COVID-19 pandemic has posed mental health challenges for people from all walks of life, including the elders in Indonesia. Due to the wide-ranging effects of this pandemic due to various phases of smart, partial, or full lockdown, people worldwide have faced serious problems particularly with their mental health.
MethodsThis quantitative study analyses the experiences of the general public particularly focused on elders, those who are in isolation due to the COVID-19 protocols and limited social or physical interaction within the society. For investigating the social support mechanism among respondents, we have gathered a sample of respondents who are elders and using social media. The data reflect the opinion of respondents on elders during this pandemic. A survey was designed to gather data from elders facing mental health issues and using social media platforms to seek information in Indonesia. An online social support scale, self-awareness and insight scale were deployed to measure responses to the issue at hand.
ResultsThe data show that the elders had varied conceptualisations about COVID-19 relating to the pandemic, i.e., eating habits, fear of death, strengthening religiosity in eating practices, fear of interacting with people, and interaction patterns. Elders were restricted to their places and had limited physical social interactions, thus social media platforms have played a significant role in developing online interaction among elders, to speak and discuss their matters for coping with the issues of isolation and mental health.
ConclusionThe online media platform is considered a great support for elders to stay connected with families, friends, as well as with other communities. The study concludes that despite declaring the non-emergency status of COVID-19, elders have still suffered with long-term repercussions of this pandemic affecting their mental health.
La pandemia de COVID-19 ha planteado múltiples desafíos de salud mental para personas de todos los ámbitos de la vida, incluidos los ancianos en Indonesia. Debido a los amplios efectos de esta pandemia debido a las diversas fases de confinamiento inteligente, parcial o total, personas en todo el mundo se han enfrentado a graves problemas, especialmente con su salud mental.
MétodosEste estudio cuantitativo analiza las experiencias del público en general, particularmente enfocado en las personas mayores, aquellos que se encuentran aislados debido a los protocolos COVID-19 y la interacción social o física limitada dentro de la sociedad. Para investigar el mecanismo de apoyo social entre los encuestados, hemos reunido una muestra de encuestados que son personas mayores y utilizan las redes sociales. Los datos reflejan la opinión de los encuestados sobre las personas mayores durante esta pandemia. Se diseñó una encuesta para recopilar datos de personas mayores que enfrentan problemas de salud mental y que utilizan plataformas de redes sociales para buscar información en Indonesia. Se implementaron una Escala de apoyo social en línea (OSS) y una Escala de autoconciencia e percepción (SRIS) para medir las respuestas al problema en cuestión.
ResultadosLos datos muestran que los ancianos tenían diversas conceptualizaciones sobre el COVID-19 en relación con la pandemia, es decir, hábitos alimentarios, miedo a la muerte, fortalecimiento de la religiosidad en las prácticas alimentarias, miedo a interactuar con las personas y patrones de interacción. Los ancianos estaban restringidos a sus lugares y tenían interacciones sociales físicas limitadas, por lo que las plataformas de redes sociales han desempeñado un papel importante en el desarrollo de la interacción en línea entre los ancianos, para hablar y discutir sus asuntos para hacer frente a los problemas de aislamiento y salud mental.
ConclusiónLa plataforma de medios en línea se considera un gran apoyo para que las personas mayores se mantengan conectadas con sus familias, amigos y otras comunidades. El estudio concluye que a pesar de declarar el estado de no emergencia del COVID-19, las personas mayores todavía han sufrido las repercusiones a largo plazo de esta pandemia que afectan su salud mental.
