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Introduction
COVID-19, a recent coronavirus disease that emerged in 2019, was found to spread mainly through respiratory droplets (Bonilla et al., 2020; Farfán-Cano, 2022; Martínez et al., 2020; Ramos, 2020; World Health Organization [WHO], 2020a). It goes beyond a public health crisis, triggering global social and economic consequences([WHO], 2020b; Gozzer, 2020; Salomon, 2020). Latin America, like Africa, experienced a delayed virus arrival. The first COVID-19 case in Latin America was reported on February 26, almost two months after the outbreak began, and the first death occurred on March 7. In response to global events, most Latin American countries closed borders, enforced isolation, and declared emergencies and curfews. Peru, the focus of the study, ranked fifth in first-year cases (CDC-Peru, 2020). Peruvian measures included mandatory isolation, border closure, suspension of activities, and support for health workers and low-income families.
Despite lower COVID-19 impact on youth (Liu et al., 2020), pandemic restrictions limited their social spaces, pushing them to rely on digital interactions. Excessive phone use can lead to sleep issues, loneliness, and depression (Chen et al., 2020). In Latin America, the impact of the pandemic has not been the same in countries with low income, digital gaps and inequality, as in Peru, where educational management faces different problems (Canaza-Choque, 2020). In the specific case of Lima, Lovón & Cisneros (2020), find that university students report feelings of stress and anxiety during the study cycle.
Due to the above, this research seeks to recognize what happened to the university students of Lima in relation to the three variables analyzed in this research from the case of the students of the Universidad Nacional Mayor de San Marcos (the largest in Lima).
1.1. Emotional impact
Emotion is defined as a complex state characterized by an excitement or disturbance that will lead to an action; it is the response to an external or internal event faced by the subject (Serrano y Ibañez, 2015). Emotional development involves physiological, expressive, and behavioral aspects, influenced by socio-cultural interactions and contextual stimuli (Echeverría et al., 1989; Serrano y Ibáñez, 2015). Emotional responses can be categorized as fear, surprise, disgust, anger, joy, and sadness (Ekman y Friesen, 1978). This study, based on the proposals of Ponce et al. (2010), has worked with this scale to understand the emotional impact of the surveyed population.
Serrano y Ibáñez (2015) explain that there are three ways in which the negative emotional impact on a person is manifested: the neuro-physiological dimension (linked to physical effects such as tachycardia, sweating, altered blood pressure, etc.), the cognitive dimension (experiencing cognitive distortions, anxiety disorders, irrational thinking, etc.) and the behavioral dimension (which can manifest itself in irritability and personality disorders or, on the opposite side, somatization as a result of inadequate emotional management). Each of these three dimensions has an impact on coping with a specific situational demand. For this reason, the present study understands 'emotional impact' as the way in which the studied population faced the context of Covid-19 in Peru. In other words, this study is interested in analyzing the "emotional state at the present time in the face of the health situation experienced" (Ponce et al., 2010, p. 10).
1.2. Effects of the Media
The media occupy a central place in the configuration of contemporary culture through the system of beliefs that structure our perception of reality and of all that they validate and make visible: media representation (Ferguson, 2007; Hall, 2013). This constitutes a fundamental source not only for the circulation of information, but also in the production and transmission of symbolic forms, the outlining of new subjectivities, the legitimization or rejection of ideologies (Thompson, 1993). Berger y Luckman (1968), noted mass media's role in shaping public reality, defining significant events and their interpretations for the majority. Social public health is no stranger to this understanding.
Several studies agree that, in the context of the influenza A(H1N1) pandemic, during 2009, the mass media played an important role in informing and misinforming on this issue: they influenced the decision-making of health professionals and civil society in general (Atlani-Dualut et al., 2015; Tuells et al., 2013) Thus, for example, the mass media often ended up complementing the information provided by doctors and nurses (Tuells et al., 2013). As a result, the mass media -the dissemination of their messages and the way they are received- is an important tool for measuring the perception of social issues in general and of public health issues in particular (as is currently the case with the pandemic unleashed by CoVID-19).
Finally, for this research it is assumed that information from the media, social actors and social networks has an effect on the behavior and actions of people: "media reports and education have the potential to affect the awareness of the public, thus can modify the community's behaviors during the infectious disease outbreak” (Zhou et al., 2020, p. 2694).
1.3. Compliance with Health Recommendations
Compliance with health recommendations is related to two attitudes: on the one hand, the continuation of a set of activities that are good for one' s health, that is, what people should do; and, on the other hand, the rejection of practices that are harmful to health or what people should not do. Furthermore, as Pavey et al. (2018) point out, "[t]he distinction between should and should not is related to two forms of morality that have been identified in the literature: proscriptive morality (what we should not do) vs. prescriptive morality (what we should do)" (p. 345).
