Identifying Social Perceptions of People Ignoring COVID-19 warnings: A Qualitative Study in Iran

doi:10.21203/rs.3.rs-743040/v1

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Identifying Social Perceptions of People Ignoring COVID-19 warnings: A Qualitative Study in Iran

https://doi.org/10.21203/rs.3.rs-743040/v1

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Objective:The coronavirus pandemic has had various impacts on people's social life and daily activities in most countries around the world, including Iran. Hygiene precautions like masking and social distancing have been suggested in order to reduce the spread of the COVID- 19 virus. There are, however, individuals in society who do not consider and ignore these health issues. The present study aims to identify the sociological perceptions of people who ignore the warnings about coronavirus infection. The qualitative research was carried out from May till July 2020. The interviewees were purposefully selected from among the individuals who avoided paying attention to coronavirus warnings in Isfahan. In 20 semi-structured interviews saturation point was obtained. The thematic analysis approach was used with MAXQDA software (version 12) to interpret the transcribed documents.

Results: The results showed 2 themes and 4 subtopics related to the sociological perceptions of people who ignored warnings about Corona. Themes and subtopics included: feelings of social anomie (disruption and social unrest, social distrust), unmet social relationship needs (intention to maintain social participation, Feeling of reduced social support). The findings indicate that, in order to tackle social perceptions contrary to health observance during the coronavirus epidemic, educational resources such as mass media, cyberspace and social programs on the necessity and importance of health observance need to be used. Policies should also be implemented in the social, cultural and legislative contexts to enhance the degree of individuals ' social responsibility for each other's health.

General Biochemistry

Molecular Biology

Internal Medicine

COVID- 19 virus

MAXQDA software

sociological

epidemic

educational resources

The Coronavirus pandemic occurred as a simple outbreak in Wuhan, China, in December 2019. However, it was spreading rapidly to other countries and becoming a global threat. It appears that most countries were not ready for this pandemic, and as a result, hospitals were full of patients and death rates increased due to this disease. Coronavirus has been reported in nearly two hundred and five countries. By 19 May 2021, more than 164 million people worldwide were infected and more than 3 million worldwide were died due to Coronavirus, A statistic which is currently risen[1].The new epidemic has turned into a public health pandemic[2, 3].

Symptoms of Covid-19 infection appear after an incubation period of about 2 days. The onset of symptoms to death ranges from 6 to 41 days with an average of 14 days [4, 3]. This period depends on the age of the patient and the patient's immune system. Fever, cough, and fatigue are the most common symptoms, and other symptoms include sputum, headache, shortness of breath, and lymphopenia. Human-to - human transmission is mainly through the emission of sneezing or coughing droplets from an infected person [5].

Due to the new and uncertain existence of Covid-19, management strategies are limited and the most effective way to deal with the disease is to prevent the spread of the virus[6].Countries around the world have taken several measures to restrict the spread of the virus, each of which has varying degrees of success[7]

Psychosocial factors currently play a very important role in taking preventive and self-care precautions against various diseases, including infectious diseases (such as coronavirus)[8, 9]. Attitudes and social factors play a significant role in the commitment of individuals to health measures against infectious disease transmission [10].In other words, health outcomes are influenced by non-medical factors such as beliefs and culture, education, social support and socioeconomic status[11].

The Covid-19 pandemic has affected people from different socio-economic groups, especially in the lower socio-economic countries [12]. A study in the United States found that among the socio-economic factors not taking precautions among American workers was their low incomes, which continued to interact and communicate even during home quarantine. People with more money remained at home, restricting their exposure to the social environment [13]. Double socio-economic costs[14] as well as the erosion of the health care system[15] will be imposed on a given community, unless individual and social groups take action to prevent widespread spread of the virus[16].

In this field, another psychosocial term is social apathy which has been commonly recognized in recent decades. It is described as a motivational disorder with a reduction in purposeful behaviors and cognitions [17]. In particular, social apathy can affect the motivation of an individual in 5 sub-areas: exploration, social relations, job / education, recreation and self-care [18, 19] .

Governments around the world are making a lot of attempt to reduce the spread of infectious diseases like coronavirus. Mandatory masking of public places, social distance observance, closing of assembly centers, academic institutions Providing conditions for virtual communication, etc.[20, 21]. One feature of government policies for people with symptoms of Covid-19 disease is home quarantine for a 7 to 14 day duration, although those with no symptoms (could become infected) have to follow social distancing [22].

