A Qualitative Study on Perception, Attitude and Apathy

towards Non-Pharmaceutical Precautionary Measures

against COVID-19 among Residents of Ibadan, Nigeria
Moronkola, O.A. 1*, Iyanda, A.B1, Moronkola, O.A2 and Omokhabi Abiola. A.2

1. Department of Health Education, University of Ibadan.

2. Department Adult Education, University of Ibadan.

*Corresponding Author: Olawale Akanbi Moronkola, Department of Health Education, University of

Ibadan, Nigeria. Telephone: +2348102415778. Email: walemoronkola@yahoo.com

Funding: The authors received no specific funding for this work.

Summary
BACKGROUND
COVID-19 emerged in Wuhan, China in December 2019 and within a short
period of time it had become a pandemic that will go down in history as a one,
perhaps non-intentional, biological warfare against humanity. It not only caused a
global health crises but also a crisis in the political, economic, educational,
entertainment (including sports, recreation, tourism) and other facets of human
endeavours. COVID-19 has challenged the wittiness of biological, basic and applied
scientists, educational, communication and other social scientists to bring their
expertise on board to curtail its spread. It has also altered day to day national,
international governance structures with serious global diplomatic and economic
challenges and shrinks the gap between the rich, not so rich and poor nations as it
exposes the vulnerabilities of all in response to its threats to lives and livelihoods.
Serious efforts are going on to develop pharmaceutical interventions, nevertheless
the most cost effective way out is non-pharmaceutical interventions of physical/social
distancing, regular washing of hands, use of alcohol based hand sanitizers, consistent
and proper use of face masks to halt or limit the spread of the virus. The
researchers’ main objective was to unravel the perception, attitude and apathy of
residents of Ibadan, Nigeria towards non-pharmaceutical precautionary measures
against the spread of COVID-19.
MATERIALS AND METHODS
This was a qualitative study. It involved residents of Ibadan living around or
in contact with the researchers, having been found by the researchers not to be
observing non-pharmaceutical precautionary measures against COVID-19.
Thematic analysis was done through identification, coding and categorizing patterns
or themes in the data collected.
RESULTS
The study focused on perception, attitude and apathy towards precautionary
measures among residents of Ibadan. Thirty people were interviewed, including 8

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 35
 (26.6%) aged 20-30 years, 10 (30.3%) 31-40, 4(13.3%) 41-50 and 8 (26.7%) aged 51
years above. 19 (63.3%) were Christians while 11 (36.7%) were Muslims. On
educational status, 6 (20.0%) had no formal education, 11 (36.7%) had secondary
education while 13(43.3) had tertiary education .Most of the respondents, except a
few, believed that COVID-19 was not real claiming to have only seen those that had
been infected by the virus in the country on different media platforms such as on
television and social media platforms. Many of the respondents had a positive
attitude while some were indifferent claiming that they could never be infected no
matter how they lived their lives. Majority claimed that it was almost impossible to
maintain social distance as they had to go out in public cars, visit markets and also
visit relatives who would not understand them if they decided to keep social distance.
CONCLUSION
The study revealed good perception of the disease, poor attitude and apathy
towards many aspects of the use of non-pharmaceutical precautionary measures.

Keywords: COVID-19, Non-Pharmaceutical Precautionary Measures

[Afr. J. Health Sci. 2020 33(6):35-43]

international concern and, in March 2020, began

Introduction to characterize it as a pandemic in order to
Coronaviruses are a family of
emphasize the gravity of the situation and urge
contagious viruses that can cause a range of mild
all countries to take action in detecting infection
to severe respiratory illnesses. These viruses can
and preventing spread. Unfortunately at that
mutate rapidly and form new types of
time, there was no medication approved by the
coronaviruses such as the severe acute
FDA and taken through controlled studies and
respiratory syndrome coronavirus 2 (SARS-
demonstrating an effect on the virus. Although
CoV-2) identified in 2019 in China, responsible
there were cures for illnesses and developments
for the COVID-19 disease pandemic [1].In late
made by leaps and bounds in our day, the
2019, a novel coronavirus, now designated
strongest and most effective weapon that society
SARS-CoV-2, was identified as the cause of an
had against this virus affecting not just health
outbreak of an acute respiratory illness in
but also economics, politics, and social order,
Wuhan, a city in the Hubei province of China. In
was the prevention of its spread. The main
February 2020, the World Health Organization
points in preventing the spread in society was
(WHO) designated the disease COVID-19,
hand hygiene, social distancing and quarantine.
which stands for coronavirus disease 2019.
With increased testing capacity, detecting more
The clinical presentation of COVID-19
COVID-19 positive patients in the community
infection ranges from asymptomatic to very
would also enable the reduction of secondary
severe pneumonia with acute respiratory distress
cases with stricter quarantine rules [3]
syndrome, septic shock and multi-organ failure
Worldwide, through the week ending 2
which may result in death [2]. In January 30,
August, 2020, 17.6 million confirmed COVID-
2020, the WHO declared the COVID-19
19 cases, including more than 680,000 deaths
outbreak a public health emergency of