The importance of health recommendations, in cases of infections and serious diseases, has been documented in studies that found compliance with them in contexts of epidemics or outbreaks (Atlani-Duault et al., 2015; Bradol, 2017; Edirne et al., 2011; Li et al., 2016). During the Coronavirus pandemic (CoVID-19), health recommendations were mainly given by the World Health Organization, which called for "frequent cleaning of hands using alcohol-based hand rub or soap and water; covering the nose and mouth with a flexed elbow or disposable tissue when coughing and sneezing; and avoiding close contact with anyone that has a fever and cough" (WHO, 2020b, párr. 1).
For proper compliance regarding these health recommendations, Peru opted for a period of quarantine throughout the country, in addition to constant messages through the media, daily press briefings conducted by the president, text messages, and other information pointing in both directions: on the proscriptive side, hand washing, use of masks and covering when sneezing; and on the prescriptive side, mandatory social isolation and curfew starting at 20:00 (Decreto Supremo Nº 044-2020-PCM y Decreto de Urgencia Nº 026-2020).
Various information channels, including state, mass media, and social networks, directly influence viewers' emotions based on provided information and narrative tools. Media responsibility is crucial in times of epidemics, impacting public perception and health recommendations. Inaccurate reporting fosters confusion and public skepticism (Giron & Martins, 2010; Serrano-Puche, 2016; Salcudean y Muresan, 2017; Vallance et al., 2018; Akingbade, 2018; Rodríguez, 2006). Media's role in transmitting risk information efficiently is evident from past outbreaks (Sugerman et al., 2012; Bergeron y Sanchez, 2005).
1.4. Background to the study
The World Health Organization (WHO) and Dimensions (SCOPUS, WOS and others) database of publications related to coronavirus has some studies related to “media”, “health recommendations” and “emotional impact”.
Parsons et al. (2020) surveyed 1996 Canadian citizens in the first year of the pandemic and observed that 39% reported experiencing emotional impact due to the pandemic. Similarly, 80% of the respondents indicated adherence to health recommendations. Likewise, in this country, Cyrkot et al. (2024) interviewed and followed 21 parents of individuals under 18 years old, discovering that they primarily relied on the internet for COVID-19 information, focusing on sources deemed credible, reliable, simple, and engaging.
Scheinfeld & Voorhees (2022) examine the influence of social media on the behavior of 459 individuals in the United States between 2021 and 2022. The researchers note that digital social networks generated a high level of FoMo (Fear of Missing Out), yet this did not directly impact non-compliance with health recommendations. Consequently, the fear of contracting the virus persisted more prominently.
In Asia, specifically in Malaysia, surveyed 827 citizens and conducted interviews with 19 individuals between the first and second year of the pandemic. The results revealed that "The internet and social media were vital platforms to mitigate against the impact of public health measures" (Cheah et al., 2023, p. 1).
In Europe, specifically in Spain, Torralbo et al. (2024) identified that adolescents and young people between 16 and 20 years old primarily sought information about COVID-19 through social media, leading to emotional impacts such as anxiety, irritability, apathy, and notably, 17% sought help from a mental health professional.
Lastly, a singular study addresses the three variables analyzed in this research (media, health recommendations, and emotional impact). This investigation targeted the Venezuelan migrant population and found that although there exists a slight positive correlation between emotional impact and media effects, as well as between the first category and adherence to health recommendations; there is no correlation between the variables of effect of media and compliance with health recommendations (Angulo-Giraldo et al., 2021).
The three variables analyzed in this research are directly related and allow us to respond to the general objective of the investigation: to understand the relationship between emotional impact, media effects and compliance with health recommendations during the coronavirus quarantine period (COVID-19) in Peru (2020).
Methods
Following the associative paradigm , this research is correlational, collecting non-changing data, retrospective and cross-sectional, capturing one-time population characteristics. About the unit of analysis, around 1,299,251 undergraduates exist in Peru, 4.2% of the total population (Superintendencia Nacional de Educación Superior Universitaria [SUNEDU], 2022). In Lima, with high COVID-19 cases, 48% of 17-25-year-olds attend university (Instituto Nacional de Estadística e Informática [INEI], 2017). This study focuses on Lima's Universidad Nacional Mayor de San Marcos (UNMSM), established in 1551, the city's largest national university, where students are connected to various regions through socio-demographic ties. (Burga, 2019; Giraldo, Díaz & Calderón, 2019; Lynch, 1990; UNMSM, 2007). Out of 13,901 UNMSM enrollees (SUNEDU, 2022), a simple random sample of 418 was obtained with a 5% margin of error and 95% confidence. However, the non-probabilistic sampling method was used, involving virtual distribution through social networks, email, and WhatsApp groups, with a 10% increase to account for potential loss or rejection (Figure 1).
