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Nosophobia, hypochondriasis, and willingness of people to seek healthcare amidst the COVID-19 pandemic in Calabar Metropolis of Cross River State, Nigeria

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Aim: This study investigated the prevalence of nosophobia, hypochondriasis, and willingness of people to seek healthcare amidst the COVID-19 pandemic in Calabar Metropolis of Cross River State, Nigeria. Methods: A cross-sectional descriptive survey design and questionnaire was used to collect data from 200 respondents randomly sampled. Data were sorted, cleaned, coded, and analysed using Statistical Package for the Social Sciences (SPSS) version 20 software, and hypotheses tested using Chi-square test, significant at 95% confidence interval (CI) (0.05). Results: One hundred and eighty two (91%) respondents presented with nosophobia and hypochondriasis, slightly more in women (92 [46%]) as compared to men (90 [45%]), and these had increased with age. Phobia was attributed more to the coronavirus disease 2019 (COVID-19) (48 [24%]), and human immunodeficiency virus and acquired immuno-deficiency syndrome (HIV/AIDS) (40 [20%]) as compared to other diseases, that also, instilled fear and anxiety on respondents. One hundred and fifty seven (78.5%) displayed poor willingness to seek healthcare. Conclusions: Nosophobia and hypochondriasis were found to be associated with age and healthcare seeking behaviour. Gender and education did not play significant role. Fear varied according to the type of diseases. Therefore, public sensitisation is necessary.
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Nosophobia, hypochondriasis, and willingness of people
to seek healthcare amidst the COVID-19 pandemic in
Calabar Metropolis of Cross River State, Nigeria
Nta Obono Okoi1, John John Etim2
1Department of Family Medicine, University of
Calabar Teaching Hospital, Calabar, Nigeria,
2Department of Public Health, Faculty of
Allied Medical Sciences, University of Calabar,
Calabar, Nigeria
Correspondence: John John Etim,
Department of Family Medicine, University of
Calabar Teaching Hospital, Calabar, Nigeria.
PIN: 540001/+234. etmjhn@gmail.com
Received: 27 July 2020
Revised: 18 August 2020
Accepted: 18 August 2020
Epub: 26 August 2020
Abstract
Aim: This study investigated the prevalence of nosophobia, hypochondriasis,
and willingness of people to seek healthcare amidst the COVID-19 pandemic in
Calabar Metropolis of Cross River State, Nigeria. Methods: A cross-sectional
descriptive survey design and questionnaire was used to collect data from 200
respondents randomly sampled. Data were sorted, cleaned, coded, and analysed
using Statistical Package for the Social Sciences (SPSS) version 20 software, and
hypotheses tested using Chi-square test, signicant at 95% condence interval
(CI) (0.05). Results: One hundred and eighty two (91%) respondents presented
with nosophobia and hypochondriasis, slightly more in women (92 [46%]) as
compared to men (90 [45%]), and these had increased with age. Phobia was
attributed more to the coronavirus disease 2019 (COVID-19) (48 [24%]), and human
immunodeciency virus and acquired immuno-deciency syndrome (HIV/AIDS)
(40 [20%]) as compared to other diseases, that also, instilled fear and anxiety on
respondents. One hundred and fty seven (78.5%) displayed poor willingness to
seek healthcare. Conclusions: Nosophobia and hypochondriasis were found to be
associated with age and healthcare seeking behaviour. Gender and education did
not play signicant role. Fear varied according to the type of diseases. Therefore,
public sensitisation is necessary.
Keywords: Diseases. Illness. Phobia. Anxiety.
