Knowledge, attitude and practices towards climate change and global warming among medical students of Trivandrum district: a cross-sectional study

INTRODUCTION

Climate change is the biggest global health threat of 21^st century.¹ Human activity is mostly responsible for the pollution of environment through urbanization, industrialization and other activities. Emission of greenhouse gases into the atmosphere have been increasing since the beginning of industrial revolution. Temperatures have risen by 0.7 °C (1.3 °F) between 1901 and 2018, thereby changing the climate in India.² As of May 2024, India is experiencing one of its most intense heatwaves in recent memory.

Global warming, driven primarily by human activities such as the burning of fossil fuels and deforestation, leads to consequences that affect both natural ecosystems and human societies. It leads to various consequences like rising temperatures, melting of ice caps, changes in precipitation patterns, ocean acidification, increased frequency of extreme weather events, loss of bio-diversity.³

Addressing global warming requires concerted efforts at both individual and collective levels to reduce greenhouse gas emissions, transition to renewable energy sources, protect and restore ecosystems, and adapt to the changes that is already underway. Failure to act swiftly and decisively risks causes irreversible damage to both the planet and its inhabitants.

The WHO in 2015, have asked all the health professionals of the world to be on the forefront in protecting the people from the harmful health impacts of the climate crisis. To achieve the United Nation’s sustainable developmental goal‑13 (SDG‑13) i.e., “to take urgent action to combat climate change and its impacts”.⁴ The role of medical fraternity will be of paramount importance as primary care physicians, in actively guiding the people to adopt healthy, environmentally friendly practices and as health administrators, to unequivocally push for more sustainable health policies.

While the scientific consensus on these issues is unequivocal, the extent to which medical students perceive and understand the complexities of climate change remains relatively unexplored. Understanding the knowledge perception of medical students in this regard is crucial, as they represent future healthcare providers whose actions and decisions will significantly impact public health outcomes.

Aim

This research aims to investigate the knowledge, attitude and perception of medical students concerning climate change and global warming. This helps to uncover potential gaps in education and opportunities for intervention. By empowering future healthcare professionals with the knowledge and awareness necessary to address climate-related health challenges, we can foster a more resilient and sustainable healthcare workforce equipped to mitigate the impacts of climate change on public health. The objectives of this study are to assess knowledge, perception and practice towards climate change and global warming among MBBS students of Trivandrum district.

METHODS

It was a cross-sectional study done among MBBS students in four medical colleges of Trivandrum district. The study was conducted from April to November 2024. Sample size is calculated using the formula-

N=Z(1-α/2)²pq/d² p=53% (proportion of knowledge about climate change among medical students in China). α=0.05 (significant level) q=100-p=47. d=relative precision, taken as 10% of the prevalence; d=5.3.

The estimated sample size was 355.The Sampling technique followed was Simple random sampling. Medical students of 18 to 30 years and those who gave consent to participate in the study were included. A semi structured questionnaire was prepared via Kobo toolbox for humanitarian response. Questionnaire consists of sociodemographic details and questionnaire taken from Telangana and Iraq.^6,10 The data obtained was coded and entered in Microsoft excel worksheet and analysis performed using the statistical software statistical package for social sciences (SPSS version -23) each question on knowledge, attitude and practice questionnaire were gives a score of 1, the total score was calculated and mean score were analysed. Those participants who score below the mean were considered to have poor knowledge, poor attitude and poor practice.

Ethical consideration

Study was conducted after obtaining institutional ethical clearance number 131/IEC/SUTAMS/2025. Also, after obtaining informed consent from the study participants. Involvement was voluntary. Data collected was totally anonymous and no identifying features were incorporated. No expenses were incurred from the study participants.

RESULTS

The data was collected from 389 medical students of government and private medical colleges of Trivandrum district. The socio demographic profile of study participants is shown in Table 1. Among 389 study participants, 149 (38%) were from the age group 21-22 years, 58% (227) were females 77% (301) of the study participants were from private medical colleges and 64% (251) were staying in the hostel.

Figure 1 shows the most common source of learning about climate change and global warming Among six options the most common source of learning were newspapers (262) and internet (255).

Figure 2 shows about awareness on consequences of climate change and global warming, the two most common consequences were diseases related to water availability (255) and vector borne diseases (251).

Table 2 shows distribution of students’ knowledge about various protocol and association on climate change and global warming. Among 389 study participants only 74% (64) have heard about Kyoto protocol and UNFCC from first year 73% (63) from second year, only 63% (72) from fourth year, 54% (41) from third year. Only 68% (51) from second year, 54% (61) from fourth year, 44% (33) from third year, and 34% (30) from first year have heard about IPCC.

