key: cord-1018403-6gahjsyc authors: Elgendy, Marwa O.; Abdelrahman, Mona A.; Osama, Hasnaa; El‐Gendy, Ahmed O.; Abdelrahim, Mohamed E. A. title: Role of repeating quarantine instructions and healthy practices on COVID‐19 patients and contacted persons to raise their awareness and adherence to quarantine instructions date: 2021-08-09 journal: Int J Clin Pract DOI: 10.1111/ijcp.14694 sha: fd231724fc61fb1380bc4cd63a6da940550a6460 doc_id: 1018403 cord_uid: 6gahjsyc OBJECTIVE: This study aimed to develop a model evaluating the role of repeating quarantine instructions and healthy practices among COVID‐19 patients and contact persons at‐home quarantine and to evaluate the instructions' adequacy in decreasing the rate of disease spread with better clinical outcomes. METHODS: A structured questionnaire was distributed to COVID‐19 patients (mild and moderate cases isolated at home) and contacting persons during May and June 2020. Data were collected using a structured online survey collected every five days for three times from each participant. The questionnaire was divided into three sections, consisting of 35 questions for a total possible score of 0 to 35. RESULTS: A total of 150 valid participant's responses out of 304 participants were obtained. Among the150 total participants, 88 were infected with COVID‐19, and 62 were contacting with COVID‐19 patients. The improvement in the score of awareness and adherence to instructions for the infected patients and their contacts was significantly high in the third questionnaire than in the second and the first questionnaire. The people who live in cities followed the instructions provided at the home quarantine better than those who live in the country. The city patients improved in symptoms better than the country patients. Also, patients followed the instructions better than their contacts. City females adhered to the instructions better than city males. Young people had high awareness score than older people. City people are committed to taking both immune boosters supplements as prophylaxis or prescribed medications on time for treatment more than country people. CONCLUSION: This study offers useful insights into factors associated with the role of repeating quarantine instructions and healthy practices to overcome the COVID‐19 pandemic. So, repeating the instructions is important to increase adherence to the instructions, decrease the rate of disease progression and decrease the spread of the infection. The coronavirus disease (COVID-19) is a new viral infection that started in China and caused the infection outbreak in the rest of the world. It is a rapidly spreading virus and is very contagious. 1, 2 COVID-19 has attracted wide attention all over the world. 3 The transmission route between people is through airborne droplets, touching or close contact with an infected person or a contaminated surface. 4 That leads to the phenomenon of clustering infection in families and hospitals. 5 Therefore, awareness of quarantine instructions provided by the World Health Organization (WHO) and national governments are fundamental for COVID-19 patients isolated at home quarantine and their close contacts. to confront the disease and prevent its spread. 6 Since treatment protocols against SARS-CoV-2 are still developing, public education and awareness of infection control measures are the mainstays to minimise the viral spread either in health care settings or in the community, 6 especially in countries with limited income resources, where health care systems, at best, have limited capacity to respond appropriately to outbreaks. Thus, management of the pandemic depends mostly on people's adherence to the recommended instructions and measures taken. 5, 7, 8 In addition, continuous counselling and repeating instructions to the quarantined COVID-19 patients and people in close contact with them play a vital role in increasing their awareness, and limiting the spread of infection. 9 Hence, the present work aimed to develop a model evaluating the role of repeating quarantine instructions and healthy practices to increase awareness and practices related to the COVID-19 quarantine instructions among the COVID-19 patients, including mild and moderate cases isolated at home and the persons contacting them at home quarantine; also, to evaluate the adequacy of the instructions to attain better clinical manifestations. This study was a prospective study that included subjects with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 with mild and moderate symptoms, isolated at home. The subjects diagnosed at Beni-Suef Chest hospital or Beni-Suef fever hospital then they were quarantined at home and followed by mem- All survey assessment questions were developed by the investigators from the instructions provided by the Ministry of Health and the WHO questionnaire. 9 These questionnaires included three main parts to assess their knowledge about the necessary practices. The average time required to fill the questionnaire was 20 minutes. Tables 1 and 2 • The role of repeating quarantine instructions and healthy practices between COVID-19 patients and contact persons at-home quarantine is very critical in decreasing the rate of disease progress. • The improvement in the score of awareness and adherence to instructions for the infected patients and their contacts was significantly high in the third questionnaire than the second questionnaire than the first questionnaire. • Repeating the instructions is important to increase adherence to the instructions, decrease the rate of disease progression and decrease the spread of the infection. Answers to the last three parts of the questionnaire were recorded as (Yes), (No) and (To some extent). The person was given a score = 1 if he/she gave the correct answer for the question and a zero score if he/she fails to provide the correct answer to end up with a total range from 0 to 35. Finally, the participants were classified according to the quarantine instructions awareness if he/she scored >28 out of 35 (>80%) points. [10] [11] [12] [13] The estimation of the minimum required sample size was carried out using G* power 3.1 software. The calculations were performed based on a 50% anticipated probability of positive response and good knowledge, with a 95% confidence interval and precision limit of 5%. Statistical analysis and data visualisation were performed in A total of 304 subjects were recruited