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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 3
| Issue : 3 | Page : 221-227 |
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Fear and Information-Seeking Behavior Related to COVID-19 in Older Indian Adults
Sreelakshmi Vaidyanathan, Suyog Vijay Jaiswal
Department of Psychiatry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| Date of Submission | 01-Oct-2021 |
| Date of Decision | 29-Oct-2021 |
| Date of Acceptance | 02-Dec-2021 |
| Date of Web Publication | 23-Dec-2021 |
Correspondence Address:
Dr. Sreelakshmi Vaidyanathan
Department of Psychiatry, All India Institute of Medical Sciences, Nagpur - 441 108, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wsp.wsp_69_21
Background: Elderly, a high-risk population for COVID-19, are further vulnerable to mental health sequelae due to several pandemic-related restrictions. This study aimed to assess fear and information-seeking behavior related to COVID-19 among older Indian adults. Methodology: It was an online, observational cross-sectional study. An open-access e-invite to the questionnaire (on Google forms) was circulated through social media. The form contained sociodemographic details, fear of COVID-19 scale (FCV-19S), and an original questionnaire on information-seeking behavior in COVID-19. Responses of adults ≥60 years of age were noted. Analyses were done with SPSS v20, and Mann–Whitney U test was used to compare the FCV-19S scores among information-seeking variables. Results: A total of 150 completed responses were obtained. Mean age of respondents was 67 ± 5.44 years; median FCV-19S score was 11; 9.33% of respondents had significant fear of COVID-19. TV/Radio (55.3%) followed by newspaper/magazines (40.7%) were the most preferred source of information. Preventive measures (75.3%) and symptoms of disease (70%) were the most sought-after information. Those who spent more time than intended searching for information have significantly higher fear scores (P = 0.025). There was no significant difference in fear score for other parameters of information-seeking behavior and its consequences. Conclusion: Less than 10% of study population of older adults had a significant fear of COVID-19. Information sought is mostly on symptoms of disease, preventive measures, and guidelines and sought through passive sources rather than active searching or in-person. Those with higher fear scores are likely to spend more time searching for information than intended and are less likely to perceive any dysfunction due to said behavior.
Keywords: Anxiety, COVID-19, information seeking behavior, older adults
How to cite this article:
Vaidyanathan S, Jaiswal SV. Fear and Information-Seeking Behavior Related to COVID-19 in Older Indian Adults. World Soc Psychiatry 2021;3:221-7 |
| Introduction | |  |
Elderly, aged 60 years and above, are a special population with a myriad of vulnerabilities and constitute around 8% of our population.[1] These testing times of the COVID pandemic have been highly challenging, especially for the elderly. High risk of infection and the imperative amplified preventive measures, including advice of strict social distancing and hand hygiene, have added to the existing troubles of poor social support, physical disabilities, and sensory/cognitive deficits for many, leading to further social isolation.
