Healthcare provision during periods of social isolation and social distancing has been delivered remotely during the COVID-19 pandemic in Brazil and elsewhere worldwide. Call centers have been introduced into the health arena as a positive strategy to maintain contact with patients living remotely and without physical contact. Interventions undertaken via telephone calls can be effective in promoting health and enhancing knowledge.
Women comprised 76.7% of our study population. More women have been reported to seek health services [15, 16], which may have led to this predominance, as our study population was derived from a specialized health unit database. In one United States study involving patients aged from 18 to 75 years diagnosed with T2DM, a population management program was designed to assist patients with T2DM in self-management through receiving telephone calls and text messages. In that study, there was also a predominance of females .
In our study, 63.3% of the participants were married. A study by Carvalho (2018) reported a similar prevalence of married participants with T2DM. Patients with T2DM living within a family structure have been found to have a more suitable environment in which to influence self-care behaviors .
The participants in our study had low levels of education, which may have impaired their access to information and hindered their self-care, in addition to making it difficult to adhere to the treatment required concerning their comorbidities. Becker (2017) suggested that telephone contact was an efficient means of health education for this vulnerable population , and it appears reasonable to continue with this type of care when aiming to clarify issues and challenges concerning COVID-19.
In total, 56.7% of the participants reported living on one to two minimum wages, which revealed further vulnerability among these patients as their limited resources may have affected their access to medication. These data can help guide health management in controlling COVID-19 better through implementing more appropriately targeted public policies to reduce the health needs of patients with chronic diseases .
Of the 30 elderly people evaluated, 21 (70%) did not present depressive symptoms, according to the GDS-15. The absence of depressive symptoms in most of the participants may be related to this elderly population not being very elderly (average age, 69.96 ± 4.46 years). Further, this absence could also be explained through the presence of family or a spouse, which has been reported to help with reducing anxiety levels in this population .
Ozamiz-Etxebarria  highlighted the presence of long-term post-quarantine psychopathological symptoms, including depression, among elderly individuals. Moreover, social isolation for elderly people can result in decreased cognitive stimuli, resulting in depression and dementia . In 2019, Valentiner reported that other methods to assist with self-care, including telephone guidance, were found to lead to a general improvement in depressive symptoms .
In terms of the 24 items derived from the Brazil MOH checklist, an average score of 7.73 (±1.61) points indicated that the elderly participants with T2DM in our study were not as well informed concerning COVID-19 as they should have been. The participant with the highest score correctly identified only 12 items, comprising 50% of the relevant information. This finding suggests that the means of communication used by elderly individuals to receive information concerning COVID-19 may not provide sufficient or accurate enough information to meet their needs during this period of social isolation. Television was found to be the most used information medium for the elderly participants in this study, which was similar to the findings of a study by Goodman-Casanova  that showed television was a major means of providing health information and social support.
Providing timely, sufficient, and accurate information can raise awareness among a population. In emergency situations involving disease outbreaks, epidemics, and pandemics, effective communication is essential, with the provision of accurate information more likely to help responsible agencies to take more effective measures .
During a health crisis, the public depends on the media to transmit accurate and updated information to make informed decisions regarding health protection behaviors. Thus, it is essential that reliable sources are available to provide assessments and recommendations [25, 26]. However, the ease of access to multiple media, along with the consumption, dissemination, creation, and sharing of information, mainly through social media, can have serious negative implications. A total of 20% of the sample claimed that one way to obtain information about COVID-19 was through social networks. However, the large amount of information generated through social networks, some of which is inaccurate, can be confusing, making it difficult to differentiate accurate from inaccurate content and facilitating the proliferation of potentially erroneous conceptions [27, 28].
While no significant relationship was found between age and the total checklist score, we observed low scores (≤50% of the total score) among the participants. This relationship may be explained as due to the limited and higher age range among the participants and that such elderly individuals tend to recall less health information . The ability to recall instructions is critical in adhering to health professionals’ recommendations and can be influenced by various factors, such as the amount of information conveyed to a patient and the manner in which it is acquired, the duration of exposure, and whether numerous interruptions occur [30, 31].
Age has been reported to influence the level of information retention . It has also been shown that, if not used frequently, the learned content passes through the working memory and is then discarded whereas, if such content is used routinely, it reaches the long-term memory and is retained . However, as the information volume increases, it becomes more difficult to recover relevant information .
The participants’ socioeconomic level (education and income) was a further consideration as this factor is an important determinant of health and of health-related matters. A person’s socioeconomic level plays a mediating role between staying in good health and acquiring effective health information in terms of facilitating health literacy, defined as the knowledge, motivation, and skills of a person to access, understand, evaluate, and apply information, and to make decisions in daily life in relation to care, prevention, and health promotion to maintain or improve that person’s quality of life .
In this study, 56.7% of the elderly participants reported having completed primary or post-elementary education; however, no statistical difference was found in relation to the total checklist score (p = 0.15). It is possible that information transmitted to this population group may have been so simple that all the participants assimilated the knowledge in a similar way. A low socioeconomic status is considered a potential risk factor for low health literacy , and education is one of the main determinants of health literacy. However, it has been suggested that education levels determined according to the number of completed school years is not accurate in measuring an individual's true educational level, as it does not take into account the different cognitive skills of each individual . Individuals with the same educational level may have different levels of cognitive skills, leading to differences in knowledge acquisition .
This study had some limitations. It can be difficult for elderly participants to answer telephone calls. Of the 38 participants we initially sought to contact, 8 did not answer our calls. The participants were also noted to be shy in their responses and some had difficulties in expressing themselves over the telephone.
In conclusion, our study showed that the elderly participants did not have in-depth knowledge concerning COVID-19, as we obtained an average of only 7.73 (± 1.61) correct answers from a total of 24 questions. This finding suggests that the knowledge sources of these elderly participants may have been deficient or that their capacity to retain information was inadequate. Television was the most cited source of information, and the total checklist scores did not show any significant difference in terms of depressive symptoms and social variables among the participants. Therefore, we suggest that tele-service interventions be encouraged and new approaches developed to disseminate accurate information concerning COVID-19.