Indonesia is a developing country with its population, being recognised among the largest users of social media, such as Facebook, Instagram, and Twitter.1–3 Facebook reported a total of 54 million users in Indonesia, making the 4th largest user country in the world, similarly the users of Twitter comprises of 22 million worldwide.4 While, reports from Twitter added that the country (Indonesia) have 385 ‘Tweets’ per second on average.5,6 This shows a unique feature that addresses the current study idea and prospects on social media as social support. The effect of online social media use among elders during the COVID-19 for mental health still remains a debated issue.7–9 However, multiple researches have been conducted on social media, social support, mental health, psychological wellbeing, social engagement, and COVID-19, but the area studying the effects of COVID-19 on elderly and utilisation of social media as supporting mechanism in the context of Indonesia needs to be researched further.10
Globally, the COVID-19 situation was reported and the experiences of people around the world are different with varying structural and cultural dynamics of the societies.11–13 Indonesia, is one of the country, which is still facing and different variants of COVID-19 have been also reported in the country.14–17 Government of Indonesia with the collaborations of national and international stakeholders provide the vaccines to the people for maintaining their wellbeing and reducing. However, now ‘new normal’ statistics of cases are reducing. But, the question still exists how the people have prepared support mechanisms like social interaction particularly for a population which is most vulnerable known as the aging factor. It is also pertinent to add here that, general masses those who were working in the cities moved to their hometown and have been working through online. But, the elderly who were residing in the cities were limited to human interaction due to non-working status and lesser social mobilities. Thus, social media was the basic vehicle which has given or provided social support and awareness on health education to the great extent. The usage of social media and wellbeing among people have been heavily influenced by Social Networking Sites (SNSs) and online community users indicate that the positive role of social media can be helpful for providing social support and healthy psychological disposition.18 Online social media platforms represents an increasingly popular vehicle for social interaction among people of all ages. In United States starting from 2005 to 2015 (around 10 years) data reveal that, the usage of social networking sites increased more than 76% among elders.19–22
Mental healthcare for elders in Indonesia can be challenging due to factors such as limited access to basic care, stigma surrounding mental health, and lack of awareness on mental health issues. Importantly, the pandemic and epidemics are the part of human history. Humans who have experienced public health emergencies were reported to have varying degrees of psychological disorders. The situation of COVID-19 and lockdown create people with distress, fear, and anxiety, and hence people were seeking information about the pandemic.23 The outbreak of the COVID-19 increased and caused huge psychological problems and psychiatric morbidities. In this condition, elders who have also faced social isolation, a mind of state in which an individual lacks a sense of social belonging, community engagement with others and fulfilling relationship is closely associated with pandemic. For instance, if people feel isolated because of restrictions on limited physical interaction, they may be able to access supportive networks by online spheres as online platforms were easily accessible.24–26 However, social media may facilitate forming connections and social support to its users from multiple channels. It may help to individuals for giving and sharing their regular life experiences to tackle with the COVID-19 and vaccine awareness.27,28
Mental health issues can affect people of all ages, including elders.29,30 In fact, they may be at a higher risk of experiencing mental health problems due to factors such as chronic health conditions, isolation, and grief. Therefore, in addition to prevent the COVID-19 cases and as well the psychological distress and difficult situation, everywhere and everyone were discussing the COVID-19 symptoms and the high ratio of deaths, effects which create distress, and mental health issues among elders. People were dealing with more psychological problems as compared to before in normal life, and in fact it was hard to determine any other social support mechanism, because of uncertainty and the majority of the people are working from home, thus only social media was the viable platform where the individuals, families, or groups was seeking health education.
It is now believed that the world exists into two conditions. One is the pre-COVID-19 world and other is the post-COVID-19 and this binary has altered every walk of life whether family, socialisation, economic, health, academic, profession, entertainment, or any other.31 This transformation has highly increased the dependency of people towards a device which is easily accessible, that is, smart phone offering unconditional usage of social media.32,33 This shows that people opt the use of social media to fulfil their needs and demands whether tangible or non-tangible as also characterised by Katz, Blumer and Gurevitch in Uses and Gratification theory. This theory postulated that people actively use media based on a purpose which is usually either their need or demand to satisfy themselves. The present study also poses that social media is one of the most commonly used form of media and is actively used by elderly during COVID-19 for their satisfaction and support from isolation and loneliness in difficult times.