Studies have reported anxiety about lethality of COVID-19 to be associated with significant deterioration in mental health of older adults.[2] Isolation, difficulty in obtaining supplies (food, medications), dependence on family for living, no earning income/financial support, close family or friend suffering from COVID-19, medical comorbidities, and lack of access to health care are possible associated factors.[3] Various environmental factors such as media coverage, with reiteration and specific focus on increased risk of infection and death among the elderly, could also be highly fear inducing and anxiety provoking.[4],[5] There have even been reports of elderly persons attempting suicide out of fear of contracting the illness.[6],[7] A study by Mistry et al. studied fear of COVID-19 in older adults in Bangladesh using Fear of COVID-19 scale and reported mean fear score of 19.4.[8] A similar study by Yadav et al. among Nepalese older adults reported a mean fear score of 18.1.[9] Thus far, there is no Indian literature available regarding fear of COVID-19 in this population. In a study by Srivastava et al. on adult Indian population, 46.9% (n = 2004) reported fear of COVID-19.[10]
Fear and information are two highly interlinked concepts, and during disasters, like the current pandemic, information is key. There has been a torrential flow of information regarding the novel coronavirus and COVID-19. The popularity of social media as a constant and ever-changing source and rampant circulation of unverified information has further complicated things. Jungmann and Witthoft reported positive correlation between virus-related anxiety and cyberchondria, i.e., repeated and/or excessive health-related internet search.[11] Garfin et al. also reported increased anxiety with excessive media consumption.[12] Studies on information-seeking behavior (abbreviated henceforth as ISB) of Indian population during COVID reported that news websites, dedicated websites of coronavirus, and medical staff were the most preferred and trustworthy sources of information, the Internet was preferred over traditional information sources and the most sought-after information was about signs and symptoms, treatment, prevention and control, list of facilities, and availability of medicines and vaccination.[13],[14]
Older adults have generally been found to prefer human sources (such as health-care providers, friends, and relatives) rather than sources like the Internet.[15] Restriction of access to information by virtue of age-related circumstances such as living situation, mobility, health conditions, access to family/friends, and comfort level in using the Internet[16] has been further amplified by the preventive measures in place for the pandemic. Significant differences in respondents' views in various age groups regarding sources of information during this pandemic were reported by a Greek study, with older participants being more informed by television (P < 0.001) and less often by the Internet (P < 0.001).[17]
Several questions come to mind regarding ISB of older adults in the context of this pandemic with respect to their sources, what information is sought and the consequences of the same. To the best of our knowledge, no other study has examined this aspect in older adults in this context.
Considering this background, and a hypothesis of increased fear of COVID-19 in elderly, this study was undertaken among older Indian adults with the aim of assessing fear of COVID-19, describing patterns of ISB related to COVID-19 and exploring any association between the same.
| Methodology | | |
Study setting
Following approval by the Institutional Research Cell and Ethics Committee, we conducted an online, observational cross-sectional study in the month of July 2020 in older Indian adults. Individuals aged 60 years and above, of both sexes, who could understand the contents of the questionnaire (assumed on the basis of completed forms), had basic proficiency in the use of online forms, and were willing to participate in the study were included.
Study procedure
Sample size was determined using the following formula:
(N = sample size, SD = Standard deviation of variable, d = absolute error or precision).[18]
With degree of precision (d) assumed at 01 (one) and standard deviation (SD) estimated at 5.68 (as taken from a prior study),[19] the sample size was found to be 124. Assuming a 20% nonresponse rate, the final sample size was determined as 150.
Purposive sampling using snowballing technique was used to recruit participants considering the social restrictions in view of the current pandemic scenario and the high vulnerability of the study population. An online data collection tool was designed using Google forms with settings that limited responses to only one per person. An open access e-invite to the form was circulated widely through various social media platforms (WhatsApp, Facebook, Twitter, etc.) and by word of mouth. No incentives were offered for participation in the study. The noted responses were documented online, and data from the form were automatically stored in a spreadsheet on Google drive, access to which was restricted to only the investigators concerned with the study. The participants were given the option to seek help and to learn about the results of the study.
Study instruments
The four sections of the Google form were as follows:
- Information regarding the study followed by explicit consent document – the rest of the sections were presented only when the person consented to participate in the study
- Questions pertaining to sociodemographic characteristics
- Fear of COVID-19 scale (FCV-19S):[20] This is a seven-item scale with five item Likert scoring with a total score obtained by adding up each item score (ranging from 7 to 35). Higher the score, greater the fear of COVID-19. The scale has good internal consistency (α = 0.82). With permission of the original authors, the scale was translated and back translated in Hindi for the purpose of this study. This being a recent scale, no validated cutoff values are currently available. For the purpose of this study, the central value of range of score of the scale was presumed as cutoff for demarcating significant fear
- COVID-19 ISB assessment questionnaire: An originally devised semi-structured questionnaire was used to record data regarding ISB in the previous 2 months. It consisted of three parts: (a) sources of information regarding COVID-19 (sources commonly used, whether information is validated), (b) searching for information related to COVID-19 (what information is sought, hours spent seeking the information, is more time spent than intended), and (c) consequences of information seeking (interferes with work or activity, felt overcautious, what finding of info about COVID led to, e.g., sharing, anxiety, relief, and more searching). Face validity of this instrument was obtained from six experts in the field. This questionnaire was also back translated in Hindi for use in this study.
