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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 70-74

Coronavirus transmission mitigation behaviors: The first-line intervention against COVID-19


Department of Management, North-Eastern Hill University (Grade “A” by NAAC), A Central University Established Under an act of Parliament, Tura Campus, Tura, Meghalaya, India

Date of Submission26-Aug-2020
Date of Decision24-Sep-2020
Date of Acceptance07-Oct-2020
Date of Web Publication08-Apr-2021

Correspondence Address:
Dr. Khundrakpam Devananda Singh
Department of Management, North-Eastern Hill University (Grade “A” by NAAC), A Central University Established Under an act of Parliament, Tura Campus, Tura - 794 002, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_84_20

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  Abstract 


BACKGROUND AND OBJECTIVE: The spread of COVID-19 across the globe develops psychological disturbance to the population. People are always trying to protect themselves from this pandemic through transmission mitigation behavioral (TMBs) practices. The understanding and practice of the exemplary coronavirus TMBs will help the population to fight the disease effectively and efficiently. This study draws the exemplary coronavirus TMBs among the Indian population and constructs a viable model to study these behaviors.
METHODS: Data collected from 238 valid respondents through online were the sample of this study. TMB items were collected from the publications of the Ministry of Health and Family Welfare, Government of India, and World Health Organization, Regional Office for Europe. AMOS, SPSS, and Microsoft Excel were used for statistical calculations. Confirmatory Factor Analysis (CFA), Bartlett's Test of sphericity and Keiser–Meyer Olkin (KMO) test, Cronbach's alpha, Principal Component Analysis (PCA), Average Variance Extracted (AVE), and composite reliability (CR) were calculated for the analysis of data.
RESULTS, INTERPRETATION, AND CONCLUSIONS: Based on the existing literature, three out of 14 TMB items was dropped, and CFA was run for the remaining 11 items. The result of CFA identified a 5-component structure. Bartlett's test of sphericity was significant at P < 0.001, and KMO measure was acceptable at 0.83. The model fit indices (λ2/df = 1.43, goodness of fit index = 0.953, adjusted goodness of fit index = 0.925, normed fit index = 0.914, Tucker-Lewis Index = 0.962, comparative fit index = 0.972, and root mean square error of approximation = 0.043) and convergent validity (AVE = 0.41 and CR = 0.88) were acceptable. Based on the statistical results, the hypothesized model is fit to examine the 11 TMB items. The 3-factor model with 11 TMB items can be adopted for further replication study, and effective practice of these items is the first-line intervention to fight the spread of coronavirus.

Keywords: Coronavirus transmission mitigation behavior, COVID-19, face mask, handwashing, pandemic


How to cite this article:
Singh KD. Coronavirus transmission mitigation behaviors: The first-line intervention against COVID-19. BLDE Univ J Health Sci 2021;6:70-4

How to cite this URL:
Singh KD. Coronavirus transmission mitigation behaviors: The first-line intervention against COVID-19. BLDE Univ J Health Sci [serial online] 2021 [cited 2021 Dec 9];6:70-4. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/1/70/313366



The cases of pneumonia with unknown etiology was detected in Wuhan city, China, on 31 December, 2019, as reported to the World Health Organization (WHO), China Country Office.[1] The disease got its official name as COVID-19 on February 11, 2020[2] and the WHO declared the COVID-19 as pandemic on March 11, 2020[3] globally infecting 17,499,750 people of them 677,183 people died from the virus as of 9:13 GMT on July 31, 2020.[4] India witnessed 1,638,870 infected cases of them 35,743 died as of 8:00 IST on July 31, 2020.[5]

The occurrence of the pandemic has headed to fear and anxiety among the worldwide population.[6] In the same measure, Taylor[7] opined that an extensive emotional distress is prevalent among the population due to COVID-19 pandemic and the anxiety at moderate level heartens people to manage the disease, whereas severe distress may lead to destruction. Discussion on mental health challenges by the people due to this deadly disease is nominal,[8] and the disease outbreak is compromising the mental health problems of individuals who are exposed to the disease.[9] Understanding the importance of screening the clinical symptoms of coronavirus anxiety,[10],[11],[12] Lee[10] has developed a Coronavirus Anxiety Scale and validated the scale in a replication study.

