|Ahead of print publication
Fear of COVID-19 and its impact on quality of life during the lockdown situation among the teaching faculty of a health University in India
Pradnya Kakodkar1, Sonal Kale2, Ramesh Bhonde1, NJ Pawar1
1 Department of Research, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
2 Public Health Dentistry, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||26-May-2020|
|Date of Decision||17-Jul-2020|
|Date of Acceptance||04-Aug-2020|
Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: With the COVID-19 pandemic, the lockdown situation, work from home and teaching through the online platform is completely a “new normal” in the present time. It is probably a state of mental turmoil of fear, novelty and anxiety among the faculty. This state is likely to affect teaching performance, learning and also have implications for the health of the faculty. Objectives: To assess the fear of COVID-19 and its impact on the quality of life during the Lockdown situation among the teaching faculty of a Health University and also study the gender differences if any. Materials and Methods: A cross-sectional survey was conducted among the teaching faculty of a Health University during April 28 through to May 8, 2020. Randomly selected 270 faculty were sent Google link of the assessment tool using the University e-mail network. They had to fill the questionnaire based on their experience of the past 1 month. Assessment tools used were fear scale of COVID-19 and adapted with permission World Health Organization quality of life (QOL)-BREF QoL. Results: Out of the 270 participants, only 198 teaching faculty participated in the survey (response rate = 73.33%). The overall mean fear score was 18.69 ± 5.57 and the overall QoL mean score was 46.29 ± 4.02. There was a gender-wise statistically significant difference observed in the fear score (t = 2.34, P = 0.02), reporting more fear in the females (19.45 ± 5.81) as compared to the males (17.57 ± 5.01). There was a negative correlation between QoL scores and Fear score r = −0.24 (P = 0.000). Conclusions: There is certainly a fear about COVID-19, but it has not impacted the quality of life
Keywords: COVID-19, faculty, fear, quality of life
|How to cite this URL:|
Kakodkar P, Kale S, Bhonde R, Pawar N J. Fear of COVID-19 and its impact on quality of life during the lockdown situation among the teaching faculty of a health University in India. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jun 13]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=316413
| Introduction|| |
The end of the year 2019 marked the spread of the novel coronavirus, which made many countries go into a historical lockdown. The virus is said to be originated in the Wuhan City of China. Within few days, the virus rapidly started spreading outside China, affecting thousands of people, causing increased mortality, which made the World Health Organization (WHO) to declare it as a public health emergency.
The virus belongs to the family of Coronaviridae and COVID-19 is caused by Severe Acute Respiratory Syndrome Coronavirus 2. The typical symptoms reported by the affected patients are high fever, soar throat, and cough. Along with this, many other symptoms such as the loss of taste sensation, smell sensation, joint pain, and diarrhea have also been found in some patients. The route of spread is through contact with saliva droplets, eyes, and nasal mucosa. To date, there is no specific treatment or vaccine discovered against novel coronavirus (COVID-19). Moreover, researchers are constantly making efforts to make a vaccine for this virus to end the pandemic.
The lockdown announced by all the countries in an effort to maintain social distancing to limit and slow down the spread of virus so that the health care sector prepares itself to handle the increasing burden of cases has made the other sectors standstill.
The educational institutions are shut, and class-room teaching has transformed into virtual teaching. The university has asked the faculty to work from home and to complete the academic theory teaching by engaging the students through the virtual training. Zoom meeting has been widely used to complete the theory portion as scheduled during this academic year.
With the Covid-19 pandemic, the lockdown situation, work from home, and teaching through the online platform is completely a “new normal” in the present time. This abrupt transformation from face-to-face classes to online lectures can probably create a state of mental turmoil of fear, novelty, and anxiety among the faculty. Many of the faculties may not even be technology savvy, have ready e-content for teaching, have appropriate gadgets, and good network connectivity to conducted classes online. Overall, this situation during the pandemic can lead to stress for the faculty to cope up with the online teaching and thus can have an impact on their mental health.