into the study, however, only 150 eligible participants completed the study. About 25% of the withdrawn subjects reported failure to respond due to technical problems, A total of 58 (38.6%) subjects included both infected cases and their contacts were rural residents. The mean awareness scores after the three consecutive visits for patients and their contacts who lived in the city differed significantly from those living in the country and the estimated p-value was P < .001 and P = .0072, respectively, as shown in Figure 2 . However, the answers to the questionnaire showed evidence of ceiling effect, since the majority of responses were at the maximum possible levels. The association between the participants' scores and the different demographic parameters was performed. There were significant differences in the achieved awareness scores between respondents depending on gender, age, educational levels, employment status, and marital status (P < .05). Multivariate analyses revealed that city residents with education levels higher than high school and employed regardless of gender had significantly higher scores in awareness (P < .05). However, contacts showed lower awareness scores after the completion of the counselling visits; especially for rural residents regardless of age, gender, occupation and marital status. Data modelling showed that the older the patient or the contact persons the lower the total score as demonstrated in Figure 3 . For the COVID-19 group, this decrease in score with increasing age was comparable between both genders, while for the contact persons the level decrease more for males with increasing age compared with females that maintained high score levels with increasing age. Also, the effect of education level resulted in a strong increase in the We analysed the data to recognise predictors for those participants who responded positively to the counselling visits and found F I G U R E 2 Box plots showing the overall response and awareness scores during the three questionnaires between (A) infected patients in the city compared with the country, and (B) contacts people in the city compared with the country F I G U R E 3 A response surface plot represents the relationship between age and gender compared with the total score for both groups; (A) for contacts, (B) for patients that participants who lived in the rural community were less likely to respond to the intervention with significantly lower awareness scores compared with city residents. Since most of the country residents showed improper attitudes toward infection control practices including disinfection of surfaces that were touched, covering mouth and nose while sneezing or coughing using a disposable tissue, and sharing personal tools. This is maybe due to the lower education levels and the lack of technology for the people who live in the country since highly educated persons can get knowledge from different sources compared with low educated ones. 7 Therefore, their achieved awareness scores were markedly less than those of city inhabitants. Thus, they needed more frequent repetition of quarantine instructions and healthy practices to increase awareness about self-hygiene and home hygiene. 15 The infected patients showed higher commitment to the quarantine instructions and proper medication use, in contrast to the contacts that showed a significantly lower awareness score. This behavior may be explained in the light of the idea that most of the contacts who participated in the study were not categorised as vulnerable populations since they did not fulfil the risk factors identified for severe COVID-19 such as elderly or presence of comorbidities. Moreover, the burden of psychological depression and loneliness resulted from quarantine instructions hindered most of the contacts against responding to the instructions and avoid social gatherings; maybe also because they were not infected. Yet, so they did not pay attention to adhere to the instructions. Consequently, infected patients from the city felt better symptoms of COVID-19, since they were committed to health guidelines with several studies which reported the positive effect of repeated counselling on awareness scores and adherence to instructions. [15] [16] [17] Most of the participants in this study (about 76.7%) were employed, but they showed no significant difference in the score compared with unemployed patients. This may be due to their limited resources in addition to the psychological consequences of not working during the pandemic which causes their lack of interest in the instructions. [21] [22] [23] [24] As the media enters every home and affects people, it is useful to develop the instructions through the media to reach the maximum benefit. 25 The strength points of this study lie in the adequate assessment of awareness and practices toward COVID-19 which was developed by in-depth personal interviews and follow-up and the application of multi-dimensional measures; in addition to randomisation of the recruited population. The study included skilful populations in smartphone use and software technology. Some rural populations have limited resources and are devoid of these skills, especially elderly ones. Patients with severe cases who needed to be admitted to the hospital are excluded from the study. Besides, there is no long-term follow-up to evaluate the clinical outcomes of this conducted survey. This study offers useful insights into factors associated with the role of repeating quarantine instructions and healthy practices in increasing the COVID-19 instructions awareness and practices to improve the infected cases and decrease the spread and transmission of the infection through the community. The improvement in the score of awareness and adherence to instructions for the infected patients and their contacts was significantly high in the third questionnaire than the second questionnaire than the first questionnaire. The people who live in cities follow the instructions provided to them at the home quarantine, are committed to taking the prescribed medication on time for treatment and so showed improvement in symptoms better than those who live in the country. Also, patients follow the instructions better than their home contacts do. City females adhere to the instructions better than city males. Young people have high score awareness than older people. 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