The aim of the study is to assess the level of knowledge and fear amongst dental patients attending dental OPD in a dental institution. A cross- sectional, questionnaire study was conducted among dental patients attending dental OPD of K.D. Dental College & Hospital, Mathura.
The study was conducted to assess the level of knowledge and fear amongst dental patient’s using Knowledge assessment questionnaire and Fear of COVID-19 Scale, which was translated into Hindi. The observed data were coded, tabulated, and analyzed using IBM SPSS Version 20. Descriptive statistics were represented as frequency and percentages for categorical variables (gender, age group and socio-economic status) and Mean ± Standard Deviation for continuous variables (knowledge score, fear during lockdown score and fear after lockdown score). Comparison of gender with fear scores was done using independent test and comparison of age group and SES with fear scores was done using using one-way ANOVA test. Pearson’s test was used to correlate between knowledge and fear scores. A p value of less than 0.05 was considered statistically significant.
One of the emergent global challenges in managing infectious diseases is dealing with the novel coronavirus 2019 (COVID-19). With the extremely high infection rate and relatively high mortality, individuals naturally began worrying about the COVID-19. Apart from reducing the transmission rate, considering an individual’s knowledge and fear is a vital aspect for their psychological wellbeing and may also largely influence the manner in which an individual may adhere to preventive measures and thereby determine the clinical outcome of COVID-19.
CONTENTS
1. INTRODUCION
2. AIM & OBJECTIVES
3. REVIEW OF LITERATURE
4. MATERIALS & METHODS
5. RESULTS
6. DISCUSSION
7. SUMMARY
8. CONCLUSION
9. LIMITATIONS
10. RECOMMENDATIONS
11. REFERENCES
12. ANNEXURES
ACKNOWLEDGEMENT
“No dissertation is a one man job, this dissertation is no exception.”
Parents are the first teachers, teachers are the second parents; with these words I humbly acknowledge the affectionate and caring attitude of my teachers throughout my work and all praises to almighty God who enlightened me to carry out this study successfully.
Firstly with deep sense of gratitude, I would like to thank my guide Dr. Navpreet Kaur, Professor and Head, Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura for her most valuable suggestions, constructive criticism, constant encouragement and suggestions that has enabled me to compile this dissertation. I remain ever grateful to her.
I would like to thank Dr. Vivek Sharma, Dr. Manish Bhalla, Readers, Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura for their personalized attention, constant inspiration, encouragement, constructive criticism and strive towards excellence.
I would like to thank Dr.Roopali Gupta Senior Lecturer, Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura for his valuable suggestions, support and guidance during the course of my study.
I would like to give special thanks to Dr.Shamaz Mohamed, for providing me the valuable guidance and helping me in the statistical analysis of the data.
I am grateful to Dr.Manesh Lahori, Director and Principal, K.D. Dental College and Hospital, Mathura for his valuable suggestions, support and encouragement.
My deepest gratitude goes to my family for their unflagging love and support throughout my life; this dissertation is simply impossible without them. Words are inadequate to express my feelings towards my father Mr. R.B Ram, my mother Mrs. Chinta Devi, my brothers Anil Kumar
Chaudhary & Sudhir Chaudhary, my sister in law Priyanka Nishad and my wife Payal Choudhary, all my family members for their blessings, affection and moral support during this work.
Very special thanks to my friend Dr.Hemendra Pratap who had always supported me from being introvert to extrovert and always motivating me to achieve a success.
I thank my co-post graduate colleagues and senior and junior postgraduate colleagues for all the help and constant encouragement rendered during various stages of dissertation.
I would like to express my gratitude to all those who have helped me directly or indirectly in bringing this dissertation to completion.
Finally I bow in reverence before DIVINE GOD for answering my prayers and for showing me the light of life.
Date:
Dr. SUNIL KUMAR CHAUDHARY
ASSESSMENT OF KNOWLEDGE & FEAR OF COVID-19 AMONG DENTAL PATIENTS IN A DENTAL INSTITUTION, MATHURA - A CROSS SECTIONAL STUDY
ABSTRACT
Introduction: One of the emergent global challenges in managing infectious diseases is dealing with the novel coronavirus 2019 (COVID-19). With the extremely high infection rate and relatively high mortality, individuals naturally began worrying about the COVID- 19. Apart from reducing the transmission rate, considering an individual’s knowledge and fear is a vital aspect for their psychological wellbeing and may also largely influence the manner in which an individual may adhere to preventive measures and thereby determine the clinical outcome of COVID-19.
Aim: To assess the level of knowledge and fear amongst dental patients attending dental OPD in a dental institution.
Materials & methods: A cross- sectional, questionnaire study was conducted among dental patients attending dental OPD of K.D. Dental College & Hospital, Mathura. The study was conducted to assess the level of knowledge and fear amongst dental patient’s using Knowledge assessment questionnaire and Fear of COVID-19 Scale, which was translated into Hindi. The observed data were coded, tabulated, and analyzed using IBM SPSS Version 20. Descriptive statistics were represented as frequency and percentages for categorical variables (gender, age group and socio-economic status) and Mean ± Standard Deviation for continuous variables (knowledge score, fear during lockdown score and fear after lockdown score). Comparison of gender with fear scores was done using independent t test and comparison of age group and SES with fear scores was done using using one-way ANOVA test. Pearson’s test was used to correlate between knowledge and fear scores. A p value of less than 0.05 was considered statistically significant.
Results: There was highly statistically significant difference (p<0.001) found between fear score of COVID-19 during lockdown and after lockdown. There was mild positive correlation (r=0.158) and highly statistically significant (p=0.00) results were found between knowledge and fear of COVID-19 during lockdown. But, after lockdown correlation between knowledge and fear of COVID-19 was mild positive (r=0.057) and results were not found to be statistically significant (p=0.057).
Conclusion: It was concluded from the present study that in a resource-challenged country such as India, individual knowledge of suggested precautionary and preventive health advisories are crucial to controlling the vicious community transmission of COVID- 19. The study found that knowledge levels were adequate in the majority of the population and were directly and significantly related to age, occupation & education of head of the family, monthly income of the family and socioeconomic class.
Key words: Knowledge, Fear, Fear Scale of COVID-19.
LIST OF TABLES
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INTRODUCTION
The Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) is responsible for the current corona virus pandemic, named COVID-19 by the World Health Organization. The World Health Organization (WHO) has declared the novel COVID-19 epidemic as a global pandemic on March 11, 2020. COVID-19 is a vastly infectious disease rapidly spreading from its origin in Wuhan City, Hubei Province of China to the rest of the world in December 2019. Globally, till 15th January 2021, 93,670,845 confirmed cases of Coronavirus disease, including 2,005,558 deaths have been reported and 216 countries, territories have been affected by the COVID-19 pandemic. As of 15th January 2021 as of 08:00 IST (GMT+5:30), the Ministry of Health and Family Welfare, the Government of India reported, a total of 10,528,508 confirmed cases and 151,954 deaths have been reported speeded over 35 states and UTs of India1.
A pandemic changes the entire environment of a population, creating psychological issues of stigmatization, fear, and discrimination, fueled by a lack of accurate and comprehensive information for the entire population. While efforts are focused on developing and testing effective treatment options, a number of public health measures have been utilized to help slow the spread of the virus including physical distancing, selfisolation and hand washing. Governments around the world have also taken unprecedented measures such as border control, lockdown, and contact tracing to contain the COVID-19 outbreak, all of which coming at significant economic cost. The COVID-19 pandemic itself as well as the public health measures (e.g., lockdown) and their subsequent consequences (e.g., job losses, financial insecurities, and disruption to day-today activities) are likely to have a major adverse impact on mental health and well-being. Indeed, there are growing concerns about the psychological impact of the COVID-19 pandemic, with available research showing that the COVID-19 pandemic has profound psychological effects on general populations, people with COVID-19 mild symptoms and healthcare professionals2.
Added to the fear of contracting COVID-19 are the significant changes to our daily lives by the quarantine imposed in the support of efforts to contain and slow down the spread of the virus. It is well known that quarantine/isolation for any cause and in the context of a pandemic (Severe Acute Respiratory Distress Syndrome /SARS, 2003) had been reported to be associated with significant mental health problems in the immediate few days of isolation and later had symptoms of post-traumatic stress disorder even after 34 weeks of discharge. Another important aspect is stigmatization and societal rejection regarding the quarantined cordon. Apart from these the pooling up of challenges imposed by quarantine such as working from home, temporary unemployment, home-schooling of children, living with limited resources and lack of physical contact with other family members, friends and colleagues, have had its own share of mental pressure which could potentially be even more detrimental in the long run than the virus itself3.
The battle against COVID-19 is still continuing in India. One of the most critical challenges in dealing with the pandemic is controlling the social response—the fear caused by the pandemic—because, as previous SARS and Ebola outbreaks have shown, fear exacerbates the damage caused by the disease itself1.To guarantee the final success, people’s adherences to these control measures are essential, which is largely affected by their knowledge towards COVID-19. Lessons learned from the SARS outbreak in 2003 suggest that knowledge towards infectious diseases is associated with level of panic emotion among the population, which can further complicate attempts to prevent the spread of the disease4.
Fear can be described as an adaptive response to the environment—a defense mechanism designed to improve the chance of survival. However, when fear is not well calibrated to the actual threat, it can be maladaptive. The origin of fear could be novelty; something that brings uncertainty to a familiar situation, such as a pandemic. When the fear is excessive, the effects may be detrimental at both the individual level (e.g., mental health problems, such as phobia and social anxiety), and the societal level (e.g., panic shopping or xenophobia). On the other hand, insufficient fear, such as ignoring government’s measures to slow the spread of coronavirus or issuing reckless policies that ignore the risks, may also result in harm for individuals and society. Societal safety measures, such as mandatory lockdowns, have their uses in preventing the spread of infections, but when such safety measures are prolonged or excessively strict they can have negative consequences, including disruption of the economy and unemployment5.
As has been seen with COVID-19, sound scientific advice is essential, but not sufficient to dispel fear and avoid panic. Authentic news reporting can increase fears because the threat is novel, unseen, and potentially fatal, especially to those most vulnerable groups in society: the aged and the sick. The very stress caused by the COVID-19 pandemic among members of the population also reduces the ability to absorb anything more than very simplistic messages, and of course certain sections of society are more susceptible to fear and panic than others—those prone to anxiety and those with underlying mental health conditions6.
Though one of the reasons little attention has been given to the mental health aspect of corona virus is its nature and ongoing impact, another potential reason appears to be the lack of psychometric measures targeting psychological disorders related to COVID-19. To bridge this gap, researchers all around the world have shown an increased interest in instrument development related to COVID-19. To date, mental health researchers have developed COVID-19-related screeners assessing fear. To provide appropriate treatment for COVID-19, medical professionals use a COVID-19 test to determine whether or not one is indeed infected. When test results are positive, medical professionals then provide specific treatment. Similarly, for mental health professionals to accurately diagnose and appropriately treat psychological symptoms (e.g. fear) related to COVID-19, they need psychometrically sound instruments to determine the presence and severity of psychological symptoms related to COVID-197.
In response to the current contingency and its emotional repercussions, medical researchers around the world have devised ways to measure the impact using scales that focus on the stress response and fear. A scale was developed to evaluate fear of the COVID-19 pandemic and its effects on the psychological mental state of the Iranian general population. After panel reviews and the corrected item-total correlation test, seven items with acceptable corrected item-total correlations were retained and further confirmed by significant and strong factor loads. The scale has high internal consistency and validity, supported by several other scales (Hospital Anxiety and Depression Scale and Perceived Vulnerability to Disease Scale), in assessing fear of COVID-19 among the general population. Numerous tests have found high internal consistency and robust psychometric
properties in several languages. The scale will also be useful in calming COVID-19 fears among individuals8.
The psychological aspects of COVID-19 fear among the dental patients during and after lockdown also need to be considered and researched. There is an urgent need to understand the knowledge of COVID-19 at this critical moment and prevalence of fear among dental patients visiting dental college for treatment during COVID-19 pandemic times using a standardized scales. Therefore, this study was undertaken with an aim to assess the level of knowledge and fear COVID-19 pandemic amongst patient’s visiting dental OPD of K.D. Dental College & Hospital, Mathura.
AIM AND OBJECTIVES
AIM: To assess the level of knowledge and fear amongst dental patients attending dental OPD in a dental institution.
OBJECTIVES:
1. To assess knowledge of COVID-19 among dental patients.
2. To assess fear of COVID-19 among dental patients using FEAR OF COVID-19 Scale.
3. To compare level of fear among dental patients with demographic variables.
4. To compare level of fear of COVID-19 during and post lockdown period among dental patients.
5. To find correlation between knowledge and fear of COVID-19 among dental patients.
REVIEW OF LITERATURE
Amit Srivastava, Renu Bala, Anoop K. Srivastava, Anuj Mishra, Rafat Shamim & Prasenjit Sinha (2020)3 conducted an online survey aimed to assess the psychological effect of the pandemic on the general population of India using COVID-19 specific scales. The study was conducted from 20th June 2020 to 4th July 2020 on persons of both sexes and aged 18 years or more. A convenient sampling method was used for recruiting participants. An online Google form was designed and distributed using social media platforms. The psychological effect of the pandemic was assessed using validated scales of coronavirus anxiety scale, obsession with COVID-19 scale, and fear of COVID-19 scale respectively. The study received responses from 2004 participants from 31 states and union territories of India. The overall prevalence of psychological disorder due to COVID-19 was 53.3% (n=1068). The prevalence of anxiety was found to be 3.29% (n=66), obsession 13.47% (270) and fear 46.9% (1045). Around 2.8% (55) of the participants suffered from all three psychological disorders. Pearson correlation test showed a significant positive correlation between all the three psychological morbidities. The study findings showed high prevalence of mental health problems among Indian population during the COVID-19 outbreak with a positive correlation between them.