INTRODUCTION
Nosophobia is the extreme or irrational fear of developing or
having a specic disease. is is otherwise known as disease
phobia. It is sometimes referred to as medical students
disease. is is because it is assumed that nosophobia tends
to mostly aect medical students surrounded by information
about dierent diseases.[1,2] Nosophobia involves the
fear of developing a specic disease, while hypochondria
involves more general worries about illness. In other words,
nosophobia is fear of diseases while hypochondriasis is
the fear of illness or illness anxiety disorder.[3] e fear of
contracting a particular disease has over time inuenced
healthcare seeking behaviour. On the other hand, this fear has
also, prevented people from willingly accessing healthcare for
routine health checks due to the fear of being diagnosed of
such ailments with the reason that ‘it is better not to know
than, to know and, live in continuous fear of dying of it’.
ese diseases range from the coronavirus disease 2019
(COVID-19), human immunodeciency virus and acquired
immunodeciency syndrome (HIV/AIDS), tuberculosis
(TB), sexually transmitted infections (STIs) to cancers of
dierent types, and many non-communicable diseases
(NCDs).[1-3]
Hypochondriasis is a preoccupation with having a serious
disease based on a misinterpretation of bodily symptoms.[4]
e diagnosis of hypochondriasis in the fourth edition of
the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) includes “four symptoms: preoccupation with or
fears of having a serious disease, preoccupation or fears persist
aer medical reassurance, preoccupation or fears interfere
signicantly with functioning”, and the symptoms last more
than six months.[1-4] e DSM-5 replaced hypochondriasis
with illness anxiety disorder, which broadens the description
of hypochondriac symptoms to include behavioural and
distress symptoms, and are more reliable and clinically useful
in identifying hypochondriasis as well as nosophobia.[1-4]
“In seven cross-sectional studies involving 6,217
respondents, the pooled prevalence of hypochondriac
symptoms among the respondents was 28.0% (95% condence
interval [CI]=19.0%–38.0%) and the symptoms were a little
more common in females (30.0%, 95% CI=19.0%–42.0%)
than in males (29.0%, 95% CI=16.0%–42.0%), but the
dierence was not found signicant”.[4]
“Previously done studies have examined barriers to health
care utilization, with the majority conducted in the context
of specic populations and diseases.[4,5] “Less research has
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Okoi and Etim: Nosophobia, hypochondriasis, and healthcare seeking amidst the COVID-19 pandemic
OJPAS® | 2020 Aug 26 [Epub ahead of print]
focused on why people avoid seeking medical care, even
when they suspect they should go”.[5] To get more insight
on this, national data was used through qualitative research
to know why people avoid medical care. Data were collected
from 1,369 participants (40% male and mean age=48.9 years).
Responses were coded using a general inductive approach.
e study showed that a total of 58.4% of the participants gave
their reason to avoiding healthcare as fear of being diagnosed
of diseases other than the signs they presented.[5]
It is no doubt that singles and youths get more worried
about STIs dues to their life style while the elderly get more
worried about NCDs.[4,5] is may be a reection of the
fact that this fear varies according to the type of diseases in
question. A particular study found out that age is not signicant
in terms of nosophobia as it varies depending on the diseases
in question.[6] Ageing is oen associated with deteriorating
body and psychological health, and the essence for prolonged
care, creating the phobia of getting old. To be detailed, similar
study investigated what people fear most in terms of disabling
chronic diseases and their concerns regarding having long-
term illnesses. Data from 518 respondents, collected through
convenience sampling, were analysed using chi-square tests
and multinomial logistic regression. Results revealed that, “of
the most dreaded diseases, heart disease and cancer are life-
threatening; however, dementia, diabetes, and hypertension
persisted and have a disabling eect for a long time.[6]
While there were variations in the diseases feared most across
gender, ethnicity, and place of residence, the biggest worry for
all respondents with regard to having a long-term illness was
that they would become a burden to their family, a concern
that superseded fear of dying. It was recommended that there
is need to provide motivation for people to adopt a healthy
lifestyle and remain healthy.[6]
Rheumatic diseases and inammatory joint disease (e.g.
arthritis) where found to be most feared by the aged, and
translates to the fear of death which, by extension makes the
elderly scared of accessing healthcare.[7] Further, it has been
found that poor healthcare seeking behaviour was associated
with the fear of being diagnosed of heart diseases and other
NCDs.[8] Recently an investigation found a good proportion
of men who were scared of being diagnosed of infertility, and
accepting vasectomy as a family planning method which as
such, prevented them from willingly seeking healthcare.[9]
e fear of HIV/AIDS is not dierent which still lingers till
today where people hardly give themselves for voluntary
testing to know their status.[10] According to some group
of researchers, the fear of testing positive to HIV/AIDS has
aected healthcare seeking behaviour in Nigeria.[11]
In March 2014, the outbreak of Ebola was reported by
World Health Organization (WHO) and was later reported in
Nigeria in August 2014. e fear of this outbreak awakened
proper hygiene practices amongst citizens globally, and
Nigeria in particular. It increased consciousness on self-
hygiene but, did not increase healthcare seeking behaviour.
