Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E

Original article

Perception of exaggeration or fear propagated by the media among the
Peruvian population during the COVID-19 pandemic

Christian R. Mejia1 https://orcid.org/0000-0002-5940-728
J. Franco Rodriguez–Alarcon2,3 https://orcid.org/0000-0003-4059-8214
Lizet Garay–Rios4 https://orcid.org/0000-0002-0577-7391
Maria de Guadalupe Enriquez-Anco5 https://orcid.org/0000-0001-9963-9178
Alfrando Moreno6 https://orcid.org/0000-0003-4803-0287
Kennedy Huaytán–Rojas7

https://orcid.org/0000-0001-9319-3849

Nory Huancahuari-Ñañacc Huari 8 https://orcid.org/0000-0001-5856-8246
Angel Julca–Gonzales9 https://orcid.org/0000-0003-4337-5251
Christian H. Alvarez10 https://orcid.org/0000-0002-8861-882X
José Choque–Vargas11 https://orcid.org/0000-0001-8653-7850
Walter H. Curioso1 http://orcid.org/0000-0003-3789-7483
1

Universidad Continental. Lima, Perú.

2

Asociación Médica de Investigación y Servicios en Salud. Lima, Perú.

3

Facultad de Medicina Humana. Universidad Ricardo Palma. Lima, Perú.

4

Facultad de Medicina Humana. Universidad Nacional del Centro del Perú. Huancayo,

Perú.
5

Universidad Nacional del Altiplano. Puno, Perú.

6

Universidad Nacional de la Amazonía Peruana. Iquitos, Perú.

7

Universidad Nacional Hermilio Valdizán. Huánuco, Perú.

8

Universidad Nacional San Cristóbal de Huamanga. Ayacucho, Perú.

9

Escuela de Medicina. Universidad Nacional del Santa. Chimbote, Perú.

Esta obra está bajo una licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES1

Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E
10

Universidad Nacional Daniel Alcides Carrión. Pasco, Perú.

11

Universidad Privada de Tacna. Tacna, Perú.

Correspondence: christian.mejia.md@gmail.com

ABSTRACTIntroduction: In global health crises the media is important for reporting on important
issues to the population.
Objective: To characterize and find associations of perceived fear or exaggeration
conveyed by the media in the COVID-19 pandemic.
Methods: Analytical and multicenter cross-sectional study. A virtual survey was conductedamong 4009 people, in 17 cities of Peru, from March 15-20, 2020. The instrument,
previously validated, evaluated three factors: the exaggeration of the media; the fear
generated and the communication coming from health personnel, family members andfriends. Relationship coefficients and p-values were calculated through the use ofgeneralized linear models, with Gaussian family and identity linkage function. Values of p
<0.05 were considered statistically significant.
Results: Social networks (64%) and television (57%) were perceived by all participants as
exaggerating information; also, television (43%) and social networks (41%) increased theperception of fear. As for their family/friends, they perceived that they exaggerated thesituation (39%) and generated fear (25%). In the multivariate analysis, women (p<0.001),
those who had completed high school (p=0.023), were university students (p=0.037) andthose with a postgraduate degree (p=0.002) had a lower total score of fear and perception of
exaggeration.
Conclusions: The perception of exaggeration and fear generation in the population were
mostly caused by television and social networks.
Keywords: Coronavirus, pandemic, social media, fear, Peru.

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Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E

Received: 27/03/2020
Approved: 05/04/2020

Introduction
The mass media become the main source of information for citizens and they have an
obligation to provide reliable and trustworthy information. (1) Media can play an importantrole in sending public health messages around the world and piquing communities’interest.(2) On several occasions, adequate media information has helped internationalorganizations, such as the World Health Organization, to ensure that each person at risk isable to make informed decisions and mitigate the effects/threats during various
pandemics.(3)However, some media have been reported to have negative effects on the health of the
population, such as what happened in Brazil in 2018 during the yellow fever vaccination
campaign. Rumors on social networks that the vaccines could kill, worked against achieving
the vaccination goal, reducing the reach from 95% to 76%. (4) Also, during the AH1N1
influenza pandemic, misconceptions about the mode of transmission and preventive
measures precipitated the onset of the peak phases, thus highlighting the harm of media
misinformation.(5) Chew C. et.al. describe that, among the media, the social network Twitteris the main source consulted by the public,(6) so misinformation on it can be quite dangerous.
This was most evident with the report of the death of two people in Nigeria, after consuming
large amounts of salt water to protect themselves from Ebola, after seeing a social media
post.(7)The coronavirus disease (COVID-19) pandemic is a global health emergency and many
countries are currently affected, with thousands of deaths and a major economic impact. (8,9)
In this context, the media should inform the population appropriately and provide data thatwill enable appropriate decisions to be taken, through the veracity and quality of theinformation they provide.(10) Good use of the media can help to understand and implement
drastic health measures, such as quarantine. This is evidenced by the high acceptance(>95%) that the Peruvian population has of the government's health policies, which included
social isolation and curfews. According to a survey conducted at the national urban level,