This ensures that everybody should reduce their unwanted social contacts, unless they need to travel and work at home to avoid interpersonal transmission of the virus whenever possible. Nevertheless, studies have shown that many people choose to ignore these health requirements for financial, economic, psychological and cultural reasons [7],In particular, where there are no legal and judicial conditions. Precautions such as masking, not having unnecessary social interactions, and self-quarantining of people suspected of Covis-19 are measures that can be taken by people to protect themselves and others from the virus contract. Nevertheless, research has shown that these interventions have extensive socio-economic implications for individuals during outbreaks [23]. The key barriers to adopting the precautionary measures include concerns such as decreased engagement in social interactions, decreased income due to a long-term work absence[24, 25].

A lot of public campaigns have been developed to inform people about the coronavirus infection mechanism, but we also find that these health alerts are overlooked by many in the population. In Iran, in the current context of sanctions, where members of society are facing serious socio-economic challenges, preventive behavior against coronavirus is also affected by these conditions. For example, if people are not aware of social guidelines and precautions, and for reasons such as stigma of the likelihood of disease, as well as cultural and behavioral factors, they may be less caring.

By performing this research, we can scientifically identify the reasons for disobedience of different social groups to disease warnings and, thus, provide accurate recommendations to policy makers and planners. Educational and cultural interventions in this regard should also be implemented

Accordingly, the present research aims to identify these people's social perceptions and, in reality, to address the question of what are the social causes and explanations for the lack of attention towards Corona from the perspective of people who do not adopt precautionary and preventive health standards?

A qualitative study using a conventional thematic approach was designed to investigate the People's Social Perceptions Ignoring new Coronavirus alerts. The study was performed from May to July 2020 at Isfahan, Iran

Sample and recruitment

Participants were recruited by purposeful method from Public centers in urban areas in Isfahan (such as shopping malls, urban bus and subway fleets, bakeries, and other public centers) where people do not meet the care and prevention requirements of Coronavirus. To this end, the researcher has monitored people who go to the public centers and don't follow preventive methods such as wearing masks and gloves or social distance. If they have given reasons for not paying attention to the Coronavirus warnings in the initial and preliminary question (interview guide), they will be interviewed..

Depending on the type and characteristics of qualitative research, the number of participants depends on the data saturation point. Because in qualitative research, unlike quantitative research which determines the sample size through statistical calculations, repeating previous information is a sign of a sufficient sample size. Therefore, using a purposive sampling method, we reached theoretical saturation by interviewing 20 participants according to the entry criteria. Participants were selected with a maximum variety of sampling regarding age, sex, education, etc.

Data were collected through interviews. The interviews were semi-structured [26]. Due to its flexibility and scope, this form of interview is ideal for qualitative studies. Semi-structured interviews offer participants the ability to thoroughly describe their understanding of the phenomenon under study.

Two researchers (M.N (PhD in Social welfare) & Z.H (PhD in Psychology)) were entering public settings (such as shopping malls, bus and subway fleets, bakeries, and other public centers) and first introduced the purpose of the interview. Since qualitative research settings are real areas of experience and life, interviews are conducted in agreement with the participants and during their free time. An interview guide, informed of the research objectives, was developed (semi-structured) to explore the detailed response. In addition, in order to verify the validity of the interview guide, the interview questions were first discussed between the research team with the collaboration of an external expert and revised. The main questions of the interview started with a general question such as "(How important do you think this disease is? What should be done to prevent getting it? Or do you believe in such recommendations or not at all?). Thereafter, more exploratory questions were asked to address the interviewees' social perceptions and the discussion phase during the interview was directed by the researcher from wider topics to smaller categories.

All respondents completed a written informed consent form and they were ensured about the confidentiality and anonymity of their information. Throughout the interview the researcher paid attention to the purpose of the interview, to create trust, providing feedback, and refraining from commenting on the interviewee. To make the content clear for the individuals interviewed questions such as: Please explain more? You mean...? etc., were asked. Each interview time lasted between 30–90 minutes, 40 minutes on average. Most interviews were tape-recorded (with the informed consent of the participants) and then transcribed verbatim.

