World Social Psychiatry

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 3  |  Issue : 2  |  Page : 92--99

Beliefs Related to COVID-19 Infection: A Cross-Sectional Web-Based Survey from India


Swapnajeet Sahoo1, Jigyansa Ipsita Pattnaik2, Susanta Kumar Padhy2, Aseem Mehra1, Mahima Panigrahi3, Ritu Nehra1, Sandeep Grover1,  
1 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Psychiatry, All Indian Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

Correspondence Address:
Dr. Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India

Abstract

Aim: To evaluate the prevalence of specific beliefs held by people with respect to SARS-2-CoV (COVID-19) infection. Study Design: Web-based cross-sectional survey by using nonprobability snow-balling sampling technique. Methodology: The survey-specific questionnaire designed based on the review of literature on the prevailing myths/beliefs was circulated by an online cross-sectional survey through the SurveyMonkey® platform using the WhatsApp®, both individually and through the WhatsApp groups, by using a nonprobability snow-balling sampling technique. Results: 1695 people participated in the survey, of which 1636 responses were found to be complete and were analyzed. The mean age of the participants was 34.55 years, and two-thirds of the participants were males (n = 1092). About one-third of the participants were educated up to graduation (32.1%), and about one-fifth were healthcare workers. Incorrect beliefs related to various preventive aspects, modes of spread of infection, and treatments were present in a significant proportion of people, with a wide variation for specific issues. When the number of participants with at least one incorrect belief related to any of the aspects of COVID-19 infection was evaluated, except for four participants, all the participants reported at least one incorrect belief. Male and female participants differed significantly in few beliefs. Conclusions: This survey highlights a widespread prevalence of myths/misconceptions in society regarding various aspects of COVID-19 infection, which warrants more focus on awareness programs.



How to cite this article:
Sahoo S, Pattnaik JI, Padhy SK, Mehra A, Panigrahi M, Nehra R, Grover S. Beliefs Related to COVID-19 Infection: A Cross-Sectional Web-Based Survey from India.World Soc Psychiatry 2021;3:92-99


How to cite this URL:
Sahoo S, Pattnaik JI, Padhy SK, Mehra A, Panigrahi M, Nehra R, Grover S. Beliefs Related to COVID-19 Infection: A Cross-Sectional Web-Based Survey from India. World Soc Psychiatry [serial online] 2021 [cited 2022 Aug 17 ];3:92-99
Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/2/92/324991


Full Text



 Introduction



The SARS-2-CoV (COVID-19) pandemic can be said to be the most dreadful event in the history of humanity in the 21st century. The currently available treatment strategies related to COVID-19 infection are associated with several controversies,[1],[2],[3],[4],[5] and this has contributed to the emergence of certain incorrect beliefs and myths associated with COVID-19. Since the outbreak of the COVID-19 pandemic, several myths have surfaced in the internet and social media platforms that have created a lot of confusion in the minds of the general public.[6],[7],[8],[9] The list of myths, beliefs, and unrecommended practices is expanding. To counter the same, international and national health authorities are trying their level best to clarify many such facts through telecommunication media (newspapers, news channels, advertisements, etc.). As the research on COVID-19 infection, its transmission, testing strategies, vaccination, and treatment guidelines is undergoing several modifications and almost every day new information is emerging, it is essential to disseminate this information to the public to ally their anxiety; however, at the same time, it is essential to check the authenticity of the information.[5],[10],[11] The public need to be made aware of following or checking information from official websites/sources[10],[11],[12] and not to believe on any random articles/blogs/posts/messages in social media platforms or news channels until and unless the information is backed by the authentic agencies.

Many misconceptions are associated with different areas/aspects of COVID-19 infection.[9] Some of the misconceptions have been associated with the spread of infection through different routes/modes, reduction of risk by using/following certain practices, and avoiding certain food items or practices. Few misconceptions have been associated with day-to-day functioning: sexual functioning, pregnancy-related, childbirth, lactation, and fear of getting the infection from persons recovered from COVID-19 infection or from those under quarantine. Unless the health authorities clarify such misconceptions, the societal reaction to all these prevailing misconceptions can have a widespread impact on people's behavior. Further, the exact prevalence of these beliefs in society is not known. Understanding the prevalence of these beliefs can help in planning and carrying out awareness activities, specifically targeting the incorrect assumptions and the prevailing myths. Keeping this in mind, the current study aimed to evaluate the prevalence of beliefs held by the people with respect to COVID-19 infection.