A questionnaire validated by Ponce et al. (2010) was modified in relation with the COVID-19 and the country. This survey modified was applied in Peru and validated through the study by Angulo-Giraldo et al. (2021) for the three variables analyzed. The emotional impact variable was evaluated based on the confluence of the following: (a) the rating of their emotional state at the current time of the situation with respect to COVID-19 ("calm", "worried", "fearful", "terrified", "angry", "disoriented" and "excited"); with (b) the Likert-type rating scale ("not at all", "very little", "little", "regularly", "much" and "very much").
The variable effects of media took into account information distributed by 3 informative spaces: the media (television, radio, press), the digital social media (WhatsApp groups with friends, family, co-workers or bosses, in addition to Twitter, Facebook and text messages) and messages from authorities (university, press conferences and briefings from authorities (university, press conferences and briefings from president Francisco Sagasti). These were evaluated with the three options suggested by Ponce et al. (2010): "reassuring information," "disturbing," and "none".
Finally, for the variable compliance with health recommendations implemented by the Peruvian government, three widespread measures were considered: social isolation; frequent handwashing with soap and water for 20 seconds; and covering nose and mouth with tissue paper when coughing/sneezing or doing it into the bend of the elbow. Response options were classified as "always", "almost always", "sometimes", "almost never" and "never". The survey was conducted between March 13 (2021) and May 13 (2021).
The data was collected through a virtual survey, and corrections were made in Microsoft Excel by one of the researchers, the same person who reviewed the database for errors. Then, the information was processed in the software Python 3.8.2 version. The Pearson correlation was considered valid with a significance of p<0.05.
Results
The main findings show that there is not a positive correlation between the variables emotional impact and effects of the media (5.4%) with a not significant association (p=0.28). The same happens with the correlation between the variables emotional impact and compliance with health recommendations (9.5%), which is not significant (p=0.05). However, there is a weak negative correlation (-23.3%) between the variables effect of the media and compliance with health recommendations (p=0.00).
By emphasizing the dimensions of the related variables, this research finds that there are only significant correlations between the effect of the media and compliance with health recommendations during the COVID-19 situation in Peru, as shown in Table 1. However, there are few significant correlations between the dimensions of emotional impact, effects of the media and compliance with health recommendations (Table 2 and Table 3).
Table 1 Significant correlations between effect of the media and compliance with health recommendations
Font: Elaboration by the authors
Table 2 Significant correlations between emotional impact and effect of the media
Font: Elaboration by the authors
Table 3 Significant correlations between emotional impact and compliance with health recommendations
Font: Elaboration by the authors
The results of this research show that the emotional impact of COVID-19 on the lives of university students was not very relevant during the period in question (March 13 - May 13, 2021). Firstly, most students reported feeling "regularly calm" (27%) and “regularly excited” (28%); they also reported feeling “a little worried” (29%), “a little fearful” (29%), “a little terrified” (28%), “a little angry” (28%) and “a little disoriented” (28%). This shows that the group of students is perceived as distant and unaware of the development of emotions to a superlative degree, that is, the findings show the absence of a serious effect on the emotional state of young university students.
Secondly, this moderation in the emotional impact of young university students is also related to the reception of informative messages, mainly from official sources and close contacts, which influence them directly. The results of this study show that the students described the information provided by the local television, as “reassuring” (41%); followed by the information sent by text messages (37%). However, information from the social media were relevant, but not in a positive way. The population surveyed indicated that the most "disturbing" information came mainly from social networks close to the subjects surveyed: Facebook (45%) and Twitter (43%). All the others sources of information were primarily classified as “none”.
It is important to add that the information send by the institutional information channels -data sources and official measures-were important to send messages “reassuring”, like the UNMSM (35%) or the messages from the President of Peru, Francisco Sagasti (34%). Moreover, it is important to note that during the period of this survey (March 13 - May 13, 2021), the President of Peru has held a one-hour press conference during 16 days.
Thirdly, regarding compliance with health recommendations, it is important to note that most of the population studied "always" and "almost always" complied with them. Thus, 84% indicated that they complied with the mandatory social isolation during the period studied, 85% stated that they did not leave home except when it was necessary, 82% kept the distance of 1.5 meter in public spaces, 77% mentioned that when they coughed, they covered their hands with a handkerchief or their forearm, and also the same percent of people admitted that used of a face shield when boarding public or private transport, finally only 69% stated that they washed their hands with soap and water for at least 20 seconds. These compelling results demonstrate the massive compliance with the norms and recommendations indicated by the Government of Peru in the period studied (2021).