Steps To Conduct Qualitative Study

In this study, the six-step for conducting qualitative study proposed by Cohen, et al, [26] was used as follows:

Set a goal: The purpose of the interview is to identify the social perceptions of people who do not pay attention to the warnings of the new coronavirus in the city of Isfahan.
Design: At this stage, the structure of the interviews is prepared based on the research goals. It also determines the sampling method. The principal sampling method in this study was purposive sampling.
Conducting Interview: The necessary information is collected according to the interview guide after obtaining informed consent and willingness to participate in the interview.
Writing: A voice recorder should be used to monitor the interviews, and the researcher should take notes and record relevant and key points at the same time.
Analysis: The process of analyzing the implicit and explicit nature of the data starts after entering the written text of the interviews into the MAXQDA software. This process aims to discover the internal relationship between the data components, to achieve the research objectives, and to identify data-related conditions and the environment.
Preparing a report

Data Analysis

An inductive thematic analysis was used to analyze transcribed documents assisted by MAXQDA (version 12). As a coding scheme, a conventional content analysis was conducted as follows: Two authors (MN, ZH) obtained data independently coded in the first stage. For data immersion, they read and re-read the documents transcribed and listened to audio-recorded interviews. In the next phase, primary themes were extracted from the data collected and checked by the team members. Themes and sub-themes were then constructed. At the last stage, the team members checked, modified, and encoded statements.

Trustworthiness criteria

We have ensured four trustworthiness criteria suggested by Lincoln and Guba for assessing the quality of the current qualitative study. These criteria are:

Credibility

This definition substitutes for the internal validity by which researchers seek to prove the validity of their findings. Thus, the researchers should send participants their interpretations of the data collected to ask participants’ opinions about the coherence or relevance analyses. The research should highlight how this feedback was received or how the explanations of the participants regarding these interpretations were addressed. In the current study, a combination of data collection methods (interview, text viewing, and annotation, document viewing) was used to increase the acceptability of the results, in addition to the mental participation of the researcher through study.

Transferability

Transferability substitutes for the concept of external validity. In other words, how much of the research findings can be used in other settings? A qualitative researcher should provide enough information for the reader to assess the applicability of the results in other environments. The researcher tries to provide accurate and purposeful explanations of the research process and the actions are taken in the study path so that others can follow the research path and the study population characteristics. At this point, the aim is to provide the reader with enough information to determine the applicability of the results in another context, for this reason, we have tried to select appropriate study samples and simultaneously collect and analyze the data.

Dependability

This definition substitutes for reliability. Dependability of the research was implemented through an audit approach in which the colleagues of the research, assisted by an external auditor, commented on the coding process and the interpretation of the interview text.

Conformability

A degree of neutrality or the extent to which the results of a study are influenced by the respondent and not by the bias, motivation, or interest of the researcher. To increase conformability, we did not openly permit our values to conduct the research and findings from it.

Table 1

Themes (categories), sub-themes, and codes related to people's social perceptions ignoring new Coronavirus warnings
Theme	Sub-theme	Codes
Feeling of social anomie	Disruption and social unrest	Perception of anomaly in society
		Economic-cultural crises in society
		Irregularity and lack of binding laws
	Social distrust	Pessimism towards society
	Social distrust	Indifference and lack of social responsibility
Unmet social relationship needs	intention to maintain social participation	Communication with others, institutions
	intention to maintain social participation	Involvement in daily social activities
	Feeling of reduced social support	Family Connections
		Support important friends / others
		Emotional support

Ethics approval and consent to participate

The study received the required ethics approval from the Isfahan University of Medical Sciences Research Ethics Committee, Isfahan Iran, with Ethics Code No. IR.MUI.REC.1399.048. Also, participants sign a written informed consent in which they have been assured that their identities and responses will be anonymous and that participants' data will be kept confidential as possible.

In the current study, a total of 20 individuals were involved who ignored COVID-19 alerts. The mean age was 38.9 years (SD = 7.5) for the participants and 24 percent were female. Their level of education varied from illiteracy to the level of postgraduate education. Self-employed and entrepreneurs (n=9), retired (n=3), housewives (n=3) and staffs (5) were among the participants.

Two general themes and four sub-themes were derived concerning the social expectations of individuals ignorant of the coronavirus warnings. The themes were: feeling of social anomie and social health disorder (Table1).