Bao-Liang Zhong, Wei Luo, Hai-Mei Li, Qian-Qian Zhang, Xiao-Ge Liu, Wen-Tian Lit et al (2020)6 conducted their study in which they investigated Chinese residents’ KAP towards COVID-19 during the rapid rise period of the outbreak. An online sample of Chinese residents was successfully recruited via the authors’ networks with residents and popular media in Hubei, China. A self-developed online KAP questionnaire was completed by the participants. The knowledge questionnaire consisted of 12 questions regarding the clinical characteristics and prevention of COVID-19. Assessments on residents’ attitudes and practices towards COVID-19 included questions on confidence in winning the battle against COVID-19 and wearing masks when going out in recent days. Among the survey completers (n=6910), 65.7% were women, 63.5% held a bachelor degree or above, and 56.2% engaged in mental labor. The overall correct rate of the knowledge questionnaire was 90%. The majority of the respondents (97.1%) had confidence that China could win the battle against COVID-19. Nearly all of the participants (98.0%) wore masks when going out. In multiple logistic regression analyses, the COVID-19 knowledge score (OR: 0.750.90, P<0.001) was significantly associated with a lower likelihood of negative attitudes and preventive practices towards COVID-2019. Most Chinese residents of a relatively high socioeconomic status, in particular women were knowledgeable about COVID-19, held optimistic attitudes, and had appropriate practices towards COVID-19. Health education programs aimed at improving COVID-19 knowledge were helpful for Chinese residents to hold optimistic attitudes and maintained appropriate practices. It was concluded that due to their limited sample representativeness generalizing of their findings to populations of a low socioeconomic status was questionable.
Daniel Kwasi Ahorsu, Chung-Ying Lin, Vida Imani, Mohsen Saffari, Mark D. Griffiths & Amir H. Pakpour (2020)8 conducted a study to develop the Fear of COVID- 19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases. The sample comprised of 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties. After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven item scale. More specifically, reliability values such as internal consistency (a = .82) and test-retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression, r = 0.425 and anxiety, r = 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability, r = 0.483 and germ aversion, r = 0.459). It was concluded from their study that the Fear of COVID-19 Scale, a seven-item scale, had robust psychometric properties. It was reliable and valid in assessing fear of COVID-19 among the general population and would also be useful in allaying COVID-19 fears among individuals.
Neha Sayeed, Sneha Patel & Sneha Das (2020)11 conducted a study in order to develop Indian scale of fear related to COVID-19 (ISF-C19) Scale developed in Hindi and was rated by two raters. Then, it was applied on twenty individuals (ten males and ten females) as a pilot study. The study had been conducted in Eastern India, in the state of Jharkhand. ISF-C19 was completed by 118 participants (females - 75 and males - 43), aged 18 years or older from the community and the subjective well-being was assessed. The psychometric properties of this instrument were investigated. Safety measures (i.e., mask, maintaining distance, gloves, and sanitizers) were taken throughout the data collection period. Results suggested that this scale had adequate sampling, adequate inter item reliability coefficient and higher overall scores on ISF-C19 indicated more severe fear related to COVID-19. It was concluded that there was an urgent need to develop a scale related to COVID-19 as there was no published Indian standardized scale before recent outbreak of pandemic. Considering the current scenario, the scale was useful to assess the fear related to COVID-19.
Dolar Doshi, Parupalli Karunakar, Jagadeeswara Rao Sukhabogi, Jammula Surya Prasanna & Sheshadri Vishnu Mahajan (2020)12 conducted a study aimed to determine the level of fear of COVID-19 among Indian residents using the Fear of COVID-19 Scale (FCV-19S) and to compare it with demographic variables. This cross-sectional online survey conducted among the Indian population employed a convenient snowball sampling technique. Age, gender, marital status, educational qualifications, health care worker status and state of residence were the demographic details (six items) collected. The seven-item FCV-19S was used to assess fear regarding COVID-19 on a five-point Likert scale. The mean score for the responses was calculated and compared based on demographic variables. A comparison of low and high levels of fear and a multiple logistic regression analysis of levels of fear with demographic variables were conducted. p< 0.05 was considered statistically significant. The study population comprised 45.6% (683) males and 54.4% (816) females, with approximately 68% belonging to the age group of 20-40 years. The overall mean score for the questionnaire was 18.00 + 5.68. A significantly higher number of the study population reported low fear (54.8%). Only gender (p = 0.08) and health care worker status (p = 0.02) revealed a significant difference based on the level of fear. Females, married status, lower educational status and being a health care worker displayed significantly higher odds for high level of fear compared to their respective counterparts in this study population. The findings of their study might helped to identify the groups most at risk and formulate tailor-made intervention strategies to ensure their optimal health in the time of global crisis.
Mohammad Anwar Hossain, K M Amran Hossain, Lori Maria Walton, Zakir Uddin, Md. Obaidul Haque, Md. Feroz Kabir et al (2020)13 conducted a prospective, crosssectional survey of among 2157 male and female subjects, 13-90 years of age to determine the level of Knowledge, Attitude, and Practices (KAP) related to COVID-19 preventive health habits and perception of Fear towards COVID-19 in subjects living in Bangladesh. Ethical approval and trial registration were obtained prior to the commencement of the study. Subjects who volunteered to participate, signed the informed consent & completed the “Fear of COVID-19 Scale” (FCS) were enrolled in the study. Twenty-eight percent (28.69%) of subjects reported one or more COVID-19 symptoms, and 21.4% of subjects reported one or more co-morbidities. Knowledge scores were slightly higher in males (8.75± 1.58) than females (8.66± 1.70). Knowledge was significantly correlated with age (p < .005), an education level (p < .001), attitude (p < .001), and urban location (p < .001). Knowledge scores showed an inverse correlation with fear scores (p < .001). Eighty-three percent (83.7%) of subjects with COVID-19 symptoms reported wearing a mask in public, and 75.4% of subjects reported staying away from crowded places. Subjects with one or more symptoms reported higher fear (18.73± 4.6) compared to subjects without fear (18.45± 5.1). It was concluded that Bangladeshis reported a high prevalence of selfisolation, positive preventive health behaviors related to COVID-19, and moderate to high fear levels. Higher knowledge and practices were found in males, in subjects with higher education levels, older age, and urban location. However, fear of COVID-19 was more prevalent in females and elderly subjects. A positive attitude was reported for the majority of subjects, reflecting the belief that COVID19 was controllable and containable.
Kanika K Ahuja, Debanjan Banerjee, Kritika Chaudhary and Chehak Gidwani (2020)14 did a study to explore the relationship between well-being and xenophobic attitudes towards Muslims, collectivism and fear of COVID-19 in India. The study was carried out on 600 non-Islamic Indians (231 males, 366 females and 3 others; mean age: 38.76 years), using convenience sampling. An online survey containing Fear of Coronavirus scale, Warwick-Edinburgh Mental Well-Being Scale and Collectivism Scale was used. Xenophobia was assessed using two scales: generalized prejudice towards Muslims and specific xenophobic tendencies towards Muslims during COVID-19. The data were analysed using correlational methods and multiple regression. The results showed that positively significant relationship existed between well-being and age as well as with collectivism, while an inversely significant relationship between well-being and fear of COVID-19 was found. The results of the multiple regression analysis showed that fear of COVID-19, age, collectivism and generalized xenophobia, in the order of their importance, together contributed to nearly 20% of variance in well-being. It was concluded that results were reflective of the importance of collectivism in enhancing well-being in these times of uncertainty. Also, Xenophobia, one of the common offshoots of pandemics, could also harm the overall well-being.
Begum Satici, Emine Gocet-Tekin, M. Engin Deniz & Seydi Ahmet Satici (2020)15 conducted study with aim to adapt the Fear of COVID-19 Scale into Turkish and investigate the relationships between fear of COVID- 19, psychological distress, and life satisfaction. Data were collected by convenience sampling method, among total 1304 participants, aged between 18 and 64 years, from 75 cities in Turkey. In the adaptation process of the Fear of COVID-19 Scale, confirmatory factor analysis, Item Response Theory, convergent validity, and reliability (Cronbach’s a, McDonald’s ro, Guttmann’s X6, and composite reliability) analyses were performed. Additionally, the mediating role of psychological distress on the relationship between fear of COVID-19 and life satisfaction was tested. The uni dimensionality of the 7-item scale was confirmed on a Turkish sample. Item Response Theory revealed that all items were coherent and fitted with the model. The results indicated that the Turkish version of the scale had satisfactory reliability coefficients. The fear of COVID-19 was found to be associated with psychological distress and life satisfaction. Results indicated that the Turkish version of the Fear of COVID-19 Scale had strong psychometric properties.
Mohsen Alyami, Marcus Henning, Christian U. Krägeloh & Hussain Alyami (2020)16 conducted a study to examine the psychometric properties of the Arabic version of the FCV-19S. Using a forward-backward translation, the FCV-19S was translated into Arabic. An online survey using the Arabic versions of FCV-19S and the Hospital Anxiety and Depression Scale (HADS) was administered. Reliability and concurrent and confirmatory validity were examined. The dataset consisted of 693 Saudi participants. The internal consistency of the Arabic FCV-19S was satisfactory (a = .88), with sound concurrent validity indicated by significant and positive correlations with HADS (r = .66). The uni dimensional structure of the FCV-19S was confirmed. It was found that the Arabic version of the FCV-19S was psychometrically robust and could be used in research in order to assess the psychological impact of COVID-19 among a Saudi adult population.
Fuad Bakioglu, Ozan Korkmaz & Hülya Ercan (2020)17 conducted a study aimed to investigate the mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. The participants consisted of 960 individuals, including 663 females (69.1%) and 297 males (30.9%).The age of the participants ranged between 18 and 76 (29.74 ± 9.64) years. As a result of the correlation analysis, a positive relationship was found between fear of COVID-19 and intolerance of uncertainty, depression, anxiety, and stress, and a negative relationship was determined between the fear of COVID 19 and positivity. The result of the analysis for the study model indicated that there was a mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. It was concluded that eliminating uncertainty from the fear of COVID-19 contributed to reducing depression, anxiety and stress, and increasing positivity.
Koubun Wakashima, Keigo Asai, Daisuke Kobayashi, Kohei Koiwa, Saeko Kamoshida & Mayumi Sakuraba (2020)18 conducted a study to verify the reliability and validity of the Japanese version of the Fear of COVID- 19 Scale (FCV-19S) and to ascertain FCV-19S effects on assessment of Japanese people’s coping behavior. After backtranslation of the scale, 450 Japanese participants were recruited from a crowd sourcing platform. These participants responded to the Japanese FCV-19S, the Japanese versions of the Hospital Anxiety and Depression scale (HADS) and the Japanese versions of the Perceived Vulnerability to Disease (PVD), which assessed coping behaviors such as stockpiling and health monitoring, reasons for coping behaviors, and socio-demographic variables. The results showed that the scale had adequate internal reliability (a = .87; ro = .92) and concurrent validity, as indicated by significantly positive correlations with the Hospital Anxiety and Depression Scale (HADS; anxiety, r = .56; depression, r = .29) and Perceived Vulnerability to Disease (PVD; perceived infectability, r = .32; germ aversion, r = .29). Additionally, the FCV-19S not only directly increased all coping behaviors (ß = .21 - .36); it also indirectly increased stockpiling through conformity reason (indirect effect, ß = .04; total effect, ß = .31). Their results suggested that the Japanese FCV-19S psychometric scale had equal reliability and validity to those of the original FCV-19S. Their findings would also contribute further to the investigation of various difficulties arising from fear about COVID-19 in Japan.
Najmuj Sakib, A. K. M. Israfil Bhuiyan, Sahadat Hossain, Firoj A1 Mamun, Ismail Hosen, Abu Hasnat Abdullah et al (2020)19 developed Fear of COVID-19 Scale (FCV- 19S) which was a seven-item uni-dimensional scale that assessed the severity of fears of COVID-19. Given the rapid increase of COVID-19 cases in Bangladesh, they aimed to translate and validate the FCV-19S in Bangla. The forward backward translation method was used to translate the English version of the questionnaire into Bangla. The reliability and validity properties of the Bangla FCV-19S were rigorously psychometrically evaluated (utilizing both confirmatory factor analysis and Rasch analysis) in relation to sociodemographic variables, national lockdown variables, and response to the Bangla Health Patient Questionnaire. Their sample comprised of 8550 Bangladeshi participants. The Cronbach a value for the Bangla FCV-19S was 0.871 indicating very good internal reliability. The results of the confirmatory factor analysis showed that the uni-dimensional factor structure of the FCV- 19S fitted well with the data. The FCV-19S was significantly correlated with the nine-item Bangla Patient Health Questionnaire (PHQ-90) (r = 0.406, p < 0.001). FCV-19S scores were significantly associated with higher worries concerning lockdown. Measurement invariance of the FCV-19S showed no differences with respect to age or gender. The Bangla version of FCV- 19S was a valid and reliable tool with robust psychometric properties which would be useful for researchers carrying out studies among the Bangla speaking population in assessing the psychological impact of fear from COVID- 19 infection during COVID-19 pandemic.
Aman Sado Elemo, Seydi Ahmet Satici & Mark D. Griffiths (2020)20 did a study to evaluate the psychometric properties of the Amharic (Ethiopian) version of the FCV- 19S. An online survey including the Amharic versions of the FCV-19S and the six-item UCLA Loneliness Scale (ULS-6) was administered to 307 Amharic-speaking participants using convenience sampling. The participants’ age ranged between 18 and 70 years. In the evaluation process, confirmatory factor analysis, Item Response Theory, concurrent validity, and reliabilities (Cronbach’s alpha, McDonald’s omega, Guttman’s lambda, and composite reliability) of the Amharic version of the FCV-19S were performed. The unidimensional structure of the FCV-19S was confirmed and the Amharic version of the FCV-19S had strong psychometric properties. All reliability coefficients of the Amharic FCV-19S were satisfactory with sound concurrent validity shown by significant and positive correlations with loneliness. The results indicated that the FCV-19S could be used in research to assess the fear of COVID-19 among Amharic-speaking populations.
Seda Kaya, Zeynep Uzdil and Funda Pinar Cakiroglu (2020)21 conducted a study with the aim to evaluate effects of fear and anxiety on nutrition during the COVID-19 pandemic. Participants were recruited by an online survey in their cross-sectional study from Turkey. The questionnaire included general demographic characteristics, level of fear and anxiety, and nutritional habits. The Fear of COVID-19 Scale (FCV-19S) and Generalized Anxiety Disorder-7 test (GAD-7) were used to determine fear and anxiety. A total sample consisted of 1012 adults. Their study showed that in pandemic, fear and anxiety caused individuals to skip breakfast and snacks less, but more at lunch. A positive significant correlation was observed between the increased consumption of yoghurt, cheese and water and FCV-19S scores. There was a positive significant correlation between cheese, legume, nuts-seeds, cake-cookies, dessert and tea consumption and GAD-7 scores. A 1-unit increase in FCV- 19S scores affected 104 times of increased consumption of yoghurt, kefir, cheese, nuts- seeds, fruit (dry) and rice-pasta. A 1-unit increase in GAD-7 scores affected 103 times of increased consumption of egg and fruit (fresh); 104 times of increased consumption of cheese and other vegetables; 105 times of increased consumption of milk, meat, poultry, fish, legume, nuts-seeds, fruit (dry), cake-cookies and tea; 107 times of increased consumption of rice-pasta and coffee and 108 times of increased consumption of bread and dessert. Their study concluded that in pandemic, anxiety and fear led to changes in individual’s nutritional habits and food preferences. Continuous surveillance of psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide. In addition, the effects of these psychological problems on nutrition should be evaluated.