Statistical analysis
Data extracted from Google forms were exported to Microsoft Excel 2019 for cleaning and coding and finally to SPSS v20 for analysis. For sociodemographic variables, total score of FCV-19S and COVID-19 ISB parameters, percentage, and descriptive statistics were calculated. As data failed the test of normality, Mann– Whitney U was used to examine the relation between fear of COVID-19 and the parameters of ISB (subscales of i: searching for information related to COVID 19 and ii: consequences of information seeking). A P < 0.05 (2-tailed) was considered statistically significant.
| Results | | |
A total of 155 responses were received. Five respondents' questionnaires were incomplete and excluded from the final analysis, leading to a final data set of 150 responses.
The mean age of the sample was 67 ± 5.44 years. The detailed sociodemographic characteristics of the study sample are as mentioned in [Table 1].
The median total score of Fear of COVID-19 Scale was 11 (n = 150; interquartile range = 8). Significant fear, presuming central value of range of score of the scale as cut– off, was seen in 9.33% (n = 14).
Information-seeking behavior
Sources of information regarding COVID-19
The details regarding various sources used to obtain information regarding COVID – 19 are provided in [Figure 1]. The most used source was TV/radio (55.3% obtained “a lot” of information from it), followed by newspapers/magazines (40.7%), social media (33.3%), and family/friends (25.3%). 32% of the sample did not check the validity of the information.
Searching for information related to COVID-19
The details regarding information sought related to COVID – 19 are provided in [Figure 2]. Most sought after information was about measures of protection of self/family (75.3%), followed by information about novel coronavirus, its spread and symptoms (70%), and government rules/guidelines (64.7%). Information on mental health issues was least sought (15.3%).
Majority of our sample population (67.33%) spent <1 h searching for this information and 10% reported to have spent more time than intended in seeking information.
Consequences of information seeking
Twelve percent of the respondents perceived interference with work/activities/family time due to seeking of information, while 16.7% felt or were told by someone that they were being overcautious with precautionary measures following information search. The consequences that finding of COVID-19 related information led to are summarized in [Figure 3]. 19.3% often found better understanding of the illness with the information, 18.7% often shared the information with family or friends, 7.3% often reported changes in sleep or appetite after finding the information, while 4.7% often reported feelings of anxiety. | Figure 3: Consequences of finding information that is sought related to COVID-19
Click here to view |
Fear of COVID 19 was compared between groups based on the responses provided for the questions of subscales of ISB assessment questionnaire [Table 2]. Higher total score of fear of COVID-19 was seen in those spending more time than intended in searching for information (Md = 18, n = 15) and this difference was statistically significant (P = 0.025).
No significant difference was found for total score of fear of COVID-19 with hours spent per day in searching for related information, perceived interference with work/activities/family time and being overcautious with precautionary measures following information search [Table 2].
| Discussion | | |
This study conducted in the context of the current COVID-19 pandemic with focus on older adults, aimed to assess fear of COVID-19, describe patterns of ISB related to COVID-19, and investigate any links between the same.
The study sample reported lesser fear than previous studies in Indian general population using the same scale. Doshi et al. reported an overall mean score of 18.00 ± 5.68 and considering the mean score as a cut off, they found that 54.8% of the study sample reported low fear.[19] Srivastava et al. on the other hand reported the prevalence of fear of COVID-19 in their sample as 46.9% with mean as 7.103 ± 0.283.[10] Our findings corroborated with studies that have shown better emotional well-being[21] and lower risk of stress consequences from COVID-19[22] in older adults when compared to those under 60 years of age. This could be the consequence of a wider emotional experience and life wisdom among older adults. Our study reported lower scores than studies on older adults using the FCV-19S by Mistry et al. (Bangladesh) and Yadav et al. (Nepal) which reported mean fear scores of 19.4 (n = 1032) and 18.1 (n = 846) respectively.[8],[9] Our sample size could be a likely limitation.
