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The problem with communication stress from face masks

Authors:
  • National Distance Education University Madrid

Abstract

Objective. Widely present pandemic-related stress resulting from the use of face masks needs definition, evaluation and treatment. Mouth coverings hamper communication, increasing stress that possibly compromises the immune system and psychological well-being of patients, health professionals and general population. Most present mouth coverings have limited antiviral efficacy but possess social and political value in addition to positive and negative psychological implications. Transparent filtering materials have become available and may help reduce communication stress, alongside several cognitive approaches. Method. A systematic search was performed of the period 2000-2020 using the keywords, with no language limits, of databases including MEDLINE/PubMed, Science Direct, PsycInfo, Google Scholar and Cochrane. The search produced 247 articles, of which 84 were partly relevant. Conclusion. Communication stress showed to be relevant in all clinical situations and in the general population. Currently no specific solutions for face mask-related communication stress are available, save for an increased use of body language and stress management. Transparent face coverings could be a panacea. Treatment of pandemic-related stress should have specific itemized protocols.
... Thus, the essential requirement to implement public health strategies that aim to mitigate the spread of SARS-CoV-2 has seen an increased use of face masks in public settings. Although facial coverings have been deemed essential for public health, there has been some enquiry on how the use of opaque face masks could impact non-verbal means of communication in community settings due to their occlusion of face regions that contribute to the holistic facial expression of emotions (Campagne, 2021). Therefore, the observation of facial expressions that convey particular emotional states can be an important facet in ensuring cohesive interpersonal communications and social interactions (Phutela, 2015). ...
... It must be acknowledged that at the time of data collection for this study, the community use of face masks within indoor settings, such as public transport and shops, was deemed an essential requirement to mitigate the spread of SARS-Cov-2 and ensure public health (World Health Organisation, 2020). With the necessary and increased use of face masks in public settings, there is a need to ascertain how covering facial features may impact interpersonal communication (Campagne, 2021). This study aimed to use an experimental design to assess how brief observations of faces in opaque facial masks could influence the recognition of all six emotional states as stipulated in Ekman's (2004) Discrete Emotion Assumption. ...
... However, this study would suggest that face masks can block areas of the face that are essential for the non-verbal communication of emotional states during brief interactions. When masks inhibit effective communication, this can potentially lead to stressful and incoherent social interactions within community settings (Campagne, 2021). It is, therefore, necessary for future research to investigate if there is a relationship between emotion recognition and state aspects of psychological wellbeing during brief social interactions in which facial coverings are worn. ...
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Since the outbreak of SARS-CoV-2 in 2019, there have been global public health initiatives that have advocated for the community use of face masks to reduce spread of the virus. Although the community use of facial coverings has been deemed essential for public health, there have been calls for enquiries to ascertain how face masks may impact non-verbal methods of communication. The present study aimed to ascertain how the brief observations of faces in opaque facial coverings could impact facial emotion recognition. It was also an aim to ascertain if there was an association between levels of empathic concern and facial emotion recognition when viewing masked faces. An opportunity sample of 199 participants, who resided in the UK, were randomly assigned to briefly observe either masked (n = 102) or unmasked (n = 97) faces. Participants in both conditions were required to view a series of facial expressions, from the Radboud Faces Database, with models conveying the emotional states of anger, disgust, fear, happiness, sadness and surprised. Each face was presented to participants for a period of 250ms in the masked and unmasked conditions. A 6 (emotion type) x 2 (masked/unmasked condition) mixed ANOVA revealed that viewing masked faces significantly reduced facial emotion recognition of disgust, fear, happiness, sadness and surprised. However, there were no differences in the success rate of recognising the emotional state of anger between the masked and unmasked conditions. Furthermore, higher levels of empathic concern were associated with greater success in facially recognising the emotional state of disgust. The results of the present study suggest that significant reductions in emotion recognition, when viewing faces in opaque masks, can still be observed when people are exposed to facial stimuli for a brief period of time.