Kevin M. Fitzpatrick, Casey Harris & Grant Drawve (2020)22 conducted a study to examine the intersection of COVID-19 fear with social vulnerabilities and mental health consequences among adults living in the United States. Data collected was from a nationally representative sample (n _ 10,368) of U.S. adults surveyed online during demographic subgroups (gender, age, income, race and ethnicity, geography). The sample was post stratification weighted to ensure a balanced representation across social and demographic subgroups (gender, age, income, race or ethnicity, geography). The sample comprised 51% females; 23% non-Whites; 18% Hispanics; 25% of households with children fewer than 18 years of age; 55% unmarried; and nearly 20% unemployed, laid off, or furloughed at the time of the interview. Respondents were fearful, averaging a score of nearly 7 on a scale of 10 when asked how fearful they were of COVID-19. Preliminary analysis suggested clear spatial diffusion of COVID-19 fear. Fear appeared to be concentrated in regions with the highest reported COVID-19 cases. Significant differences across several U.S. census regions were noted (p< .01). Additionally, significant bivariate relationships were found between socially vulnerable respondents (female, Asians, Hispanic, foreign-born, families with children) and fear, as well as with mental health consequences (anxiety and depressive symptoms). Depressive symptoms, on average, were high (16+ on the Center for Epidemiologic Studies Depression scale) and more than 25% of the sample reported moderate to severe anxiety symptoms. More in-depth psychosocial research was needed using nationally representative samples that could help to inform potential mental health risks, as well as by targeting specific mental health interventions. Mohammad Ali, Zakir Uddin, Palash Chandra Banik, Fatma A. Hegazy, Shamita Zaman, Abu Saleh Mohammed Ambia et al (2020)23 conducted a cross-sectional online survey in April 2020 among 1296 participants using the Google form platform. Considering the social distancing formula and pandemic situation, they collected data using popular social media networks. Univariate and bivariate analyses were used to explore the collected data on KAP, fear, and socio demographic factors. Their results showed that overall knowledge score was 9.7 (out of 12) and gender differences (female vs male: 9.8 vs 9.5) were significant (p=0.008) in the bivariate analysis. Knowledge score variances were found significant in some regions by gender, marital status and education qualification. The highest and lowest mean knowledge scores were recorded in the Middle East (10.0) and Europe (9.3). Despite having a high fear score (22.5 out of 35), 78.35% of respondents were in a positive attitude and 81.7% in good practice level. Fear score rankings: Middle East (1st; 23.8), Europe (2nd; 23.2); Africa (3rd; 22.7); South Asia (4th; 22.1); Oceania (5th; 21.9); and North America (6th; 21.7). They didn’t find a correlation between fear and knowledge. Also, due to the nature of the online survey, aged and rural populations were under representing (e.g. more than half of the responders were 16-29 age groups). It was concluded from their study that KAP and fear variation existed among geographical regions. Gender, marital status and education qualification were factors in knowledge variances for some regions. KAP and fear measures could assist health education programs considering some socio demographic factors and regions during an outbreak of highly contagious disease and, which could uplift a positive attitude and good practice.
Pratik Khanal, Navin Devkota, Minakshi Dahal, Kiran Paudel, Shiva Raj Mishra & Devavrat Joshi (2020)24 conducted a study aimed to identify factors associated with COVTD-19 fear among health workers in Nepal during the early phase of pandemic. A web- based cross-sectional survey was conducted in the month of April-May 2020 among 475 health workers directly involved in COVTD-19 management. The Fear Scale of COVID 19 (FCV-19S) was used to measure the status of fear. Scatter plots were used to observe the relationship between fear and other psychological outcomes: anxiety, depression and insomnia. Multivariable logistic regression was done to identify factors associated with COVID fear. Their results showed that COVTD-19 fear score was moderately correlated with anxiety & depression, and weakly correlated with insomnia (p<0.001). Nurses (AOR=2.29; 95% CI: 1.23-4.26), health workers experienced stigma (AOR=1.83; 95% CI: 1.12-2.73), those working in affected district (AOR=1.76; 95% CI: 1.12-2.77) and presence of family member with chronic diseases (AOR=1.50; 95% CI: 1.01-2.25) was associated with higher odds of developing COVID-19 fear as compared to other health workers, health workers not experiencing stigma, working in non-affected district and not having family member with chronic diseases respectively. Their study concluded that Nurses, health workers facing stigma, those working in affected district and having family members with chronic diseases were more at risk of developing COVID-19 fear. It was thus recommended to improve work environment to reduce fear among health workers to employ stigma reduction interventions and ensure personal and family support for those having family member with chronic diseases.
Rubia Carla Formighieri Giordani , Milene Zanoni da Silva, Camila Muhl & Suely Ruiz Giolo (2020)25 conducted a study aimed to assess the fear of COVID-19 in the Brazilian population, validate the FCV-19S and examine the association of its scores with socio demographic and pandemic-related variables. A total of 7430 participants were recruited in this online survey. From the factor analysis results, FCV-19S proved to be suitable, indicating a higher level of fear for women and also for those aged 18-29 years. Besides, belonging to a high-risk group and having relatives diagnosed or deceased by COVID-19 showed a positive association with fear. Their findings pointed out the most vulnerable groups, which could assist in planning mental health actions.
Hiep T. Nguyen, Binh N. Do, Khue M. Pham, Giang B. Kim, Hoa T.B. Dam, Trung T. Nguyen et al (2020)26 conducted a cross-sectional study from 7 to 29 April 2020 on 5423 students at eight universities across Vietnam, including five universities in the North, one university in the Center and two universities in the South. An online survey questionnaire was used to collect data on participant’s characteristics, health literacy, fear of COVID-19 using the FCoV-19S, and health-related behaviors. Their results showed that seven items of the FCoV-19S strongly loaded on one component, explained 62.15% of the variance, with good item-scale convergent validity and high internal consistency (Cronbach’s alpha = 0.90). Higher health literacy was associated with lower FCoV-19S scores (coefficient, B, - 0.06; 95% confidence interval, 95%CI, -0.08, -0.04; p < 0.001). Older age or last academic years, being men, and being able to pay for medication were associated with lower FCoV- 19S scores. Students with higher FCoV-19S scores more likely kept smoking (odds ratio, OR, 1.11; 95% CI, 1.08, 1.14; p < 0.001) or drinking alcohol (OR, 1.04; 95% CI, 1.02, 1.06; p < 0.001) at an unchanged or higher level during the pandemic, as compared to students with lower FCoV-19S scores. It was concluded that, the FCoV-19S was valid and reliable in screening for fear of COVID-19. Health literacy was found to protect medical students from fear. Smoking and drinking appeared to have a negative impact on fear of COVID-19. It was recommended that strategic public health approaches were required to reduce fear and promote healthy lifestyles during the pandemic.
Jaishankar Bharatharaj, Mohsen Alyami, Marcus A. Henning, Hussain Alyami & Christian U. Krägeloh (2020)27 conducted a study which translated the seven-item Fear of COVID-19 Scale (FCV-19S) into Tamil and tested its psychometric properties so that the scale could be used in Tamil-speaking populations. The FCV-19S was translated into Tamil following a forward-backward translation procedure. Using an online-based survey, 95 participants completed the Tamil version of the FCV-19S alongside questions about demographic information. Psychometric properties were examined using Partial-Credit Rasch analysis, which was suitable for analyzing a questionnaire of this length with the present sample size. Results showed that the data fit for the Rasch model was confirmed without the need for any adjustments. Item means were comparable to those reported in other studies, with some evidence of clustering of items, although not sufficient to challenge the uni dimensionality of the scale. Reliability was very high (a= 0.93) and there was no evidence of differential item functioning by age, sex or education. They concluded that Tamil version of the FCV-19S had a uni dimensional structure with robust psychometric properties. It could thus be used in research assessing the psychological impact of COVID-19 among Tamil speaking populations. Further studies with larger samples were recommended to provide population reference values.
Leodoro J. Labrague & Janet Alexis A. de los Santos (2020)28 conducted a crosssectional research design study involving 261 frontline nurses in the Philippines. FCV-19S standardized scales were used for data collection. Their results showed that the composite score of the fear of COVID-19 scale was 19.92. Job role and attendance of COVID-19- related training predicted fear of COVID-19. An increased level of fear of COVID-19 was associated with decreased job satisfaction, increased psychological distress and increased organisational and professional turnover intentions. It was concluded that Frontline nurses who reported not having attended COVID-19-related training and those who held part-time job roles reported increased fears of COVID-19. It was recommended that addressing the fear of COVID-19 might result in improved job outcomes in frontline nurses, such as increased job satisfaction, decreased stress levels and lower intent to leave the organisation and the profession.
Muhammad Aziz Rahman, Nazmul Hoque, Sheikh M. Alif, Masudus Salehin, Sheikh Mohammed Shariful Islam, Biswajit Banik et al (2020)29 conducted a study aimed to identify factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. A cross-sectional online survey was conducted among residents in Australia, including patients, frontline health and other essential service workers, and community members during June 2020. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10); level of fear was assessed using the Fear of COVID-19 Scale (FCV-19S); and coping strategies were assessed using the Brief Resilient Coping Scale (BRCS). Logistic regression was used to identify factors associated with the extent of psychological distress, level of fear and coping strategies while adjusting for potential confounders. Results showed, among 587 participants that the majority (391, 73.2%) were 30-59 years old and females (363, 61.8%). More than half (349, 59.5%) were born outside Australia and two-third (418, 71.5%) completed at least a Bachelor’s degree. The majority (401, 71.5%) had a source of income, 243 (42.3%) self-identified as a frontline worker, and 335 (58.9%) reported financial impact due to COVID-19. Comorbidities such as pre-existing mental health conditions (AOR 3.13, 95% CIs 1.128.75), increased smoking (8.66, 1.08-69.1) and alcohol drinking (2.39, 1.05-5.47) over the last four weeks, high levels of fear (2.93, 1.83-4.67) and being female (1.74, 1.15-2.65) were associated with higher levels of psychological distress. Perceived distress due to change of employment status (4.14, 1.39-12.4), alcohol drinking (3.64, 1.54-8.58), providing care to known or suspected cases (3.64, 1.54-8.58), being female (1.56, 1.002.45), being 30-59 years old (2.29, 1.21-4.35) and having medium to high levels of psychological distress (2.90, 1.82-5.62) were associated with a higher level of fear; while healthcare service use in the last four weeks was associated with medium to high resilience. Their study concluded identified individuals who were at higher risk of distress and fear during the COVID-19 pandemic specifically in the State of Victoria, Australia. Specific interventions to support the mental wellbeing of these individuals should be considered in addition to the existing resources within primary healthcare settings.
Murat Yildirim, Ekmel Ge?er & Ömer Akgül (2020)30 conducted a study that examined the effects of vulnerability, perceived risk, and fear on preventive behaviors of COVID-19. The study used a sample of 4,536 Turkish adults (M = 30.33 ± 10.95 years) recruited from 17 March through 1 April 2020. Vulnerability, perceived risk, fear and preventive behaviors were measured with self-rating scales. Participants mostly engaged in avoidance of public transportation and frequent handwashing as preventive behaviors. Women had a significantly higher vulnerability to, perceived risk and fear of new coronavirus compared to men. Correlation results indicated that age, gender, education level, vulnerability, perceived risk and fear were related to preventive behaviors. The results suggested that vulnerability, perceived risk and fear could significantly increase engagement in preventive behaviors during the novel coronavirus pandemic and important implications for research and practice.
Inbar Levkovich and Shiri Shinan-Altman (2020)31 conducted a study sought to assess the pandemic’s psychological impact on the Israeli public. Using mixed methods they assessed Israeli adults during the COVID-19 outbreak. In their quantitative study, participants (N=1407) completed an online battery of measures assessing psychological variables and perceived threat related to COVID-19. Statistical analyses included tests for between-group differences and Pearson correlations. The qualitative study entailed in- depth, semi structured interviews conducted by telephone (N=38). The quantitative findings indicated that about 48% of the public had negative emotional reactions and 20% perceived that they were liable to contract the virus. Moreover, a positive correlation was found between these feelings and the degree of perceived threat. Three major themes emerged from the qualitative study: 1) a sense of shock and chaos; 2) gradual adjustment to the new reality; and 3) fears and concerns for self and family members. The study’s results revealed the following sources of participants’ emotional responses and sense of threat: health concerns regarding themselves and their loved ones; employment concerns; problems with children and spouses caused by being together at home; and difficulties entailed in working at home. The study also revealed that many of the psychological variables and perceived threats were related to COVID-19. While social distancing might make people feel safer, it could also increase their feelings of isolation, stress and frustration and cause difficulties in many life situations. Their findings pointed to the necessity of addressing the public’s perceived susceptibility and emotional reactions about COVID-19.
Benjamin Garcia-Reyna, Gilberto Daniel Castillo-Garcia, Francisco José Barbosa- Camacho, Guillermo Alonso Cervantes-Cardona, Enrique Cervantes-Pérez, Blanca Miriam Torres-Mendoza et al (2020)32 in a cross-sectional study used the Fear of COVID-19 Scale (FCV-19S) to assess the response to fear within health staff in Mexico in which they administered the Spanish version of the FCV-19S to hospital staff. A total of 2860 participants—1641 female and 1218 male personnel from three hospitals—were included in the study. The internal reliability of the scale was good, with Cronbach’s alpha of 0.902. A confirmatory factor analysis (CFA) was conducted on the seven items of the FCV-19S, showing good model fit (x2 (7) = 29.40, p < .001; CFI = .99; TLI = .99; RMSEA = .03; SRMR= .010; AIC = 71.40). They found a global FCV-19S mean score of 19.3 ± 6.9, with a significant difference in scores between women and men. Their survey showed a significantly higher level of fear in nursing and administrative personnel, which might be explained by the nursing staff being in close contact with infected patients and the administrative staff lacking understanding of the possible implications of the infection, compared with nonclinical hospital personnel.