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Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E

16% of people report feelings of fear.(11) In this sense, it is important to evaluate theexaggerated information and, in the worst case, false information that circulates throughsocial networks and is disseminated by the media. This is why effective communication andadequate risk communication are necessary.(12) The objective of the research was tocharacterize and find associations of the perception of fear or exaggeration disseminated by
the media during the COVID-19 pandemic in a population not yet studied—the Peruvian
population.

Methods
Studio design
An observational, cross-sectional, analytical, and multicenter study was conducted between
March 15 to 20, 2020.

Population and sample
The study includes 4,009 surveys, conducted virtually in the most important cities of Peru:
Arequipa, Ayacucho, Cajamarca, Cerro de Pasco, Chiclayo, Chimbote, Cusco, Huancayo,
Huánuco, Ica, Iquitos, Lima, Piura, Pucallpa, Puno, Tacna y Trujillo.
People who answered the virtual survey voluntarily, in a complete and appropriate manner(no patterns or anomalous responses), were included. We excluded 323 surveys for being
incomplete (not having one or more of the media perception responses) and 193 for being
taken by minors.
A non-randomized sampling was conducted, which led to a snowball type sampling, where
each respondent requested the participation of their family, friends, fellow students andacquaintances, so that they could share it with other people at the same time.

Variables and tools
The survey consisted of 12 questions to measure the perception of the media, which waspreviously validated in the following phases. First, a bibliographic search was conductedwith scientific articles and other sources of grey literature. In the absence of instrumentsthat fit our reality, we decided to propose our own; the first measurement instrument wasconstructed with 13 items with answers in a Likert type scale (from very much in agreement
to very much in disagreement). Later, an expert judgment was carried out for validation,with 30 experts from different specialties (infectious diseases experts, epidemiologists,

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Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E

health professionals, internists, nurses, and psychologists). Then a pilot survey was
conducted with more than 380 people in 17 cities of Peru. Finally, a statistical validation of
the survey was carried out, where three factors were found, all with adequate statistical andvalidity measures.
Post-survey implementation, the Cronbach's global alpha (0.92) was measured as well as
the Cronbach’s alpha for each of the three factors. Exaggeration of means (items 2, 4, 6, and
8 of the survey), with alpha of 0.90; generated fear (items 1, 3, 5, and 7 of the survey), withalpha of 0.92; and communication of health personnel, family, and friends (items 9, 10, 11,
and 12 of the survey), with alpha of 0.84. These were contained in the survey and were
adjusted for the variables of sex, age, and educational level.

Procedure
After the development of the project and the pilot, the survey was conducted usinga Google Drive sheet. The privacy of the respondents was respected at all times, in theinterest of preserving their anonymity in the research. Also, at the beginning of the survey,
it was mentioned that the overall results would be published in a scientific journal and thatby filling out the survey, the participants understood that they were giving their consent.
Later, a spreadsheet was generated in the Microsoft Excel program (version for Windows
2019), where at first manual debugging was performed and then the information was passed
to a database in the Stata v.11.1 statistical program (StataCorp LP, College Station, TX,
USA), where a second quality control was performed.

Statistical analysis
The analysis was done in three phases. In the first phase, the descriptive analysis of thevariables was done, for which the frequencies/percentages for the categorical variables andthe median/interquartile range for the numerical variables were calculated (after evaluating
the normality of the variables, by means of Shapiro Wilk's statistical test). In the second
phase, a bivariate statistic was used, where the perception of each of the items was crossed
according to the main characteristics. Finally, an analytical statistic was used, where eachone of the 12 items was measured, according to the measured socio-demographic variables.
This was done with the test of generalized linear models, with the Gaussian family, identity
linkage function, and robust models. The adjusted coefficients, 95% confidence intervals

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Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E(CI 95%) and p values were obtained. It was considered statistically significant when a pvalue of less than 0.05 was obtained.