The study evaluate the role of social media in providing healthcare during pandemic. It can be equally beneficial for policymakers and other stakeholders for making better strategies by using social media during COVID-19 or other health emergencies in future among elders. The study exhibits that how elderly have conceptualised and coped up with COVID-19 pandemic and more specifically during the lockdown when they could not move freely. It also focused one the attributes of a positive outcome of the usage of social media for health education among families, friends, and social networks of elders. Viewing the significance of this situation, the present data may support the advisors or public health practitioners to get a better insight into social media during the prevalence of COVID-19 among masses in Indonesia. The researchers can get further insight to develop knowledge and practices from this rapidly evolving situation.
MethodsThe data were gathered by carrying out a public survey in Indonesia. All the procedures carried out in this study were approved from the research committee in Universitas Airlangga, Indonesia. Prior to data collection, a pre-testing was done to analyse the accuracy of the survey and variable in accordance with objectives. Around 384 respondents completed their responses in March and April, 2020 (2 months) and among them, 36 responses were found out among the missing data. Thus, a total of 348 responses were taken for the data analysis which is a considerable sample size in quantitative social research.34 The survey link was limited to only Indonesian citizens or those residing in Indonesia. The socio-demographic profile of the respondents shows that, the majority of population in this study were female 71.3% of 248, male 28.7% of 100, and we received mixed responses marital status where we found, 56% of 195 were single, and 43.1% of 150 were married, and 30.9% were divorced.
There were multiple ways to disseminate the online survey link and shared it through Facebook posting, WhatsApp, and sending emails to general public. The students from the Faculty of Social and Political Sciences, Universitas Airlangga Indonesia played an important role in the speedy collection of the data. It is to note that, at the time of collection of data, the Government of Indonesia imposed full lockdown in the country and people faced an untoward situation. However, due to the imposition of lockdown and strict physical regulations, researchers could not go into the research field themselves for the purpose of gathering data. A questionnaire was prepared with the help of literature review and further refined through pre-testing, that aimed to investigate the public opinion on social media platforms on COVID-19 health education. The questionnaire was designed in Bahasa Indonesia to facilitate and convenience to respond to the survey.
For analysis of the data, 4 major themes were presented in this survey, including demographic status, the importance of social media for health education, seeking social support, and social media benefits in pandemics or wellbeing, family connection, and interaction through online ways, and information regarding preventive approach in controlling the spread and prevalence of fear among the public in Indonesia. At last, a coding frame was also categorised for the conversion of data into digits (numerical form), and then it was exported to SPSS for the analysis. Keeping into consideration the nature of data, inferential statistics using multinominal regression and ANOVA was applied. All the ethical procedures carried out in this study were in line with the concerned research committee from Universitas Airlangga, Indonesia. The respondents to this research were voluntary and their informed consent was obtained before the submission of the survey form.
Results and discussionThe results presented in this section were collected during the COVID-19 pandemic in Surabaya, Indonesia. The usage of social media platforms is perceived as easy and accessible to individuals for sharing health/medical information, positing material for the prevention of the virus, and sharing religious practices for better treatment and cure during the pandemic.35 The purpose of this study was to examine the public perception on elders using social media platforms for information and seeking social support, and awareness (health education), as during the pandemic, seeking information was on peak in Indonesia. The procedure of data collection through an online survey was started in March and ended in April, 2020 from respondents residing in Indonesia. Due to smart or partial lockdown conditions, the survey collection procedure mode was online using social media platforms such as Facebook, WhatsApp, and others. We requested faculty students, staff, and colleagues to share these survey links among their networks. All the questions and variables of the survey were reported in English (as the general medium of instruction). The respondents were supposed to respond to some main questions to submit their survey accordingly. We did not collect their contact details for the sake of confidentiality and gave them an open choice for their participation and responses.
