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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 75-81

Awareness, attitude, and action about COVID-19 among Rural Elders: A cross-sectional rapid pilot survey


1 Centre for the Study of Social Exclusion and Inclusive Policy, University of Mysore, Mysore, Karnataka, India
2 Department of Economics, Karnataka State Open University, Mysore, Karnataka, India

Date of Submission19-May-2020
Date of Decision18-Aug-2020
Date of Acceptance15-Oct-2020
Date of Web Publication08-Apr-2021

Correspondence Address:
Dr. Devajana Chinnappa Nanjunda
Centre for the Study of Social Exclusion and Inclusive Policy, University of Mysore, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_40_20

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  Abstract 


BACKGROUND: The China origin coronavirus has spread across the globe including India. As per the epidemiology, the corona is targeting the elderly people more. Hence more aged people are being infected in India and losing their lives as well. The government has taken all the efforts to prevent the effects of this pandemic on the citizens.
OBJECTIVE: The major aim of the current study is to find out the perception and opinions of COVID-19 among the rural elderly people.
METHODS: The current study has been conducted in the Mysore district, Karnataka State, using a snowball technique through local health workers. Moreover, local sources have been used to collect the data by using survey questionnaires, and descriptive data were collected over the telephone with the respondents (because of lockdown).
RESULTS: The majority of respondents are well aware of the pandemic and have expressed serious concern and have taken required precautionary methods However, but they lack more precise information in practice.
CONCLUSION: The specific and concrete knowledge about the corona pandemic is very crucial while evaluating a proper plan to prevent spreading the disease and evidence-based clinic awareness. Frequent communication between health workers, media, and other sources is very vital and of higher concern interpreted into more compliance with cautionary endorsements.

Keywords: Corona, COVID-19, elders, health, rural, society


How to cite this article:
Nanjunda DC, Lakshmi JS. Awareness, attitude, and action about COVID-19 among Rural Elders: A cross-sectional rapid pilot survey. BLDE Univ J Health Sci 2021;6:75-81

How to cite this URL:
Nanjunda DC, Lakshmi JS. Awareness, attitude, and action about COVID-19 among Rural Elders: A cross-sectional rapid pilot survey. BLDE Univ J Health Sci [serial online] 2021 [cited 2021 Dec 9];6:75-81. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/1/75/313352



At the present world scenario, the health condition is under emergency as novel coronavirus or commonly known as COVID-19 has widely spread across the continents. Medically, speaking coronavirus is causing serious respiratory disorder and was first identified in the Wuhan provision of China in around November–December 2019. Since the first few weeks of its identification, it was an undiagnosed virus, but later on, the scientific community has revealed the phylogenetic and other details about the virus and its mutations. The clinical symptoms of this virus include dry cough, cold, fever, uneasiness, running nose, body ache, tiredness, and finally severe respiratory problem. By the end of April, the virus has spread across 196 countries. This virus has left maximum casualty in America, Spain, and Italy as per the last report.[1]

Officially, coronavirus case was reported in India in the 1st week of March 2020. At the end of April, India had accounted for around 30,000 infected cases and 1000 plus deaths. Clinical data show the fatality rate of COVID-19 in India is much more than severe acute respiratory syndrome (2003), Middle East respiratory syndrome (2005), and H1N1 (2006). In India, Maharashtra, Delhi, Uttar Pradesh, and Tamil Nadu have been considered as worst-hit states. The total number of positive cases has also gradually increased in Karnataka and Telangana states. The situation seems under control in Kerala. To date, no medicines for COVID-19 and current patients are being treated with symptomatic approaches including antibiotics. Around 80 different companies globally have been involved in discovering the vaccine. The certain states have started plasma therapy as per the advice of the Indian Council of Medical Research, and in some cases, results are encouraging. Although many infectious diseases have haunted the public even before there is a kind of fear already engulfing the community today. “It is found that the peoples' emotional status may affect negatively on recommended and required health behavior changes and the individual vulnerability to illness may get more vigorous.”[2] Because of migration, there is a fear that corona may spread even among the rural people and there is a report that in some rural areas, people have barricaded the roads which connect the villages using throne shrubs, iron fens, rocks, and wooden pieces, so that no new person should enter the village from the urban areas (various Indian daily's'). The government has already pressed out several programs to control this endemic problem but, to overcome fear, and to enhance knowledge, and best practice about the disease among the community need to be researched on an urgent basis for evidence-based policy.[2] With this background, this study is to reveal elders' awareness of infection about COVID-19 and suggestive measures.