Results
Of the 4,009 properly completed surveys, 54.3% (2166) were answered by women. The
median age of respondents was 23 years (interquartile range 20–28 years). Depending on
the level of education, most reported undergraduate studies (67%), followed by technicalstudies and graduate studies (both 8% each). With respect to the perceived exaggeration of
the magnitude of the situation (Fig. 1), people perceived that the media that exaggerated themost were social networks (26% strongly agreed and 38% agreed), followed by television(21% strongly agreed and 36% agreed), and newspapers/magazines (17% strongly agreed
and 35% agreed).

Fig. 1 - Perception of the Peruvian population about the exaggeration of the media regarding
COVID-19

Regarding the perception of fear generated by the situation (Fig. 2), people perceived thatthe media most conducive to such fear were television (15% strongly agreed and 28%
agreed), followed by social networks (16% strongly agreed and 25% agreed) andnewspapers/magazines (12% strongly agreed and 24% agreed).

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Revista Cubana de Investigaciones Biomédicas. 2020;39(2):e698E

Fig. 2 - Perception of the Peruvian population about the fear generated by the media regarding
COVID-19

With regard to the perception of the communication coming from the health sector or theirfriends/family (Fig. 3), people perceived that family/friends greatly exaggerated thesituation (13% strongly agreed and 26% agreed) and generated a lot of fear in them (8%strongly agreed and 17% agreed).

Fig. 3 - Perception of the Peruvian population about the communication ofhealth, family, and friends regarding COVID-19

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In the multivariate analysis (Table 1), it was found that, women (Coefficient: 0.28; CI 95%:
0.15–0.53; p value<0.001), those who had secondary education (Coefficient: 0.05; CI 95%:
0.01–0.67; p value=0.023), with a university degree (Coefficient: 0.07; CI 95%: 0.01–0.85;
p value=0.037), and with a postgraduate degree (Coefficient: 0.02; CI 95%: 0.01–0.24; pvalue=0.002) had a lower total score, adjusted for age. Regarding the total score of theexaggeration disseminated by the media, it was women who perceived that there was lessexaggeration (Coefficient: 0.49; CI 95%: 0.38–0.62; p value<0.001), adjusted for age andeducation.

Table 1 - Multivariate analysis of factors associated with the sum total and exaggeration
factor that may be disseminated by the media during the COVID-19 pandemic

Note: The age variable was analyzed in its quantitative form. The coefficients (the 95% confidence intervals)
and p values were obtained through generalized linear models, with the Gaussian family, identity-binding
function, and robust variance models.

In relation to the total score of fear generated by the media (Table 2), the older the
respondents, the greater the perception of fear generated by the information sources(Coefficient: 1.018; CI 95%: 1.005–1.032; p value=0.008), adjusted for sex and educational
level. Women (Coefficient: 0.50; CI 95%: 0.39–0.63; p value<0.001), those with secondary

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education (Coefficient: 0.27; CI 95%: 0.09–0.79; p value=0.017), with a university degree(Coefficient: 0.28; CI 95%: 0.10–0.78; p value=0.078) or with a postgraduate degree(Coefficient: 0.17; CI 95%: 0.06–0.50; p value=0.001) had a lower communication score of
exaggeration and fear from health personnel and friends/family, adjusted for age.

Table 2 - Multivariate analysis of factors associated with the sum of fear andcommunication coming from health personnel and friends/family in the COVID-19
pandemic

Discussion
It was found that exaggeration and fear were perceived more in social networks andtelevision. At present, television is the most important medium for the transmission of
information (13,14) and social networks are becoming the preferred means of receiving
information.(15) Television is so important that the time spent in front of it is used as a healthindicator (16) or a dissemination strategy to spread knowledge and prevent diseases.(17,18)
Social networks, on the other hand, can have a negative or positive influence on people, andcan cause or exacerbate anxiety and/or depression. (19,20)

Our results coincide with those reported in a population of university students in Colombia,
where, by means of inquiries, we studied the perception of fear with respect to issues of

