The effectiveness of a health education intervention to reduce anxiety in quarantined COVID-19 patients: a randomized controlled trial | BMC Public Health

Several studies support the significant relationship between quarantine and poor mental health during the COVID-19 pandemic. It was shown that the longer the quarantine lasts, the higher the anxiety, depression and stress levels are. Many reasons could explain this poor mental health outcomes such as the lack of knowledge about the disease, the daily increase in the number of confirmed cases and deaths and the fear of infecting family members and putting their lives in danger [9].

The current findings suggest that health education may play a conspicuous role in alleviating the psychological burden of isolated patients with Covid 19. In light of this, several authors have emphasized the importance of setting up a follow-up (telemedicine, tele-psychiatry) in order to minimize the mental impact of covid, particularly during the isolation period [24, 25].

Therefore, researchers in our study developed an education program that focused on explaining the nature of the disease, how to act if complications and the preventive measures to adopt during the isolation period and evaluated the effectiveness of this program in reducing anxiety levels.

According to our findings, the prevalence of isolated patients with Covid 19 suffering from anxiety with (HAD_A score ≥ 8) was 22.6%. The two groups of this trial were characterized by comparable general data, levels of anxiety and depression at baseline. Interestingly, patients in the education group experienced significant improvements in their self-reported anxiety symptoms at one week follow-up.

Our study aligns with existing literature and supports the understanding that individuals with extensive knowledge about COVID-19 tend to experience lower levels of anxiety related to the disease. This is consistent with findings from various studies conducted on Ghanaian physical education teachers [26]Turkish COVID-19 patients [27]Turkish midwifery students [28]and Qatari and Middle Eastern health care worker [29]. Hence, it is proposed that factors promoting awareness of COVID-19 can contribute to increased levels of consciousness and, accordingly, reduce anxiety [30,31,32]. In our study, we propose that education, as a factor promoting awareness, may have an inverse impact on the anxiety response.

The association between individuals with extensive knowledge about COVID-19 and lower levels of anxiety related to the disease could be attributed to several factors. First, knowledge provides a sense of understanding and control over the situation, reducing uncertainty and fear [33]. When individuals are well-informed about the causes, transmission, prevention, and treatment of COVID-19, they are more likely to feel confident in their ability to protect themselves and others, thereby alleviating anxiety.

Plus, knowledge about COVID-19 helps individuals differentiate between accurate information and misinformation or rumors. This ability to discern reliable sources and factual information can prevent unnecessary worry and anxiety caused by misleading or exaggerated claims [34].

Some studies, however, report a positive correlation between knowledge and anxiety regarding COVID-19. These studies suggest that individuals who possess awareness of the uncertainties associated with COVID-19 are prone to experiencing heightened levels of anxiety [30, 35, 36]. The increased levels of anxiety could be attributed to the unparalleled fear, apprehension, and nervousness provoked by the COVID-19 pandemic, alongside an increased awareness of the severe repercussions of the virus. There may be several factors contributing to this contradictory finding, including unconsidered moderating effects of other variables and methodological flaws or disparities.

Upon reviewing the existing literature, scant information is available concerning health education interventions specifically targeted towards individuals in quarantine due to COVID-19. In fact, the limited studies available in this area primarily concentrate on the experiences of healthcare workers rather than the general quarantined population. To our knowledge, this is the first randomized controlled trial (RCT) to assess the positive effects of health education on anxiety scores among quarantined patients with covid 19.

For example, a recent uncontrolled trial involving 21 Canadian healthcare workers (HCWs) investigated the efficacy of the RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) program. The study reported a statistically significant reduction in symptoms of anxiety, depression, and posttraumatic stress disorder [37]. Conversely, another randomized controlled trial (RCT) examining the impact of the PsyCovidApp intervention showed no significant effects on symptoms of depression, anxiety, and stress when compared to a control app among HCWs caring for COVID-19 patients. Interestingly, the effectiveness of the latter app was observed specifically among HCWs who were concurrently receiving psychotherapy or psychotropic medications [38]. But this trial had several limitations.

Furthermore, a longitudinal study was conducted in Tunis by the department of child psychiatry of Mongi Slim. The research team followed 166 children and adolescents with known mental illness via telephone. They concluded that one third of the cohort reported a significant reduction of their anxiety symptoms [39].

As secondary outcomes, neither group in this study showed significant difference of compliance with hygiene measures and adherence to isolation over time. This observation may be attributed to the influence of mass media and widespread awareness campaigns that have targeted the entire population in terms of COVID-19 prevention.

The role of the mass media in disseminating information and raising awareness about the importance of hygiene measures and isolation cannot be underestimated [40]. Through various channels such as television, radio, social media, and public health announcements, the general population has been consistently exposed to messages promoting preventive measures against COVID-19. These campaigns have emphasized the significance of practices such as regular handwashing, wearing masks, maintaining social distancing, and adhering to isolation guidelines when necessary.

The extensive reach of these awareness campaigns has likely contributed to a comparable level of knowledge and understanding of hygiene and quarantine measures among individuals from both the intervention and control groups in our study. As a result, there may have been a general consensus and shared understanding among participants regarding the importance of compliance with hygiene measures and adherence to isolation.

The present study had some limitations: All the judgment criteria used were based on the participants’ responses for both the primary endpoint (the HAD scale) or the secondary endpoints (compliance with hygiene measures and with quarantine), which could alter the objectivity of the judgment. However, the use of self-reported scales to measure depression and anxiety is common because of their convenience and low cost. Besides, due to the nature of the intervention, double blinding is not possible. Hence, to minimize the risk of bias the statistical analyzer was blind to his assessment. We also note that our data lacks information on confounders such as the access to pandemic health education through online inquiry lines or websites of health authorities, socioeconomic factors and educational level… In addition, the decrease in anxiety and stress could not be conditioned by the content of the educational messages but conditioned by the simple fact of feeling accompanied in the COVID-19 process by a health professional who does observe and guide you in the face of any complications that is why further research evaluating the impact of this accompaniment feeling should be conducted . Another limitation is the exclusive inclusion of subjects with telephones and those who do not require hospitalization, which can alter the generalizability of our results. Lastly, prospective studies often show an important dropout rate, which was the case. Nevertheless, our simple size was large enough to cover this limit. Despite these limitations, the significant differences in psychological profile between the two groups are novel findings providing evidence that health education has an important impact on reducing anxiety levels in subjects with Covid 19 during the isolation period.

Such intervention consisting on a psychological support via virtual care (telemedicine, telephone, application…) could be adopted by public health policy makers and physicians while fighting the Coronavirus.

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