Saquib Mulla, Shibin Shaju, Simran Bathija & Nidhi Poothulil (2020)33 conducted their study in an attempt to design and develop the Fear of COVID-19 Scale (FCV-19S) to understand and complement the clinical efforts of practicing dentists in the frontline, in preventing the spread and treating of COVID-19 cases with emergency dental problems. Their study examined the effects of COVID-19 outbreak on practicing dentists in terms of their stress levels, specifically psychological stress and anxiety using FCV-19S on a nine-item one-dimensional scale with robust psychometric properties that measured stress levels and anxiety aspects. The analysis of data gathered using online purposive and convenient sampling survey-based study among practicing dentists (n=126) using Google forms from 25th March 2020 to 25th May 2020. Results showed that despite having a high standard of knowledge and practice, dental practitioners around India were in a state of stress and fear while working in their respective clinics due to the COVID-19 pandemic effects on humanity. However, there was no significant difference between the genders of practicing dentists about their apprehension of personal safety from COVID-19. But it was noted that there was a significant difference between the gender of practicing dentists regarding their confidence level to live with COVID-19 and their performance as the ‘p’ value was .046 and .001 respectively. The analysis of the data demonstrated a significant difference between male and female gender among the practicing dentists regarding the stress level due to COVID-19. It was concluded that the FCV- 19S, a nine-item scale, had robust psychometric properties which were reliable and valid in assessing fear of COVID-19 among the practicing dentists and would also be useful in allaying COVID-19 fears among individuals with dental problems.
Tomas Caycho-Rodriguez , Lindsey W. Vilca , Mauricio Cervigni , Miguel Gallegos , Pablo Martino , Nelson Portillo et al (2020)34 conducted a study which evaluated the psychometric properties of the Scale of Fear of COVID-19 (FCV-19S) in a sample of 1,291 Argentines. The two-related factor structure of the FCV-19S had satisfactory goodness-of- fit indices using structural equation modeling and item response theory. Their results showed that the reliability was adequate, the factor structure was strictly invariable across age groups and the model that evaluated the relationships between fear of COVID-19, anxiety, and depression had adequate goodness of fit indices as well they proposed a model to evaluate the relationship between fear of COVID- 19, anxiety, and depression. They also showed that the structural model presented adequate fit indices (x2 = 1544.95; p < .001; RMSEA= 0.068; CFI=0.95; TLI=0.94) and the measurement models were adequately represented by their items. The results also indicated that FCV-19S had strong psychometric properties to measure fear of COVID-19 in the general population of Argentina.
Dana Tzur Bitan, Ariella Grossman-Giron, Yuval Bloch, Yael Mayer, Noga Shiffman & Shlomo Mendlovic (2020)35 conducted a study in which they evaluated the psychometric properties of the Hebrew version of the Fear of COVID-19 scale (FCV-19S), developed to assess different aspects of the fear of the pandemic, in a normative population of participants in Israel. Participants (n = 639) were asked to complete the FCV-19S scale, as well as to report anxiety, depression, and stress levels using validated scales. When forcing a two-factor structure model, the analysis revealed two factors pertaining to emotional fear reactions and symptomatic expressions of fear. Gender, sociodemographic status, chronic illness, being in an at-risk group, and having a family member dying of COVID-19 were positively associated with fear of COVID-19. The measure was associated with anxiety, stress and depression. These results suggested that the FCV-19S had good psychometric properties, and could be utilized in studies assessing the effects of the pandemic on the population's mental health.
Chandrima Ray, Priyanka Singh & Ranajit Mandal (2020)36 conducted a study which was a prospective cross-sectional study conducted on 80 female patients who were undergoing treatment for various gynecologic malignancies at a tertiary care oncology cancer centre in Eastern India. Fear of COVID-19 scale (FCV-19S) was used to assess the psychological impact of COVID-19 among the study population. Telephonic interviews were also conducted to collect data. Study results showed that 78% of the patients were afraid of contracting COVID-19 on coming out of their house; higher number of poorly educated patients had fear of the COVID-19 infection. Fifty-one percent patients were ‘very fearful’ of the COVID-19 infection and the most common cause of fear was of ‘losing life due to corona virus. Eighty-six percent of the patients found talking to the doctor telephonically reassuring. It was concluded that the COVID-19 pandemic had instilled fear and anxiety among the patients of gynecological cancer preventing them to report for follow-up. Alternative strategies needed to be explored to render effective follow-up care to oncology patients. Yoga Setyo Wibowo, Rizki Karya Utami, Yunita Nadia, Emmanuel Nizeyumukiza & Farida Agus Setiawati (2020)37 conducted their study with a aim to analyze the Fear of COVID-19 Scale (FCV-19S in the Indonesian population. Exploratory Factor Analysis (model 1) and Confirmation Factor analysis (model 2) were used for their study. A total of 117 participants responded to the scale. The results of the analysis showed that Exploration Factor Analysis (EFA) showed a Barlett Test of Sphericity of 335.270 (p<0.05) which meant that there was a significant correlation between observed variables. The results of the EFA showed that the scale had two dimensions. Furthermore, the results of the CFA revealed that the Indonesian version of FCV-19S exhibited very good construct validity (factorial and convergent), and acceptable reliability. These findings suggested that the Indonesian version of FCV-19S was a developmentally appropriate instrument that could be used to examine fears of coronavirus in Indonesia.
Akihiro Masuyama, Hiroki Shinkawa & Takahiro Kubo (2020)38 conducted a study aimed to adapt and validate a Japanese-version Fear of COVID-19 Scale (FCV-19S) with a sample of adolescent students from Japan. The Japanese-version FCV-19S, Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire for Adolescents (PHQ-A), and Perceived Vulnerability to Disease Scale (PVDS) were administered to a sample of Japanese adolescents in schools in this study. The results of revealed that the Japanese-version FCV-19S had a bi-factor model consisting of the emotional response factor and the physiological response factor, with a high reliability (emotional: a = .71; physiological: a = .82). Constructive validity was shown by the significant positive correlation between the GAD-7 and emotional (r = .11) & physiological response (r = .25) between PHQ-A and physiological response (r = .19), as well as between both factors and the PVDS subscale (rs > .16). Taken together, their results indicated that the Japaneseversion FCV-19S had a high internal consistency and moderately good construct validity. David Chun Yin Li & Ling Leung (2020)39 conducted a study in which data on knowledge and fear of coronavirus disease 2019 (COVID-19) and perceived stress were collected in July 2020 from a convenience sample of Filipino domestic workers in Hong Kong by asking participants to take part in three questionnaires. First, twelve questions related to knowledge associated with the prevention and identification of COVID19 were used to assess participant’s knowledge regarding COVID-19. Second, the Fear of COVID- 19 Scale (FCV-19S) was used to assess participants’ perceived fear of infection. Third, the Short Form Perceived Stress Scale (PSS-4) was used to measure participant’s perceived stress. Pearson product moment correlation coefficients were obtained to assess the relationships between the total scores of the three questionnaires. Both the FCV-19S and PSS-4 used a five-point Likert scale. Pearson bivariate correlations were used to assess the relationships between knowledge of COVID, fear of COVID, and perceived stress. Cronbach’s alpha coefficients were obtained to assess the three questionnaires’ reliabilities. All statistical analyses were carried out using IBM Statistical Package for Social Sciences Version 23.0. Results showed that the relationship between knowledge of COVID and fear of COVID was significant, r(108) = +0.23, p = .02; the relationship between fear of COVID and perceived stress was not statistically significant, r(108) = +0.17, p = .08; the relationship between knowledge of COVID and perceived stress was not statistically significant, r(108) = -0.11, p = .26. It was concluded that because the effectiveness of COVID-19 preventive measures was affected by the collective knowledge and attitude of all residents, including those of ethnic minorities who were marginalized by mainstream society, health policymakers would benefit from their study in the context of the ongoing COVID-19 global pandemic.
Zegarra-Valdivia, Chino-Vilca & Ames-Guerrero (2020)40 conducted a study which aimed to assess the knowledge, attitudes and vulnerability perception of Peruvians during the coronavirus outbreak. Using a web-based cross-sectional survey data was from 225 selfselected participants, evaluating demographic information. The overall respondents were between 18 and 29 years old (56.8%), were females (n = 134), belonged to educated groups, and graduated professionals (69.3%), the majority of them. Logistic regression showed that knowledge was highly correlated with education (p=0.031), occupation (p=0.002), and age (p= 0.016). Their study identified that people reported adequate knowledge by identifying expected symptoms and virus transmission ways in COVID-19 disease. There was a significant perceived susceptibility to contract the mentioning virus, displaying stigmatized behavior (59.1%) and fear of contracting the virus from others (70.2%). Additionally, it was reported to lack people's confidence to health national authorities on the sanitary responses (62.7%), preparedness for the disease (76.9%) and the lack of adequate measures to deal with it (51.1%). They concluded that public policies considered guidelines on knowledge translation and risk communication strategies for both psychological responses in a timely manner and ensuring compliance with public control measures by the population.
Degena Bahrey Tadesse, Gebremeskel Tukue Gebrewahd & Gebre Teklemariam Demoz (2020)41 conducted a hospital-based cross-sectional study aimed to determine the knowledge, attitude, practice, and psychological response among nurses toward the COVID-19 outbreak in Northern Ethiopia. The data were collected from March to April 2020. Data was collected through a self administered questionnaire. The data were entered into Epi-data manager version 4.2 and exported to SPSS 23 for analysis. Descriptive analysis was reported to describe the demographic, mean knowledge, attitude, practice and psychological response score of nurses. Results showed that a total of 415 nurses participated in this study making that 100% response rate. Of the participants, 241(58.1%) were females. From the 415 nurses, 307(74%), 278(67%), 299(72%), and 354(85.3%) had good knowledge, good infection prevention practice, a favorable attitude, and disturbed psychological response towards COVID-19 respectively.
Sophia Risin (2020)42 conducted a study in order to find the relationship between knowledge and fear, one that had been contested with two prevalent schools of thought; was ignorance bliss, or was knowledge security. Their study surveyed 109 people and utilized a Google Form. The form consisted of three parts, the first of which being a background question asking about location and age, the second part was a short seven question background knowledge questionnaire about the virus, and the third part was ranking questions for fear, anxiety, and impact. For their data set, the chi-squared test for association and the Spearman rank correlation coefficient were utilized to assess the data for statistically significant connections as levels of impact, anxiety and fear were ordinal data. There were highly statistically significant associations between: fear and anxiety; anxiety and accuracy; and fear and accuracy and highly statistically significant negative correlations between: anxiety and accuracy; & fear and accuracy. Their study suggested that knowledge was linked to lower anxiety and fear levels, contrary to the popular belief that ignorance is bliss.
Sally Mohammed Elsayed Ibrahim & Marwa Abdelhamid Mohammed Mahmoud (2020)43 conducted a descriptive cross-sectional correlational research design study at Temai Elamdid health insurance outpatient clinics that affiliated to the Egyptian Ministry of Health on a convenience sample of 185 patients attending the previous study setting. Four tools were used in their study; demographic and clinical data structured interview schedule, COVID-19 knowledge structured interview schedule, COVID-19 preventive practices structured interview schedule and fear from COVID-19 scale. It was found that more than two fifth of middle aged adults and more than one third of older adults had satisfactory COVID-19 preventive practices, Furthermore, more than one third of middle aged adults and one third of older adults had good COVID-19 knowledge with statistically significant difference found between two groups. Also, significant relation was found between both COVID-19 knowledge and preventive practices and fear from COVID-19 among the study subjects (P=0.000). In the same direction, there was statistically significant difference between middle aged adults and older adults regarding COVID-19 knowledge and preventive practices and higher level of COVID-19 fear (P=0.000). It was concluded in their study that older adults had a significant lower score of COVID-19 knowledge and preventive practices and higher level of COVID-19 fear than middle aged adults as strong negative correlation between fear from COVID-19 and either COVID-19 knowledge & preventive practices was found. It was recommended that educational programs should be developed and implemented by nurses in different care settings to increase their awareness about COVID-19.
Diana Carolina Awad, Aline Zaiter, Peter Ghiya, Karine Zaiter, Jean G Louka, Chadi Fakih et al (2020)44 conducted a cross-sectional observational study on pregnant women living in Lebanon, using an electronic survey (Google form). Questions about demographics, knowledge of the COVID-19, risk perception, precautionary measures, source of information and degree of trust, anxiety levels were asked. Data was analysed using the SPSS version 22. Descriptive, bivariate, and multivariate analyses were carried out and p<0.05 was considered statistically significant. With 449 pregnant women enrolled, the mean knowledge score was 4.4 (± 1.17) over 5. The mean perception score was 30.2 (± 5.4) over 51, while the mean precaution score was 19.7(± 3.04) over 25. As for the anxiety, the mean score was 7.1(± 5.8) over 21. Significant correlation was found between knowledge score vs both perception and precaution score (R=-0.213, p<0.001/R=0.465, p<0.00, respectively), between perception score vs knowledge, precaution, and anxiety scores (R= -0.213, p<0.001/ R=0.107, p=0.023/R=0.248, p<0.001, respectively), between precaution score vs knowledge and perception scores (R=0.465, p<0.001/ R=0.107, p=0.023, respectively) and finally between GAD 7 anxiety score vs perception score (R=0.248, p<0.001). Using the Kruskal Wallis, Mann-Whitney, the bivariate analysis it was found that pregnant women had higher GAD7 score when they were multiparous (p=0.021) and when they had the Lebanese nationality (p=0.042). Accordingly, lower GAD7 score was noted with higher level of education (p=0.021). It was concluded that a high knowledge score among pregnant women across Lebanon suggested a strong commitment on the part of these women to gain a better understanding of their health, their responsibilities towards their foetuses, and to counter this pandemic. However, a better communication between pregnant women and their physicians with the help of midwives was encouraged towards better management of care and better support.
MATERIALS AND METHODS
A cross- sectional, questionnaire study was conducted among dental patients attending dental OPD of K.D. Dental College & Hospital, Mathura. The study was conducted to assess the level of knowledge and fear amongst dental patient’s using Knowledge assessment questionnaire and Fear of COVID-19 Scale, which was translated into Hindi. BRIEF PROFILE OF THE STUDY AREA Mathura is full of stories of Krishna, his birth and the part of his life he spent there with Radha Rani. Mathura is a city in the North Indian state of Uttar Pradesh. It is located approximately 50 km north of Agra, and 145 km south-east of Delhi; about 11 kilometers from the town and 4 and 22 kilometers from Govardhan. One of the major contributors in the economy of Uttar Pradesh are Mathura Industries. Mathura Refinery located in the city is one of the biggest oil refineries of Asia. This oil refinery of the Indian Oil Corporation is a highly technologically advanced oil refinery. Silver polishing industry is another industry. Textile printing industry that includes both sari-printing and fabric dyeing is another major industry of the region. Apart from these other industries are water tap manufacturing units and other decorative and household items. Mathura also is a big centre for production of cotton materials9.