Owing, to this background, a survey was conducted among the teaching faculty of a health University in Pune (India). The main objective of this survey was to assess the fear of Covid-19 and its impact on the quality of life and further assess the gender difference, if any.
| Materials and Methods|| |
A cross-sectional survey was conducted among the teaching faculty of a Health University from April 28, through to May 8, 2020. The study protocol is approved by the scientific and Institutional ethics committee (DYPCPT/ISEC/25/2020).
The study University is situated in Pune and is among the top-ranked Universities in India. It is engaged in education in medical, paramedical, and life sciences. The usual mode of teaching is in person, classroom teaching, and hands-on laboratory teaching/patient training.
The sampling frame consists of 2700 active email users. The sample size for the survey was 10% of the total sampling frame. Using random sampling method (random number table), 270 e-mail ids of the faculty were collected.
The data was collected using self-administered questionnaire: Fear scale of COVID-19 and adapted with permission WHO quality of life (QOL)-BREF (WHOQOL-BREF) QOL assessment tool.
The Fear scale of COVID-19 had 7 questions and the responses were based on 5-point Likert scale. The WHOQOL-BREF has been adapted to assess the QOL during the COVID-19 situation. The original WHOQOL-BREF is a 26 item questionnaire which has been modified to 16 items. The questions Q 3, 4, 10-16, and 22-25 were deleted and 4 new question related to Lockdown situation (Q3, 10, 14, 15) were added. Ten subject experts assessed the face validity and content validity of the modified questionnaire. The newly added questions had a content validity ratio of >0.62 (which is a minimum value for analysis by 10 experts). The responses were also based on 5-point Likert scale (1 for very dissatisfied to 5 for very satisfied). Three questions (Q14,-16) were marked in reverse.
The final score for the Fear scale of COVID-19 was calculated by adding the individuals' score for the seven questions, the minimum score was 7 and the maximum was 35. While, for the QOL tool, the final score was obtained by adding the scores from fourteen questions (Q3-16) while the two questions (Q1, 2) were treated as the core questions with which the summated QoL scores were compared. The minimum possible QoL score was 14 and the maximum was 70.
The data collection was done while the University was closed, and the faculty worked from home during the lockdown period. It was an anonymous survey. Participation was voluntary and with consent. A Google form was prepared and was circulated online to the teaching faculty through the University e-mail network. After 4 days, a reminder mail was sent. The survey link was closed after 10 days. Informed consent form and participant information sheet were attached to the Google link along with the questionnaire. In case of doubt or any faculty needed psychological support for fear during the pandemic state, contact details of the counselor was provided in the information sheet.
The collected data were entered and analyzed using IBM SPSS (Statistical Package for Social Sciences) version 21.0 for Windows. The findings were expressed in terms of percentages, mean and standard deviation gender-wise difference between mean scores was tested by using independent sample t-test. Co-relation was assessed using eta correlation analysis. P < 0.05 was considered significant. For the purpose of result interpretation in the Fear scale, the choices of agree and strongly agree were grouped as agreement and disagree and strongly disagree as disagreement.
| Results|| |
Out of the 270 participants, only 198 teaching faculty participated in the survey. The response rate was 73.33%. The participants included 79 (39.9%) males and 119 (60.1%) females in the age range of 25–63 years. The participating faculty had a Bachelors/Masters/Ph.D. in the field of Medical, Dental, Homeopathy, Ayurved, Nursing, Physiotherapy, Biotechnology, Optometry and Business and Management.