The dataset validates social media as social support, social media for health education, public perception and social support for families, friends, and networks through social media platforms. Out of 453, a total of 348 responses were gathered and it was suitable for analysis. The data were further coded in to SPSS and then analysed. After the analysis of data saving syntax file, the data are formulated into tables.
Online Social Support ScaleOnline Social Support Scale (OSSS) was initiated and developed.36 The OSSS has been used in various research studies to assess the relationship between online social support and various outcomes, such as mental health, physical health, and social connectedness. It has been found to be a reliable and valid tool for measuring perceived online social support. We have used a similar scale in which the data focused on 3 scales, starting from, ‘absolutely true’, ‘undecided’, and ‘absolutely not’. The variables mentioned in Table 1 consists of 9, each focused on the respondent's social support and usage of social media for awareness. Furthermore, this scale was developed by Christina Lee and Nicole Gloor in 2001 and consists of 23 items that assess the following 4 dimensions of online social support (see Fig. 1): (1) esteem support measures the perceived level of support an individual receives related to self-esteem, such as positive feedback, praise, and compliments, (2): informational support related to obtaining information and advice, such as seeking guidance on a particular issue or topic, (3): network support to measure the support an individual receives related to establishing and maintaining connections with others, such as building relationships and social networks, and (4): the emotional support related to emotional needs, such as providing comfort, empathy, and understanding.
Elderly's conceptualisation of COVID-19.
| Variables | Mean | Std. deviation | Skewness | Kurtosis |
|---|---|---|---|---|
| COVI-19 is related to eating habits | 2.62 | 1.310 | 0.117 | 1.155 |
| COVID-19 cause fear and death | 2.52 | 1.312 | 0.259 | 1.114 |
| Strengthening religiosity in our eating practices | 2.84 | 1.298 | −0.181 | −0.178 |
| Fear of interacting people | 2.85 | 1.302 | −0.201 | −0.184 |
| Strengthening religiosity in our interaction patterns | 2.98 | 1.349 | −237 | 1.144 |
Social media platforms provide a massive reach and can connect people from different parts of the world. Health education can benefit from social media's wide reach, as it enables health organisations to communicate with people who may not have access to traditional health education channels. Social media platforms enable health organisations to share information and updates in real-time, which is crucial during public health crises. This timeliness can help to prevent the spread of misinformation and enable people to take appropriate action to protect themselves and their communities. The respondent's opinions were gathered regarding the health education on COVID-19 infection spread by the general public, government, followers on social media platforms. These variables consist of 8 items and the mean was calculated as 1.75, the respondents responded to each item on a 3-item point that was labelled as ‘completely/maximum’, ‘to a moderate degree’, and ‘not at all or never think’.
Self-awareness and Insight Scale (SRIS)Self-awareness is an important aspect of managing the impact of COVID-19 on individuals. It can be defined as the ability to recognise and understand one's own emotions, thoughts, and behaviours, and how they are being influenced by external factors such as the COVID-19 pandemic. Self-awareness and Insight Scale (SRIS) was prepared and developed to measure the self-consciousness which accesses the internal state awareness (insight) from self-reflection.37 There were 9 items in this scale providing several diagnostic treatments for COVID-19 considered social support are inquiring from colleagues, families, and friends. Moreover, sending religious and health awareness to cope with the situation. These items are rated on a 6-point scale such as: ‘absolutely true’, ‘true’, ‘somewhat true’, ‘somewhat untrue’, ‘untrue’, and ‘absolutely untrue’. Self-awareness can help individuals recognise and address any biases or misconceptions they may have about the pandemic and its impact on different communities. This can help to promote empathy and understanding towards others who may be experiencing different challenges or struggles during this time. Therefore, it is considered as an important tool for individuals to manage the impact of COVID-19 on their mental and emotional wellbeing, as well as to promote empathy and understanding towards others.