... If one or both of them have a hearing loss, there would be reliance on oral communication, leading to significant negative impacts (Ten Hulzen & Fabry, 2020). This can lead to practitioners experiencing communication stressors because interpersonal communication is negatively affected, with face coverings obscuring the mouth, limiting visual cues, and reducing understanding (Campagne 2021). A study by Heider et al. (2021) that aimed to determine the prevalence of voice disorders in healthcare workers of highrisk hospital care units found that nearly 33% of healthcare personnel reported voice disorders during the pandemic period; this being higher than the prevalence of voice disorders in general population at any other time which is around 7%. ...
... While most of the participants in the current study did not feel more selfconscious when speaking using face masks, about a third of participants felt more self-conscious when speaking using face masks. Communication stress emanates when interpersonal communication is negatively affected, as with face coverings (Campagne 2021), and can make you feel more distracted and self-conscious, further weakening your connection with others (Pryor, 2020). ...
... The mouth transmits the emotional content and meaning of the message, and one can already perceive messages from the speaker's mouth, such as happiness, sadness, anger and doubt. Facial recognition is thus an important social and psychological input for both children and adults (Campagne 2021). ...
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Background: The use of face masks and/or shields can pose a challenge during communication. They block facial expressions thus removing visual cues and affect sound transmission making it difficult to hear speech clearly. Given the widespread use of face coverings, it seems reasonable to clarify if communication in typical speakers and listeners has significantly differed. Health science students as future practitioners need to understand challenges that arise from using face coverings. Objective: This study aimed to determine health sciences students’ perception of the communicative impacts of face coverings. Method: The study employed a descriptive, self-administered online survey, obtaining information from 96 health science undergraduate students. Results: All participants changed their manner of speaking in that they spoke louder when wearing masks and focused more on eye contact when someone was wearing masks. These were statistically significant (p = 0.450 and p = 0.035 respectively). Fifty-three percent reported using more listening effort and feeling anxious when communicating. Approximately 33% indicated that it was challenging to read emotions, such as sad or unhappy, when someone wore a mask. Most, 61%, were positive or very positive about wearing masks. The level of difficulty differed depending on the listening environment. It was harder to understand the doctor, nurse, or other healthcare workers when they wore face coverings than when listening to their friends and family, which had little effect, this being statistically significant (p = 0.025). Conclusion: Challenges envisaged in practice included frequent communication breakdowns, inability to connect and build trust between patient and practitioner, and communicating in noisy environments. Coping strategies, future clinical and research implications were proposed, and limitations acknowledged.
... Understanding the impact of mask type on audiovisual perception is important, as the National Association of the Deaf (NAD) and opinion pieces have recommended use of transparent face masks to allow access of visual cues during both spoken and manual communication (Campagne, 2021;NAD, 2020). The clear mask manufactured by ClearMask™ (ClearMask LLC, Baltimore, MD, U.S.A.) was approved by the FDA in August 2020 for use during the COVID-19 pandemic to improve visual cues in the medical environment, but is more expensive than standard surgical masks. ...
... Facial recognition is an important social and psychological input for children and for adults (Freire & Lee, 2001). Facial cues are important for sign language users, thus nontransparent face masks would be expected to impact their communication accessibility (Campagne, 2021). Additionally, face masks obscure reading of emotion, an important skill for communication development in young children (Carbon, 2020). ...
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Objective: To investigate effects of surgical and transparent face masks during the Covid-19 pandemic on audiovisual speech recognition of words for deaf and hard-of-hearing children. Design: Recorded Word Intelligibility by Picture Identification test (WIPI) was presented in quiet via a computer monitor to children in a quiet test room. The acoustic power spectra of each mask type were compared to the baseline no mask condition. Percent correct word recognition was recorded for four mask conditions (no mask, surgical mask, transparent apron mask and ClearMask) in counterbalanced order. Repeated measures ANOVA was used to test for significant differences in word recognition scores across mask types. Study Sample: Thirteen children (3 to 7 years) in a private auditory oral school wearing hearing aids, bone-anchored hearing aids or cochlear implants. Children were excluded if English was not their primary language or if they had a severe speech-language delay, uncorrected vision loss, or developmental disorder that would affect the results. No children had been exposed to or had contracted the Covid-19 virus. Results: Acoustic spectra showed a decrease in the 2000-8000 Hz region for the transparent apron mask. The surgical mask and ClearMask showed fewer acoustic effects. Children with hearing aids performed similarly to children with cochlear implants. Word recognition was significantly poorer for surgical masks and transparent apron masks. The ClearMask condition was not significantly worse than the no mask condition for words in quiet. Conclusions: Standard surgical and custom apron shield masks significantly hampered word recognition, even in quiet conditions. The commercially available ClearMask did not significantly affect scores in quiet for young deaf and hard-of-hearing children, but scores were highly variable.
