Korea Disease Control and Prevention Agency (KDCA) raised a disease alert of the highest level on February 23, 2020. It emphasized prevention against the infection [4], infection-prevention principles, and high-intensity social distancing. Implementing proper precaution principles is paramount to preventing the spread of COVID-19. The success of such measures often depends on compliance with preventive actions, which, in turn, is affected by factors such as knowledge and perceptions regarding COVID-19 [5].

People’s health beliefs inform their preventive health practices [6]. The perceptions that constitute health beliefs are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The health belief model is used for detecting the infection risk level in order to induce positive changes in one’s health. Additionally, the health belief model is a helpful tool for predicting preventive health behaviors in individuals [7]. Thus, health beliefs can be considered to predict health behaviors and prevent the spread of new infectious diseases [7]. For example, Lee’s [8] study on nursing college students revealed that participants’ health beliefs about MERS were related to their preventive health practices.

Generally, in the first and second years of nursing college, students are educated about basic nursing principles and the basic stages of integrated education; later, they participate in the practicum of third- and fourth-year students. Throughout the COVID-19 pandemic, nursing students completed their clinical practicum in hospitals that had a relatively high infection risk. Albaqawi et al. [5] reported that, because of their high level of learning and the COVID-19-related information in nursing students’ theoretical courses and hospital exposure, their knowledge increased as they climbed higher on the academic ladder. However, nursing education must ensure that students in all grades have equal access to COVID-19 resources (e.g., course information, lectures, practice training, and e-learning) in order to prevent knowledge gaps among students in different grades [5]. Nursing students are future healthcare professionals who will have to address emerging infectious diseases in the future [9]; therefore, it is necessary to investigate the health beliefs, knowledge levels, and infection-prevention performances of nursing students in all grades.

The researchers investigated the impact of health beliefs and knowledge on nursing students’ COVID-19 infection-prevention behavior throughout this study. Furthermore, the researchers intended to (1) provide nursing students with basic data in order to establish an educational program for efficient and implementable infection prevention and (2) help nursing students comply with infection-prevention guidelines and consequently promote good health.

Most of the participants of this study had no educational experience regarding COVID-19; however, their COVID-19-related knowledge level received a score of 84 points, indicating relatively high levels of knowledge. Over half of the participants were found to have gained knowledge about COVID-19 through more than five Internet searches. It is believed that the KCDA’s response guidelines, including the latest updates regarding COVID-19 and social distancing, may have affected the nursing students’ knowledge of COVID-19. For the students, the items with the lowest level of COVID-19 knowledge were “It is spread only through droplets” and “It is treated with a commercially available antiviral drug.” COVID-19 mainly spreads through droplets, but direct contact with infected people, contaminated materials, or contaminated surfaces can also transmit the virus. It is also possible for COVID-19 to spread during aerosol production or in enclosed spaces [14]. Kwok et al. [16] found that medical students touched their faces an average of 23 times per hour, with 44% touching mucous membrane areas (e.g., mouth, nose, and eyes), which are the main channels through which bacteria or viruses spread. The most frequent contact with mucous membranes was conducted through the mouth (36%), nose (31%), and eyes (6%). In a study by KDCA [17], facial contact accounted for 50% of all physical contact cases. Among them, mucosal contact between the eyes, nose, and mouth accounted for 46.3% of all physical contact cases. Average contact frequency between the mouth and nose was found to be high, and the mouth area was reported to have the longest contact time. Therefore, to prevent the spread of COVID-19 through contact, people must wear masks and comply with proper hand hygiene. Hand hygiene is the single most important measure for preventing the transmission of healthcare-associated infections [18]. Nursing students may be exposed to infectious agents and risk becoming disease carriers to others, including patients, during clinical practice in hospitals. Accordingly, nursing students should be able to perform adequate hand hygiene based on accurate knowledge [18]. Therefore, it is necessary to thoroughly educate nursing students on proper hand hygiene through fundamental nursing theory and practice classes and clinical practice in hospitals.