Table 1 describes the results about factor variables of the study. Factor variables focus on conceptualisation of COVID-19 by elderly and include 5 items to measure the main variable. The table depicts the data about measures of central tendency, skewness, and kurtosis of all the items. The findings of the data show that the distribution of items of factor variable to be considered normal as no item has either higher or lower value than the range between −2 to +2 for skewness and −7 to +7 for kurtosis. Hair et al. argue that distribution of items of a variable is to be considered normal if the values of skewness and kurtosis range between −2 to +2 and −7 to +7, respectively. 38
In Table 2, the measures of central tendency, skewness, and kurtosis of the outcome variable of the study are reported. According to Hair et al. (2010), data are considered normally distributed if the values of each item range between −2 to +2 for skewness and −7 to +7 for kurtosis.39 The results given in the table attributes that the distribution of all the items can be considered normal as the values of skewness and kurtosis are within the ranges given by Hair et al.
Social support mechanism for elderly.
| Variables | Mean | Std. deviation | Skewness | Kurtosis |
|---|---|---|---|---|
| Rely on comments from general people | 1.73 | 0.510 | −0.308 | −0.439 |
| Taking advice from family | 1.67 | 0.530 | −0.113 | −0.823 |
| Taking advice from friends | 1.75 | 0.520 | −0.232 | −0.326 |
| Relationship with online friends | 1.72 | 0.574 | 0.098 | −0.528 |
| Participating in online social activities | 1.66 | 0.526 | −0.135 | −0.881 |
Source: Primary data.
Table 3 reports the results about correlation between demographic factors, i.e., gender, marital status, family type, and occupation of the respondents and social support mechanism consisting of 5 items discussed above in methodology section. Bivariate correlation was applied and the results reveal that there existed strong relationship between gender of the respondents and adapting a supporting mechanism by using social media indicated with level of significance .002>.05, family type of the respondents and adapting a supporting mechanism by using social media indicated with level of significance .000>.05, and family type of the respondents and frequency of usage of social media apps at level of significance .001>.05.
Correlation: Demographic factors and social support mechanism.
| Variables | p-value |
|---|---|
| Gender of the respondents* Social media support in COVID-19 | .002* |
| Marital status* Social media support in COVID-19 | −.001 |
| Family type* Social media support in COVID-19 | .000* |
| Occupation* Social media support in COVID-19 | −.052 |
| Family type * Frequency of usage of social media apps | .001* |
Note: *p<.05.
Table 4 shows bivariate analysis of the data where association between all the items of factor variable and outcome variable were drawn. Each item of factor variable (5 items) was cross-checked with each item of outcome variable (5 items). The association was measured at a confidence interval of 95% where level of significance is determined as less than 0.05. The data report that there exists strong**, moderate*, and weak association between variables. It is evident from the results that there was strong association between COVID-19 conceptualised as related to eating habits and taking advice from friends (sig. 0.003), fear of death and taking advice from family (sig. 0.001), as fear of death and developing online relationships (sig. 0.004), as fear of death and participation in online social activities (sig. 0.005), as strengthening religiosity in our eating practices and relying on interaction with people (sig. 0.001), as strengthening religiosity in our eating practices and taking advice from family (sig. 0.004), as strengthening religiosity in our eating practices and developing online relationships (sig. 0.005), as fear of interacting with people and taking advice from family (sig. 0.001), COVID-19 conceptualised as fear of interacting with people and taking advice from friends (sig. 0.004), COVID-19 conceptualised as strengthening religiosity in our interaction patterns and relying on interaction with people (sig. 0.001), and COVID-19 conceptualised as strengthening religiosity in our interaction patterns and taking advice from family (sig. 0.001).
