Journal of Indian Association of Public Health Dentistry

: 2022  |  Volume : 20  |  Issue : 1  |  Page : 63--68

Discernment in practicing nonpharmacological modes of intervention in combating SARS COVID-19: Reflections of dental patients in India

Suresh Chand Yaddanapalli, Parveen Sultana Shaik, Srinivas Pachava, Srinivas Ravoori, Raja Sekhar Potluri 
 Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Correspondence Address:
Srinivas Pachava
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh


Background: As a massively polarizing practice, concealing or face covering has emerged in the midst of the coronavirus disease 2019 (COVID-19) pandemic. Given the increasing speculation regarding therapeutic control measures, nonpharmacological approaches offer promising successful mitigation in the battle against severe acute respiratory syndrome (SARS) COVID-19. The evaluation of public capacity, prospects, and actions offers recommendations for public oversight of the implementation of prevention activities. Hence, this investigation was aimed to explore the discernment in practicing nonpharmacological modes of intervention in combating SARS COVID-19 among a group of people, dental patients. Materials and Methods: A pictorial questionnaire survey was done using convenience sampling, aimed at participants visiting the triage facility of the institution to capture their discernment in practicing nonpharmacological modes of intervention for 3 months. Results: A total of 6015 individuals with a mean age of 35.44 ± 14.20 years participated in the study. The majority of the participants were in the age group of 18–30 years (n = 2340, 38.9%) with female (n = 3105, 51.6%) and urban (n = 3745, 62.3%) predominance. Most of the study participants had purchased cloth masks (n = 2980, 49.5%) and had spent about 10–50 INR per mask (n = 4050, 80.6%). Patients have reported that the usage of a mask (n = 1330, 22.1%) was the most difficult measure to follow and also stated that sanitizing hands (n = 2505, 41.6%) was the easiest measure to follow during this pandemic. Crowding in the market (n = 2255, 37.5%) and placing masks around the neck (n = 735, 12.2%) were infringements served in their surroundings. Irrespective of educational qualification touching the outer area of the mask was the most common noncompliance reported by the participants which were statistically significant (P = 0.0001). Conclusion: The study participants have divulged that usage of masks and following social distance in public transport were the most difficult preventive measures of SARS COVID-19 to follow. Evaluating the attitudes of public in preventive procedures for COVID-19 can pave the way to make comprehensive guidelines.

How to cite this article:
Yaddanapalli SC, Shaik PS, Pachava S, Ravoori S, Potluri RS. Discernment in practicing nonpharmacological modes of intervention in combating SARS COVID-19: Reflections of dental patients in India.J Indian Assoc Public Health Dent 2022;20:63-68

How to cite this URL:
Yaddanapalli SC, Shaik PS, Pachava S, Ravoori S, Potluri RS. Discernment in practicing nonpharmacological modes of intervention in combating SARS COVID-19: Reflections of dental patients in India. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Jun 30 ];20:63-68
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Having affected more than 72,196,732 confirmed cases and 1,630,521 deaths worldwide, the severe acute respiratory syndrome (SARS) coronavirus disease 2019 (COVID-19) pandemic continues to evolve at a rapid pace.[1] The vulnerability index for the management of and response to the SARS COVID-19 epidemic in India shows that Andhra Pradesh score as 0.714, where 1.0 is the most vulnerable and 0.0 least vulnerable.[2] The spread of the new COVID has influenced individuals everywhere in the world, state and Local governments are making clearing moves to stop the spread of the illness and alleviate the general well-being and financial effect of the flare-up.[3] Analysts and legislative authorities consider this pandemic as challenging with huge legal and procedural concerns including basic security, legitimate perspective, opportunities, and financial impact as communities, states, and countries respond to the scourge.[4]

Concealing or face-covering among the SARS COVID-19 pandemic has arisen as a profoundly polarizing practice. With given uncertainty mounting on therapeutic measures in controlling, nonpharmacological methods offer promising effective mitigation in combating SARS COVID-19.[5] Assessing public capability, opportunity, and behavior provide a guide to monitor the public in adopting preventive practices. One such method of assessing is through questionnaire surveys. Validated and short questionnaire surveys that are aimed at capturing behavior can offer an insight into issues concentrated in adopting preventive behavior.[6]

Fearing transmission of disease in the dental practice majority of the dentists are yet to resume full-fledged practice.[7] Among these circumstances and in the wake of public interest, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, opened its complete oral health services in August 2020, whereas in earlier months of lockdown it provided emergency services. To minimize the need for personal protective equipment, a Kiosk center with glass supported by indoor and outdoor audio for Triage purposes has been erected under Public Health Dentistry Department in the portico of the college to screen patients through health interviews to rule out SARS COVID-19 before they are sent to the Oral Medicine and Radiology Department for oral examination. Hence, with this background, a study was done to explore practices of nonpharmacological modes of intervention in combating SARS COVID-19 by dental patients visiting institution.