... A maszkviselés célja a páciensek és az egészségügyi dolgozók védelme a fertőzéstől, így a maszk sok esetben a biztonsággal, védelemmel asszociálódik. Ugyanis bármilyen, arcot takaró védőruházat viselésének pszichológiai, szimbolikus funkciója is van: ellensúlyozza a láthatatlan, globálisan fenyegető veszély okozta szorongást [10]. Ambivalens módon azonban negatív szuggesztióként, azaz olyan, önkéntelenül ható üzenetként is működhet, amely negatív hatással van a páciens észlelésére. ...
... A túl nagy távolság érdektelenséget, személytelenséget jelenthet [3], ami további akadályként nehezedik a bizalmi kapcsolat építésére. Ráadásul ez a "kommunikációs stressz" -amellett, hogy mind a páciensek, mind az egészségügyi szakemberek pszichés jóllétére is negatívan hat -ronthatja az immunrendszer működését is, akadályozva ezzel a betegséggel való megküzdést [10]. ...
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In the fight against the epidemic, the use of masks has become commonplace, which is a significant challenge in everyday communication situations. This problem has been present in some areas of healthcare in the past, but today's universal use of masks and personal protective equipment (PPE) is both a symbolic and practical barrier between doctor and patient, making it difficult to establish an effective communication and connectivity on several levels. Therefore, it has become necessary to develop unified communication protocols that help building a relationship of trust in healthcare so that emotional availability of providers and safe physical distance are achieved simultaneously. The aim of our study is to summarize the effects of mask wearing and PPE usage on the physician-patient communication and also the trust and empathy processes that emerge within the relationship through the review of the current literature. We would also like to draw attention to the effects on healthcare staff. Our goal is also to formulate recommendations, taking into account domestic and international experience, that can be used to improve the communication of healthcare professionals, and through that, the satisfaction of the most important actors in care, patients and caregivers.
... Human psyche attempts to restore lost freedom through reactance in the form of noncompliance, rage, and so on. Such forms of reactive behaviour take precedence when In health care settings, face coverings cause communication stress (Campagne, 2021). ...
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The threat of epidemic outbreaks like SARS-CoV-2 is growing owing to the exponential growth of the global population and the continual increase in human mobility. Personal protection against viral infections was enforced using ambient air filters, face masks, and other respiratory protective equipment. Available facemasks feature considerable variation in efficacy, materials usage and characteristic properties. Despite their widespread use and importance, face masks pose major potential threats due to the uncontrolled manufacture and disposal techniques. Improper solid waste management enables viral propagation and increases the volume of associated biomedical waste at an alarming rate. Polymers used in single-use face masks include a spectrum of chemical constituents: plasticizers and flame retardants leading to health-related issues over time. Despite ample research in this field, the efficacy of personal protective equipment and its impact post-disposal is yet to be explored satisfactorily. The following review assimilates information on the different forms of personal protective equipment currently in use. Proper waste management techniques pertaining to such special wastes have also been discussed. The study features a holistic overview of innovations made in face masks and their corresponding impact on human health and environment. Strategies with SDG3 and SDG12, outlining safe and proper disposal of solid waste, have also been discussed. Furthermore, employing the CFD paradigm, a 3D model of a face mask was created based on fluid flow during breathing techniques. Lastly, the review concludes with possible future advancements and promising research avenues in personal protective equipment.