STUDY POPULATION - Dental patients attending the dental O.P.D of K.D. Dental College & Hospital.
INCLUSION CRITERIA
- New patients visiting the dental OPD were included
- Age between - 18 years and above
- Patients attending dental OPD between 9:30 am- 2 pm
- Subjects giving verbal voluntary informed consent
EXCLUSION CRITERIA
- Patients below the age of 18 years were not considered.
- Patients not giving consent were not included.
ETHICAL CLEARANCE
Before scheduling the present study, the ethical clearance was obtained from institutional ethical clearance committee of K.D. Dental College and Hospital.
OBTAINING APPROVAL FROM THE RESPECTIVE DEPARTMENTS
Permission for conducting the study in the patients visiting dental OPD of the dental college was obtained from Institution Principal & Head of Departments of the respective departments.
INFECTION CONTROL
All the standard procedures and protocols were followed to ensure the infection control during the study. Autoclaved gown, head cap, face shield, disposable gloves and masks were worn by the examiner during the study. The gloves were changed and disposed off as per measures of BMW management. Hands were sanitized by using hand sanitizer regularly. Gowns were cleaned and autoclaved every day after collecting data.
SAMPLING
Sample Size Estimation
Sample size calculation was done using the formula given below.
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Based on the sample size determination obtained it was necessary to take 384 as the minimum sample size. However, a higher sample size of 500 was selected to compensate for any kind of permissible error and to increase the accuracy of study.
Pilot study
Prior to being finalized, Questionnaire was translated into Hindi language for the convincing and better understanding of the patient. The questionnaire was pilot-tested on 30 patients in dental OPD to ensure its validity and reliability. The Cronbach a value for the knowledge questionnaire was 0.71 and FCV- 19S was 0.871, indicating very good internal reliability. The corrected item-total correlations were all between 0.59 and 0.70. This procedure was done to ascertain the appropriateness of each question, as well as eliciting from any feedback. Minor modification regarding demographic details and knowledge regarding COVID-19 were added after this pilot test taking into account the comments and suggestions received.
COLLECTION OF DATA
Due to COVID-19 pandemic each patient’s temperature and Blood Oxygen level was recorded by Lab technicians using Non-Contact Infrared Digital Thermometer and Pulse oximetry respectively. Data was collected after dental patient were examined in Department of Oral Medicine & Radiology. Data was collected by using the Close - ended questionnaire among patients who gave verbal consent. Data was collected in the month of December 2020 and January 2021.
CLOSE - ENDED QUESTIONNAIRE
A close - ended questionnaire was used to collect general information. The structured questionnaire was prepared in Hindi for ease and convenience of patients. Due to COVID-19 pandemic condition in order to take precautions questionnaire was filled by examiner by asking questions from the patients. In this study, an Indian language translation of Knowledge assessment questionnaire & Fear of COVID-19 Scale was used.
PARTS OF QUESTIONNAIRE
- First part included general information regarding participant’s demographic profile and socioeconomic status (modified Kuppuswamy scale 2020)10.
- Second part of the questionnaire included knowledge assessment of COVID-196.
The questionnaire had 12 questions: 4 regarding clinical presentations (K1-K4), 3 regarding transmission routes (K5-K7) and 5 regarding prevention and control (K8-K12) of COVID-19. These questions were answered on a true/false basis with an additional “I don't know” option. A correct answer was assigned 1 point and an incorrect/unknown answer was assigned 0 points. The total knowledge score ranged from 0 to 12, with a higher score denoting a better knowledge of COVID-19.
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- Third part of the questionnaire included Fear of COVID-19 Scale.
The Fear of COVID-19 Scale
This self-rating instrument was introduced by Daniel Kwasi Ahorsu, Chung-Ying Lin, Vida Imani, Mohsen Saffari, and Mark D. Griffiths & Amir H. Pakpour (2020)7 Participants had to respond each item by answering one of the five (5) responses that reflected how they felt or acted toward COVID-19.
FEAR SCALE OF COVID-19
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Scoring: The participants indicated their level of agreement with the statements using a five- item Likert type scale. Answers included “strongly disagree,” “disagree,” “neutral” “agree” and “strongly agree”. The minimum score possible for each question was 1, and the maximum was 5. A total score could be calculated by adding up each item score (ranged from 7 to 35). Response was recorded for during and post lockdown period of COVID-19 pandemic among the study participants.
DATA ANALYSIS
The observed data were coded, tabulated, and analyzed using IBM SPSS Version 20.
Descriptive statistics were represented as frequency and percentages for categorical variables (gender, age group and socio-economic status) and Mean ± Standard Deviation for continuous variables (knowledge score, fear during lockdown score and fear after lockdown score). Comparison of gender with fear scores was done using independent t test and comparison of age group and SES with fear scores was done using using one-way ANOVA test. Pearson’s test was used to correlate between knowledge and fear scores. A p value of less than 0.05 was considered statistically significant.
RESULTS
A cross-sectional questionnaire study was conducted to assess the level of knowledge and fear of COVID-19 amongst dental patients attending dental OPD in a dental institution in Mathura. The final sample size consisted of 500 study participants visiting K.D. Dental College, Mathura.
Gender wise distribution of study participants
Among total five hundred (100%) study participants, 325(65%) were males and 175(35%) were females. (Table 1, Figure 1)
Agewise distribution of study participants
In total among 500(100%) study participants, 176(35.2%) study participants were of 18-29 years age group, 116(23.2%) study participants were of 30-49 years age group and 208(41.6%) study participants were in the age group of >50 years age. (Table 2, Figure 2)
Distribution of study participants on the basis of occupation of head of the family Among total 500(100%) study participants, 118(23.6%) participants were skilled agricultural, shop, fishery workers, 86(17.2%) were skilled workers & shop market workers, 50(10%) were trade workers and plant & machine operators each, 48(9.6%) were unemployed, 47(9.4%) were elementary occupation, 36(7.2%) were technicians associates professionals, 25(5.0%) were professionals, 23(4.6%) were clerks and 17(3.4%) were senior officials & managers. (Table 3, Figure 3)
Distribution of study participants on the basis of education of head of the family
Among total study participants, approximately 114(22.8%) of study participants had intermediate education, 104(20.8%) were illiterates, 88(17.6%) had graduate degree and 75(15%) were professionals. Study participants those who had primary, middle and high school certificate constituted about 44(8.8%), 18(3.6%) and 57(11.4%) respectively. (Table 4, Figure 4) Distribution of study participants on the basis of monthly income of the family Among 500(100%) study participants, 191(38.2%) had monthly income of family <10001 rupees, 132(26.4%) had around 10,002-29,972 rupees, 109(21.8%) had around 29,973- 49,961 rupees, 21(4.2%) had around 49,962- 74,755 rupees, 35(7.0%) had around 74,756-99,930 rupees and 12(2.4%) belonged to the group of 99,931- 199861 rupees. (Table 5, Figure 5)
Distribution of study participants according to socioeconomic status
Among the total 500 (100%) study participants, 203(40.6%) study participants were from upper lower status, 129(25.8%) study participants were from lower middle status, 117(23.4%) study participants were from upper middle status, 40(8.0%) study participants were from lower status and only 11(2.2%) study participant was from upper status. (Table 6, Figure 6)
Knowledge regarding COVID-19 among study participants
For item K1 that was “The main clinical symptoms of COVID-19 are fever, fatigue, dry cough and myalgia482 (96.4%) participants gave correct answer while 18 (3.6%) study participants gave incorrect answer.
For item K2 that was “Unlike the common cold, stuffy nose, runny nose and sneezing are less common in persons infected with the COVID-19 virus. ”, 349(69.8%) study participants gave incorrect answer and 151(30.2%) study participants gave correct answer.
For item K3 that was “There currently is no effective cure for COVID-19, but early symptomatic and supportive treatment can help most patients recover from the infection. ”, 338 (67.6%) (46.155%) study participants gave correct answer while 162(32.4%) study participants gave incorrect answer.
For item K4 that was “Not all persons with COVID-19 will develop to severe cases. Only those who are elderly, have chronic illness and are obese are more likely to severe cases. ” 328 (65.6%) study participants gave incorrect answer while 172(34.4%) study participants gave correct answer.
For item K5 that was “Eating or contacting wild animals would result in the infection by the COVID-19 virus.”, 297(59.4%) study participants gave incorrect answer and 201(40.2%) study participants gave correct answer.
For item K6 that was “Persons with covid-19 cannot infect the virus to others when a fever is not present.”, 333(66.6%) study participants gave incorrect answer and 167(33.4%) study participants gave correct answer.
For item K7 that was “The COVID-19 virus spreads via respiratory droplets of infected individuals.”, 405 (81%) study participants gave correct answer while 95(19%) study participants gave incorrect answer.
For item K8 that was “Ordinary residents can wear general medical masks to prevent the infection by the COVID-19 virus”, 436 (87.2%) study participants gave correct answer while 64(12.8%) study participants gave incorrect answer.
For item K9 that was “It is not necessary for children and young adults to take measures to prevent the infection by the COVID-19 virus”, 253 (50.6%) study participants gave correct answer while 247(49.4%) study participants gave incorrect answer.
For item K10 that was “To prevent the infection by COVID-19, individuals should avoid going to crowded places such as train station and avoid taking public transportation.”, 348(69.6%) study participants gave correct answer while 152(30.4%) study participants gave incorrect answer.
For item K11 that was “Isolation and treatment of people who are infected with the COVID-19 virus are effective ways to reduce the spread of the virus. ”, 384(76.8%) study participants gave correct answer while 116(23.2%) study participants gave incorrect answer.
For item K12 that was “People who have contact with someone infected with the COVID-19 virus should be immediately isolated in a proper place. In general, the observation period is 14 days.”, 307(61.4%) study participants gave incorrect answer and 193(38.6%) study participants gave correct answer. (Table 7)
Total scores regarding COVID-19 knowledge among study participants
Among the total 500 (7.06 ± 2.960) study participants, for each participant minimum core was 0 and maximum score was 12. (Table 8)
Distribution of study participants on basis of knowledge scores of COVID-19
In this present study, among 500(100%) study participants, 191(38.2%) had good knowledge score (9-12), 160(32%) had average knowledge score (5-8), 147(29.4%) had poor knowledge score (1-4) and 2(0.4%) had no knowledge of COVID-19. (Table 9)
There was no statistically significant difference (p=0.108) found between males (2.05 ± 0.839) and females (2.18 ± 0.801) with knowledge of COVID-19. (Table 10)
Agewise comparison of knowledge scores of COVID-19
There was highly statistically significant difference (p=0.00) found between study participants of 18-29 years age group(2.45 ± 0.699), 30-49 years age group (2.19 ± 0.827) and age group of >50 years age(1.75 ± 0.821) with knowledge of COVID-19. (Table 11)
Comparison of knowledge scores of COVID-19 with occupation of head of the family
There was highly statistically significant difference (p=0.00) found between study participants who were unemployed(1.40±0.736), had elementary occupation(1.66±0.522), plant & machine operators(2.20±0.404), craft & related trade workers(2.08±0.752), skilled agricultural & shop, fishery workers(1.72±0.815), skilled workers & shop market sales workers(2.64±0.701), clerks(2.83±0.388), technicians associate professionals(2.19±0.951), professionals(2.72±0.458) and legislators, senior officials & managers(2.76±0.437). (Table 12)
Comparison of knowledge scores of COVID-19 with education of head of the family
There was highly statistically significant difference (p=0.00) found between study participants who were illiterates (1.28±0.582), had primary school certificate (1.32±0.639), middle school certificate (2.11±0.323), high school certificate (2.30±0.462), intermediate (2.37±0.655), graduates (2.48±0.742) and professional or honours (2.67±0.684). (Table 13)
Comparison of knowledge scores of COVID-19 with monthly income of the family There was highly statistically significant difference (p=0.00) found between study participants who had monthly family income around <10001 rupees (1.58±0.691), around 10,002-29,972 rupees (2.19±0.811), around 29,973- 49,961 rupees (2.61±0.489), around 49,962- 74,755 rupees (2.76±0.436), around 74,756-99,930 rupees (2.26±0.980) and 99,931- 199861
rupees(3.00±0.00). (Table 14)
Comparison of knowledge scores of COVID-19 with socioeconomic class
There was highly statistically significant difference (p=0.00) found between study participants who were from upper status (3.00±0.000), from upper middle status (2.61±0.686), study participants who were from lower middle status (2.46±0.650), from upper lower status (1.64±0.686) and from lower status (1.50±0.784). (Table 15)
Study participant’s responses for Fear of COVID-19 questions
For item 1 that is “I am most afraid of COVID-19”, 179(35.8%) participants responded that they agreed, 139 (27.8%) strongly agreed, 122 (24.4%) were neutral, 33(6.6%) strongly disagreed and 27(5.4%) disagreed during lockdown. After lockdown, 180(36.0%) participants responded that they agreed, 138 (27.6%) were neutral, 97(19.4%) strongly disagreed, 44(8.8%) strongly agreed and 41(8.2%) disagreed.
For item 2 that is “It makes me uncomfortable to think about COVID-19”, 251(50.2%) participants responded that they agreed, 96(19.2%) were neutral, 64 (12.8%) strongly agreed, 45(9.0%) disagreed and 44(8.8%) strongly disagreed during lockdown. After lockdown, 173(34.6%) participants responded that they agreed, 153(27.6%) strongly disagreed, 83(16.6%) were neutral, 57(11.4%) disagreed and 34(6.8%) strongly agreed.
For item 3 that is “My hands become clammy when I think about COVID-19”, 175(35.0%) participants responded that they disagreed, 142(28.4%) were neutral, 116(12.8%) strongly disagreed, 52(10.4%) agreed and 15(3.0%) strongly agreed during lockdown. After lockdown, 216(43.2%) participants responded that they strongly disagreed, 158(31.6%) disagreed, 99(19.8%) were neutral, 26(5.2%) agreed and only 1(0.2%) strongly agreed.
For item 4 that is “I am afraid of losing my life because of COVID-19”, 135(27.0%) participants responded that they were neutral, 122(24.4%) strongly disagreed, 108(21.6%) agreed, 88(17.6%) disagreed and 47(9.4%) strongly agreed during lockdown. After lockdown, 206(41.2%) participants responded that they strongly disagreed, 118(23.6%) were neutral, 93(18.6%) disagreed, 59(11.8%) agreed and 24(4.8%) strongly agreed.