 Materials and Methods

Owing to the fact that pictures are better at communication than written words, as one picture is worth a thousand words, pictographs were used as a medium to discern preventive measures in practicing nonpharmacological modes of intervention in combating SARS COVID-19. This was a cross-sectional pictorial questionnaire survey done on convenience sampling, which was aimed at participants visiting dental institutions to discernment in practicing nonpharmacological modes of intervention. The participants are reflective of the general population of this area in terms of their nativity and belongingness to all walks of life. This study was done over 3 months (September 2020 to November 2020) on 6015 individuals who were chosen on a random basis among 300 patients on an average visiting per day for oral health needs, interviews were made at the triage section of the institute asking for their perception's and practices regarding the various preventive measures after obtaining consent.

The questionnaire consisted of demographic data and items related to preventive measures followed and noncompliance observed concerning SARS COVID-19. Two panels were utilized for this purpose. The first one with color pictographs attached on SARS COVID-19 preventive measures, and on the other panel, the pictures of noncompliance were placed. The panels consisting of pictographs of preventive measures followed and noncompliance practices observed in the family and surroundings were finalized from the pilot study done among 54 participants with good reliability (Cronbach's alpha [α] = 0.82).

Ethical approval

A detailed review of the multifaceted aspect of the research and about the consent of the participants was elaborated for approval from the Institutional Ethical Committee (Pr. 255/IEC/SIDS/2020), while the anonymity of the study participants was secured by following the ethical principles of the World Medical Association Declaration of Helsinki.


A total of 6015 individuals with a mean age group of 35.44 ± 14.20 years participated in the study. The majority of the participants belonged to 18–30 years' age group (n = 2340, 38.9%) with female (n = 3105, 51.6%), urban (n = 3745, 62.3%), and marital status (n = 4025, 66.9%) predominance. It was found that 49.5% of the individuals in the study were illiterates (n = 2975) followed by participants with high school education (n = 805, 13.4%) while with reference to occupation majority of them fell under semi-profession category (n = 1845, 30.7%) [Table 1].{Table 1}

Most of the study participants used purchased cloth mask (n = 2980, 49.5%) followed by custom made/free cloth mask (n = 2220, 36.9%) [Figure 1]. Regarding the amount spent on purchasing each mask, the leading percentage of the individuals spent about 10–50 INR (Indian rupees) (n = 4050, 80.6%) [Figure 2]. Many individuals reported that maintaining social distance in the public transport (n = 1530, 25.4%) and the usage of the mask (n = 1330, 22.1%) were the most difficult practices to follow during this pandemic. They also perceived that sanitizing hands (n = 2505, 41.6%) and using hand wash (n = 1835, 30.5%) were the easiest practices to follow [Table 2].{Figure 1}{Figure 2}{Table 2}

Many participants observed that crowding in the market (n = 1300, 21.6%) and touching the outer area of the mask (n = 940, 15.6%) were the derelict of the COVID-19 measures by their family members, while it was warranted that crowding in the market (n = 2255, 37.5%) and placing mask around the neck (n = 735, 12.2%) were infringements observed in their surroundings [Table 3]. When comparing the noncompliance practices of the participants with their educational level, almost all the participants with various education levels have acquiesced that touching the outer area of the mask as the most disregard practice followed by them, except for the participants with primary school level education, where P = 0.001 which was statistically significant [Table 4].{Table 3}{Table 4}


This study was done to explore the reflections of the society through dental patients visiting a dental organization in rehearsing nonpharmacological methods of mediation in battling SARS COVID-19. Surveying participants who are going to dental offices on identifying with receiving preventive conduct in battling COVID-19 can help in better treatment conventions and furthermore provide some insight into the unsafe conduct of the subject, encouraging dental specialists in better managing through appropriate guidelines and alterations.[8] The desire for the prevention by an individual relies on the psychological need maintain which is influenced by means of autonomic and controlled motivation which accordingly depends on their attitude, subjective guidelines, and perceived behavioral control. Segregation toward the estrangement of and the making of people who wear a face mask in public areas or social gatherings that empower the obliviousness of social separation measures may sabotage a person's relatedness and emotional standards with regard to COVID-19 avoidance.[9] The absence of network selection to preventive measures for shortening coronavirus is because of fluctuated reasons which incorporate regulatory omissions, being critical, dread and nervousness, counterfeit news, accepted practices, culture, and governmental issues.[10],[11]