At the correlational level between dimensions of the variables, we can see that the association between categories of the variables "compliance with health recommendations" and "effects of media" shows that the impact of television is negatively and yet weak correlated with all dimensions of the former variable except "keeping the distance in public spaces". Similarly, the impact of newspapers is weakly and negative significantly correlated with compliance in "handwashing with soap and water" (0,00), "mandatory social isolation" (0,02), and "keeping the distance in public spaces" (0,03). Radio also exhibits weak and negatively significant correlations with "handwashing with soap and water", "covering nose and mouth when coughing", "use of masks", and "mandatory social isolation" (0.00 for each). Messages sent via WhatsApp groups (family members or co-workers) similarly maintain significant yet weak and negative associations with various compliance measures, including not leaving home except when necessary (0,03), "covering nose and mouth when coughing" (0,00), "use of masks" (0,03), and "mandatory social isolation" (0,06). Similar patterns are observed with WhatsApp groups with friends, which exhibit a negative and weak association with compliance with social isolation measures (0,03). In contrast, messages in workplace settings show only weak correlations with "handwashing with soap and water" (0,01). Regarding digital social media, correlations were consistently negative, with Twitter messages significantly impacting "handwashing with soap and water" (0,00), "covering nose and mouth when coughing" (0,01), and "use of masks" (0,03), while Facebook information significantly influenced these latter two dimensions (0.03 and 0.01 respectively). Finally, text message information exhibited weak negative correlations with "covering nose and mouth when coughing" (0,03), "use of masks" (0,00), and "mandatory social isolation" (0,00).Significant correlations between the dimensions of the variables "emotional impact" and "effect of the media" indicate that "worried" had a significant, albeit weak, impact with television (0.02) and radio (0.00) information, while "fearful" was weakly associated with newspaper (0.00) and radio (0.00) information, as well as with WhatsApp groups (family members or co-workers) (0.00) and SMS (0.01). Moreover, the emotion of "disoriented" also showed a weak significant relationship with the WhatsApp group with family. Finally, the emotion of "excited" was the most significantly associated with various sources of information: positively with messages in the workplace (0.00) and negatively with messages from TV (0.00), radio (0.02), WhatsApp groups (family members or co-workers) (0.00), Facebook (0.00), and SMS (0.00).
Finally, significant correlations between the dimensions of the variables "compliance with health recommendations" and "current emotional state" consistently demonstrated weak associations, indicating that being "calm" is positively associated with "use of the mask" (p=0.00), while being "excited" is associated with "mandatory social isolation" (p=0.02).
Discussion
As explained in previous sections, in the context of COVID-19 pandemic in Peru, the emotional impact on the population is associated with the effect of the media (radio, television, text messages, social networks, among others) and also with compliance with health recommendations. Although Peru's objective in the face of the pandemic is to comply with WHO recommendations, the population is reacting not only to the risk of the disease, but also to the crisis that it generates in the economic, political, social and educational aspects, etc. These aspects are interrelated not only with the way in which each person will carry out their daily work, but also with the emotional state with which information will be sought to answer their doubts and concerns about issues that may generate curiosity.
Firstly, regarding emotional impact, the literature shows that the emotional impact of pandemics or outbreaks has an effect on the emotions of medical health professionals and the population in general. In Australia, a high emotional impact was reported in the face of Equine Influenza (EI): "many person-related risk factors for adverse psychosocial response" (Taylor et al., 2010, párr. 1), such as a sense of poor ability to adapt to change and poor ability to recover from adversity. The same occurred in Sierra Leone following the Ebola outbreak (2014-2015) during which health workers described experiencing "'suffering', 'loneliness', being 'isolated' and feeling 'full of sadness' since the onset of Ebola" (McMahon et al., 2016, p. 1236). Similarly, in the face of COVID-19, Tavares et al. (2020) state that fear is quickly perceived as a consequence of mass quarantine. Lelis et al. (2020) found that 52% of higher education students from health sciences courses in Minas Gerais (Brazil) presented symptoms of depression, while 41% of anxiety. In Peru, Yarlequé et al. (2020) show that more than 50% of Peruvian university students are in the medium or high level of anxiety. These results are close to the results of Gonzáles et al. (2020), who found 40% confinement anxiety in university students in Mexico. 7 out of 10 Peruvians have mental health problems in the context of the pandemic. However, this study indicated that the group of students is perceived as distant and unaware of the development of emotions to a superlative degree, that is, the findings show the absence of a serious effect on the emotional state of young university students.