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 36
were reported to the WHO. Over the preceding face and mouth after interacting with a possibly
seven days, the pandemic continued to contaminated environment. To reduce the risk of
accelerate with almost 1.8 million new cases and transmission in the community, individuals were
40 thousand new were deaths reported – a daily advised to wash hands diligently, practice
average of 256,294 cases and 5,675 deaths per respiratory hygiene (i.e., cover their cough), and
day. It took only 4 days for the number of cases avoid crowds and close contact with ill
to increase from 16 million to 17 million [4]. individuals, if possible [3].
The virus has an incubation period of Coronavirus disease (COVID-19)
about five days, spread from human-to-human, having been declared as a global pandemic and
especially via respiratory droplets , body no vaccines or specific drugs for COVID-19
contacts ,having contacts with contaminated available a better understanding and
objects, parts of the body especially hands and implementation of universal safety precautions
faces-eye-nose-mouth. It can also be acquired was essential for the prevention of COVID-19
through contacts with asymptomatic persons, virus infection globally. People’s adherence to
thereby, making COVID-19 highly contagious. the universal precautionary measures against
It spread almost in all countries of the world COVID-19 was essential, largely affected by
within a short period of time, having serious their knowledge and beliefs [5].
health consequences for all especially the elderly In Nigeria there were strong
with pre-existing comorbidities. With no cure in interventions by the federal and state
sight, management of associated symptoms and governments through up-scaling of health
diseases was the best option as well as attempts facilities, risk communication, advocacy, health
at developing a vaccine against the disease. campaign and sensitization, closures of places of
Those with COVID-19 presented, worship and schools ,mass media enlightenment
among others, characteristic symptoms of programmes on the need for the use of the non-
fatigue, sore throat, difficulty in breathing, pharmaceutical precautionary measures to
diarrhea, vomiting and fever. Many challenges safeguard the public health against COVID-19.
and consequences for communities in terms of Nevertheless, there was apparent apathy among
health, social, and economic aspects emerged as residents of Ibadan towards the non-
a result of outbreaks of disease [1].To slow pharmaceutical precautionary measures. If no
down the outbreak, non-pharmaceutical safety care was taken, this could lead to untold
precautionary measures against the diseases consequences due to the potential spread of the
were advocated. virus. Hence, the need for this qualitative study
Early screening, diagnosis, isolation, on perception, attitude and apathy towards non-
and treatment became necessary to prevent pharmaceutical precautionary measures against
further spread. Preventive strategies focused on COVID-19 among the residents of Ibadan,
the isolation of patients and careful infection Nigeria.
control, including appropriate measures adopted
during the diagnosis and the provision of clinical
care to infected patients. The most important
strategy for the population was to frequently
wash their hands and use portable hand
sanitizers as well as avoiding contact with their

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 37
Materials and Methods Reliability and Validity of
Study Design Data Instrument
The researchers adopted the descriptive The instrument was validated by three
and exploratory design. Focus group discussions health sciences experts. Pilot testing of the
and in-depth interviews were used to collect interview guide was carried out to ensure
relevant data from the respondents. relevant data were obtained. Necessary revisions
and adjustments were made before the actual
Study Population study.
The participants were residents of
Ibadan who were not using non-pharmaceutical Data Management and
precautionary measures against COVID-19
transmission during the four-week study period.
Analysis
Notes were taken during each interview
Sampling Technique and prompt summary were documented at the
Convenience sampling technique was end of each interview.Thematic analysis was
adopted. In this qualitative study, those sampled done through identification, coding and themes
were residents of Ibadan living around or having categorization. Data was presented in text format
contacts with the researchers. These had been or verbatim. Thematic analysis was done
observed by the researchers to be ignoring the through identification, coding and categorizing
non-pharmaceutical precautionary measures patterns or themes in the data collected.
against COVID-19.
Ethical Issues
Data Collection Researchers informed respondents that
Data collection was through interviews participation was voluntary from the beginning
held in three locations in Ibadan, comprising ten to the end, they were assured of confidentiality
residents each in an area. There was a limit of and non-disclosure of information given
ten respondents from each location due to individually and that the exercise was purely for
thematic saturation achieved after the eighth academic purposes.
person. A total of 30 people eventually
interviewed.
Results
The study focused on perception,
Recruitment of Participants attitude and apathy towards safety precautionary
Participants were friends and measures among residents of Ibadan. Thirty
acquaintance in the neighbourhoods who had people were interviewed including 8 (26.6%)
previously been engaged in discussions with the between the ages of 20 -30years, 10 (30.3%) 31-
researchers, having been observed to be ignoring 40, 4(13.3%) 41-50 and 8 (26.7%) 51 years and
the non-pharmaceutical precautionary measures above. Also 19 (63.3%) were Christians while
against COVID-19 or complying inconsistently. 11 (36.7%) were Muslim. On educational status,
They were informed about the study and obliged 6 (20.0%) had no formal education, 11 (36.7%)
to participate. An interview guide with prepared had secondary education while 13(43.3) had
items of discussion was used. tertiary education.

