Impact of Covid-19 Pandemia on Knowledge and Habits during Lockdown Period in Spain

Research Article

J Dent & Oral Disord. 2021; 7(1): 1153.

Impact of Covid-19 Pandemia on Knowledge and Habits during Lockdown Period in Spain

Ruiz-Roca JA¹, Zamora MG², Garcia Moya J², Pons-Fuster LE³ and Lopez-Jornet P²*

1Faculty of Medicine and Odontology, Hospital Morales Meseguer, Spain

2Medicine and Odontology. Hospital Morales Meseguer Clinica Odontologica, Spain

3Faculty of Medicine University, Murcia and Research Biomedical Institute of Murcia, Spain

*Corresponding author: Pia Lopez-Jornet, Hospital Morales Meseguer Clínica Odontologica Universitaria, Medicina Oral Adv. Marques De Los Velez S/N Murcia 30008, Spain

Received: December 12, 2020; Accepted: February 04, 2021; Published: February 11, 2021


Objective: In April 2020, the coronavirus pandemic 2019 (COVID-19) was at its peak in Spain, what required the isolation of the population. Our study aimed at assessing the knowledge, behaviour and lifestyle during the lockdown due to COVID-19 outbreak, as well as the adaptation to COVID-19 recommendations.

Material and Methods: Questionnaires were sent via e-mail and completed by 777 individuals (289 men; 488 women). The Questionnaire consists of 36 simple questions according to COVID-19 clinical management guidelines developed by the Spanish Department of Health. The structure of the questionnaire is organized in sections a) demographics of the population, b) knowledge about COVID-19 symptoms; c) habits and general prevention measures against COVID-19, and d) block concerning oral hygiene habits.

Results: The response rate was 54%, with a mean age of 41 years. We found that during quarantine there was a change in habits and, if the individual belonged to a risk group, there was an increase in the frequency of hand washing (p<0.001), as well as in the consumption of tobacco (p<0.001), alcohol (p=0.02) and tranquilizers (p<0.001). During this quarantine period the interest in taking more care of the mouth was 14%, being higher if the individual belonged to a risk group (p=0.05). When studying the frequency of tooth brushing and comparing this action before and during the COVID-19 lockdown no differences were found (p=0.258).

Conclusions: Belonging to a risk group increases the interest in improving prevention, hand and oral hygiene habits and should, therefore, be extended to the rest of the population by means of health education.

Clinical Relevance: Health education programmers designed to improve knowledge about COVID-19 are helpful in promoting optimistic attitudes and maintaining safe practices.

Keywords: COVID-19; Habits; Questionnaires; Oral hygiene


Spain has seen a sudden and disruptive outbreak of infection caused by COVID-19, thus requiring strict measures to limit its spread. Coronavirus disease 2019 is infectious in origin and caused by the SARS-CoV-2 virus. It was first detected in the Chinese city of Wuhan (province of Hubei) in December 2019, having reached more than 185 territories and countries and on the 11th March 2020, the World Health Organization (WHO) declared it as a pandemic [1-5].

This pandemic has overwhelmed health care systems and has led to dramatic preventive measures in many countries such as Spain. WHO is developing strategies in collaboration with global experts, governments and associations to rapidly expand scientific knowledge about this new virus, track its spread and virulence, and to advise countries and populations on measures to protect health and prevent the spread of this outbreak [6-10]. This is a highly transmissible virus whose main route of transmission occurs through respiratory droplets (droplet nuclei) which are produced when an infected person sneezes or coughs. Contact transmission due to contaminated surfaces or fomites is also relevant [7].

Symptoms appear from two to fourteen days later, with an average of five days after exposure to the virus. This causes flu-like symptoms, including fever, ineffective cough, and dyspnea, loss of smell, muscle pain, and fatigue. Severe cases are characterized by pneumonia, acute respiratory distress syndrome, sepsis, and septic shock leading to death. Currently, there is no specific treatment; the major therapeutic measures consist in relieving symptoms and maintaining vital functions [1,8].

Nowadays, prevention through programs involving lockdown at home, hygiene measures, social distancing and early case detection are key to lead to a considerable reduction in the number of potential cases. Changing individual and collective behaviours is crucial to flatten the contagion curve in other words, slowing down the rate of contagion so that our health systems can face the crisis [2,8]. Contagion can be prevented by frequent hand washing, or failing this, by disinfecting them with hydroalcoholic gel, by covering the mouth when coughing or sneezing, maintaining interpersonal distance between one another, as well as alternative preventive measures, such as the use of masks. This epidemic context entails changes in lifestyle, such as eating habits, physical activity, and tobacco and alcohol consumption [2-9].