  Methods Top


This pilot study has been conducted in the rural parts of Mysore districts of Karnataka state and adjoining three villages with the help of local nongovernmental organizations (NGOs), health workers, and Anganwadi teachers using a snowball sampling technique. Since the entire country was under lockdown, we could not do any detailed survey rather we had a very small and rapid assessment survey with an open-ended survey questionnaire among 84 elders who are above the age of 60 years and odd with the help of local contacts. Because of various unavoidable and time factors issues finally, we could contact only 84 respondents. Before approaching the informants, oral consent has been taken by them. Health workers explained the main aim and objective of the study in the local language to the informants. In a few cases, we have used the telephonic survey technique to collect the descriptive data. Since the local health workers are in touch with the rural people on a daily basis, we approach the health workers through the contacts of local people with a two-page questionnaire to collect the data while visiting homes in their jurisdictions.

The researcher used some contacts in the village for the smooth collection of data as it was not possible to visit the field due to lockdown. The questionnaire (originally prepared by the ICMR) had about 22 questions focusing on knowledge, perception, and practice about coronavirus including their demographic details. Later, data were cross-checked twice to make sure about the quality and validity, and not such information was omitted by the researcher. The field team was in touch with the key researcher regularly to discuss and to report the activity in the field over the phone and mail. Care was taken to capture the sociodemographic details of the respondents for cross-checking. Data and themes were organized categorically from the beginning and analyzed through the SPSS software (SPSS 18 VERSION IBM, USA).


  Discussion Top


Corona has created a panic among the public. The data show that > 70% of the respondents know how corona spreads among human beings. However, few respondents are under the impression that only selective people will get a virus and only 54% of them know anybody can infect with coronavirus at any time. Respondents are not very much aware of “some may not have symptoms and in majority cases, it will be asymptomatic but positive/carrier.” In such cases, they need more information here. Respondents are also aware that there is no such medicine available for the corona problem as of today and 70% of them say it is better to visit the hospital to get emergency treatment rather waiting for anything. We feel this percentage should be enhanced further so that any suspect should immediately visit the nearby hospital for the test. For the question of how a person can prevent himself/herself from being coronavirus infected, respondents have a high percentage of knowledge here in [Table 1]. The interesting aspect is that around 83% of them know about preventing coronavirus infection, and all of them are using masks now. Their level of education and income play a key role here [Table 2]. However, we found that these are not the quality masks. Shortages of a good mask are a big issue and masks are being sold for the higher prices in the rural areas where the poor cannot afford it. Around 31% of elders feel a piece of cloth is better than using a mask. Hence, 21% of respondents are using a piece of cloth to cover the mouth and nose. Around 29% of elders have no exact idea of why they should use masks while going out on their work. These respondents do not know the glaring difference between cloth and mask. A shortage of masks is also a reason. Some of them said that the mask is very incompatible to wear, so that the poor and rural people cannot afford it [Table 1].
Table 1: Knowledge, attitude, and practice of the respondents

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Table 2: Sociodemographic factors of the respondents

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Around 71% of elders are aware of the usage of sanitizer to fight against COVID-19. Moreover, there is a need to have an emergency campaign to promote that any soap with alcoholic content can be used as a sanitizer if they cannot afford any quality sanitizer. The fact is that only 56% of them were regularly washing their hands before the coronavirus incident had started. This is where we need to create more awareness under the WASH project, especially among low-income groups in the rural areas. Respondents have admitted that they were not using any masks before this endemic started except in the certain cases. Regarding the exact symptoms of coronavirus, we got some mixed responses. Respondents are not completely aware of all symptoms of corona infection. Some of them say cough or some of them only fever-like common features. Only a few respondents are aware of the breathing problem breathing corona infection. Media people must focus on all sorts of symptoms while creating awareness among the public with some visuals.[3]

We strongly believe that a majority (84%) of respondents have neither visited any crowded place (in and out) nor to any social gathering and if any they had worn masks while going out (78%). These could be credited to the firm regulatory actions taken by the local governments, grass-root health campaigns, the active role of local NGOs, and also the service of police departments by knocking off all people's movements. Moreover, it is because of the elder's higher level of awareness and understanding about the wide-spreading contagion of the COVID-19 virus, targeting especially elders.[4]