 Methodology



It was an online cross-sectional survey conducted through the SurveyMonkey® platform. For this, a survey link was circulated by using the WhatsApp®, both individually and through the WhatsApp groups. A nonprobability snowball sampling technique was used, and people completing the survey were urged to forward the same to their contacts. Participation in the survey was completely voluntary, and the probable participants had the full freedom of not participating in the study. Similarly, those filling the survey were under no compulsion to forward the same to others. These were ensured by the snowball sampling in that the researchers were not directly involved in the circulation of the survey after a certain stage.

The survey invitation clearly stated that the participants would have the right not to participate in the survey, and participation in the survey would imply providing informed consent. The survey link stated clearly that those not willing to participate could ignore the message. The survey link was circulated in mid-May 2020 and the link was deactivated after 3 weeks. The survey could be responded only once by using a particular device.

The study was approved by the institute's ethics committee.

The survey-specific questionnaire was designed based on the review of literature on the prevailing myths/beliefs. For these, websites of the World Health Organization (WHO), Centers for Disease Control (CDC), and Ministry of Health and Family Welfare of India (MoHFW) were screened for the information available for the prevailing myths. In addition, the information about beliefs and myths was also derived from the newspaper reports. This information was further supplemented by the researcher's experience while working with people in quarantine, people with COVID-19 infection, and other healthcare workers (HCWs). Initially, the researchers generated incorrect beliefs and myths, and further internet search was done to verify the facts. Based on the evidence published in peer-reviewed journals in the form of a randomized trial, cohort study or at least one case report, and conclusions drawn from these reports, we consider the beliefs to be correct or incorrect.

Based on this, a particular belief was considered correct or not and whether it was a myth. Based on this, a self-rated questionnaire was designed with three response options, i.e. “Yes,” “No,” and “Don't Know”. This initial questionnaire was reviewed by a group of mental health professionals, physicians, and experts from public health working with patients with COVID-19. Based on their inputs, items were revised for the semantics and content of the questionnaire. Then, the questionnaire was given to 10 lay persons for their opinion with respect to the language of various items and the response options. These participants were interviewed by the researchers to understand if they had any difficulty in interpreting the questionnaire and responding to the questions. Based on these inputs, the questionnaire was further revised to make the language of the questionnaire simpler. In addition, another response option of “Can't say” was added so that the participants have another option, which can capture those ambivalent about certain beliefs. Based on this, the final questionnaire was made and given to another set of experts from psychiatry, and public health to evaluate the face and content validity.

The survey questionnaire was initially developed in English and then translated to Hindi and Odia by using the World Health Organization methodology, recommended for translation and back translation of scales.[13]

Descriptive statistics were applied, and the data collected were analyzed using SPSS 20.0 version. (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) Chi-square test was used to compare different subgroups of the participants.

 Results



Close to 1700 (n = 1695) people participated in the survey, of which 1636 responses were complete and were analyzed. Before analysis of the data, the IP addresses were checked to avoid any kind of duplicate response. Checking for duplicacy yielded 10 responses, which were doubtful, and hence, we discarded the same. Responses from those aged <18 years were discarded.

The mean age of the participants was 34.55 (standard deviation - 11.96) years, and two-third of the participants were males (n = 1092; 66.7%). Half of the participants were married and were living with their spouse (n = 824; 50.4%). About one-third of the participants were educated up to graduation (32.1%), and about one-fifth were HCWs. Most (n = 92.1%) of the participants were residing in urban areas (cities/towns) [Table 1], suggesting good access to information technology resources.{Table 1}

[Table 2], [Table 3], [Table 4] show the prevailing beliefs related to various aspects of COVID-19 infection. Incorrect beliefs related to various preventive aspects, modes of spread of infection, and treatments were present in a significant proportion of people, with a wide variation for specific issues. When the number of participants with at least one incorrect belief related to any of the aspects of COVID-19 infection was evaluated, except for four participants, all the participants reported at least one incorrect belief.{Table 2}{Table 3}{Table 4}

