Covid-19 pandemic has threatened the mental health of people in all its aspects worldwide. Peer support generally has positive effects on the mental health of a wide range of recipients and can be presented through a variety of available media (24). The present study explored the effectiveness of multimedia-based peer education on anxiety in Covid-19 patients along with the usefulness of this peer support as a form of mental health support for these patients. Studies have shown that use of the experiences of peer groups, adequate education and information related to the disease, control and follow-up care through people who have practical knowledge of the disease and are affected by it would improve the health status of patients (25).
Based on the results of the present study, Covid-19 patients had moderate to severe anxiety in both groups, but the anxiety score in the intervention group was significantly reduced post-intervention compared to the control group. In this regard, Viswanathan et al. (2020) examined the effects of the relationship between support groups and individuals’ mental health care through video conferencing during the Covid-19 epidemic. They asked physicians, nurses, and patients to communicate and provide individual health care through video communication. The results revealed that they had high anxiety level due to anxiety and fear of contracting Covid-19 to family members and stress because of social distancing. They also found that this method of communication and providing support through remote peer groups and individual counseling are a beneficial model for supporting individuals during this global crisis (26). Kong et al. also showed that 34.7% of Covid-19 inpatients have symptoms of anxiety and there is a significant relationship between the frequency plus severity of anxiety of patients and low social support. Also, the use of practical interventions to improve social support is very helpful in improving patients' perceived anxiety (27).
In a study, Suresh et al. investigated the use of peer support to enhance mental health during the Covid-19 pandemic. They reviewed previous studies conducted from October 2019 to March 2021, and concluded that this pandemic has considerably worsened the mental health of global populations. It has also been shown that peer support has positive effects on the mental health of a wide range of people and can be presented through various available media. They believe that peer support in general can be useful for improving mental health during the Covid-19 pandemic and will be an effective tool in case similar events occur in the future (28).
Ding & Yao also performed an interventional study on the effect of peer education on adolescent anxiety, depression, and sleep disturbance during the Covid-19 pandemic. They found that people experienced a great deal of anxiety and depression, where the anxiety level in the intervention group was reduced more significantly as compared to the control group following peer-to-peer communication (P < 0.001) (29). With the target group in the above study including adolescents, the authors found the use of peer education is effective on improving the experienced psychological burden, which was consistent with the results of the present study. Considering the similar characteristics of the members in the peer education approach, a simple and reliable learning environment is created and patients can use the experiences of their peers for improvement of symptoms (30).
In a systematic review of studies on effectiveness of one-to-one peer support in mental health services, White et al. showed that one-to-one peer support had a positive effect on outcomes and this group of interventions can contribute to improving the psychological status of patients (31). In a clinical trial study, Molazem et al. investigated the effect of peer group education on patients' anxiety levels and found that use of peer education could significantly reduce the average anxiety score compared to the control group (18). Peer support, which is a peer-to-peer social and emotional support, is an effective mental health resource which can potentially be used to improve mental health under these situations (28).
In this regard, Aalaei et al. formulated a protocol entitled “Mobile application design and evaluation of its effects on the psychological parameters of Covid-19 inpatients”. In this protocol, 112 Covid-19 inpatients were randomly divided into control and intervention groups. In the intervention group, a mobile application was used to educate patients, establish two-way interactions between patients and caregivers, and record patients' symptoms. Patients in the control group would receive only routine care. The primary outcome included changes in SAS. The authors stated that resolving patients' ambiguities through informative medical and psychological content, monitoring patients during hospitalization and recovery, and sending online feedback by physicians will help reduce stress and improve treatment outcomes (32).
Access to digital social technologies may reduce many of the negative effects of disrupted face-to-face communication (33). Indeed, research shows that online social communication contributes to maintaining relationships (34), enhancing intimacy, and decreasing loneliness (35). Thus, social media use can improve the ability to overcome mental health stress due to Covid-19 disease. Multimedia-based communication provides secure, remote communication for Covid-19 patients and is regarded as a highly practical supportive intervention.
In the present study, due to the limitations associated with an educational and face-to-face communication program, the use of a multimedia-based peer education was a highly useful program which reduced anxiety. In this regard, Habibzadeh et al. carried out a study entitle: “the effect of video- and peer-video based education on the anxiety of patients undergoing coronary angiography”. The control group only received the routine education program. The results revealed that there was no statistically significant difference between the four groups in terms of the mean pre-intervention anxiety scores; however, there was a significant reduction in post-intervention anxiety score in all three intervention groups compared to the control group (36).
In their study titled “online social communication as a buffer of anxiety and health isolation during Covid-19 disease”, Stuart et al. (2020) found an increase in anxiety and depression scores, in particular when patients were alone and isolated during Covid-19 pandemic, while participating in online social media could reduce levels of anxiety and depression. They found that online social communication inhibited the negative effects of anxiety in isolated patients. These results provide promising ways to reduce vulnerabilities during a pandemic and highlight the need to promote alternative social support mechanisms in the absence of face-to-face communication (37).
The results of this study confirmed the main hypothesis of the present study suggesting that COVID-19 patients experience massive anxiety due to sudden involvement with the disease as well as unstable physical conditions, being far away from family, and lack of knowledge about the length of hospitalization.
Also, due to the limitations associated with the physical presence of the peer group, the use of multimedia-based peer education is a practical intervention to shape the process of effective patient communication. The peer education is an effective method in which people learn from each other through observation, imitation, and modeling. In this method, the development of knowledge, attitude, and healthy behaviors occurs by those who are not professionally trained in that field but have common experiences (38).
Study limitations
In the present study, the peer support group was used for only four months during the Covid-19 pandemic. It is suggested to continue use of such interventions until the end of the Covid-19 pandemic in future research. This is because when the intervention is completed, its efficacy can be reduced. The present study only investigated the effect of the multimedia-based peer group on reducing patients' anxiety. Thus, other media environments apart from multimedia can be used to improve and compare the effect of the intervention in future research.