Fear of COVID-19
The Fear of Covid-19 score ranged from 7 to 31. [Table 1] shows the distribution of the responses according to the Fear scale of Covid-19. Majority of the faculty responded in disagreement to four questions that were about fear of loss of life, loss of sleep, and symptoms such as clammy hands or palpitations (Q3, 4, 6, 7) while majorly there was agreement on feeling afraid, nervous or uncomfortable with regard to thoughts about the COVID 19/Coronavirus (Q1, 2, 5). 57.3% were most afraid of the coronavirus-19 (Q1), 46.1% agree that it makes them uncomfortable to think about it (Q2), 45.5% agreed that it makes them nervous while watching news and stories from social media (Q5). In contrast, 61.2% disagreed that their hands become clammy on thinking about it (Q3), 52.3% were not afraid of losing their life (Q4), 76.6% disagreed that they cannot sleep thinking about it (Q 6) and 65.7% disagreed that their heart palpitates on thinking about it (Q 7).
|Table 1: Distribution of the study participants according to the fear scale of coronavirus-19 questionnaire (n=198)|
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Quality of life of faculty during lockdown period
[Table 2] describes the participants' responses to the QoL tool. The results indicate that faculty rated their health to be on the positive side (Good = 59.2% and Very Good = 13.8%) and were satisfied with their health (satisfied = 61.4% and very satisfied = 21.3%). Majorly, a greater percentage of the faculty had opted for satisfied and very satisfied options.
The overall mean fear score was 18.69 ± 5.57 and the overall QoL mean score was 46.29 ± 4.02. There was a gender-wise statistically significant difference observed in the fear score (t = 2.34, P = 0.02), reporting more fear in the females (19.45 ± 5.81) as compared to the males (17.57 ± 5.01). The QoL score did not differ by gender (males: 46.34 ± 4.43, females: 46.26 ± 3.74) [Table 3].
|Table 2: Percentage distribution of the study participants according to the quality of life assessment questionnaire (n=198)|
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[Table 4] shows the correlation between the overall QoL scores and QoL rating (Q 1) and health satisfaction (Q 2). Poor correlation between QoL rating and QoL scores was noted with 11% variance. Moderate correlation between health satisfaction and QoL scores was noted with 20% variance.
|Table 4: Correlation of quality of life total scores with quality of life rating and health satisfaction|
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There was a negative correlation between QoL scores and Fear score r = −0.24 (P = 0.000).
| Discussion|| |
On March 24, 2020, the government of India, ordered the first nationwide lockdown for 21 days (Phase 1), which was then further extended twice till May 17, 2020 (Phase 2). This survey was conducted 1 month after the lockdown was ordered, and the participants have responded to this questionnaire based on their experiences during this lockdown period.
Ahorsu et al. developed the Fear of COVID-19 Scale, which is a seven-item scale, possessing robust psychometric properties and reported to be a reliable and valid tool in assessing fear of COVID-19. Based on the results of the present study, it can be interpreted that there is some degree of fear among our study participants but not of the severest extent [Table 1]. The fear score for females was significantly more compared to the males [Table 3] and this result is in consensus with the literature reports that have confirmed that women as compared to men gave higher fear ratings.,
QOL is defined as individuals' perceptions of their position in life in the context of the culture and value systems, in which they live and in relation to their goals, expectations, standards, and concerns. Here, the study participants have experienced a new way of life “Work from Home” during the past 1 month. Classroom teaching had got transformed into virtual teaching. The workload had also reduced. There were no more practical sessions to be engaged for the students. However, the preparation of e-content and using virtual classroom teaching aids was the new style of engaging the students. As per the QoL survey results, 1 month lockdown due to the COVID-19 pandemic did not seem to negatively affect the QOL of the people. The continuous race of the daily routine halted suddenly, they were able to spend more time with the family. The time spent in traveling amongst traffic had reduced and that extra time was now available with them to probably use it thoughtfully. The level of sound and air pollution had reduced, and there was better quality air for breathing.
Lockdown has caused disruptions to daily routines. This impact has been reported by 14.5% of people to a little extent, 38.9% to a moderate amount, very much for 30.8% and for 12.5% to an extreme amount (Q3). Barring a few exceptions (6%), majority 57.4% and 18.4%, respectively, are satisfied and very satisfied with their capacity to do work from home (Q11). Majority of the people were dissatisfied (42.3%) and very dissatisfied (18.9%) as they were unable to meet their friends and family (Q14). However, to a great extent, technology has played a vital role to remain connected through video-calling.