... 27 They are known to degrade speech perception, discrimination, and intelligibility with environmental noise, inducing substantial increase in self-perception of vocal changes, vocal effort, and communication stress. 8,9,[28][29][30][31] Moreover, they increased perceived vocal symptoms and difficulties in coordinating speech and breathing during speech production, especially for professional voice users. 32 The effect of wearing masks on speech production and voice parameters needs to be investigated in order to interpret the voice outcome measured in different conditions. ...
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Objectives The COVID-19 pandemic has affected the voice assessment protocols for dysphonic patients. In this study, we compared the changes in acoustic measures of the healthy population as well as dysphonic patients due to glottic insufficiency between the pandemic period requiring face masks and the prepandemic period when the masks were not essential. The clinical reliability of the acoustic measures with and without face masks was explored. Methods A total of 120 patients (age = 42.3 ± 11.9 yrs) with glottic insufficiencies such as UVFP and sulcus vocalis and 40 healthy population (age = 40.5 ± 11.2 yrs) cohorts were enrolled during the pandemic period. Age- and gender-matched 120 patients and 40 healthy population cohorts who underwent voice assessment without face masks before the pandemic were enrolled as prepandemic controls. Acoustic measures and overall severity estimates of vowel and speech samples were compared, which included cepstral peak prominence (CPP), L/H spectral ratio (SR), their standard deviations, F0, jitter percent (Jitt), shimmer percent (Shim), noise-to-harmonic ratio (NHR), Cepstral Spectral Index of Dysphonia (CSID), and Acoustic Psychometric Severity Index of Dysphonia. Results Both patients and healthy cohorts showed higher SRv and SRs but lower CSIDv during the pandemic compared to the prepandemic period. F0 of the healthy male controls during the pandemic was higher than during the prepandemic periods, while the CSIDs was lower for the pandemic period. The pandemic patient cohort showed lower σSRs compared to the prepandemic patient cohort. When the acoustic measures of patients were compared to the healthy population cohort, the patient cohort showed lower CPP and σCPPs, while higher σCPPv, Jitt, Shim, and NHR during both pandemic and prepandemic period. Overall, the area under the curve of the acoustic measures and overall severity estimates was similar between the mask and non-mask groups, although the AUC of the SR measures was poor. Conclusions Wearing face masks during the pandemic did not compromise the overall reliability of the acoustic analysis in patients with glottic insufficiency, suggesting the current protocol of acoustic analysis can be carried out reliably while wearing a mask to ensure safety in the pandemic era.
... The visibility of facial expressions and clarity of speech is both highly relied upon in everyday communication, but the regulated use of the face mask disregards this modality almost entirely [6]. This becomes even more crucial in the context of physical distancing regimes [68], where proxemic studies report a habitual reduction of eye contact when spaced more than twelve feet (3.6 m) apart, i.e., public distance [69]. Additionally, studies related to pandemic behaviour have demonstrated how face masks influence interpersonal distances [70]. ...
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Within the field of movement sensing and sound interaction research, multi-user systems have gradually gained interest as a means to facilitate an expressive non-verbal dialogue. When tied with studies grounded in psychology and choreographic theory, we consider the qualities of interaction that foster an elevated sense of social connectedness, non-contingent to occupying one’s personal space. Upon reflection of the newly adopted social distancing concept, we orchestrate a technological intervention, starting with interpersonal distance and sound at the core of interaction. Materialised as a set of sensory face-masks, a novel wearable system was developed and tested in the context of a live public performance from which we obtain the user’s individual perspectives and correlate this with patterns identified in the recorded data. We identify and discuss traits of the user’s behaviour that were accredited to the system’s influence and construct four fundamental design considerations for physically distanced sound interaction. The study concludes with essential technical reflections, accompanied by an adaptation for a pervasive sensory intervention that is finally deployed in an open public space.
... Literature has identified factors that impact stress from mental conditioning to quality of food (Sumaedi et al., 2021;Najem et al., 2020), communication (i.e., communication stress from face mask) (Campagne, 2021), strategic posts on social media or actions aimed at ensuring sustainability (Yadav et al., 2021), and those factors are outside the preview of this study. The intention of consumers to seek health information predicts their intention to use such information from social media in a substantial way . ...