We found broadcast media (television/radio), print media (newspapers/magazines), and Internet media (social media) to be the preferred sources of information regarding COVID-19 among the study population. This deviates from previous studies which have shown older adults to prefer human sources.[15] The possible explanation to this could lie in the context of the high vulnerability of the study population, the innate nature of COVID, and the strict social restrictions in place during the pandemic. Passive sources of information such as television/radio and newspapers have been preferred over those requiring active seeking of information such as searching the Internet which is similar to a Greek study by Skarpa and Garoufallou.[17] Restriction of access to information by virtue of age-related circumstances such as mobility and comfort level in using the internet could have influenced the same.[16]
Measures of prevention/protection of self or family were the most sought-after information which is similar to previous studies and in line with the aim of various involved agencies to promote preventive measures in the population.[11],[13],[14] Better understanding of the illness and feelings of reassurance/relief after information search were reported more than feelings of anxiety or confusion, possibly indicating some success in the reporting and dissemination of information regarding COVID-19.
Our search found limited literature on the relation between fear and ISB. Ebrahim et al. reported a significant association of increased frequency of seeking COVID-19 information with anxiety as measured by GAD-7 scale.[23] Jungmann and Witthoft reported a positive correlation between health anxiety and cyberchondria during the COVID-19 pandemic: “stronger the cyberchondria, higher the virus anxiety.”[11] Thus, our finding of spending more time than intended in searching for information being associated with higher fear of COVID-19 is similar to these studies.
The group spending more hours per day in searching for related information showed higher levels of fear, though this association was not significant. This too appears in lieu of the abovementioned finding with our sample size being a possible limitation.
There was no significant association between fear of COVID-19 and other parameters such as respondent's perception of interference with work/activities/family time and perceiving or being told that they are overcautious with precautionary measures following information search. Although too preliminary to comment, as the study population comprised mainly of retired persons, they may not have perceived any possible dysfunction in these areas as distressing. Moreover, subjective reporting could have also created some bias and distress in this scenario is possibly better reflected in aspects such as more time spent than intended in searching for information. With establishment of a universal new normal with respect to hygiene and sanitation, precautionary measures taken may not have been perceived as being overcautious.
Possible implications of our study are further exploration into sources of information regarding COVID-19 and improving accessibility of older adults to the same. strategic targeting of their preferred sources of information and improving the quality of information provided could serve to strengthen prevention measures and be a crucial step in the protection of this vulnerable age group. Building awareness regarding verification of validity of any information is crucial to avoid unnecessary fear and misinformation. Furthermore, usage of tools such as self-monitoring apps could help keep a check on the amount of time spent in looking for information and thereby help reduce fear levels.
The online sampling methodology could possibly have limited the sample size and thus prevented the generalization of the study, though the social restrictions and high vulnerability of the study population left little choice in the matter. The self-report nature could exhibit some bias and the cross-sectional design might limit the establishment of a cause-effect relationship, indicating the need for further prospective longitudinal studies exploring various factors related to ISB in older adults. The use of standardized questionnaires and focus on a less explored vulnerable population are the strengths of this study.
| Conclusion | | |
Older Indian adults have some fear related to COVID-19, but significant fear was seen in <10% of the study population. Symptoms of COVID-19, preventive measures, and guidelines were the most sought for information and passive sources ranging from news media to social media were preferred over traditional direct human sources or official information among the study population. Those with higher fear scores were likely to spend more time searching for information than intended and were less likely to perceive any dysfunction due to this behavior.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]
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