According to studies, Ebola conjured palpable fear on
Nigerians and triggered better self-hygiene, but did not really
solve the problem of better healthcare seeking behaviour.[12]
In a research article on “Long shadow of fear in an epidemic:
fearonomic eects of Ebola on the private sector in Nigeria,
researchers highlighted that Ebola was worsened by a fear
of contagion that aggravated the health crisis.[13] e study
ndings reveal that the fearonomic eects of Ebola included
health service outages and reduced healthcare usage as a
result of misinformation and aversion behaviour by both
patients and healthcare providers.
This is not different from the current COVID-19
pandemic where globally, people are scared of the
pandemic and has triggered better personal hygiene and
healthy social behaviours but, rather worsens people
access to healthcare because of the fear of being diagnosed
of COVID-19, isolation, stigmatisation, etc.[11-13] On
27 February, 2020, the first official case of COVID-19 in
Nigeria was confirmed. The patient was an Italian citizen,
who had then arrived in Lagos from Europe and who, a
few days later, tested positive for the disease.[14] Ever
since, Nigerian States have been recording an upsurge in
the number of COVID-19 cases, and this has instilled fear
on both healthcare teams and the public. This fear has
affected mental health and healthcare seeking behaviour of
Nigerians. Therefore, there is need in tackling such mental
health issues.[15] However, since then, till the time this
study was completed, Cross River State, as one of the States
in Nigeria, has been the only State in Nigeria that has not
recorded any case of COVID-19. Though, Cross River
State has not recorded any case, her citizens are scared, and
this has resulted to poor and decline in healthcare seeking
behaviour in the people and has aggravated the practice of
self-medication. It was based on this background that this
study was instigated.
Statement of problem
It is no doubt that government, educators, and researchers
are making tangible eorts to increase awareness on the
need for better healthcare seeking behaviour but, the
fear of being positive for certain diseases has prevented
people from constantly presenting themselves for health
screenings. It is a common belief that it is better to live
without knowing your status of any diseases especially the
ones without symptoms and those without found cure than
knowing it, then continue to live in fear of dying from it one
day. is fear has been displayed by respondents in the area
of HIV/AIDS, certain cancers, TB, STIs, Ebola, COVID-19,
and many others. e researchers observed that the fear of
these diseases has over time, negatively aected healthcare
seeking behaviour, coupled with the current global outbreak
of COVID-19 pandemic which has currently made every
Nigerian and Cross Riverians in particular, to refrain from
willingly seeking healthcare.[14,15] ere is really a gap
in knowledge about these diseases and trust on healthcare
providers which has to be bridged. It was based on this
observed problem, the researchers were interested in the
st udy.
Objectives
is study investigated the prevalence of nosophobia,
hypochondriasis, and peoples’ willingness to seek healthcare
amidst the COVID-19 pandemic in Calabar Metropolis of
Cross River State, Nigeria.
Okoi and Etim: Nosophobia, hypochondriasis, and healthcare seeking amidst the COVID-19 pandemic
OJPAS® | 2020 Aug 26 [Epub ahead of print]
Hypotheses
e following hypotheses were tested:
H1
ere is no association between demographic variables (gender,
age, and education) and nosophobia/hypochondriasis.
H2
ere is no association between nosophobia/hypochondriasis
and healthcare seeking behaviour.
METHODS
e study adopted a cross-sectional descriptive survey design.