For item 5 that is “When watching news and stories about COVID-19 on social media, I become nervous or anxious”, 195(39.0%) participants responded that they agreed, 136(27.2%) strongly agreed, 82(16.4%) were neutral, 62(12.4%) disagreed and 25(5.0%) strongly disagreed during lockdown. After lockdown, 190(38.0%) participants responded that they agreed, 103(20.6%) were neutral, 98(19.6%) disagreed, 70(14.0%) strongly disagreed and 39(7.8%) strongly agreed.
For item 6 that is “I cannot sleep because I’m worrying about getting COVID-19”, 161(32.2%) participants responded that they strongly disagreed, 155(31.0%) disagreed, 119(23.8%) were neutral, 51(10.2%) agreed and 14(2.8%) strongly agreed during lockdown. After lockdown, 288(57.6%) participants responded that they strongly disagreed, 141(28.2%) disagreed, 66(13.2%) were neutral, 3(0.6%) agreed and only 2(0.4%) strongly agreed.
For item 7 that is “My heart races or palpitates when I think about getting COVID-19.”, 145(29.0%) respondents were neutral, 123(24.6%) disagreed, 122(24.4%) strongly disagreed, 90(18.0%) agreed and 20(4.0%) strongly agreed during lockdown. After lockdown, 242(48.4%) participants responded that they strongly disagreed, 124(24.8%) disagreed, 96(19.2%) were neutral, 37(7.4%) agreed and only 1(0.2%) strongly agreed. (Table 16)
Total scores regarding COVID-19 fear among study participants
Among the total 500 (20.75 ± 5.145) study participants, total fear score of COVID-19 during lockdown range was found to be from 7 to 35 among study participants while after lockdown, among 500(16.41 ± 5.013)study participants total fear score of COVID-19 range was found to be from 7 to 29. (Table 17)
Distribution of study participants on basis of total fear scores of COVID-19 during lockdown
Among total 500(100%) study participants 328(65.6%) had medium fear (16-24), 106(21.2%) study participants had high fear (25-35) and 66(13.2%) study participants had low fear (7-15). (Table 18)
Among total 500(100%) study participants, 277(55.4%) had medium fear (16-24), 203(40.6%) study participants had high fear (25-35) and 20(4.0%) study participants had low fear (7-15). (Table 19)
Genderwise comparison of fear of COVID-19
There was no statistically significant difference (p=0.325) found between males (20.59 ± 5.216) and females (21.06 ± 5.012) with fear of COVID-19 during lockdown. However, after lockdown there was statistically significant difference found (p=0.011) between males (16.00 ± 5.002) and females (17.19 ± 4.955) with fear of COVID-19. (Table 20, Figure 7)
Agewise comparison of fear of COVID-19
There were no statistically significant difference found between both during lockdown (p=0.094) and after lockdown (p=0.487) between 18-29 years old age group (DFTS=21.43 ± 4.843, AFTS= 16.51 ± 4.869), 30-49 years age group (DFTS= 20.28 ± 5.241, AFTS= 16.79 ± 5.081) and 50 years and above age group (DFTS= 20.45 ± 5.303, AFTS= 16.12 ± 5.102) respectively. (Table 21, Figure 8)
Comparison of fear of COVID-19 according to socioeconomic status
There was statistically significant difference found when socioeconomic status of study participants was compared with fear of COVID-19 both during lockdown (p=0.033) and after lockdown (p=0.042) between upper status (DFTS=23.64 ± 5.316, AFTS= 18.36 ± 5.591), upper middle (DFTS= 21.28 ± 5.278, AFTS= 16.86 ± 5.002), lower middle (DFTS= 21.17 ± 4.613, AFTS= 16.91 ± 4.685), upper lower (DFTS= 20.33 ± 5.189, AFTS= 16.08 ± 5.063) and lower status respectively (DFTS=19.23 ± 5.677, AFTS= 14.63 ± 5.290). (Table 22, Figure 9) Comparison of fear score of COVID-19 (during and after lockdown)
There was highly statistically significant difference (p<0.001) found between fear score of COVID-19 during lockdown (20.75 ± 5.145) and after lockdown (16.41 ± 5.013). (Table 23, Figure 10)
Correlation between knowledge and fear of COVID-19 among dental patients
There was mild positive correlation (r=0.158) and highly statistically significant (p=0.00) results were found between knowledge and fear of COVID-19 during lockdown. However, after lockdown correlation between knowledge and fear of COVID-19 was mild positive (r=0.057) and results were not found to be statistically significant (p=0.057). (Table 24)
TABLES
TABLE 1: GENDER WISE DISTRIBUTION OF STUDY PARTICIPANTS
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TABLE 2: AGE WISE DISTRIBUTION OF STUDY PARTICIPANTS
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TABLE 3: DISTRIBUTION OF STUDY PARTICIPANTS ON THE BASIS OF OCCUPATION OF HEAD OF THE FAMILY
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TABLE 4: DISTRIBUTION OF STUDY PARTICIPANTS ON THE BASIS OF EDUCATION OF HEAD OF THE FAMILY
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TABLE 5: DISTRIBUTION OF STUDY PARTICIPANTS ON THE BASIS OF MONTHLY INCOME OF THE FAMILY
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TABLE 6: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO SOCIOECONOMIC STATUS
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TABLE 7: KNOWLEDGE REGARDING COVID-19 AMONG STUDY PARTICIPANTS
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TABLE 8: TOTAL SCORES REGARDING COVID-19 KNOWLEDGE SCORES AMONG STUDY PARTICIPANTS
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TABLE 9: DISTRIBUTION OF STUDY PARTICIPANTS ON BASIS OF KNOWLEDGE SCORES OF COVID-19
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TABLE 10: GENDERWISE COMPARISON OF KNOWLEDGE SCORES OF COVID-19
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TABLE 11: AGEWISE COMPARISON OF KNOWLEDGE SCORES OF COVID-19
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TABLE 12: COMPARISON OF KNOWLEDGE SCORES OF COVID-19 WITH OCCUPATION OF HEAD OF THE FAMILY
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TABLE 13: COMPARISON OF KNOWLEDGE SCORES OF COVID-19 WITH EDUCATION OF HEAD OF THE FAMILY
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TABLE 14: COMPARISON OF KNOWLEDGE SCORES OFCOVID-19 WITH MONTHLY INCOME OF THE FAMILY
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TABLE 15: COMPARISON OF KNOWLEDGE SCORES OF COVID-19 WITH SOCIOECONOMIC CLASS
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TABLE 16: STUDY PARTICIPANTS RESPONSES FOR FEAR OF COVID 19 QUESTIONS
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TABLE 17: TOTAL SCORES REGARDING COVID-19 FEAR AMONG STUDY PARTICIPANTS
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TABLE 18: DISTRIBUTION OF STUDY PARTICIPANTS ON BASIS OF TOTAL FEAR SCORES DURING LOCKDOWN
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TABLE 19: DISTRIBUTION OF STUDY PARTICIPANTS ON BASIS OF TOTAL FEAR SCORES AFTER LOCKDOWN
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TABLE 20: GENDERWISE COMPARISON OF FEAR OF COVID-19
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TABLE 21: AGEWISE COMPARISION OF FEAR TOTAL SCORES OF COVID-19
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TABLE 22: COMPARISON OF FEAR OF COVID-19 ACCORDING TO SOCIOECONOMIC STATUS
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TABLE 23: COMPARISON OF FEAR SCORES OF COVID-19 (DURING AND AFTER LOCKDOWN)
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TABLE 24: CORRELATION BETWEEN KNOWLEDGE AND FEAR SCORES OF COVID-19 AMONG DENTAL PATIENTS
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* significant at p < 0.05
Knowledge and During lockdown Fear - Mild positive correlation (significant)
Knowledge and After lockdown Fear - Mild positive correlation (nonsignificant)
FIGURES
FIGURE 1: GENDERWISE DISTRIBUTION OF STUDY PARTICIPANTS
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FIGURE 2: AGEWISE DISTRIBUTION OF STUDY PARTICIPANTS
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FIGURE 3: DISTRIBUTION OF STUDY PARTICIPANTS ON THE BASIS OF OCCUPATION OF HEAD OF THE FAMILY
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FIGURE 4: DISTRIBUTION OF STUDY PARTICIPANTS ON THE BASIS OF EDUCATION OF HEAD OF THE FAMILY
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FIGURE 5: DISTRIBUTION OF STUDY SUBJECTS ACCORDING TO MONTHLY FAMILY INCOME
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FIGURE 6. DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO SOCIOECONOMIC STATUS
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FIGURE 7. GENDERWISE COMPARISON OF FEAR OF COVID-19
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FIGURE 8. AGEWISE COMPARISON OF FEAR OF COVID-19
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FIGURE 9. COMPARISON OF FEAR OF COVID-19 ACCORDING TO SOCIOECONOMIC STATUS
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FIGURE 10. COMPARISON OF FEAR SCORES OF COVID-19 (DURING AND AFTER LOCKDOWN)
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DISCUSSION
Gender wise distribution of study participants
In this present study, among 500(100%) study participants, 325(65%) were males and 175(35%) were females. Similar results were seen in the studies conducted by Mohsen Alyami et al2, Amit Srivastava et al3, Mohammad Anwar Hossain et al11, Koubun Wakashima et al16, Najmuj Sakib et al17, Sally Mohammed Elsayed Ibrahim et al42 in which males were 370(57.9%), 1146(57.19%), 1166(54.1%), 291(65%), 4790(56%), 113(61.1%) and 269(42.1%), 858(42.81%), 99(45.9%), 159(35%), 4360(44%), 72(38.9%) were females respectively. However, in contrast in study conducted by Bao- Liang Zhong et al6, Zegarra-Valdivia et al39 and Degena Bahery Tadesse et al40 males were 2368 (34.3%), 91(40.4%), 175(49.1%) and 4542 (65.7%), 134(59.6%), 241(58.9%) were females respectively.
Agewise distribution of study participants
In this present study, 500(100%) study participants were selected, out of which 176(35.2%) study participants were of 18-29 years age group, 116(23.2%) study participants were of 30-49 years age group and 208(41.6%) study participants were in the age group of >50 years age. However, in study conducted by Mohammad Ali et al21, 600(52.6%)study participants were of 18-29 years age group, 553(44.1%) study participants were of 30-49 years age group and 42(3.3%) study participants were in the age group of >50 years age. Also, the results of the present study were in contrast to studies conducted by Bao-Liang Zhong et al6, Muhammad Aziz Rahman et al27 in which 3574(51.7%), 391(73.2%) study participants were of 30-49 years age group, 2821(40.8%), 102(19%) study participants were of 18-29 years age group and 515(7.5%), 41(7.7%) study participants were in the age group of >50 years age.
Distribution of study participants on the basis of occupation of head of the family
In this present study, out of 500(100%) study participants, 118(23.6%) participants were skilled agricultural, shop, fishery workers, 86(17.2%) were skilled workers & shop market workers, 50(10%) were trade workers and plant & machine operators each, 48(9.6%) were unemployed, 47(9.4%) were elementary occupation, 36(7.2%) were technicians associates professionals, 25(5.0%) were professionals, 23(4.6%) were clerks and 17(3.4%) were senior officials & managers. No earlier studies has been carried that showed distribution of study participants according to occupation of head of family in order to assess the Knowledge and Fear of COVID- 19.
Distribution of study participants on the basis of education of head of the family
In this present study among total study participants, approximately 114(22.8%) of study participants had intermediate education, 104(20.8%) were illiterates, 88(17.6%) had graduate degree and 75(15%) were professionals. Study participants those who had primary, middle and high school certificate constituted about 44(8.8%), 18(3.6%) and 57(11.4%) respectively. Similar results were seen with the study conducted by Mohammad Anwar Hossain et al11 in which most of the study participants belonged to 696(32.3%) intermediate education group. Among rest of participants about 596(27.6%) were graduates, 423(19.6%) had middle school certificate, 201(9.3%) had post graduation degree, 183(8.5%) had primary school certificate and 58(27%) were illiterates. However results were in contrast to the studies conducted by Mohsen Alyami et al2 and Chandrima Ray et al35 in which 64(10%) and 8(10%) study participants had intermediate education, 4(0.6%) and 28(35%) had primary school certificate, 13(2%) and 7(8.75%) had middle school certificate, 111(17.4%) and 6(7.5%) had high school certificate and 320(50.1%) and 13(16.25%) had graduate degree respectively. Also, in the study conducted by Mohsen Alyami et al2 none of the study participants were illiterates while in the study conducted by Chandrima Ray et al35 none of the study participants were professionals respectively.
Distribution of study participants on the basis of monthly income of the family In the present study among 500(100%) study participants, 191(38.2%) had monthly income of family around <10000 rupees, 132(26.4%) had around 10,002-29,972 rupees, 109(21.8%) had around 29,973- 49,961 rupees, 21(4.2%) had around 49,962- 74,755 rupees, 35(7.0%) had around 74,756-99,930 rupees and 12(2.4%) belonged to the group of 99,931- 199861 rupees. No earlier studies have been carried out that show distribution of study participants according to monthly family income in order to assess the Knowledge and Fear of COVID-19.
Distribution of study participants according to socioeconomic status
In this present study, out of 500(100%) study participants, 203(40.6%) study participants were from upper lower status, 129(25.8%) study participants were from lower middle status, 117(23.4%) study participants were from upper middle status, 40(8.0%) study participants were from lower status and 11(2.2%) study participants were from upper status. No earlier studies have been carried out that show distribution of study participants according to socioeconomic status in order to assess the Knowledge and Fear of COVID-19.
Knowledge regarding COVID-19 among study participants
In this present study, for item K1 that was “The main clinical symptoms of COVID-19 are fever, fatigue, dry cough and myalgia,” 482 (96.4%) participants gave correct answer while 18 (3.6%) study participants gave incorrect answer. Similar results were seen in the study conducted by Bao-Liang Zhong et al6 in which 6662(96.4%) participants gave correct answer and 248(3.6%) gave incorrect answer respectively.
In this present study, for item K2 that was “Unlike the common cold, stuffy nose, runny nose, and sneezing are less common in persons infected with the COVID-19 virus.”, 151 (30.2%) participants gave correct answer while 349(69.8%) study participants gave incorrect answer. Similar results were seen with the study conducted by Bao-Liang Zhong et al6 in which 4851(70.2%) participants gave correct answer and 2059(29.8%) gave incorrect answer.
In this present study, for item K3 that was “There currently is no effective cure for COVID-2019, but early symptomatic and supportive treatment can help most patients recover from the infection.” 338(67.6%) participants gave correct answer while 162(32.4%) study participants gave incorrect answer. Similar results were seen with the study conducted by Bao-Liang Zhong et al6 in which 6495(94%) participants gave correct answer and 415(6%) gave incorrect answer.