Gender differences regarding incorrect beliefs and myths

Compared to females, significantly higher proportion of males believed that use of garlic (P = 0.003), sniffing alcohol (P = 0.008), and drinking alcohol (P = 0.04) reduce the risk of COVID-19 infection, whereas a significantly higher proportion of females believed that drinking warm water (P = 0.009) was associated with lower chance of developing COVID-19 infection and higher proportion were unsure about the role of sunlight (P = 0.019) in prevention of infection. In terms of factors which can increase the risk of infection compared to females, significantly higher proportion of males believed that mosquito bite (P = 0.003), consumption of nonvegetarian food (i.e. eggs [P = 0.005], chicken [P = 0.013], and fish [P = 0.003]); donating blood (P = 0.002), purchases products from overseas (P = 0.007), using milk packets (P = 0.039), having unprotected sexual intercourse with spouse (P = 0.001), and having unprotected sexual intercourse with an unknown person (P = 0.025) can increase the risk of COVID-19 infection. When the beliefs related to pregnancy and breastfeeding were evaluated, compared to females, significantly higher proportion of males believed that pregnant women with COVID-19 infection will require cesarean section (P = 0.043), had increased risk of miscarriage (P = 0.005), and transmission of infection from mother to child through the breast milk (P = 0.04). Further, a significantly higher proportion of males also believed that having malaria (P = 0.003) and taking vaccines against pneumonia (P < 0.001) provide immunity against the COVID-19 infection. A significantly higher proportion of males also believed that COVID-19 infection only affects older people (P = 0.001), and no vaccine can be developed against the COVID-19 infection (P = 0.002).

 Discussion



The present study was conducted with an aim to understand the prevalence of various misconceptions related to COVID-19 in the general population through a web-based online survey. The survey questionnaire was developed after a focused group discussion with experts and included almost all the prevailing incorrect beliefs/myths/misconceptions mentioned in websites of different authentic health authorities (WHO, CDC, and MoHFW, India)[8],[10],[12] and also reported in newspaper articles from time to time. In addition, few misconceptions were added based on the authors' experience while working with people under quarantine. Therefore, it can be said that the survey questionnaire was quite broad, and to make it easy and understandable, four options (Yes, No, Can't say, and Don't know) were used. Rather than using three options (Yes, No, and Don't know), we included the option of Can't say to tap people who were ambivalent about these beliefs.

The present study suggests that incorrect beliefs/myths/misconceptions associated with various aspects of COVID-19 infection (getting infected/prevention and treatment) are highly prevalent in society.

According to the present study, some of the beliefs regarding the practices which were claimed to reduce the chance of getting infected were use of garlic, turmeric, lemons, gargling with warm water, and drinking warm water. While the basis of using garlic, turmeric, and lemons (Vitamin C) is that these commodities have antimicrobial properties and enhance immunity, yet till date, no double-blind randomized controlled trials during the current pandemic have been published to support the fact and these items can be used to enhance overall immunity against COVID-19 infection.[9],[14],[15] Although the AYUSH Ministry of India advocates the role of these commodities in preventive aspects of COVID-19, yet these have not been evaluated in a proper trial to confirm their role in prevention of COVID-19 infection. Keeping this in mind, the awareness programs or advertisements which focus on these commodities' role should clearly mention the role of these in enhancing immunity, in general, which does not necessarily prevent COVID-19 infection.

Similarly, the beliefs that “rinsing mouth with warm saline water” and “drinking warm water” can soothe a sore throat, but following these practices does not necessarily prevent one from getting infected by COVID-19. The beliefs regarding the practices of drinking/sniffing/inhaling alcohol have not been evaluated to say that these confer any protection against COVID-19 infection. Accordingly, there is a need to improve awareness and address these prevailing misconceptions among the people. Higher prevalence of these misconceptions related to alcohol among males, compared to females, suggests that males may accept these more often to rationalize their alcohol use.

About one-fifth to half of the participants either held the beliefs or were ambivalent about the preventive aspects of exposure to sunlight, taking hot bath, efficacy of hand dryers, had beliefs that pneumococcal vaccine or BCG vaccination can be effective against the novel coronavirus, believed that of cow dung/cow urine, or performing religious chants can prevent COVID-19 infection. These myths can be attributed to widespread circulation of messages related to these on the various social media platforms, and these have been negated from time to time owing to lack of scientific evidence in favor of such claims.[6],[9],[14],[15]

The present study also suggests that a significant proportion of people in the general population either have misconception or are unsure about the role of factors such as nonvegetarian food items, having pets at home, mosquito bite, buying products from overseas, using Chinese products, and consuming Chinese foods in increasing the risk of developing COVID-19 infection. Some of these beliefs are possibly related to the origin of COVID-19 infection from the Wuhan meat market and transmission of COVID-19 infection through blood. Some of the earlier reports also suggest prevalence of misbelief that COVID-19 can be transmitted through blood and this has resulted in scarcity of blood in blood banks.[16],[17] At the outset of the COVID-19 pandemic, there was lot of speculation about spread of infection through newspapers, milk packets, unwashed vegetables, and buying products from overseas as these could be the sources of fomite transmission. However, with time, it is becoming clear that COVID-19 virus can survive on inanimate products for limited number of hours, and hence, the use of these commodities is not necessarily associated with increased risk of COVID-19 infection, if the hand hygiene measures are followed carefully. Therefore, for safety precautions, adequate hand hygiene measures after touching these products can help prevent risk of infection, and there is no need to panic or avoid buying newspapers/milk packets, etc.