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climate change and social security, and its association with the media as a trigger. Here thefactors that trigger fear were classified into four levels—fear of disease being at the thirdlevel, which was underestimated by the Colombian youth population. (21)Silvia Barei, in her work, states that the media can be important drivers of the spread of fear,
and they are even exploited by some people worldwide.(22) It is also known that the
information they disseminate may be biased, which would provoke fear in the case of certain
infectious diseases.(23) This can even occur in other emergency situations, such as in thecontext of drug trafficking, where they can also be the main propagators of fear. (24)In the current COVID-19 crisis, not only did the virus spread rapidly, but the misinformation
about the outbreak generated panic among the public and even a lot of inaccurate/erroneous
information became virulent.(25) To combat this misinformation, geographic information
systems were developed, such as the Johns Hopkins University Center for Science andSystems Engineering (JHU CSSE) dashboard, the WHO ArcGIS Operations Panel for
COVID-19, among others. (26)
A study carried out in China on the psychological impact of COVID-19 on the population,
under similar conditions to ours (in quarantine and through virtual surveys, using thesnowball method to reach a greater number of respondents), obtained the following results.
The medium most used to gain information about this disease was the Internet, and theinformation provided was perceived to be satisfactory. In our study, the majority of the
population surveyed reported that social networks exaggerate information, which differsfrom what was found in the Asian population. People in this study reported less fear after
receiving information from health personnel. In the case of China, people who perceived
that their family doctors were not trained to diagnose or recognize COVID-19, developed
stress, anxiety, and depression. (27)Among the other sources of communication, it was found that family members and friends
were the ones who exaggerated the most and spread fear among the respondents, comparedto health personnel, who had low percentages of these two perceptions. This can be
explained by the fact that family and friends are often the closest people, and if they are
misinformed or unaware of the situation, they can generate misinformation, which can befurther replicated by word of mouth. In contrast, families can play an important supportive
role, both emotionally and socially, which is indispensable while coping with adversity.(28)Thus, in the case of people infected with HIV/AIDS, it has been seen that living with aperson who reinforces negative stereotypes with regard to their disease, increases the fear
and isolation of the infected people.(29) However, this may be influenced by education, basic

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principles, moral, ethical, religious, cultural, political or other conceptions. That is why theindividuals today are more informed; however, it is essential that they have digital literacy
skills in health.(30,31)
Women had lower perception of different aspects of exaggeration or fear. There are reports
stating that women believe that the information provided by media is reliable and true,
unlike men,(31) which would explain their lower perception of exaggeration. Interestingly,
in our study, the information provided by the media generated more fear in men than inwomen, while in other studies regarding fear, the results are contrary. For example, in astudy conducted in Mexico, on types of fear and their prevalence according to gender, it was
shown that in general, women feel more fear than men.(32) A review of fear of media-related
crime also found that women are more fearful.(33) These results can be explained by the factthat they are more driven by feelings or emotions, either by the special education or
upbringing style they receive in relation to men, this being more noticeable in Muslim
cultures.(34) At other times, they are determined to care of their relatives under health risks,
as happened in Uganda during the Ebola outbreak. (35)
The fact that women in our country are less afraid may be related to their practice ofconducting thorough research while making decisions.(36) For example, a recent Peruvian
study showed that women were the most informed when consuming products marked withoctagons—which identify high levels of sugar, fat and salt in food products—with men
being the most reluctant to understand and use them. (37)The older the age, the more the fear perceived, which is understandable and even expected,
since the older population is at a much greater risk of complications from the disease. (38,39)
Possibly this is why the perception of fear is higher, especially if they have comorbidities
for possible complications or even a possible fatal outcome, as found in some
populations.(40)On the other hand, studies show that people with a higher academic degree had lesser
perceptions of exaggeration and fear.(41) Even if it is perceived that there are alterations in
the emission of messages from the media, the interviewees remain calm because of theirgreater education of hygiene, not affecting their daily life.(42)The study, carried out in the midst of a health emergency, has some limitations. One of themis the selection bias. Since the study does not have a representative sample, it is not possible
to extrapolate the results to the entire Peruvian population. In addition, the instrument did
not include variables such as the search for information to make decisions and selfmedication, which should be studied in future. However, due to the size of the sample (moreEsta obra está bajo una licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES

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than 4,000 people) and the diversity of the regions included in this project, we consider thatthe results constitute a good approximation of the situation in our country. At the same time,
this study does not delve into the rural reality of Peru, since the respondents lived in cities.
Therefore, studies that explore the perceptions of the rural population are necessary.
In conclusion, social networks and television were identified as the media that generated themost fear and exaggeration among respondents. Family and friends also contributed in the
propagation of erroneous and exaggerated information. Finally, women and those withhigher education perceived less exaggeration and fear caused by the media because they
considered the information shared by media to be reliable.

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Conflict of interest
The authors declare that they have no conflict of interest.

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