To protect themselves from coronavirus, the general population draw information on methods of protection.[13] As a protective mechanism of the pandemic, the WHO[14] instructed various measures which include avoiding to touch facial parts (nose, eye, and mouth), handwashing at least for 20 s with soap and water, use of alcohol-based hand sanitizer, use of face mask, and social distancing. Previous studies on disease transmission experienced the practice of washing hands with soap.[15],[16] Studies found that COVID-19 transmission mitigation behaviors (TMBs) such as washing hands and wearing face mask seem to diminish the psychological impact of the disease.[17],[18]

The above discussions suggested that coronavirus-related anxiety and TMBs may be equally vital to fight the deadly disease in addition to invent the vaccine to cure. The study sought to draw the exemplary coronavirus TMBs among the Indian population and construct a viable model to study these behaviors.


  Materials and Methods Top


Participants and procedure

Data collection from an Indian population was performed through online mode (WhatsApp, social media, and e-mail) by providing a Google Form questionnaire link during June 11–16, 2020. There were 246 respondents, of which 238 responses were found valid. The participation of the respondents was voluntary. The inclusion criteria of the respondents were only those respondents who had exposed at least 1 h per day to the items associated to COVID-19 such as Facebook, WhatsApp, news, discussion hour, and think about the pandemic for the last 2 weeks at the time of filling the e-questionnaire. It is because of the nature of study, in which the TMBs of the pandemic need to be drawn out. The sociodemographic and clinical variables of the respondents are shown in [Table 1].
Table 1: Sociodemographic and clinical characteristics of the respondents (n=238)

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Background information

Questions on gender, age, qualification, area of residence, marital status, the total number of family members, occupation, family income, history of chronic illness, and COVID-19 infection were asked to the respondents to gather background information.

Transmission mitigation behaviors

The Ministry of Health and Family Welfare, Government of India[19] has issued an illustrative guide on COVID appropriate behaviors that contains TMBs. The WHO, Regional Office for Europe,[20] has also published a “Survey tool and guidance: behavioral insights on COVID-19” on April 17, 2020, wherein a suggested sample questionnaire to measure the behavioral insights on COVID-19 pandemic is available. These two sources were the basis of collecting TMB items and developing the TMB questionnaire. Before administrating the questionnaire, the items were adapted to the context of the study area. The final questionnaire consisted of 14 items, and each item is scored on a bipolar seven-point scale ranging from 1 to 7. These items are self-explanatory and listed below with their item codes.

(TMBI 1) Follow recommendations from authorities to prevent spread of novel coronavirus.

(TMBI 2) Avoiding to touch eyes, nose, and mouth with unwashed hands.

(TMBI 3) Wash/sanitize hands with soap/sanitizer.

(TMBI 4) Staying home when sick.

(TMBI 5) Covering mouth and nose when cough or sneeze.

(TMBI 6) Taking caution when opening letters, delivery boxes, etc.

(TMBI 7) Wearing a face mask when move out.

(TMBI 8) Physical distancing outside the household.

(TMBI 9) Self-isolation till sanitization.

(TMBI 10) Disinfecting surfaces of house and household items.

(TMBI 11) Disinfecting mobile phone after coming back from office, market, etc.

(TMBI 12) Not seeing family members living outside own home.

(TMBI 13) Not seeing friends during these days.

(TMBI 14) Eating garlic, ginger, and lemon during these days.

Questions such as

  1. Covering your mouth and nose when you cough or sneeze is extremely not practiced/practiced
  2. Wearing a face mask when you move out of your home is extremely not practiced/practiced, etc., were asked to the respondents.


Statistical analysis

AMOS Version 26 was used to calculate Confirmatory Factor Analysis (CFA) and SPSS Statistics Version 20, (Developed by International Business Machines, Armonk, New York, USA) for other statistical analyses in the study. Before any of the statistical operation, data cleaning through observation was performed for insuring correct and consistent data with no missing values. Bartlett's Test of sphericity and Keiser-Meyer Olkin (KMO) test for sampling adequacy, and Cronbach's alpha for internal consistency were calculated. Principal Component Analysis (PCA) was also applied to draw the factor loadings of the TMB items. Convergent validity was measured through Average Variance Extracted (AVE) and composite reliability (CR).

Period

Collection of data was done through online from June 11 to 16, 2020. The valid responses were from 238 respondents who reside in the North Eastern Region (NER) of India. The paper was finalized in July 2020.