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 38
 The three themes emanating from the “Death is certain; they should not make
study were: us afraid all the time .Thank God they are not
i. Perception of COVID-19. saying it is from Africa the disease comes from,
ii. Attitude towards COVID-19 like what they said about HIV/AIDS.”
iii. Apathy towards COVID-19.
On attitude towards physical or social
Perception of COVID-19 distancing, majority claimed that it was almost
Most of the respondents except a few
impossible to do that as they had to go out in
believed that it was not real because they
public cars, visit market and also visit relatives
claimed to have seen those that have been
who would not understand if they decided to
infected by the virus only on different media
keep social distance.
such as television and social media platforms.
Concerning washing of hands with soap
One response each for and against the reality of
or alcohol base hand sanitizer, majority of the
COVID-19 are as presented below:
respondents claimed to have done this at first but
no longer did it regularly. Only two respondents
“Whoever perceives the disease as not
claimed to be doing it regularly.
real is a fool because we all know sebi, that our
immediate past Governor was said to
“I cannot do without washing my hand
have died of the disease, and they also say that
with soap. I go out with alcohol- based hand
the current Governor and some other Governors
sanitizer anytime I‟m going out and I
in Nigeria had it but got healed after they were
apply it very often. I don‟t want to get Covid o,
isolated, attended to by health workers and after
this life is precious.”
two weeks, they got well again”.
Apathy towards COVID-19
“There is nothing called corona virus.
They are just fooling us. Awon ijobakan fi make
Use of Non-Pharmaceutical
owo ni. Opin aye lo de, gbogbowa la Preventive Measures
siku‟.” On whether they maintain physical or
social distancing, majority claimed that it was
Attitude towards COVID-19 almost impossible to do that as they had to go
Most of the respondents had positive
out in public cars, visit markets and also visit
attitude while some were indifferent claiming
relatives who would not understand if they
that they could never be infected no matter how
decided to keep social distance. One said:
they lived their lives.
Some of the respondents said the
“What, it is part of our culture to come
following:
close. Eh! Eh! Do we have enough public
transportation service or we are not
“COVID-19 is a disease of the rich who
going to the market. I bet you, they are deceiving
go out in air conditioned cars, stay in AC offices
themselves.”
and live in AC houses. Politicians and those who
have money to travel outside and come back to
Nigeria should worry about the disease and
their friends as well as relatives.”

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 39
 “Mami onigba, won a wo mi mora ni “As I am more than 55years, in line with
(my mother will not accept this from me), social their warning, I use face mask consistently when
distance ko, social distance ni‟ I go outside and need to meet people as we now
(nonsensense)” have to behave like „Lagbaja‟(Lagbaja- a
popular musician who always covers his head
Concerning washing of hand with soap region like a masquerade).”
or alcohol-based hand sanitizer, majority of the
respondents claimed to have done this at first but On-going out only when necessary, all
no longer did it regularly. Only two claimed to the respondents maintained that when COVID-
be doing it regularly. Below are mixed reactions 19 first started, they were not going out at all,
from respondents: but later went out to do essential things. Some of
the responses given were:
“I cannot do without washing my hand “At first, I was strict with my family
with soap. I go out with alcohol- based hand members not to go out during the lockdown, but
sanitizer anytime I‟m going out and I as times went by, due to economic hardship,
apply it very often. I don‟t want to get Covid o, people need to go out as the palliatives provided
this life is precious.” understandably cannot go round.”

“I better trust God. Will I be carrying “Hunger kills faster than COVID-19
water all over, and do I have sufficient money to and that death from hunger is more painful than
take care of myself before I think about that of COVID-19. Me, I must go out o so that
sanitizer.” my family will not suffer hunger."