In this present study, for item K4 that was “Not all persons with COVID-2019 will develop to severe cases. Only those who are elderly, have chronic illnesses, and are obese are more likely to be severe cases.” 172(34.4%) participants gave correct answer while 328(65.6%) study participants gave incorrect answer. Similar results were seen with the study conducted by Bao- Liang Zhong et al6 in which 5058(73.2%) participants gave correct answer and 1852(26.8%) gave incorrect answer.
In this present study, for item K5 that was “Eating or contacting wild animals would result in the infection by the COVID-19 virus.” 201(40.2%) participants gave correct answer while 297(59.4%) study participants gave incorrect answer. However, results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 6316(91.4%) participants gave correct answer and 594(8.6%) gave incorrect answer.
In this present study, for item K6 that was “Persons with COVID-2019 cannot infect the virus to others when a fever is not present.” 333(66.6%) participants gave incorrect answer while 167(33.4%) study participants gave correct answer. However, results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 6170(89.3%) participants gave correct answer and 740(10.7%) gave incorrect answer.
In this present study, for item K7 that was “The COVID-19 virus spreads via respiratory droplets of infected individuals.” 405(81%) participants gave correct answer while 95(19%) study participants gave incorrect answer. However results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 6758(97.8%) participants gave correct answer and 152(2.2%) gave incorrect answer.
In this present study, for item K8 that was “Ordinary residents can wear general medical masks to prevent the infection by the COVID-19 virus.” 436(87.2%) participants gave correct answer while 64(12.8%) study participants gave incorrect answer. Results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 5106(73.9%) participants gave correct answer and 1804(26.1%) gave incorrect answer.
In this present study, for item K9 that was “It is not necessary for children and young adults to take measures to prevent the infection by the COVID-19 virus.” 253(50.6%) participants gave correct answer while 247(49.4%) study participants gave incorrect answer. Results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 6675(96.6%) participants gave correct answer and 235(3.4%) gave incorrect answer.
In this present study, for item K10 that was “To prevent the infection by COVID-19, individuals should avoid going to crowded places such as train stations and avoid taking public transportations.” 348(69.6%) participants gave correct answer while 152(30.4%) study participants gave incorrect answer. Results were in contrast with the study conducted by Bao- Liang Zhong et al6 in which 6813(98.6%) participants gave correct answer and 97(1.4%) gave incorrect answer.
In this present study, for item K11 that was “Isolation and treatment of people who are infected with the COVID-19 virus are effective ways to reduce the spread of the virus.” 384(76.8%) participants gave correct answer while 116(23.2%) study participants gave incorrect answer. Results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 6786(98.2%) participants gave correct answer and 124(1.8%) gave incorrect answer.
In this present study, for item K12 that was “People who have contact with someone infected with the COVID-19 virus should be immediately isolated in a proper place. In general, the observation period is 14 days.” 307(61.4%) participants gave incorrect answer while 193(38.6%) study participants gave correct answer. However, results were in contrast to the study conducted by Bao-Liang Zhong et al6 in which 6723(97.3%) participants gave correct answer and 187(2.7%) gave incorrect answer.
Total scores regarding COVID-19 knowledge scores among study participants
In this present study, among the total 500 (7.06 ± 2.960) study participants, for each participant minimum score was 0 and maximum score was 12. Similar results were seen in the studies conducted by Bao-Liang Zhong et al6 and Mohammad Anwar Hossain et al11, in which among the total 6910(10.8±1.6) and 2157(8.71±1.64) study participants, for each participant minimum score was 0 and maximum score was 12.
Distribution of study participants on basis of knowledge scores of COVID-19
In this present study, among 500(100%) study participants, 191(38.2%) had good knowledge score (9-12), 160(32%) had average knowledge score (5-8), 147(29.4%) had poor knowledge score (1-4) and 2(0.4%) had no knowledge of COVID-19. However, results were in contrast to the study conducted by Sally Mohammad Elsayed Ibrahim et al42 in which 92(49.7%) study participants had high knowledge score, 65(31.14%) had poor knowledge score and 28(15.14%) had average knowledge score of COVID-19 respectively.
Genderwise comparison of knowledge scores of COVID-19
In this present study, there was no statistically significant difference (p=0.108) found between males (2.05 ± 0.839) and females (2.18 ± 0.801) with knowledge of COVID-19. However, results were in contrast to the studies conducted by Bao-Liang Zhong et al6 and Mohammad Anwar Hossain et al11 in which there were statistically significant difference (p<0.01) was found between males (10.5±2.0, 8.75±1.58) and females (10.9±1.3, 8.66±1.70) respectively,
Agewise comparison of knowledge scores of COVID-19
In this present study, there was highly statistically significant difference (p=0.00) found between study participants of 18-29 years age group(2.45 ± 0.699) , 30-49 years age group (2.19 ± 0.827) and age group of >50 years age(1.75 ± 0.821) with knowledge of COVID-19. Similar results were seen in the study conducted by Bao-Liang Zhong et al6 in which statistically significant difference (p<0.01) was found between study participants of 18-29 years age group(10.4 ± 1.9) , 30-49 years age group (11.1 ± 1.2) and age group of >50 years age(10.9 ± 1.3) with knowledge of COVID-19.
Comparison of knowledge scores of COVID-19 with occupation of head of the family
In this present study, there was highly statistically significant difference (p=0.00) found between study participants who were unemployed(1.40±0.736), had elementary occupation(1.66±0.522), plant & machine operators(2.20±0.404), craft & related trade workers(2.08±0.752), skilled agricultural & shop, fishery workers(1.72±0.815), skilled workers & shop market sales workers(2.64±0.701), clerks(2.83±0.388), technicians associate professionals(2.19±0.951), professionals(2.72±0.458) and legislators, senior officials & managers(2.76±0.437). No earlier studies has been carried that compared knowledge scores of COVID-19 with occupation of head of family.
Comparison of knowledge scores of COVID-19 with education of head of the family
In this present study, there was highly statistically significant difference (p=0.00) found between study participants who were illiterates (1.28±0.582), had primary school certificate (1.32±0.639), middle school certificate (2.11±0.323), high school certificate (2.30±0.462), intermediate (2.37±0.655), graduates (2.48±0.742) and professional or honours (2.67±0.684). Similar results were seen in with the study conducted by Mohammad Anwar Hossain et al11 in which statistically significant difference (p<0.01) was found between study participants who were illiterates (8.83±2.0), had primary school certificate (8.17±2.13), middle school certificate (8.54±1.85), high school certificate (8.79±1.63), graduation (8.86±1.31) and professional or honours (8.82±1.21).
Comparison of knowledge scores of COVID-19 with monthly income of the family
In this present study, there was highly statistically significant difference (p=0.00) found between study participants who had monthly family income around <10000 rupees (1.58±0.691), around 10,002-29,972 rupees (2.19±0.811), around 29,973- 49,961 rupees (2.61±0.489), around 49,96274,755 rupees (2.76±0.436), around 74,756-99,930 rupees (2.26±0.980) and 99,931- 199861 rupees(3.00±0.00). No earlier studies have been carried out that compared knowledge scores of COVID-19 with monthly income of the family.
Comparison of knowledge scores of COVID-19 with socioeconomic class In this present study, there was highly statistically significant difference (p=0.00) found between study participants were from upper status (3.00±0.000), from upper middle status (2.61±0.686), study participants were from lower middle status (2.46±0.650), from upper lower status (1.64±0.686) and from lower status (1.50±0.784). No earlier studies have been carried that compared knowledge scores of COVID-19 with socioeconomic class.
Study participant’s responses for Fear of COVID-19 questions
In the present study, for item 1 that is “I am most afraid of COVID-19”, 179(35.8%) participants responded that they agreed, 139 (27.8%) strongly agreed, 122 (24.4%) were neutral, 33(6.6%) strongly disagreed and 27(5.4%) disagreed during lockdown. However, the results of the present study were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 582(38.8%),3150(42.4%) & 207(37.7%) agreed; 361(24.1%), 1894(25.5%) & 125(22.8%) were neutral; 291(19.4%), 891(12%) & 72(13.1%) disagreed; 148(9.9%), 1283(17.3%) & 93(16.9%) strongly agreed; and 117(7.8%), 212(2.8%) & 52(9.5%) strongly disagreed respectively. In the present study, 180(36.0%) participants responded that they agreed, 138 (27.6%) were neutral, 97(19.4%) strongly disagreed, 44(8.8%) strongly agreed and 41(8.2%) disagreed in response of fear items after lockdown. No other studies have taken fear scale item 1 of COVID-19 after lockdown.
In the present study, for item 2 that is “It makes me uncomfortable to think about COVID-19”, 251(50.2%) participants responded that they agreed, 96(19.2%) were neutral, 64 (12.8%) strongly agreed, 45(9.0%) disagreed and 44(8.8%) strongly disagreed during lockdown of COVID-19. However, the results of the present study were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 129(8.6%), 286(3.8%) & 85(15.5%) strongly disagreed; 369(24.6%), 1142(15.4%) & 89(16.2%) disagreed; 292(19.5%), 1681(22.6%) & 99(18%) were neutral; 609(40.6%), 3310(44.5%) & 203(37%) agreed; and 100(6.7%), 1011(13.6%) & 73(13.3%) strongly agreed during lockdown of COVID-19. After lockdown, 173(34.6%) participants responded that they agreed, 153(27.6%) strongly disagreed, 83(16.6%) were neutral, 57(11.4%) disagreed and 34(6.8%) strongly agreed. No earlier studies had taken fear scale item 2 of COVID-19 after lockdown.
In the present study for item 3 that is “My hands become clammy when I think about COVID- 19”, 175(35.0%) participants responded that they disagreed, 142(28.4%) were neutral, 116(12.8%) strongly disagreed, 52(10.4%) agreed and 15(3.0%) strongly agreed during lockdown. However, the results of the present study were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 355(23.7%), 2394(32.2%) & 294(53.6%) strongly disagreed; 700(46.7%), 3537(47.6%) & 87(15.8%) disagreed; 218(14.5%), 959(12.9%) & 93(16.9%) were neutral; 200(13.4%), 1011(13.6%) & 59(10.7%) agreed; and 26(1.7%), 110(1.5%) & 16(2.9%) strongly agreed during lockdown of COVID-19. After lockdown, 216(43.2%) participants responded that they strongly disagreed, 158(31.6%) disagreed, 99(19.8%) were neutral, 26(5.2%) agreed and only 1(0.2%) strongly agreed. No earlier studies had taken fear scale item 3 of COVID-19 after lockdown.
In the present study for item 4 that is “I am afraid of losing my life because of COVID-19”, 135(27.0%) participants responded that they were neutral, 122(24.4%) strongly disagreed, 108(21.6%) agreed, 88(17.6%) disagreed and 47(9.4%) strongly agreed during lockdown. However, the results of the present study were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 319(21.3%), 573(7.7%) & 172(31.3%) strongly disagreed; 543(36.2%), 1439(19.4%) & 76(13.8%) disagreed; 278(18.5%), 1624(21.9%) & 125(22.8%) were neutral; 293(19.6%), 2983(40.1%) & 123(22.4%) agreed; and 66(4.4%), 811(10.9%) & 53(9.7%) strongly agreed during lockdown of COVID-19. After lockdown, 206(41.2%) participants responded that they strongly disagreed, 118(23.6%) were neutral, 93(18.6%) disagreed, 59(11.8%) agreed and 24(4.8%) strongly agreed. No earlier studies had taken fear scale item 4 of COVID-19 after lockdown.
In the present study for item 5 that is “When watching news and stories about COVID-19 on social media, I become nervous or anxious”, 195(39.0%) participants responded that they agreed, 136(27.2%) strongly agreed, 82(16.4%) were neutral, 62(12.4%) disagreed and 25(5.0%) strongly disagreed during lockdown. However, the results of the present studies were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 200(13.3%), 580(7.8%) & 76(13.8%) strongly disagreed; 424(28.3%), 1554(20.9%) & 70(12.8%) disagreed; 279(18.6%), 1579(21.3%) & 93(16.9%) were neutral; 509(34%), 2857(38.4%) & 222(40.4%) agreed; and 87(5.8%), 1011(13.6%) & 860(11.6%) strongly agreed during lockdown of COVID-19. After lockdown, 190(38.0%) participants responded that they agreed, 103(20.6%) were neutral, 98(19.6%) disagreed, 70(14.0%) strongly disagreed and 39(7.8%) strongly agreed. No earlier studies had taken fear scale item 5 of COVID-19 after lockdown.
In the present study for item 6 that is “I cannot sleep because I’m worrying about getting COVID-19”, 161(32.2%) participants responded that they strongly disagreed, 155(31.0%) disagreed, 119(23.8%) were neutral, 51(10.2%) agreed and 14(2.8%) strongly agreed during lockdown. However, the results of the present study were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 539(36%), 2332(31.4%) & 299(54.5%) strongly disagreed; 650(43.4%), 3502(47.1%) & 79(14.4%) disagreed; 179(11.9%), 1065(14.3%) & 95(17.3%) were neutral; 111(7.4%), 456(6.2%) & 69(12.6%) agreed; and 20(1.3%), 75(1%) & 7(1.3%) strongly agreed during lockdown of COVID-19. After lockdown, 288(57.6%) participants responded that they strongly disagreed, 141(28.2%) disagreed, 66(13.2%) were neutral, 3(0.6%) agreed and only 2(0.4%) strongly agreed. No earlier studies had taken fear scale item 6 of COVID-19 after lockdown.
In the present study for item 7 that is “My heart races or palpitates when I think about getting COVID-19.”, 145(29.0%) respondents were neutral, 123(24.6%) disagreed, 122(24.4%) strongly disagreed, 90(18.0%) agreed and 20(4.0%) strongly agreed during lockdown. However, the results of the present study were in contrast to studies conducted by Dolar Doshi et al10, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27 in which 493(32.9%), 1954(26.3%) & 285(51.9%) strongly disagreed; 622(41.5%), 3135(42.2%) & 86(15.7%) disagreed; 198(13.2%), 1162(15.6%) & 93(16.9%) were neutral; 160(10.7%), 994(13.4%) & 76(13.8%) agreed; and 26(1.7%), 185(2.5%) & 9(1.6%) strongly agreed during lockdown of COVID-19. After lockdown, 242(48.4%) participants responded that they strongly disagreed, 124(24.8%) disagreed, 96(19.2%) were neutral, 37(7.4%) agreed and only 1(0.2%) strongly agreed. No earlier studies had taken fear scale item 7 of COVID-19 after lockdown.