In this study, participants were not very susceptible to developing COVID-19, and their perceived barriers to preventing COVID-19 were not very high. In contrast, their preventive health behaviors were very high. These findings echo that of Fathian-Dastgerdi et al. [19], who studied low sensitivity levels and preventive behavioral obstructions among adolescents. Similarly, in a study of adults aged 18 to 77 years, Shahnazi et al. [12] found that, although perceived barriers such as handwashing-related barriers (perceived barrier to independent preventive behaviors) were low, perceived barriers were still highly influenced by environmental barriers such as shortages of masks, alcohol sponges, and disinfectants. Although masks were not readily available in the early days of the COVID-19 pandemic, the Korean government actively intervened to provide the public with sufficient amounts of hand sanitizer and masks. Consequently, prevention barriers appeared to be lower at the time of this study. Furthermore, the Korean government raised the infectious disease alert level to “orange”–the third level in a four-tier alert system–in January 2020 and promoted COVID-19 prevention rules via mass media and government websites; therefore, the students’ perceived benefits of the guidelines were high, and their level of prevention was considered to have increased.

Additionally, COVID-19-related preventive health behaviors were significantly correlated with searches for COVID-19 information, perceived severity, perceived benefits, cues to action, and knowledge (r = .27, p < .01) and were significantly negatively correlated with perceived barriers. In the study by Fathian-Dastgerdi et al. [19], protective behavior, self-efficacy, perceived benefit, and perceived severity were positively correlated with each other, whereas perceived susceptibility and perceived barriers were negatively correlated; these findings were similar to those of the current study. As excessive obstacles can interfere with the creation of health behaviors [12], it is essential to increase disease prevention-related awareness and reduce environmental barriers to preventive behavior.

In this study, high levels of COVID-19-related preventive health behaviors, higher university years (junior and senior), and high educational experiences regarding COVID-19 resulted in lower perceived barriers and higher cues to action. In a study on COVID-19 repositories, symptoms, and prevention, Elgzar et al. [20] trained nursing students using presentations, group conversations, and problem-solving methods. The authors reported that overcoming their perceived barriers to implementing COVID-19-related preventive actions increased participants’ self-efficacy. In contrast, Shahnazi et al. [12] reported that inducing perceived benefits increased self-efficacy and led individuals to overcome their perceived barriers. Therefore, national efforts are necessary for reducing negative perceptions such as inconvenience, costs, and pain in carrying out COVID-19-related preventive actions. The results of this study also indicate that COVID-19-related knowledge is positively correlated with perceived susceptibility, severity, benefits, and preventive health behaviors. In South Korea, nursing students are educated about infection-control theory in basic nursing and learn core basic nursing skills in practice classes [21]. They then increase their infection control-related knowledge and proficiency through the third- and fourth-year curriculum and clinical practice [21]. However, the core basic nursing skills focus on the use of simple sterile gowns and waste management [21]. Furthermore, the clinical practice focuses only on the disease-related knowledge, nursing interventions, and primary infection-control performance necessary for preventing healthcare-associated infections [21]. Therefore, it is evident that it is insufficient for improving performance related to specialized patient care (e.g., the donning and doffing of personal protective equipment, the treatment and response procedures necessary for infectious disease patients, the preparation and application of practical infection-control guidelines in healthcare settings, patient screening, and so on), which is necessary during infectious disease pandemics, such as the COVID-19 situation [21]. Furthermore, WHO has warned that new infectious diseases are emerging at an unprecedented rate [22]. Therefore, it is necessary to educate nursing students about emerging infectious diseases, including COVID-19, in order to raise their awareness of the seriousness of such viruses, provide them with practical information, and promote their individual readiness for emerging infectious diseases.

The first limitation of this study was that the subjects were convenience sampled from two nursing universities in South Korea. The second limitation was that COVID-19-related preventive health behaviors were self-reported and not directly observed. Last, although this study was conducted relatively recently, its results must be compared with those of other studies examining the latest situation, as the COVID-19 pandemic situation has been changing dramatically since then. As more than two years have passed since the initial outbreak, changes in health beliefs should be considered along with the education and testing experiences of nursing students. Therefore, further studies are warranted in this regard.

This study aimed to determine the effect of health beliefs and COVID-19-related knowledge on infection-prevention behaviors among nursing students. The factors that significantly affected COVID-19-related preventive health behaviors were students’ university year of study, experience regarding COVID-19 prevention education, perceived severity, perceived barriers, and cues to action. Therefore, COVID-19-related preventive health behaviors should be promoted by increasing awareness of COVID-19 and imparting COVID-19 education in nursing courses.