There was a marginal difference in the opinion of the people about staying home during lockdown. About 30.8% were dissatisfied versus 29.7% showed satisfaction (Q15). Probably, it was a mixed reaction of slowing down of life and, at the same time, missing the rapid speed of the daily routine.
Mass home-confinement directives (lockdown) are new and it raises concern about how people will react individually and collectively. On the mental health front, it was remarkable to note that negative feelings such as blue mood, despair, anxiety, and depression were never felt by 27.9% of participants, though seldom reported by 43.7%, quite often by 19.8% and a small percentage reported it very often (7.1%) and always (1.5%) (Q16). It is reported that some groups may be more vulnerable than others to the psychosocial effects of pandemics.
There was an inverse relation noted between the fear scale and QoL in the present study. This could be attributed to the study population, which is well educated and probably abided by the lockdown measure and instructions of preventing the spread of COVID-19, resulting into a positive effect on their quality of life.
No studies in the literature regarding the fear, QOL and unique COVID-19 situation among the academic faculty have been found. However, five articles could be retrieved assessing the mental health and fear among health-care workers and the general population. The results of the present study are not compared and discussed with these studies because of the heterogeneity in the study group and the methodology. Bohlken et al. reported that health-care workers were under extensive strain due to stress, anxiety, and depression due to COVID-19. Medical staffs were more concerned about their families, patient's mortality and personal safety triggering their mental health. A study among among the health workers from China reported that around three-fourth of them were under distress and presented with symptoms of depression, insomnia, and anxiety, respectively. Stress was associated with a lack of availability of Covid-19 treatment, rapid transmission rate, lack of social support, and deterioration in sleep quality. Further, a cross-sectional questionnaire survey conducted using self-designed 38-item tool among the people of West Bengal specified that they were depressed and irritated with the situation; they were in a fear of contracting the disease and were even getting themselves tested repeatedly; majortiy of them were worried about the financial loss and health of their families; around 2.2% also reported of taking antidepressants and antianxiety drugs to cope up with their mental stress and dealing with the change during the lockdown period was a difficult task to adjust.
The study has its own limitation. Since WHOQOL-BREF has been modified, it no longer remains the same original WHOQOL-BREF and hence the scores are not comparable to any other WHOQOL-BREF studies in the literature. This study was conducted among the highly educated group of people, and the results cannot be generalized communitywide. Another important concern is the “social desirability” which is always reported as a bias in the studies where outcomes are obtained through self-reporting. Social desirability seems to enhance well-being measures because individuals tend to increase the degree of their satisfaction and happiness, resulting in response artifacts and is a serious threat to the validity of self-reported data. In the present study, if there has been any social desirability bias, it remains undetermined. It has been observed that respondents who are not willing to answer a particular question put a check on “Neutral.” It is just like an escape for those respondents, which ultimately divert the results and the true essence cannot be achieved. In the present study, the percentage of people responding as “Neutral” have been nearly one-third of the total sample. These “Neutral” replies can result in response bias, which can impact the overall survey results. It remains unexplored if this has had any impact on our study findings. Finally, the results drawn are from comparatively small sample size, and further research may be needed to confirm the findings with a larger sample.
| Conclusions|| |
The study results clearly demonstrate that there is certainly a fear about COVID-19, but it has not impacted the quality of life. It can also be inferred from the existing data that the study population seems to be highly accommodative and adapted to sudden changes in lifestyle of work from home without disturbing the quality of life. These results are post 1 month after the lockdown. However, further research will be needed to assess the long term effects and on different sects of people.
The authors would like to acknowledge the support of Mr. Jairam Choudhary, Incharge- Software development cell, who helped with the University email network. Thank you to all the participants for responding to the survey questionnaire.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]