Kissing, touching/caressing, or having sexual intercourse with anyone suspected of having COVID-19 can increase the risk of infection. Accordingly, there is a need to avoid sexual intimacy with such persons. However, this does not mean that sexual intimacy with known partner with no contact history with any COVID patient should be avoided. The present survey shows that such beliefs are quite prevalent in society and there is a need to address the same as part of the awareness programs. On the other hand, the present survey also suggests that 22% of participants reported no risk of getting infection with unprotected sexual intercourse with unknown persons. This misconception can be very detrimental as one does not know the COVID-19 status of an unknown person. Hence, any type of sexual intimacy with unknown persons should be avoided in the current scenario.

There are many viewpoints that have speculated that there are misconceptions about the spread of nCoV-SARS through sexual practices, transmission during childbirth/labor, vertical transmission from mother to the fetus, and transmission from mother to the baby through breast milk.[18],[19],[20] The present study demonstrates the prevalence of such beliefs in significant proportion of the people in the society. The WHO and many experts worldwide have suggested that normal vaginal delivery should be conducted in all practical cases and that the cesarean section to be conducted only in cases with appropriate indications.[21],[22] Similarly, information about the breastfeeding during COVID-19 have been available on the websites of almost all health authorities (WHO, CDC, and MoHFW),[15],[23],[24],[25],[26] and also various pediatric neonatology guidelines[27],[28] have suggested the beneficial effects of breastfeeding, how to breastfeed a newborn by an infected mother (with proper hand hygiene and with masks), yet the findings of the present study [Table 3] suggest that more awareness is required for this sensitive topic.

A section of the survey questionnaire dealt with opinions related to chance of developing infection with regard to the level of contact with infected persons, persons in quarantine, persons with travel history, persons who have recovered from COVID-19 infection, and the HCWs. Understanding the misconceptions about this aspect of transmission can help in understanding the prevalent social and public stigma.[29],[30],[31],[32],[33],[34] Recently, several reports from across the world about stigma and discrimination faced by the people who have recovered from COVID-19 and the UNESCO had labeled the social stigma related to COVID-19 as a global phenomenon.[34] The WHO and local/national health authorities have tried to increase awareness about these misconceptions (for example, only coming in close contact [<6 feet] of an infected person for a substantial period of time [at least 15 min] or touching used articles can lead to infection).[10],[35] However, it appears that these messages have not percolated well in society and the presence of these misconceptions is possibly contributing significantly to stigma associated with COVID-19 infection.

Beliefs such as COVID-19 affect only older people, and Indians have better immune system are completely false. Although greater mortality has been reported among aged individuals, this should not be seen as young individuals being immune to it.[36] This belief can be detrimental to the society, as such beliefs can make one prone to discard the infection control norms, make one over-confident, and make a person prone to getting infected. The present survey suggests that only a small proportion of people have such beliefs, and this can be considered as proper awareness about the infection in society.

According to the findings of the present survey, about one-fourth of the participants also believed that Muslims were responsible for spread of COVID-19 infection. Similarly, about 40% of the people believed that the COVID-19 infection is a bioweapon developed by China to gain power over the world. These beliefs in society against a particular community or nationality can lead to more disharmony; hence, blaming and discrimination need to be addressed.

The present survey also suggests that in general, there were few gender differences in various myths and misconceptions which need to be focused while carrying out awareness programs.

This survey has certain limitations that are applicable to any online survey such as limited number of responses and responses limited to snow-balling sampling technique. Hence, the findings cannot be generalized to entire country. Further, the survey was limited by the fact that we used a self-designed questionnaire, for which only face validity was evaluated. The survey was also limited to those who received the survey link and those who had smartphone with internet connection. Future studies must attempt to overcome these limitations. Moreover, there was very low proportion of responses from the rural background and future studies should try include more responses from rural areas as these comprises the major part of Indian population.

 Conclusion



To conclude, this survey highlights that there is a widespread prevalence of myths in society regarding various aspects of COVID-19 infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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