Total scores regarding COVID-19 fear among study participants
Among the total 500 (20.75 ± 5.145) study participants, total fear score of COVID-19 during lockdown range was found to be from 7 to 35 among study participants. Similar results were seen in the studies conducted by Dolar Doshi et al10, Kanika K Ahuja12, Rubia Carla Formighieri Giordani et al23 and Muhammad Aziz Rahman et al27, where among the total 1499(18.0±5.68), 600(17.047±5.964), 7430(19.8±5.3) and 549(18.4±6.5) study participants, for each participant minimum score was 7 and maximum score was 35. After lockdown, among 500(16.41 ± 5.013) study participants total fear score of COVID-19 range was found to be from 7 to 29. No earlier studies were conducted using fear scale of COVID-19 after lockdown.
Distribution of study participants on basis of total fear scores of COVID-19 during lockdown
In the present study, among total 500(100%) study participants 328(65.6%) had medium fear (16-24), 106(21.2%) study participants had high fear (25-35) and 66(13.2%) study participants had low fear (7-15). No earlier studies have been carried out that show distribution of study subjects according to total fear scores during lockdown.
Distribution of study participants on basis of total fear scores of COVID-19 after lockdown
In the present study, among total 500(100%) study participants, 277(55.4%) had medium fear (16-24), 203(40.6%) study participants had high fear (25-35) and 20(4.0%) study participants had low fear (7-15). No earlier studies have been carried out that show distribution of study subjects according to total fear scores during lockdown.
Genderwise comparison of fear of COVID-19
In the present study there was no statistically significant difference (p=0.325) found between males (20.59 ± 5.216) and females (21.06 ± 5.012) with fear of COVID-19 during lockdown. However, the results were in contrast to studies conducted by Dolar Doshi et al10, Mohammad Anwar Hossain et al11, Rubia Carla Formighieri Giordani et al23 and Sally Mohammad Elsayed Ibrahim et al42 where there was statistically significant difference (p=0.007) found between males (17.57 ± 5.87, 18.07 ± 4.94, 18.0 ± 5.1 & 8.72 ± 1.54) and females (18.36 ± 5.50, 19.07 ± 5.04, 20.4 ± 5.2 & 17.89 ± 3.76) with fear of COVID-19 during lockdown. After lockdown there was statistically significant difference found (p=0.011) between males (16.00 ± 5.002) and females (17.19 ± 4.955) with fear of COVID-19. No earlier studies had shown genderwise comparison with fear scale of COVID-19 after lockdown.
Agewise comparison of fear total scores of COVID-19
In the present study there were no statistically significant difference (p=0.094) found between 18-29 years old age group (21.43 ± 4.843), 30-49 years age group (20.28 ± 5.241) and and 50 years and above age group (20.45 ± 5.303) during lockdown. However, the results were in contrast to study conducted by Carla Formighieri Giordani et al23 in which there was statistically significant difference (p<0.05) found between 18-29 years old age group (20.6± 5.4), 30-49 years age group ( 19.7 ± 5.3) and and 50 years and above age group (18.7 ± 4.9). After lockdown, there was no statistically difference (p=0.487) found between 18-29 years old age group (16.51 ± 4.869), 30-49 years age group (16.79 ± 5.081) and and 50 years and above age group (16.12 ± 5.102). No earlier studies had done agewise comparison with fear scale of COVID-19 after lockdown.
Comparison of fear of COVID-19 according to socioeconomic status
In the present study there was statistically significant difference found when socioeconomic status of study participants was compared with fear of COVID-19 during lockdown (p=0.033) between upper status (23.64 ± 5.316), upper middle (21.28 ± 5.278), lower middle (21.17 ± 4.613), upper lower (20.33 ± 5.189) and lower status (19.23 ± 5.677).No earlier studies were conducted for comparison of fear of COVID-19 according to socioeconomic status. After lockdown there was statistically significant difference (p=0.042) found when socioeconomic status of study participants was compared with fear of COVID-19 between upper status (18.36 ± 5.591), upper middle (16.86 ± 5.002), lower middle (16.91 ± 4.685), upper lower (16.08 ± 5.063) and lower status (14.63 ± 5.290). No earlier studies were conducted for comparison of fear of COVID-19 according to socioeconomic status after lockdown.
Comparison of fear scores of COVID-19 (during and after lockdown)
In the present study there was highly statistically significant difference (p<0.001) found between fear score of COVID-19 during lockdown (20.75 ± 5.145) and after lockdown (16.41 ± 5.013). No earlier studies were conducted for comparison of fear of COVID-19 (during and after lockdown).
Correlation between knowledge and fear scores of COVID-19 among dental patients.
In the present study there was mild positive correlation (r=0.158) and highly statistically significant (p=0.00) results were found between knowledge and fear of COVID-19 during lockdown. However, after lockdown correlation between knowledge and fear of COVID-19 was mild positive (r=0.057) and results were not found to be statistically significant (p=0.057). No earlier studies were conducted for correlation between knowledge and fear scores of COVID-19 among dental patients.
SUMMARY
The aim of the study was to assess the level of knowledge and fear amongst dental patients attending dental OPD in a dental institution in Mathura city. The final sample size consisted of 500 dental patients.
- A total of 500(100%) study participants were selected from dental institutions.
- A total of 500(100%) study participants were selected, out of which 325(65%) were males and 175(35%) were females.
- A total of 500(100%) study participants were selected, out of which 176(35.2%) study participants were of 18-29 years age group, 116(23.2%) study participants were of 30-49 years age group and 208(41.6%) study participants were in the age group of >50 years age.
- Among total 500(100%) study participants, out of which 118(23.6%) participants were skilled agricultural, shop, fishery workers, 86(17.2%) were skilled workers & shop market workers, 50(10%) were trade workers and plant & machine operators each, 48(9.6%) were unemployed, 47(9.4%) were elementary occupation, 36(7.2%) were technicians association, 25(5.0%) were professionals, 23(4.6%) were clerks and 17(3.4%) were senior officials & managers.
- Among total study participants, out of which 114(22.8%) of study participants had intermediate education, 104(20.8%) were illiterates, 88(17.6%) had graduate degree and 75(15%) were professionals. Study participants those who had primary, middle and high school certificate constituted about 44(8.8%), 18(3.6%) and 57(11.4%) respectively.
- Among 500(100%) study participants, out of which 191(38.2%) had monthly income of family around <10001 rupees, 132(26.4%) had around 10,002-29,972 rupees, 109(21.8%) had around 29,973- 49,961 rupees, 21(4.2%) had around 49,962- 74,755 rupees, 35(7.0%) had around 74,756-99,930 rupees and 12(2.4%) belonged to the group of 99,931- 199861 rupees.
- Among the total 500 (100%) study participants, 203(40.6%) study participants were from upper lower status, 129(25.8%) study participants were from lower middle status, 117(23.4%) study participants were from upper middle status, 40(8.0%) study participants were from lower status and 11(2.2%) study participants were from upper status.
- Among 500(100%) study participants, 191(38.2%) had good knowledge score (9-12), 160(32%) had average knowledge score (5-8), 147(29.4%) had poor knowledge score (14) and 2(0.4%) had no knowledge of COVID-19.
- Among total 500(100%) study participants 328(65.6%) had moderate fear (16-24), 106(21.2%) study participants had high fear (25-35) and 66(13.2%) study participants had mild fear (7-15) during lockdown.
- Among total 500(100%) study participants, 277(55.4%) had moderate fear (16-24), 203(40.6%) study participants had high fear (25-35) and 20(4.0%) study participants had mild fear (7-15) after lockdown.
- There was no statistically significant difference (p=0.325) found between males and females with fear of COVID-19 during lockdown but after lockdown statistically significant difference (p=0.011) were found.
- There were no statistically significant difference found between both during lockdown (p=0.094) and after lockdown (p=0.487) between 18-29 years old age group, 30-49 years age group and 50 years and above age group.
- There was statistically significant difference found when socioeconomic status of study participants was compared with fear of COVID-19 both during lockdown (p=0.033) and after lockdown (p=0.042) between upper status, upper middle, lower middle, upper lower and lower status respectively.
- There was highly statistically significant difference (p<0.001) found between fear score of COVID-19 during lockdown and after lockdown.
- There was mild positive correlation (r=0.158) and highly statistically significant (p=0.00) results were found between knowledge and fear of COVID-19 during lockdown. But, after lockdown correlation between knowledge and fear of COVID-19 was mild positive (r=0.057) and results were not found to be statistically significant (p=0.057).
CONCLUSION
- It was concluded from the present study that in a resource-challenged country such as India, individual knowledge of suggested precautionary and preventive health advisories are crucial to controlling the vicious community transmission of COVID-19. The study found that knowledge levels were adequate in the majority of the population and were directly and significantly related to age, occupation & education of head of the family, monthly income of the family and socioeconomic class. The majority of the population had medium fear scores both during lockdown and after lockdown with significantly higher scores found in women after lockdown and among different socioeconomic classes during & after lockdown. There was mild positive correlation and highly statistically significant results were found between knowledge and fear of COVID-19 during lockdown. The results of the present study also showed that there was mild positive correlation between knowledge and fear of COVID-19.
- Bulk of misinformation, rumour-mongering, negative perceptions and role of media are important to influence the prejudice and stigma during pandemics. The case fatality is surely a concern. However, such mutual hatred and communalism can further increase public agitation and competition for health care, overburdening the limited health resources in the country. Stakeholders at all levels, individual, community and administrative need to be responsible for preventing COVID-19 transmission. At times when the world is facing an unprecedented threat, preventing any form of marginalization can improve positivism and resilience. The more COVID-19 is stigmatized, the more divisive, inflammatory and counterproductive it will be. ‘Collective’ connectedness can help humanity live and emerge through this pandemic, perhaps stronger and more hopeful than before.
LIMITATIONS
Limitations of study include following:
- A convenience sample was used that does not adequately represent the general population of Mathura. Therefore, it is necessary to have a more representative and diverse sample to compare and generalize the results.
- A self-report measure was used to assess Knowledge and fear of COVID-19. This technique can be influenced by social desirability, memory, and other biases, so it is recommended to use other information gathering techniques such as in-depth interviews.
- The study had a cross-sectional design which prevents providing information about causality among the variables for knowledge and fear of COVID-19. Future studies should have a longitudinal design to evaluate the causal relationships between the variables mentioned above.
- The stability of the FCV-19S scores over time was not examined. Test-retest reliability measures should be incorporated in the future.
- The absence of the factor invariance assessment by gender was due to the unequal number of males and females in present study in which most of them were males. It is suggested that for factor invariance analysis it is necessary that the number of participants in each group be similar.
RECOMMENDATIONS
Based on the results of the present study the following recommendations were suggested:
- Educational programs should be planned and implemented by healthcare professionals in different care settings regarding COVID-19 and providing the public with educational materials such as; books, pamphlets and videos to increase their awareness about COVID-19 and promoting their COVID-19 preventive practices to stop its spread.
- Development and implementation of psychological rehabilitation programs for the public is needed to alleviate their COVID-19 fear and help them to cope with novel coronavirus outbreak.
- Future researches are needed to assess factors that affect COVID-19 knowledge and level of COVID-19 fear.
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ANNEXURE I.
Abbildung in dieser Leseprobe nicht enthalten
Frequently Asked Questions: ASSESSMENT OF KNOWLEDGE & FEAR OF COVID-19 AMONG DENTAL PATIENTS IN A DENTAL INSTITUTION, MATHURA - A CROSS SECTIONAL STUDY
What is the primary aim of this study?
The study aimed to assess the level of knowledge and fear amongst dental patients attending a dental OPD (Outpatient Department) in a dental institution regarding COVID-19.
What were the specific objectives of this study?
The objectives included assessing COVID-19 knowledge, evaluating COVID-19 fear using the FEAR OF COVID-19 Scale, comparing fear levels with demographic variables, comparing fear levels during and post lockdown, and finding the correlation between knowledge and fear of COVID-19 among dental patients.
What type of study was conducted?
A cross-sectional, questionnaire-based study was conducted.
Where was the study conducted?
The study was conducted among dental patients attending the dental OPD of K.D. Dental College & Hospital in Mathura.
What were the inclusion criteria for participants?
The inclusion criteria included new patients visiting the dental OPD, those aged 18 years and above, patients attending the OPD during specific hours (9:30 am - 2 pm), and subjects providing verbal voluntary informed consent.
What were the exclusion criteria?
Patients below the age of 18 and those who did not provide consent were excluded.
What instruments were used to collect data?
A close-ended questionnaire translated into Hindi was used. It included questions on demographic information, socioeconomic status, a knowledge assessment of COVID-19, and the Fear of COVID-19 Scale.
What did the knowledge assessment questionnaire cover?
The knowledge assessment questionnaire consisted of 12 questions, 4 regarding clinical presentations, 3 regarding transmission routes, and 5 regarding prevention and control of COVID-19.
What is the Fear of COVID-19 Scale?
The Fear of COVID-19 Scale is a self-rating instrument with five-item Likert type scale. The minimum score is 7, and the maximum is 35. The total score is calculated by adding up each item score. Responses were recorded for during and post lockdown period of COVID-19.
How was the data analyzed?
The data were coded, tabulated, and analyzed using IBM SPSS Version 20. Descriptive statistics, independent t-tests, one-way ANOVA tests, and Pearson's test were used.
What were some key findings regarding knowledge of COVID-19?
The study found that knowledge levels were adequate in the majority of the population and were directly and significantly related to age, occupation & education of head of the family, monthly income of the family and socioeconomic class.
What were some key findings regarding fear of COVID-19?
The majority of the population had medium fear scores both during lockdown and after lockdown with significantly higher scores found in women after lockdown and among different socioeconomic classes during & after lockdown. A statistically significant difference was found when socioeconomic status of study participants was compared with fear of COVID-19 both during and after lockdown.
Was there a correlation between knowledge and fear of COVID-19?
Yes, there was a mild positive correlation and highly statistically significant results were found between knowledge and fear of COVID-19 during lockdown. After lockdown the correlation between knowledge and fear, while still mild positive, was not statistically significant.
What were the limitations of the study?
Limitations included the use of a convenience sample, reliance on self-report measures, the cross-sectional design, the lack of examination of FCV-19S score stability over time, and the absence of gender factor invariance assessment.
What were the recommendations based on the study's results?
Recommendations included planning educational programs, providing educational materials to the public, developing psychological rehabilitation programs, and conducting future research to assess factors affecting COVID-19 knowledge and fear levels.
- Quote paper
- Sunil Kumar Chaudhary (Author), 2021, Assessment of Knowledge and Fear of COVID-19 Among Dental Patients in a Dental Institution, Mathura. A Cross Sectional Study, Munich, GRIN Verlag, https://www.grin.com/document/1007212