However, we also found around 23% of respondents who are not using any preventive method while going out thinking that “they do not mind if they get coronavirus.” Health workers found that some elders are going to crowded places to collect water, paddy fields, and other agricultural/horticultural activities, and they not maintaining any social distancing or using masks. When they are asked about this, a respondent said, “we know these people over the years and they are all healthy and nothing can be harmful to them.” They are maintaining or preferring a social distance policy with the unknown/outside people only. They said “In villages, we live as one community; many families share single and common water source and work together on fields.” This kind of strange and adamant behavior can be seen among both genders.[5]

Elderly women spend their time with their traditional groups by playing some games to kill time without maintaining any social distance or protection. This kind of group game has caused a drastic and sudden increase in the positive cases in a district of the northern part of the Karnataka state. For this the respondents, said, “we are already old and have seen in and out of life; we are not at all worried about our life.” Respondents have a mixed knowledge about the impact of “community spreading of the virus,” and they have just heard about it on news channels and dailies. They need to be aware of the impact of community spreading and their role in avoiding. This is very important. Rural people have a unique sociocultural background, and this “social distancing” is a new concept for them and they are not entirely ready to accept this concept.[6] Respondents are maintaining social distancing just because of pressure and fear not voluntarily. Respondents feel the social distance is like an emotional detachment from their families and friends, which make them, isolated. They feel it would be a type of psychological problems in the long run. Some elders completely rejected this notion and said that more study is required for practicing social distancing in the rural areas [Table 3].
Table 3: Continuation of the [Table 1] Knowledge, attitude and practise of the Respondents

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“We don't even think of being alone, our family is very big, how can we live without friends, neighbors, and relatives? We prosper only on social solidarity and connectedness and all is our fate and deeds only.”

Another respondent replied,

“it is next to impossible to maintain social distancing when most of the village houses are bunched up five to six in a room always; social distance is possible if you have a big house.”

Our study also says few respondents have a potentially dangerous and risky behavior toward coronavirus. Risky behavior among these elderly people might be because of believing that they have a lower risk of infection with the coronavirus or inherited masculine ideology. Further, few respondents felt that in thickly populated areas, low-income areas, and strictly populated villages social distance is almost impossible. It is because after the lockdown, the influx of the urban migrants to their native rural areas is unimaginable in many rural parts.

Respondents have some idea about the concept of quarantine. They have some good level of awareness about the differences between social isolation and quarantine, and they are not exactly aware of why quarantine is required. Some of them showed interest to meet their friends who are in-home quarantine! Some of them said, “If the government imposes to stay home or make strict quarantine policies they will become mad over some time and they may lose everything.” Moreover, also they have no idea about the difference between isolation and quarantine. Respondents are feeling that staying at home always or a quarantine policy in the long-term affects individuals as well as their families. They say all these issues create a new social disparity in the long run. The intervention has highly required knowledge in case of isolation and quarantine among rural people.[7]

“Lockdown and seal down is a good idea, but people will not follow these rules because every person in the rural areas is a very hard worker and spent most of their time in agricultural activities. Hence, we cannot put them all, at home for an unspecified amount of time. The government may bring any rules and regulations, nevertheless, people will not listen because rural people need to focus on their livelihood activities, and nowadays, rural people are very busy in pre-monsoon work and this is not wrong also;”

Some of the respondents said, “anyway one may die out of corona. Similarly, we may also die due to hunger if we do not work.” They say incidents of coronavirus are only in the urban areas; not much in the villages.

Regarding immediate worry about COVID-19 diseases, only 43% of them said that it can make a member of the family sick; however, the majority of people are more worried about the disturbance of economic conditions in future. It shows that the elders are not very serious about the unpleasant fate of their family members/community rather about the future life. Only 53% of the elderly know corona can kill anyone in the family so all are equal under risk. When they were asked a key question like, if you came in contact with a coronavirus diseased, suspected/affected individual, what would you do? The majority of them said thtthey would inform the local authority and 56% of them wait for symptoms for confirmation. Truly speaking a few of them said, “we don't know what to do.” This is where immediate intervention is required by the local health staff. We also found that few respondents are not ready for voluntary self-quarantine [Table 4].
Table 4: Action and practice among the respondents'