Calabar Metropolis is the capital of Cross River State with an
area of 406 km2 and population of 461,796. Administratively,
it is divided into Calabar Municipal and Calabar South Local
Government Areas, and lies between Latitude 4048 North
and Longitude 8017 East. Bounded to the North by Odukpani
and Akamkpa Local Government Areas, Great Kwa River to
the East, and to the South is the Calabar River. ere are a
total of 137 healthcare facilities (44 private, 16 public, and
77 primary healthcare centers [PHC]). National population
commission (2015) revealed that, there are about 74,580
households in the metropolis as projected, and there are 11
wards in Calabar Municipality Local Government Area and
13 wards in Calabar South Local Government Area. e
study area has one federal university, one state university,
one private university, one college of health technology, and
various secondary and primary schools. e main dwellers
are the Eks, the Efuts, and the Quas whose major, widely,
and common spoken language is Ek and Ejagam. ey as
well use English as means of communication.
Multi-stage sampling technique was used in the study.
Formula used for sample size calculation was:
n = (Z2pq)/d2
Where: n = sample size
Z = Z-score: standard normal deviation at 95% level of
condence (1.96)
p = prevalence (50% = 0.5) [50% was estimated since
there was no known prevalence]
d = margin of error (7% = 0.07)
n = (Z2pq)/d2 = (1.962 x 0.5 x 0.5)/0.072 = (3.8416 x 0.5 x
0.5)/0.0049 = 0.9604/0.0049 = 196
Calculating for two per cent non response rate (two per
cent based on authors’ discretion) = 196 x 2/100 = 196 x 0.02
= 3.92
Adding 3.92 of non-response to the calculated sample =
3.92 + 196 = 199.92
erefore, n = 200
Systematic sampling techniques was used to sample
streets and households following the sequence rst, third,
h, seventh, ninth, 11th, etc. till a total of 200 (100 males and
100 females) respondents were sampled from 100 households
in 15 wards. Two respondents each were sampled from each
household through simple random sampling technique. e
choice of 200 sample size was done conveniently not by scientic
calculation in order to help the researchers conveniently carry
out the study within their limited resources. Respondents
who were on a brief visit to the metropolis were excluded
from the study. is was to allow the researchers collect data
from only those who are fully residents of the study area.
is was also to allow for better discussion of the ndings in
line with the characteristic of the respondents in the study
area. Instrument used for data collection was questionnaire
designed by the researchers. e questionnaire had two parts:
part A focused on respondents consent while part B focused
on respondents’ sociodemographic characteristics and
assessment of nosophobia/hypochondriasis and healthcare
seeking behaviour. Respondents were to provide responses
based on ve Likert scale on the scale one, two, three, four,
and ve.
Respondents’ verbal and written consent were sought
before data was collected. Condentiality of respondents was
assured and freedom to participate or withdraw from the study
was guaranteed. Data were collected from respondents in their
place of residence and it spanned through three months. Data
collected were sorted, cleaned, coded, and analysed using
Statistical Package for the Social Sciences (SPSS) version
20soware, and hypotheses were tested and cross-tabulated
using Chi-square test. Results were signicant at 95% CI
(0.05). Results are presented using descriptive statistics
like frequencies, percentages, charts, tables, and inferential
statistics for easy interpretation and comprehension.
RESULTS
Data were collected from 200 respondents (100 males and
100 females). Majority (65 [32.5%]) were aged 50 years and
above while a few (11 [5.5%]) were below 18 years. Most of the
respondents had tertiary education (64 [32.5%]) while the least
proportion (40 [20.0%]) had no formal education (Table1).
Table 1: Demographic data of respondents
Variables Frequency (%)
Gender
Males 100 (50.0)
Females 100 (50.0)
Age
Below 18 years 11 (5.5)
18-25 years 12 (7.0)
26-33 years 24 (12.0)
34-41 years 31 (15.5)
42-49 years 55 (27.5)
50 years and beyond 65 (32.5)
Education
No formal education 40 (20.0)
Primary education 45 (22.5)
Secondary education 51 (25.5)
Tertiary education 64 (32.5)
Okoi and Etim: Nosophobia, hypochondriasis, and healthcare seeking amidst the COVID-19 pandemic
OJPAS® | 2020 Aug 26 [Epub ahead of print]
A total of 182 (91.0%) admitted to have fear of illness
and infections while only 18 (9.0%) boldly said they have
no fear for any diseases. e diseases which exerted most
fear on the residents were COVID-19 (48 [24.0%]), followed
by HIV/AIDS (40 [20.0%]) and STIs (32 [16.0%]) while the
least feared disease was Ebola (seven [3.5%]) as shown in
Figure1.