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Purpose The Internet is used as a tool to seek health information by individuals. Mental health concerns are the high prevalence of the novel coronavirus disease 2019 (COVID-19) and preventive steps are required to curb the illness. Therefore, to gain more insight into health concerns, it is now a common practice to seek health information on the Internet. This study propose an integrated theoretical model to explore the relationship between COVID-19 protocols and perceived online trust with online health information seeking intention (OHISI) and a moderating effect of perceived severity and perceived urgency. Design/methodology/approach Data are collected from 325 athletes in the category of individual and team sports through an online survey in a Likert-scale questionnaire. The analysis is performed with a quantitative methodology. Findings The study reveals the bright side of online health information (OHI), which brings athletes together and has played out with virtual happy hours, meetings and events. The bright side of OHI reflects social, cultural, technological and economic benefits. An OHI chatbot offers bright personalised side information to the individual seeker, which is more convenient and efficient than human capabilities. Originality/value The pivotal contribution is the integrated theoretical framework that is derived from multidisciplinary literature to capture the complexity of OHI. Also, it conceptualises the constructs in the context of OHI and COVID-19.
Article
Objectives Restrictions due to the COVID-19 pandemic mandated fundamental changes to student evaluations, including the administration of the observed structured clinical examination (OSCE). This study aims to conduct an in-person OSCE to verify students’ practical skills under necessary infection control practices and the impact of face masks on student–patient interactions. Design Cross-sectional design. Setting The OSCE at Medical School of Tuebingen takes place in October 2020. Participants A total of 149 students (third year of study) completed the survey (RR=80.1%). It was their first OSCE. Primary and secondary outcome measures Primary outcome measure was how this type of OSCE was evaluated by participating students in regard to preparation, content and difficulty as well as in real life. Secondary outcome measures were how the implemented hygiene actions influenced the OSCE, including the interaction and communication between students and standardised patients (SPs). Items were rated on a 6-point Likert scale (1=completely to 6=not at all). Means, SDs, frequencies and percentages were calculated. Results 149 students, 32 SPs and 59 examiners participated. The students rated the OSCE with 2.37 (±0.52) for preparation and 2.07 (±0.32) for content. They perceived the interaction to be significantly disrupted by the use of face masks (3.03±1.54) (p<0.001) compared with the SPs (3.84±1.44) and the examiners (4.14±1.55). In general, the three groups considered the use of face masking the OSCE to be helpful (1.60±1.15). Conclusions An in-person OSCE, even in the midst of a global pandemic, is feasible and acceptable to both students and faculty. When compared the students’ results to previous students’ results who completed the OSCE before the pandemic, the results indicated that students felt less prepared than under non-pandemic circumstances; however, their performances on this OSCE were not lower.
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Objective: To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic. Materials and methods: This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic; and the Essential Activities Group, with individuals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed. Results: Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feedback, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing. Conclusion: Use of face masks increases the perception of vocal symptoms and discomfort, especially in individuals who wore it for professional and essential activities.
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The fundamental aim of this study is to determine the effects of prolonged usage of N95 respirators and surgical facemasks amid health care workers in our institution. Cross-sectional study. SRM medical college hospital, Kattankulathur. A self-constructed questionnaire containing 20 queries regarding the effects of prolonged use of face masks, after being analysed by the experts of our institution were handed over to 250 participants.. All participants wore either surgical masks or N95 respirators for a minimum of 4 h per day. People aged between 20 and 48 years were selected for this study. Study period was from 20/07/2020 to 26/07/2020. Completed questionnaires were sent for statistical analysis. A total of 250 healthcare workers participated in the study, out of which 179 were females. The acquired results were excessive sweating around the mouth accounting to 67.6%, difficulty in breathing on exertion 58.2%, acne 56.0% and itchy nose 52.0%. This study suggests that prolonged use of facemasks induces difficulty in breathing on exertion and excessive sweating around the mouth to the healthcare workers which results in poorer adherence and increased risk of susceptibility to infection.
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