This is a situation that requires a flexible approach to learn how to acquire new knowledge and skills in the short term. At present, an atypical and stressful scenario is being faced. From the point of view of health, a picture that predicts significant changes in habits in the coming months is drawn [1-4]. Promoting and maintaining a healthy lifestyle remains a global challenge. It is essential, therefore, to investigate risky behaviors and to identify factors that influence healthy lifestyles during lockdown due to the occurrence of COVID-19 [5,6]. The purpose of this study was to assess knowledge and behaviours during the COVID-19 outbreak in Spain. In addition, lifestyle factors and their adaptation to COVID-19 recommendations were intended to be identified.

Material and Methods

The research was conducted with integrity and in accordance with ethical principles accepted and approved by the Research Ethics Committee of the University of Murcia (ID: 2850/2020). Individuals older than 18 years of age, with Spanish nationality and residence in Spain during quarantine, and cognitively capable of understanding and answering the questions were included in the study. Those who had recovered from the disease and/or had symptoms associated with COVID-19 were excluded.

A cross-sectional, descriptive and observational study was designed and the questionnaire was distributed through the 2.5.6 survey platform of the Information Technology Department of the University of Murcia. A brief introduction was initially made about background, objectives, procedures, voluntary nature of participation, anonymity and confidentiality statements and help to complete the questionnaire, and the link to complete it was provided through a URL.

Questionnaire and protocol

The sample of this study comprises population residing in Spain during COVID-19 lockdown, and the survey was conducted after one month of lockdown. Following an informed consent form, the questionnaire was designed to assess the population’s knowledge and behaviour, prevention measures, and information regarding COVID-19 during quarantine.

The participants had to respond and confirm their participation voluntarily, and upon confirmation the link of the survey opened in order to complete the questionnaire. The COVID-19 survey was made up of 36 simple questions according to COVID-19 clinical management guidelines published by the Spanish Department of Health for COVID-19 [9]. The structure of the questionnaire comprised several sections a. demographics of the population, age, sex, and educational level, b. knowledge about COVID-19; c. habits and general prevention measures against COVID-19 during quarantine d. block concerning oral hygiene habits during COVID-19 period. The survey was available online for one week.

Statistical analysis. Data were analyzed using the SPSS 20.0 statistical programme (SPSS® Inc, Chicago, IL, USA). A descriptive study of each variable was conducted. The Kolmogorov-Smirnov normality test and the Levene variance homogeneity test were applied; data showed a normal distribution and were accordingly analyzed by using parametric tests. The associations between the different qualitative variables were studied by means of Pearson’s chisquare test. The associations between different quantitative variables were studied by using Student’s t-test for two related samples. The Wilcoxon test was applied to assess the frequency of tooth brushing before and after one month of lockdown. Statistical significance was accepted for p≤0.05.


In this study, 1436 individuals accessed the questionnaire and a total of 777 questionnaires were answered, obtaining a response rate of 54%.

Characteristics of participants

Description of the main characteristics of the sample (Table 1). The majority are women (62.8%) aged between 18 and 80 years, being the mean age 41 years (SD=15.1) and 63% of the sample have university education. With regard to COVID-19, most of the respondents do not belong to COVID-associated risk population groups (hypertension, diabetes, respiratory system condition, cancer, pregnancy) (Table 2).The majority of respondents do recognize the main symptoms, such as persistent cough, fever, sore throat, tiredness and respiratory distress caused by the virus. Regarding the recommended measures during lockdown period, 29.6% have never left home and 37.6% go out once per week, 12.2% more than once per week and 22% go out once per day. With regard to age, when comparing the groups over 60 years of age and less than or equal to 60 years of age, no significant differences were found (p=0.149) concerning leaving home during quarantine. However, in people at risk there is a tendency to stay at home (p=0.05), thus keeping lockdown measures. Regarding habits during this period, 41.4% do not feel more tired and 74.3% of those surveyed have varied their daily routines considerably. Thus, 85.1% have increased the frequency of hand washing, 42.6% have increased the consumption of tobacco and 8.6% the consumption of alcohol; 54% sleep less or stay awake at night and in 56% of individuals mood is low and 7.1% need to take an anxiolytic.