  Results Top


Principal component analysis

Altogether, 14 TMB items [Table 2] were subjected to PCA with Varimax rotation. To check the sampling adequacy, Bartlett's test of sphericity and KMO measure were conducted. Bartlett's test of sphericity was significant at P < 0.001 and KMO measure was acceptable at 0.83. The total variance explained of the analysis identified a 5-component structure with initial eigenvalues >1.0 and cumulative total variance explained at 63.29%. The identified component structure was also supported by scree plot. The component-wise factor loadings of each item are shown in [Table 2]. Thirteen TMB items with factor loadings > 0.5 were considered and the remaining one item (TMBI 1) with lower factor loading was dropped for further analysis.
Table 2: Component-wise factor loadings of Transmission Mitigation Behavior Items

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Confirmatory factor analysis

From PCA output, 5-component structure was observed, in which component 1 with six items, component 2 with three items, component 3 with two items, and components 4 and 5 with one item each, respectively. Arguments against and for the inclusion of single item component in a construct have been a debate for many years. The use of single item components in a construct is not supportive.[21],[22],[23],[24],[25] Since the single item components have the possibility to ignore measurement unreliability of a construct, components 4 (with TMBI 5) and 5 (with TMBI 14) [Table 2] were dropped for further analysis of this study. The 11 TMB items after dropping TMBI 1 (loading <0.5), TMBI 5, and TMBI 14 (being single item in components 4 and 5) were run for CFA to test whether or not the 11 TMB items identified through PCA adhered into coronavirus TMB construct. The result of CFA is shown in [Figure 1].
Figure 1: The result of Confirmatory Factor Analysis of the 11 transmission mitigation behavioral items

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Model fit indices

λ2/df = 58.8/41 = 1.43

Goodness of Fit Index (GFI) = 0.953

Adjusted Goodness of Fit Index (AGFI) = 0.925

Normed Fit Index (NFI) = 0.914

Tucker-Lewis Index (TLI) = 0.962

Comparative Fit Index (CFI) = 0.972

Root Mean Square Error of Approximation (RMSEA) = 0.043

Convergent validity

To measure the quality of the hypothesized Coronavirus Transmission Mitigation Behavior Model (CTMBM), AVE and CR were calculated. For this purpose, the standard regression weight loadings of CFA output were transported to Microsoft Excel. Generally, the threshold for adequate consideration of a model is when AVE ≥0.5 and CR ≥ 0.7, respectively. Fornell and Larcker[26] argued that the convergent validity of a construct is still adequate even though AVE < 0.5 but the CR > 0.6. In this study, the calculated AVE (0.41) and CR (0.88) were considered adequate for the model.


  Discussion Top


This study investigated various coronavirus TMBs based on the TMB items issued by the WHO, Regional Office of Europe and MoHFW, Government of India. 14 TMB items were selected and PCA was run. The rotation method used was Varimax with Kaiser Normalization. KMO measure was acceptable at 0.83 and Bartlett's test of sphericity was significant at P < 0.001. The result of PCA identified a 5-component structure measuring the cumulative total variance explained at 63.29% with initial eigenvalues > 1.0. Items with factor loadings of > 0.5 were considered, and in this regard, component 1 consists of six items, component 2 with three items, component 3 with two items, and components 4 and 5 with one item each. Based on the existing literature on the inclusion and exclusion of single item component in a construct, the 4th and 5th components with one item each were dropped for further analysis.

The remaining 11 items under three factors were applied in CFA. Various model fit indices were considered. The value of λ2/df = 1.43 was acceptable. Other indices which are GFI = 0.953, AGFI = 0.925, NFI = 0.914, TLI = 0.962, and CFI = 0.972, respectively, are greater than the conventional thresholds (0.9) and therefore statistically significant. The RMSEA was measured at 0.043, which was also less than the threshold of 0.05. The AVE (0.41) was adequate, and CR (0.88) was beyond the threshold.

The overall results of this study support the hypothesized model [Figure 1] to examine the 11 TMB items under three factors.

The study was an attempt to draw out the exemplary coronavirus TMBs under practice by an Indian population. Thirteen behaviors were found through PCA. Further, these have reduced to 11 for CFA, and based on these 11 items, a model was developed.

These 11 coronavirus TMB items [TMBI 2, TMBI 3, TMBI 4, TMBI 6, TMBI 7, TMBI 8, TMBI 9, TMBI 10, TMBI 11, TMBI 12, and TMBI 13 in [Table 2]] can be practiced as the exemplary TMBs by the population to protect from COVID-19. The hypothesized CTMBM may be adopted for the replication and validation study of TMBs in different samples. This model may provide a way to understand the coronavirus TMBs and help the policy planner and health practitioners to fight the disease. People are in a state of confusion due to hyperinformation in the social media. If only these 11 items are considered to be the exemplary coronavirus TMB items, as supported by the findings of the study, it may be easier to practice TMBs effectively. Therefore, the findings of the study conclude that these 11 coronavirus TMBs under three factors can mitigate the spread of COVID-19 if practiced effectively and efficiently by the population. The practice of these TMBs is only the first-line intervention to fight this pandemic.

The hypothesized model has its limitations as data were collected from NER of India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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