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The elders are the opinion that that is the job of the government to prevent the community from getting coronavirus. Some of the elders define that, the health workers and local district administration must control the corona issue. Around 66% of them said that it is the duty of every individual in this regard. There is a need to intervene here as every stakeholder has its role and responsibility in fighting against corona and only the government cannot do everything all alone without the support of the public. People have a different awareness to take some actions to prevent their community from getting affected by coronavirus. They are all well aware of using sanitations, sanitizing buildings, avoid going out, etc., those who are well educated and are from well off families use hand sanitizer often. Some rich people have charity-mind, so they wish to feed the needy and poor people. Respondents have the opinion that our public health management system needs to be revised soon.[8]

For a question like why certain elderly people have not taken any serious action to prevent themselves from the corona problem? Some of them said, “it is not their priority” and few of them said, “this is the fate of human beings; nothing is in our hands and God will save the people.” The lack of social responsibility of some of the elderly people can be observed here in their opinions. Local health staff can create more awareness about their role in preventing the spread of corona. When a question about lockdown was asked, “elderly people support the lockdown system. However, they are much worried about the economic condition of their young siblings and the impact on the next monsoon, failure of the agriculture system amidst of corona outbreak.” Elderly people think that youngsters should involve in the agricultural activities rather than visiting urban areas in search of jobs in the postcorona situation. Their opinions might not be the same. It may differ according to different situations. Moreover, they say that they must ready to lead a new life.[9]

This study found that people are very confident in the rural areas about the ending of the corona issue at the earliest and some percentage of people suspects this problem may continue even for a few more months. Rural elders who are well educated, sensible, and cautious are voluntarily avoiding the masses, gatherings; social functions, avoiding handshakes, and public meetings. The majority of respondents have a very positive attitude in taking precautions and prevention measures. Rural elderly are well aware of how corona normally spreads and what are the preventive measures need to take. It is found that elderly people are very much serious about the current issue but not very much happy with the lockdown system.[10]

The awareness about coronavirus has become beyond our expectations among senior citizens in rural areas. The higher level of knowledge about COVID-19 among the rural elders is quite unexpected as this survey has been conducted during the later stage of the epidemic. However, it seems elderly people are not very much aware of the coronavirus being spread through invisible droplets. This is because media and other sources are underpinning this issue. Senior citizens also use a wide variety of information communication tools in this information age.[11] One more important reason for this may be the overwhelming reports which were continuously appearing on traditional sources such as TV channels, radio, and dailies and the government efforts. We suggest new studies are needed about how social networks in the rural areas including informal media which can play a very powerful, effective, and efficient role in preventing corona.


  Conclusion Top


It is to mention that sophisticated knowledge and awareness about COVID-19 shows a high number of elders are away from negative attitudes, negligence, and unsafe practices or health behavior regarding COVID-19 in this study. The findings clearly show the positive health education through media improving elders' knowledge and practice toward COVID-19. It is also required to focus on different demographic factors, especially low levels of education, excluded, low income, and occupation while creating knowledge so that marginalized and underprivileged people get more benefits out of this health campaign.[12],[13] Such efforts must apparent personal susceptibility and self-efficacy in taking required precautionary actions. Local traditional media can play a key role. The health workers must create awareness about three vital issues such as (1) spreading corona through invisible droplets, (2) the asymptomatic nature of the carrier, and (3) anyone can infect. Furthermore, there is a dire need to educate and prepare the old age people about how to live and fight with a corona in days to come.

Recommendations

  1. Create more awareness about spreading coronavirus through droplets among elderly people
  2. Create more awareness about in majority cases corona may be nonsymptomatic but carrier
  3. Create awareness focusing the point that “anyone can get corona or it may affect anyone in the family”
  4. Creating awareness about active public participation in controlling corona rather than completely depending on the government/NGOs
  5. Create awareness about community spreading
  6. (stage 3)
  7. Restrict on rural-urban connections for a few months
  8. Creating awareness about the significance of home quarantine if they are suspected
  9. The effort to provide low-cost quality hand sanitizer through the public distribution system.


Applying research to health practice

  • Use hand sanitizer often
  • Avoid group games or informal group meetings in the rural areas at least for the next 2 years
  • Social distancing must be made compulsory
  • The community engagement model needs to be practiced to tackle COVID-19
  • Create a local health network through apps in the local language.


Study limitations

  • Limited sample representativeness and limited access to the respondents
  • The author could not visit the field because of lockdown
  • Unstandardized and insufficient valuation of attitudes and practices without using any scale
  • Only a few focus group discussion was on line and limited in-depth; interview; telephonic discussion is not enough
  • Very limited time used for developing the questionnaire
  • Study findings cannot be generalized.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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