A greater proportion of the respondents (64 [32.0%])
reported fear of death as a major reason to their phobia
while 50 (25.0%) said fear of stigmatisation and 46 (23.0%)
said disease that has no found cure triggers more fear in
them (Figure2). Randomly, 157 (78.5%) would never want
to seek healthcare for routine checks except very ill while
only 43(21.5%) admitted being ever ready to seek healthcare
(visiting health facilities) even when they show no signs or
symptoms for any disease.
Hypothesis one (H1)
ere is no association between demographic variables
(gender, age, and education) and nosophobia or
hypochondriasis. ough, there is a slight dierence in the
prevalence of nosophobia or hypochondriasis among females
(92 [46.0%]) than men (90 [45.0%]), analysis using Chi-
square test showed that the association was not statistically
signicant (P=0.62; degree of freedom [df]=1; Chi-
square=0.24). e null hypothesis was therefore not rejected
and then concluded that there is no statistically signicant
association between gender of an individual and nosophobia
or hypochondriasis in the study area.
e next sociodemographic variable tested was age.
e analysis showed that nosophobia or hypochondriasis
is associated with age where older persons showed more
symptoms, and analysis using Chi-square test showed that the
association was statistically signicant (P=0.001; df=5; Chi-
square=20.08). erefore, the null hypothesis was rejected to
imply that there is association between age and nosophobia or
hypochondriasis in the study area.
e third sociodemographic variable tested was
education. Although the prevalence of nosophobia or
hypochondriasis was more among people with tertiary
education, the analysis on education was not found signicant
(P=0.15; df=3; Chi-square=5.32). erefore, the researchers
Figure 1: The reported most feared diseases/illnesses by respondents. COVID-19: Coronavirus disease 2019; HIV/AIDS: Human immunodeciency virus/acquired
immunodeciency syndrome; STIs: Sexually transmitted infections; TB: Tuberculosis.
Figure 2: Respondents’ reasons behind nosophobia/hypochondriasis.
Okoi and Etim: Nosophobia, hypochondriasis, and healthcare seeking amidst the COVID-19 pandemic
OJPAS® | 2020 Aug 26 [Epub ahead of print]
failed to reject the null hypothesis by concluding that there
is no association between education and nosophobia or
hypochondriasis in the study area (Table2).
Hypothesis two (H2)
ere is no association between nosophobia or
hypochondriasis and healthcare seeking behaviour
(willingness to visit health facilities). Of all the 182 (91.0%)
respondents who display nosophobia or hypochondriasis,
only 38 (19.0%) admitted having better healthcare seeking
behaviour while 144 (72.0%) would not want to seek
healthcare except in critical conditions. Analysis using Chi-
square test showed that the association was statistically
signicant (P=0.001; df=1; Chi-square=7.82). Based on
this, the researchers rejected the null hypothesis thereby
concluding that there is association between nosophobia or
hypochondriasis and healthcare seeking behaviour among
residents in the study area (Table3).
DISCUSSION
A good proportion of respondents (91.0%) displayed fear
of illness and disease (nosophobia or hypochondriasis)
and of this percent that are scared, 78.5% displayed poor
willingness to want to seek healthcare (visiting health
facilities) for routine checks except in critical conditions.