Feeling of social anomie

Disruption and social unrest

In this regard, the interviewees stressed the existence of discrepancies, inconsistencies and the lack of binding laws in society that have generated some sort of confusion and disruption in society. Under these circumstances, the interviewees did not believe in the application of the Corona precautionary guidelines. One of the interviewees said that:

No one seems to obey in society. There is no order, no one is fined and since there are no rules for this, I can't trust whether or not these issues are true."

One interviewee said:

There is nothing out of place; the lack of transparency in society is evident from people to officials everywhere. "There is no sense to the corona in this case."

The interviewees discussed the issue of disunity and social instability from an economic and cultural perspective. In such a way that Corona's presence was connected to problems of economic benefit and consumerism in society, and this was seen as a reason for resistance and not to take preventive warnings seriously.

One interviewee stated:

"The corona issue today has become an economic marketplace for gangs to sell their products, particularly contraceptives. On the other hand, the culture of society has been consumed and disorder is prevalent all over the world, from the economy to people's style of consumption".

Social distrust

Interviewees in this field considered one of the reasons for distrust as pessimism against society as a whole, and in particular in the area of Coronavirus management.

One interviewee stated the following:

"I do not believe it until I see it with my own eyes. These are political issues and we are all being played by the government. Corona is another of these games."

Another sub-category related to social distrust was indifference and lack of social responsibility. Interviewees did not care about the likelihood that members of the community would be harmed by their own lack of hygiene, and in no way considered themselves socially responsible. One of the interviewees stated:

"Well, let others distance themselves from me, I just can't take care of those who don't come close to me. I don't care whether others have this disease or not."

Unmet social relationship needs

Intention to maintain social participation

Several concepts were identified by the interviewees who did not observe the health issues in this theme. One of these sub-categories was called Intention to maintain social participation. Within this subcategory, the interviewees expressed codes such as communication with others and interruption of day-to-day social activities. One interviewee stated the following:

"Since this Coronavirus arrived, I was really frustrated. I can't get to my everyday commutes. I can't do my administrative work anymore as normal and I've been constrained by that."

And another interviewer said:

"I had a variety of activities in my community and at work every day before this infection, and my life was really busy. Today, I am quite tired from all the inactivity. the situation has become complicated for me.."

Feeling of reduced social support

Another subcategory that was relevant to "unmet social relationship needs" was the impression that interviewees had decreased social support as a result of social restrictions. Interviewees indicated reduced levels of support in family relationships, support for friendships and emotional support. One of the interviewees commented:

"To have a relationship with my family members is very important to me and I can't end it under any conditions, even for a short period of time. The relationship gives me a sense of support. This corona prevented that and I couldn't limit that relationship anymore.

The interviewees found it difficult to reduce the support they got from friends during the corona as well as support from friends / important others. One interviewee said, for instance:

"I need to take some time off with my friends to talk about daily things because I really like them and they support me a lot in trouble. The corona limits these relationships and I was suffered under these constraints."

Another interviewee cited a lack of social support as reasons not to take seriously the safety warnings:

"I'm a human being who is really emotional. I just have to talk to someone face to face and feel pain and pulse for him to understand me. Corona induces that feeling to me"

This study identified and explained the social perceptions of individuals who did not respond to the warnings of Covid-19. The study showed that two general themes, including feelings of social anomie and unmet social relationship needs (each with two subclasses) can be drawn from interviews with individuals.

Two subcategories of Disruption and social unrest and social distrust have been placed on the theme of social anomie. Anomie is, in fact, a condition in a society in which there is a lack of coherence or a lack of norms and values previously shared by members of the community [28]. According to Durkheim's theory, respondents felt that this corona condition is correlated with a breakdown of norms and values, leading to the feeling that the person does not belong to others and society and is not meaningfully linked with others. Other research, along with our findings, have shown that feeling of anomalous circumstances in society can lead to increased aimlessness and hopelessness, and ultimately failure to comply with preventive and health behaviors [29, 30]. People prefer not to embrace social cultural norms in this condition, and this gap in value contributes to anomie. According to Parsons Theory, those who are not affiliated with their communities and have some form of social distrust are reluctant to follow the rules [31]. Studies on the prevalence of Ebola virus in Africa have illustrated the principles of mutual trust and a sense of social unity in humans following successful preventive behaviors [32, 33]. Also, Regulatory protocols for corona disease may be the case.