The data also show the access to information from official sources and TV that the surveyed students have. In Peru, 55% of the urban population consumes more digital media and 45% more traditional media. However, there is an increase in traditional media consumption in low SES sectors, while digital media consumption is greater in high SES sectors (IPSOS, 2019). Likewise, 100% of people in Lima have a television, 91% a radio and 96% a cell phone, but only 87% have a cell phone with internet access (Consejo Consultivo de Radio y Televisión [ConcorTV], 2019). The high presence of televisions in Peruvian homes is also related to the increase in their consumption: the COVID19 pandemic implied an increase in 42% of the consumption of this medium, with a daily average of 6 and a half hours of viewing (El Comercio, 2020). In addition to this, Peruvians mainly consume news (27%) and consider that this is the closest medium (30%) (ConcorTV, 2019). In the same sense, it should be specified that the communication messages of the government authorities were transmitted mainly by television, which could explain the importance of television when sharing “reassuring” messages. In addition, these messages from the Peruvian government authorities were shared by text messages, which explains their relevance for university students. It should be noted that the percentage of respondents who felt calm with the messages of President Franciso Sagasti (34%) coincides with the percentage of approval that young Peruvians grant to his management during the month of April 2021 (33%) (IEP, 2021).
The academic literature (Wang, 2006; Sugerman et al., 2012) agrees that the information sent by official channels -especially when it is of a technical nature- avoids an increase of the crisis; however, this has not happened with the traditional media (radio and press) or with social networks., on the contrary, as the results of this study show, they are providing peace of mind and a sense of moderation in the population. Based on the mentioned, it remains to analyze the role of the press in contexts of social crisis, and consider it essential not to promote a social alarm, not to increase the perception of risk, but on the contrary, to contribute to the reduction of anxiety and panic (Jurado & Jurado, 2014; Lázaro-Rodríguez y Herrera-Viedma, 2020).
In relation with the information presented about compliance with health recommendations by university students coincides with the fact that 95% of Peruvians approve the declaration of obligatory social isolation (IPSOS, 2020) recommended by the WHO (2020b) and also with the compliances carried out in other countries such as Italy or the United States (Barari et al., 2020; Utych & Fowler, 2020).The importance of complying with health recommendations, and specifically with social distancing, has an impact on avoiding the exponential increase of infection (McCann, 2020; Telles, 2020).
Although this research does not find a correlation between the variables of emotional impact and compliance with health recommendations, recent studies find that restrictions on staying at home impact mental health (depression, anxiety, insomnia, stress) compared to other populations (Killgore et al., 2021), which is worse for people in a state of greater vulnerability since they receive a greater impact on their mental health, as well as suffer more from the restrictions of mobilization or social isolation (Hyun-Soo & Laurence, 2020).
Conclusions
This research finds that there are no correlations between the variables studied (emotional impact, effects of the media and compliance with health recommendations). This finding coincides with that found by Angulo-Giraldo, Guanipa-Ramírez & Albites-Sanabria (2021) regarding the impact of the same variables studied on Venezuelan migrant women residing in Lima. Specifically, the media does not have a correlation with the emotional state of university students, but the media did have a relevant impact on young university students in complying with health recommendations, for this reason, it is necessary that future research clearly determines the role they played in this context and their contribution to emotional stability or compliance with health recommendations.
A second conclusion reveals that the information received by university students did not exhibit a direct correlation with their emotions, although some media did have a brief impact on their emotions. This underscores the need to delve deeper into how these young individuals interact with traditional media (especially television and radio) and nearby digital environments (such as WhatsApp groups).
A third conclusion is that while there was no significant correlation between compliance with health recommendations and emotional impact, some dimensions did show a minimal association between the two, primarily related to feeling "calm" and "excited" when indoors, suggesting that it was the safest place for them. Additionally, the use of masks, strongly reinforced by the Peruvian government as the safest method to prevent contagion, elicited emotions aligned with the sense of protection provided by this physical item, akin to when they were indoors.
Finally, a fourth conclusion arises from the minimal yet positive correlation between the effect of the media and compliance with health recommendations. The association between these variables indicates that certain messages managed to reinforce the perception of protection during the pandemic, instilling a sense of security amidst the crisis. This highlights the importance of adopting a coordinated strategy between traditional media, digital social platforms, and individuals themselves in disseminating alert messages to ensure pandemic precautions are adhered to. In times of crisis, it is evident that all channels play a crucial role in societal care, particularly among university students.