is is a signicant proportion which justies that phobia
can inuence willingness to seek healthcare. is nding is
corroborated by studies whose nding showed that a total of
58.4% of participants displayed fear of diseases and served
as reason for avoiding health facilities to prevent being
diagnosed of diseases other than the signs they presented.[5]
To further support this nding, additional studies found that
the most feared diseases were that of NCDs and fear of dying
which caused people to avoid healthcare.[6]
e present study showed that there is no statistically
signicant association between gender of an individual and
nosophobia or hypochondriasis in the study area. is means
Table 2: Association between demographic variables and nosophobia/hypochondriasis
Test variables Nosophobia/hypochondriasis Chi‑square P‑value
Not scared Scared
Gender Total
Male 10 (5.0%) 90 (45.0%) 100 (50.0%) 0.24 0.62
Female 8 (4.0%) 92 (46.0%) 100 (50.0%)
Total 18 (9.0%) 182 (91.0%) 200 (100%)
Age
Below 18 year 4 (2.0%) 7 (3.5%) 11 (5.5%) 20.08 0.001*
18-25 years 4 (2.0%) 10 (5.0%) 14 (7.0%)
26-33 years 1 (0.5%) 23 (11.5%) 24 (12.0%)
34-41 years 1 (0.5%) 30 (15.0%) 31 (15.5%)
42-49 years 5 (2.5%) 50 (25.0%) 55 (27.5%)
50 years and above 3 (1.5%) 62 (31.0%) 65 (32.5%)
Total 18 (9.0%) 182 (91.0%) 200 (100%)
Education
No formal education 7 (3.5%) 33 (16.5%) 40 (20.0%) 5.32 0.15
Primary education 3 (1.5%) 42 (21.0%) 45 (22.0%)
Secondary education 5 (2.5%) 46 (23.0%) 51 (25.5%)
Tertiary education 3 (1.5%) 61 (30.5%) 64 (32.0%)
Total 18 (9.0%) 182 (91.0%) 200 (100%)
*Statistically signicant at P value<0.05 or Chi-square>Critical value (Cv). (dfGender=1; CvGender=3.84) ; (dfAge=5; CvAge=11.07); (dfEducation=3; CvEducation=7.81)
Table 3: Association between nosophobia/hypochondriasis and healthcare seeking behaviour of respondents
Test variables Healthcare seeking behaviour (people willing to seek
healthcare amidst the fear)
Chi‑square P‑value
Will not Will seek
Nosophobia/hypochondriasis Total
Not scared 13 (6.5%) 5 (2.5%) 18 (9.0%) 7.82 0.001*
Scared 144 (72.0%) 38 (19.0%) 182 (91.0%)
Total 157 (78.5%) 43 (21.5%) 200 (100%)
*Statistically signicant at P value<0.05 (df=1; Critical value=3.84)
Okoi and Etim: Nosophobia, hypochondriasis, and healthcare seeking amidst the COVID-19 pandemic
OJPAS® | 2020 Aug 26 [Epub ahead of print]
that it can be present in an individual despite the gender. is
is not signicant probably because individual dierences
can determine whether or not fear for illness or sickness is
displayed, not really whether one is male or female. Ones
gender has nothing to do with fear for a particular disease.
is is not too dierent from a similar research nding that
the pooled prevalence of hypochondriac symptoms among
respondents was a little more common in females than in
males whose dierence was not signicant.[4]
e analysis on age showed that nosophobia or
hypochondriasis is associated with age where older persons
showed more symptoms, and analysis using Chi-square
test showed statistically signicant association. is further
means that fear of diseases increases as one gets older. is
may be probably because of the fear of death as one gets
older.[7] e public health signicance is obvious in that, as
people get older, they get more skeptical about their health
and feel more susceptible to morbidity and mortality; hence,
there in need to focus public health intervention actions on
such groups. is is in tandem with a research that found
that rheumatic diseases and inammatory joint disease (e.g.
arthritis) were most feared by the aged (older groups) and
translates to the fear of death which, by extension made the
elderly scared of accessing healthcare.[7] Contrary to this
nding, a study found out that age is not signicant in terms
of nosophobia.[6] is contrary nding may probably be due
to dierences in study area (place of residence), ethnicity, and
sample size used by the researchers, as well as dierence in
sociodemographic characteristics of respondents used in the
st udy.
Education was not found statistically signicant. is is
evident because the prevalence of nosophobia or hypochondriasis
was slightly higher among people with tertiary education.
erefore, the researchers concluded that there is no association
between education and nosophobia or hypochondriasis in the
study area. is justies the fact that being learned or not does
not really eliminate fear for that which is known. However,
knowledge for a particular illness may create awareness that will
trigger precautionary measures but, may not really eliminate the
fear of such illness.[3,9] is further implies that, no matter what
one’s educational level is, one may be susceptible to nosophobia
or hypochondriasis.