Multinomial regression model between conceptualisation of COVID-19 and social support mechanism.
| Variables | Rely on comments from general people | Taking advice from family | Taking advice from friends | Developing relationships (Online) | Participating in online social activities | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Chi-Sq | Sig. | Chi-Sq | Sig. | Chi-Sq | Sig. | Chi-Sq | Sig. | Chi-Sq | Sig. | |
| COVID-19 is related to eating habits. | 6.7 | 0.566 | 7.2 | 0.204 | 8.8 | 0.003** | 5.5 | 0.702 | 10.0 | 0.258 |
| COVID-19 is fear of death. | 11.9 | 0.015* | 6.0 | 0.001** | 7.6 | 0.464 | 16.8 | 0.004** | 6.4 | 0.005** |
| Strengthening religiosity in our eating practices. | 12.9 | 0.001** | 4.0 | 0.004** | 8.9 | 0.347 | 8.9 | 0.005** | 14.4 | 0.041* |
| Fear of interacting people. | 7.5 | 0.042* | 8.0 | 0.001** | 8.2 | 0.004** | 5.1 | 0.05 | 14.2 | 0.037* |
| Strengthening religiosity in our interaction patterns. | 5.5 | 0.001** | 0.9 | 0.001** | 10.8 | 0.210 | 4.1 | 0.018* | 16.4 | 0.037* |
Note: p<.05.
Moreover, a few of the variables had moderate association among them such as COVID-19 conceptualised as fear of death and relying on interaction with people (sig. 0.015), COVID-19 conceptualised as strengthening religiosity in our eating practices and participation in online social activities (sig. 0.041), COVID-19 conceptualised as fear of interacting with people and relying on interaction with people (sig. 0.042), COVID-19 conceptualised as fear of interacting with people and participation in online social activities (sig. 0.037), COVID-19 conceptualised as strengthening religiosity in our interaction patterns and developing online relationships (sig. 0.018), and COVID-19 conceptualised as strengthening religiosity in our interaction patterns and participation in online social activities (sig. 0.037).
Table 5 shows the acceptance of hypothesis regarding the social media for social support among elders during COVID-19 in Indonesia. The data certified that the level of significance is .923 constant explains the user’s intention to use the social media for social support means. The purpose of ANOVA analysis is to determine the significance difference in social support based on social media usage. In the ANOVA test, we have fixed social support as dependent variable, while social media as independent category. The dimension of social support are emotional support, instrumental support, and informational support, while the social media is set as social media applications.
ConclusionThe growing trend of the usage of social media for social support and mental health cures are essential for all, but also for elders in Indonesia. Online media platform offers social support and counselling services for elders, addressing both physical and psychosocial health needs. The study deployed the self-awareness and insight scale to measure the self-consciousness, and it predicts that, due to social media, elders are educated and self-aware. Furthermore, social media was supportive during the pandemic issues, and it also provided health education but on the other side, it also connected the elders to others for taking care for their social supports, i.e., families, friends, and other social networks. The present study was inclusive to analyse the public perception on elders during the pandemic, as they were isolated and restricted to limited space, and considering the social media as an instrument for being a social support platform. It is important to provide individuals with accurate information about COVID-19 and its prevention, as well as resources for mental health support. This can include providing access to counselling services and mental health hotlines, as well as encouraging individuals to engage in self-care practices such as exercise, meditation, and connecting with loved ones.
FundingFunding for this research was availed from Universitas Airlangga, Indonesia.
Ethical approvalThis study was conducted by the mutual cooperation of research team, and the questionnaires was approved by the head of the research committees, at Universitas Airlangga, Indonesia.
Informed consentAn informed consent was taken before starting the survey.
Authorship contribution statementMM has formulated this data, analysed and arranged it in order, MS wrote the description of the tables and abstract, RI reviewed it and prepared the value of the data. Whil AA assembled the data and designed the method section.
This survey was conducted with the help of Universitas Airlangga, Indonesia [Universitas Airlangga, Grant/Award Number: Special grant on COVID Outbreak (No. 1061/UN3.14/PT/2020]. The authors would like to extend their vote of thanks to all the participants, and in value support to our work. We are also thankful to Rector Universitas Airlangga, for providing the grant to share the outcome of social media as a health education tool in COVID-19.