One of the reasons for failure in preparedness for epidemics is the lack of a comprehensive National Public Health Act in India. The number of enactments gives gigantic capacity to general well-being functionaries that should be figured out. General health authorities, such as examiners and well-being officials working with different assignments not only have a few essential requirement paraphernalia but are also influenced by defilement, similarity, giving grants, licenses, and enlistments; giving regulatory requests; forcing common punishments, and directives. Conclusively, there are one or different purposes behind not executing these well-being enactments in a genuine sense and general well-being stays defenseless against social, mental, and actual danger factors.[12],[13],[14] Three principal factors hold up traffic of counteraction; individuals do not appreciate the dangers they run, it conflicts with human instinct for individuals to quiet themselves down in inflexible disengagement as a method for securing others, what's more, individuals regularly unwittingly go about as a proceeding with risk to themselves as well as other people.[15]

We are at a point in the development of living through a pandemic where the individuals who have returned in the operatory are getting more acclimated with giving patient consideration inside the bounds of what is called “the new normal.” Depending on convictions, comfort level, and neighborhood guidelines, a portion of our patients is returning with a “the same old thing” mentality. Others are careful, however agreeable, and afterward, there are the individuals who are not prepared to return by any stretch of the imagination. The examination applies an unmistakable investigation to dental patients' information in the extraordinary period and presents notable and important findings of dental visits relating to socioeconomics. There is a clear contrast between the general numbers of people even in these emergency times in looking for dental administrations which mirrored that females use more dental administrations than men inferable from different reasons. In the current observation, the proportion was 51.6% females to 48.4% males.[16]

Purchased/custom made/free cloth masks were the personal choices of the study participants as a nonpharmacological means of a preventive measure adopted as they are affordable, available, accessible, reusable, and recyclable due to which they are widely used as a public health intervention strategy.[17]

In this study, it was observed that crowding in the market, touching the outer area of the face mask, and usage of the mask as a neck warmer were the infringements observed by the participants in their family and surroundings. Isolation and social distancing measures, including edicts to stay at home, have been brought into place globally to reduce the transmission of the virus, but at a huge cost to individuals and society. In addition to these measures, other effective interventions to increase adherence to behaviors that individuals in communities can enact to protect themselves and others: as reported by Glynda Alves that 90% of Indians are aware of wearing a mask as a preventive measure, but only 44% were wearing a mask where discomfort was revealed as a key reason for noncompliance.[18] This study provides the evidence to start applying behavioral science methods and models to understand and modify the individual's perceptions and nonpharmacological practices.[19]

The amount spent on each mask by the individuals was about 10–50 INR which might be due to the reason that the amount India spends on public health per capita every year is 1112 INR less than the cost of a single consultation in the country's top private hospitals or roughly the cost of a pizza at many hotels, that comes to INR 93 per month or INR 3 per day.[20] The average cost of manufacturing these surgical face masks was around 40–45 paisa, while that for N95 mask is about ₹10–12, but due to market dynamics, these were being sold at a much higher price which was not affordable.[21]

For the vast majority of people, wearing a mask is a new thing. While we as a whole conform to wearing masks out in the open, it is significant we attempt to expect as meager as conceivable about others, dependent on whether they are wearing one. It is anything but difficult to make a hasty judgment. As wearing a mask in broad daylight turns out to be more normal in numerous parts of the world, either on the grounds that it's obligatory where you live or on the grounds that you decide to wear one, it very well may be enticing to expect individuals who do not wear masks are reckless, misinformed, or egotistical. Dental specialists and individual dental patients are no exemption from this philosophy as the authors perceived. Understanding public capacity, opportunity, and motivation in receiving preventive strategy are the critical hotspots for conduct change; if not, any endeavor to change the conduct will just turn into purposeful publicity rather an adjustment in conduct.

Individual social desirability bias cannot be excluded owing to the fact that questionnaire studies elicit a conscious positive response; however, when asked about the most common preventive measure in combating SARS COVID-19 was not followed in the surroundings, and the family was found to be crowding in markets which reflected the lapse in following preventive measure as a whole in the community.


One of the most basic needs for a dental patient is the availability of transport in availing oral health care, with the pandemic majority of the participants reported that following social distancing in the public transport is the most difficult preventive measure reflecting the need to address the issue. While crowding in markets is the most common noncompliance observed within the family and in surroundings highlighting the importance of the need for strict implementation of legislative measures.

Overall, mask etiquette was the most difficult to follow hence required upliftment of cognitive skills on the usage of masks among the community. Noticing a patient's preventive conduct is one of the vital accomplishments for productive dental administrations conveyance among the corona infection pandemic. Dental foundations may end up being upheavals of cases if patients who go into the grounds are not checked or perceived. Effective guidance and making to comprehend guidelines are conceivable just on investigating patient's mentalities toward adopting preventive protocols for SARS COVID-19.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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