A total of 19.0% respondents admitted willingness to
visit healthcare facilities for care at any time while 72.0% of
respondents reported not being willing to seek healthcare
except in critical conditions. Analysis using Chi-square test
showed that the association was statistically signicant.
Based on this, the researchers concluded that there is
association between nosophobia or hypochondriasis
and healthcare seeking behaviour (willingness to seek
healthcare) among residents in the study area. at is,
perceived susceptibility can inuence willingness to seek
healthcare. is is supported by a study that poor healthcare
seeking behaviour is associated with the fear of being
diagnosed of a disease.[8] To further support this nding,
a study by a team of researchers established that the fear of
being tested positive to HIV/AIDS has aected healthcare
seeking behaviour in Nigeria.[11,13,14] However, due to fear
of being diagnosed of disease, people may still feel reluctant
to visit health facilities.[14] It is no doubt that, even if
people had health seeking behaviour, they may be scared to
contract diseases in hospitals and clinics. ese reasons may
not really be far from the disease phobia but, as well may
include fear of suering that may be incurred by the disease
and its treatment, stigmatisation, loss of time from work,
becoming burden to their families, mental stress, etc.[16,17]
e basic limitations of this study includes: smallness of
the sample size that may not allow for generalisation of
this study nding, study area (place of residence) that gives
respondents unique characteristics that may be dierent
from people in other locality, ethnicity, time of the study
(timing) which took place during the COVID-19 upsurge
that may have contributed to the high prevalence of disease
fear among respondents, and statistical tools used in the
analysis of the data collected (choice of methodology).
Conclusion
is study focused on prevalence of nosophobia and
hypochondriasis as it inuences healthcare seeking
behaviour. is was carried amidst the COVID-19 pandemic
which made people to avoid healthcare services. Respondents
presented nosophobia or hypochondriasis in one way or the
other, and were slightly prevalent in women as compared to
men, increases with age and educational level. Respondents
displayed more fear for COVID-19 and HIV/AIDS than
other diseases. A signicant proportion never wanted to
seek healthcare for fear of illness. Looking at association of
nosophobia with sociodemographics, gender and education
were not statistically signicant while only age was statistically
signicant. However, the association between nosophobia,
hypochondriasis, and healthcare seeking behaviour was
statistically signicant. e researchers recommend the
following based on the key ndings from the study:
i. ere is need for continuous increase in awareness
creation on the essence of regular health checks by
stakeholders like healthcare workers, researchers, non-
governmental organisations (NGOs), government,
academia, religious leaders, and health educators to
prevent diseases in its primary phase.
ii. Since the prevalence of nosophobia/hypochondriasis
progresses with age, intervention focus should be more
on adults and the elderly for it to be more eective.
iii. Taking healthcare to where people live and work is
another way forward. In other words, strengthening of
PHC services is important.
iv. To contain with the COVID-19 pandemic and reduce its
phobia, house to house screening or collection of samples
for COVID-19 test will help in better investigation while
those tested positive should be treated with dignity,
privacy, and respect as this will allow people to willingly
give themselves for health screenings knowing too well
that, whether tested positive or negative, they will be
handled with utmost condentiality.[18] To authenticate
the ndings of this study, the researchers suggest a
post-COVID-19 study to be conducted to investigate
nosophobia and hypochondriasis, to ascertain whether
it may have inuence on willingness of people to seek
healthcare.
Okoi and Etim: Nosophobia, hypochondriasis, and healthcare seeking amidst the COVID-19 pandemic
OJPAS® | 2020 Aug 26 [Epub ahead of print]
ACKNOWLEDGEMENTS
e authors thank all the respondents who were visited in
their households and who took their time to participate in
this study. Finally, the authors acknowledge the eort of the
research assistants who took pains to collect data and assisted
in the smooth completion of this study.
AUTHOR CONTRIBUTIONS
NOO: Conceptualisation, original dra preparation, review
of the manuscript, funding of the study; JJE: Methodology,
review, and editing, statistical data analysis and interpretation,
revising the manuscript. All authors have read and agreed to
the published version of the manuscript.
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Source of support: Nil. Declaration of interest: None.
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