Table 3 shows the distribution of knowledge on climate change and global warming among medical students. 95% of students are aware that climate change and global warming is affecting Kerala and are aware of the ways to reduce climate change.

The mean score was 14. Those study participants who scored above 14 were considered to have good knowledge and those with scored below 13 were considered to have poor knowledge. Hence 70% (271) study participants were having good knowledge on climate change and 30% (118) were having poor knowledge on climate change

Table 4 shows the attitude of medical students towards climate change and global warming. Among 389 study participants 72% (281) believes cardiovascular and respiratory disease are the major health impacts of climate change, 82% (320) believes increased infections , vector borne disease transmission are the major health impacts of climate change, 38% (148) believes malnutrition is the major health impact of climate change, 42% (165) believes food migration and civil conflicts are the major health impacts of climate change, and 20% (78) believes obesity is the major health impact of climate change.

The mean score was 5. Those study participants who scored above 6 were considered to have good attitude and those with scored below 5 were considered to have poor attitude. Hence 70% (271) study participants were having good attitude on climate change and 30% (118) were having poor attitude on climate change and global warming.

Table 5 shows distribution of practices adopted to reduce the effects of climate change and global warming. The most common practice followed were usage of public transport to save fuel (76%) and reducing the usage of plastic and recycle if necessary (72%).

The mean score was 5. Those study participants who scored above 5 were considered to have good practices and those with scored below 4 were considered to have poor practices. Hence 70% (271) study participants were having good practice to reduce climate change and global warming and 30% (118) were having poor practice on climate change and global warming.

Table 6 shows the association between the level of knowledge, attitude and practice with the contributing factors of climate change and global warming. There was a significant association with socioeconomic status of medical students with the level of knowledge (p<0.045). Similarly, the association with age and place of residence had a significant association with the level of attitude towards climate change and global warming (p<0.002, 0.01 respectively). Age, year of education and socioeconomic status had a significant association with the level of practice towards climate change and global warming (p<0.003, p<0.000, p<0.001 respectively).

DISCUSSION

This research aimed to explore the level of knowledge, perceptions, and practices of MBBS students in Trivandrum regarding climate change and the global warming. 70% (271) study participants have a good knowledge on climate change and global warming. Our findings are consistent with the results of a studies done in China and Spain where 83% and 76% respectively had good knowledge.^5,8 The high level of knowledge could be because of inclusion of environmental health topics in college curriculum or through personal interest which is supported from the findings of our study. But there is limited incorporation of climate change content in the curriculum (only 20% of students reported learning about it in their courses) which stands out as a critical gap. The most common source of learning was internet (72%). Our findings are consistent with a study done in Jaipur among medical students.¹⁰

Another significant finding of this study is that a majority of the students perceived climate change as a major public health threat. The students identified respiratory and cardiovascular diseases, as well as vector-borne diseases like malaria and dengue, as the most significant health impacts of climate change. Our findings are consistent with the study done in Jaipur, China and Indonesia.^8-10 This understanding is reflective of current medical and public health research, which connects climate change to a wide range of health problems, including heat- related illnesses, infectious diseases, malnutrition, and mental health issues. Only 67% (260) opted for buying environmentally friendly products, 65% (253) use energy saving appliances. Our study supports a gap between awareness and action which could be because of busy schedules, the stress of their academic environment and lack of institutional encouragement which may be inhibiting them from adopting greener practices. This points to the need for more structured, supportive interventions that can bridge this gap such as institutional sustainability policies, targeted campaigns within medical school settings.

Our study offers valuable insight into the role of primary care physicians within the medical fraternity to take greater strides in both encouraging others and adopting environmentally friendly practices. Our study identified a need to convert the knowledge into everyday practice for achievement of SDG 13 by 2030. Limitation of our study is limited exploration of factors influencing behavior change. From our study we recommend that it is the need of the hour to encourage student-led initiatives like campaigns, and projects, Hands-on activities, project-based learning and organize field trips to reinforce learning on climate change and global warming.

CONCLUSION

Our study demonstrates that among the MBBS students in Trivandrum district 70% of study population has good knowledge, 52% have good attitude and 61% have good practices towards climate change and global warming. The most common consequence of climate change and global warming identified were diseases related to air quality, vector borne diseases and water borne diseases. The most common source of learning on climate change and global warming are newspaper and internet. The findings also highlight the importance of integrating more climate change consequences into the medical curriculum, which can help in achieving climate resilient ecosystem.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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