“My brother, where is that water they

Discussion
This was a qualitative study on
ask us to be using to wash hands regularly, you
perception, attitude and apathy towards non-
know our leaders are never sincere and always
pharmaceutical precautionary measures against
pretend to act as if all is well.”
COVID-19 among residents of Ibadan, Nigeria.
The outcome of this study can be explained in
On use of face mask, few claimed to use
the following lines. The study found that most
it regularly compared to most that did not use it.
respondents perceived COVID -19 to be real and
Some reactions are documented below:
not a fallacy. The study outcome is in line with
the view that on January 30, 2020, the WHO
“It inconveniences me and there are
declared the COVID-19 outbreak, a public
arguments for and against using nose mask
health emergency of international concern and,
regularly, so I don‟t even know which side is
in March 2020, began to characterize it as a
correct. I choose to do what is convenient for me
pandemic in order to emphasize the gravity of
on that one.”
the situation and urge all countries to take action
in detecting infection and preventing spread.

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 40
This was because the virus which is the interacting with a possibly contaminated
pathogen, spread mainly from person to person environment. To reduce the risk of transmission
especially through respiratory droplets produced in the community, individuals should be advised
when an infected person coughs or sneezes to wash hands diligently especially before and
which may land in the mouths or noses of other after preparing and eating food, using the toilet,
nearby individuals or be inhaled into the or touching any surfaces., practice respiratory
lungs[1,2,3]. hygiene (i.e. cover their cough), and avoid
The attitude of the respondents towards crowds and close contact with ill individuals, if
the disease, may fuel its spread as many were of possible[3,7].
the opinion that it is the disease of the political The use of face masks is was not
class or elites as those who died due to the popular as expected due to what respondents
disease as orchestrated by the media were described as constituting inconveniences. The
members of the political class. Also some of the need to provide financially was also forcing
respondents exhibited fatalistic attitude by people out of their homes despite the threat of
claiming that either way something will surely being susceptible to COVID-19 infection. But
end up killing them, hence there is no need to this finding is contrary to the opinion of experts
fret about the disease. upholding the use of face masks in the
Many respondents showed apathy to the community to primarily serve as a means of
non-pharmaceutical precautionary measures source control. This measure can be particularly
against COVID-19 as many did not engage in relevant in epidemic situations when the number
social/physical distancing. This is against the of asymptomatic but infectious persons in the
general belief, as documented, that the community can be assumed to be high.
behaviour of the public is important for outbreak Wearing a face mask could be
management, particularly during the early phase considered, especially when visiting busy,
when no treatment or vaccination is available closed spaces, such as grocery stores, shopping
and non-pharmaceutical interventions are the centres for example; when using public
only options. transport; and for certain workplaces and
The efficacy of non-pharmaceutical professions that involve physical proximity to
interventions depends on a persons’ degree of many other people (such as members of the
engagement and compliance in precautionary police force, cashiers – if not behind a glass
behaviours, such as face-mask wearing, hand partition, and so on) and when teleworking is not
hygiene, and self-isolation. Willingness to possible [3].
engage in precautionary behaviours voluntarily It has been noted that the WHO
depends on risk perception toward the current emphasized that all countries must strike a
health threat [6]. balance between protecting health, preventing
Many respondents also did not engage economic and social disruption, and respecting
in hand washing regularly due to lack of water human rights. When implemented early and
and minimal use of sanitizers due to cost. combined with other coordinated control
However, the most important strategy for the measures, universal masking in East Asia
population to undertake is to frequently wash provided a feasible solution to keep infection
their hands and use portable hand sanitizer and rates low and the economy open. These
avoid contact with their face and mouth after approaches are in contrast to restrictive social

African Journal of Health Sciences Volume 33, Issue No.6, November -December, 2020 41
distancing policies that have forced the economy People should be educated not to
into recession in many parts of the world. It is underestimate health-promoting behaviours that
time to consider universal masking as we reopen safeguard them from risk of COVID- 19, but
our economy and continue the battle against reinforce such positively with evidence-based
COVID-19 [8]. accurate information and ensure that those so
In a quantitative study, it was reported empowered also serve as social networks to
that properly washing hands with soap and water encourage these positive health promoting
(95.5%), not touching eye-nose-mouth with behaviours among friends, co-workers and
unwashed hands (92.7%), and avoiding crowded family members to forestall the spread of the
places (90.3%) were commonly known methods virus from person to person.
of preventing COVID-19 transmission.
However, 15 (6.1%) mentioned that children and
Competing Interests: The authors
have declared that no competing interests exist.
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