In the area of social indifference, which was one of the categories of social anomie, it seems that people, who believe others in society do not observe health points, do not find themselves obligated to follow these health points and believe the same for others in some way. It leads to disrespect, thus generating a sense of distrust in society Indifference is a phenomenon that affects mental-psychological equilibrium such as emotion, cognition, and behavior. In fact, people who are indifferent to their community health deny their commitment, civic commitment and social responsibility and do not value the health care of people in the community [34]. Numerous studies have shown a particular role in care measures for various infectious and non-communicable diseases [35, 36].

Another theme from the interviews was unmet social relationship needs, which included two sub-themes of intention to maintain social participation and Feeling of reduced social support. Participation in daily activities and contact with institutions is seen as part of the social health cycle of the person [37]. Because of the limitations and disorders that the prevalence of infectious diseases brings to society, social activities and participation have been affected [38].

While the primary purpose of distance controls and social travel restrictions was to prevent the spread of the virus on a social level and to protect vulnerable people, these limitations had far-reaching socio-economic implications [39].

other research on the new coronavirus outbreak, in line with our study, have shown that closures and social distancing measures to prevent the spread of the disease have raised concerns of decreased social interactions[40] and raised domestic abuse, including physical, psychological and sexual[41, 42].

In the present research, participation in organizations and everyday activities were identified as categories in which the precautionary measures against the virus were not completely complied with by individuals [43]. Other studies have shown that quarantine and social isolation during coronavirus outbreaks are associated with more symptoms of depression and anxiety [44] as well as feelings of social disunity among different age groups[45].

Participants cited the lack of social resources such as family relationships and peer support as reasons why they did not want to take preventive steps. Because family members and friends provide emotional and social support and sympathy, it can reduce anxiety and worry [46]. Social interaction decreases negative emotions like anxiety. Today, with the growing incidence of infection with Quid 19 in Iran, precautionary measures such as masking and observing social distance have led people to feel less emotional support and belonging to a group than before[47]. This has contributed to negligence of the precautions. Other studies have shown that the precautionary measures against corona disease depend on a number of socio-economic factors, such as determining the source of income for people in quarantine[48], developing virtual communication infrastructure[49] and food supply chains[50] by governments.

In some emergencies, such as the spread of a contagious disease, socio-economic reasons such as deteriorating social ties, depletion of support resources such as family and friends, perceptions of social anomaly, and social distrust may lead people to failing to comply with precautionary measures. As a result, policymakers need to take action to change these attitudes. These include the development of educational programs related to the importance of health standards on various platforms such as television, advertising and cyberspace, education and the necessary warnings about the consequences and complications of coronavirus, programs aimed at increasing the level of social responsibility of individuals. In addition, it may be useful to develop various entertainment programs in the digital space to improve family leisure time, alternative financial programs such as loans to guarantee the level of income earned before the corona, in particular those requiring daily livelihoods.

We've found some limitations in this study. One of the weaknesses of this study was the unique circumstances created by Corona at the community level, and it was particularly difficult for researchers to schedule and interact properly with the interviewees.

Abbreviations

Not applicable

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request

Ethics approval and consent to participate

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Funding

The study was funded by Isfahan University of Medical Sciences, Isfahan, Iran with research code No. 199049.

Authors' contributions

M.Ndesigned the study. M.N and Z.H drafted the manuscript. All authors read and approved the finalmanuscript.

Acknowledgements

The authors would like to thank all interviewees who participate in this study.

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Editorial decision: Minor revision
07 Sep, 2021
Review #2 received at journal
26 Aug, 2021
Reviewer #2 agreed at journal
29 Jul, 2021
Reviewers invited by journal
25 Jul, 2021
Reviewer #1 agreed at journal
25 Jul, 2021
Review #1 received at journal
25 Jul, 2021
Editor assigned by journal
11 Jul, 2021
Submission checks completed at journal
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You are reading this latest preprint version

Identifying Social Perceptions of People Ignoring COVID-19 warnings: A Qualitative Study in Iran

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Abstract

Introduction

Methods

Steps To Conduct Qualitative Study

Data Analysis

Trustworthiness criteria

Results

Discussion

Conclusion

Limitations

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References

Supplementary Files

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Version 1