Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Saraswati Dental College
On Sep 2018

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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : LC26 - LC32 Full Version

COVID-19 Vaccine Behaviour among People Attending a Tertiary Care Centre, Punjab, India

Published: March 1, 2022 | DOI:
Ravi Kumar Garg, Kranti Garg, Nitin Gupta, Vishal Chopra, Ankur Gupta

1. Assistant Professor, Department of Paediatric Surgery, Government Medical College, Patiala, Punjab, India. 2. Associate Professor, Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India. 3. Ex-Professor, Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. 4. Professor and Head, Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India. 5. Junior Resident, Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India.

Correspondence Address :
Ravi Kumar Garg,
Assistant Professor, Department of Paediatric Surgery, Government Medical College, Patiala, Punjab, India.


Introduction: Coronavirus Disease 2019 (COVID-19) appropriate behaviour and vaccination are two critical defenses in the fight against this pandemic. As these need to be followed religiously, this preventive behaviour should be thoroughly investigated.

Aim: To examine the COVID-19 vaccine behaviour amongst people attending tertiary care centre at Patiala, Punjab, India.

Materials and Methods: A cross-sectional study was conducted on 200 individuals attending the Outpatient Department of Government Medical College at Patiala, Punjab, India, from 15th July to 22nd July 2021. Individuals were administered socio-demographic questionnaire, General Health Questionnaire-12-Hindi version (GHQ-12), and COVID-19 vaccine related and COVID-19 appropriate behavior related questionnaire. Actual observation by the clinician regarding proper use of face masks, hand hygiene and social distancing was done and objectively scored on 0-10 for each item with a scale interval of 2. Analysis was conducted using IBM Statistical Package for the Social Sciences (SPSS) version 22.0.

Results: Only 40% individuals were vaccinated. After eligibility, there was a mean delay of 4.20±3.51 weeks (median: 4 weeks) and 13.40±3.33 weeks (median: 12 weeks) in the vaccinated and unvaccinated individuals. Out of 120, 86 unvaccinated participants planned to get vaccinated in future. Significantly lower scores were obtained for actually observed COVID-19 appropriate behaviour (proper mask usage, hand hygiene and social distancing) as noted by the clinician vs the scores as reported by the participants.

Conclusion: There were few takers for the COVID-19 vaccine, even weeks after eligibility. The COVID-19 appropriate behaviour was largely not being followed properly and the false sense of following the same complicated issues further. With multiple waves of the pandemic one after the other, and booster doses of vaccination, there is still an urgent need to sensitise the population at the grass root level regarding the COVID-19 vaccine behaviour to fight this pandemic.


Coronavirus disease 2019, Pandemic, Social vaccine behaviours

Researchers, scientists and health care workers across the world are fully engaged in discovering an effective drug and vaccine for COVID-19 (1). In the quest and focus for a vaccine and a drug for COVID-19, people are becoming ignorant of the COVID-19 appropriate behaviour, despite repeated warnings issued by the Government from time to time. Maladaptive and adaptive behaviours are the two types of community behavioural responses seen in pandemic like situations (1). Such responses are guided by a fine interplay of various factors: administrative, social, financial, societal, individual and so on (1),(2). As time passes by in the COVID-19 pandemic, it becomes more and more important to understand such responses, particularly the social vaccine behaviours and preventive measures being adopted by the general public.

The months from February to July 2021 have witnessed people commonly flouting the social norms, not following the COVID-19 appropriate behaviour and enjoying ‘revenge’ holidays [3[,[4[,(5). On one end of the paradigm is the ‘intentionally’ careless population who is a threat to any prevention and management protocols, and on the other end is the ‘unintentionally’ careless one, who lives in the false sense of security of following the COVID-19 appropriate behaviours, but in reality is not doing the same and is even bigger a threat to the continuous spread of the infection (1),(2),(3),(4),(5). Intentional and unintentional carelessness over a period of time will lead to multiple waves of COVID-19, one after the other (2).

In India, the vaccination drive against COVID-19 was launched in January 2021, and was ramped up time and again. In different phases, it covered the people at risk initially and then, the whole population at large (6),(7),(8),(9),(10). However, since its launch, vaccine hesitancy prevailed and there were not many takers for the vaccine (11). Subsequently, as the second wave gripped the nation, the country faced a shortage of vaccines because of panic, a sudden ‘want’ of vaccination by the masses and gaps in the demand and supply. Even after the case numbers fell, the shortage of the vaccines persisted by and large (12),(13).

The preventive behaviour for curtailing this pandemic need to be prioritized (14). There is an urgent need to investigate the vaccine behaviour amongst the masses so that appropriate steps can be taken and policies formulated accordingly. The Union Health Ministry reported 50% of the Indians not wearing a mask, and only 14% wearing it properly (15). The Ministry also found nine most affected districts of Punjab, amongst others, not following the COVID-19 appropriate behaviour (16). The data on vaccination by the end of May 2021 showed only 2.5% of Punjab population to be fully vaccinated (17). This study was hence planned to examine the COVID-19 vaccine behaviour amongst people presenting to the outpatient departments attached to Government Medical College, Patiala, Punjab, India. COVID-19 appropriate behaviour in real life conditions has not been factually observed/recorded in the past. The COVID-19 appropriate behaviour was observed and recorded by the clinician and compared with the behaviour as reported by the participant in this study.

Material and Methods

This cross-sectional study was conducted in the Outpatient Departments of Government Medical College, Patiala, Punjab, India, from 15th to 22nd July, 2021. The study was approved by the Institutional Research and Ethics Committee {vide letter number (Trg).EC/NEW/.INST/2020/997/16838 dated 13th July,2021}.

Inclusion criteria: The patients and their relatives/accompanying persons more that 18 years of age and eligible for COVID-19 vaccination were presenting to the Outpatient Departments of Government Medical College, Patiala, Punjab were included in the study.

Exclusion criteria: Individuals were excluded if they were less than 18 years of age, were pregnant/lactating females, had pre-existing psychiatric illness, had lack of competency for completing the questionnaires, had evident memory deficits on clinical assessment, had lack of capacity or had organicity (delirium, dementia).

Sample size calculation: Leaving aside socio-demographic variables, there were roughly 20 other variables which were assessed. On the advice of the statistician, 10 times the sample size, i.e., 200 participants were taken in order to be able to run multivariate analysis.

Details of Assessment Parameters

After informed consent, baseline assessment was done using the following instruments:

1. Socio-demographic performa: A specially constructed structured Performa was used to record the relevant data.
2. COVID-19 vaccine related questionnaire: Eligibility for vaccination was assessed for each participant. The vaccination status and concerns regarding the same were noted. Reasons for being vaccinated/non-vaccinated were enquired. The worry of the individuals due to an increase in duration between the two doses of Covishield from a minimum of four weeks to 12 weeks (18), was also noted on a scale of 0-10. There were 15 questions in the questionnaire [Annexure I].
3. General Health Questionnaire-12-Hindi version (GHQ-12): It is a 12-item screening instrument which is validated in the Indian population and was used for measuring psychological distress (19). It is scored from 0 to 12, with a score of 0/1 for each item. The total of the scores of all the 12 items of an individual is the GHQ-12 score of that individual. Any individual scoring ≥3 was defined as a case with psychological morbidity (20),(21).
4. COVID-19 appropriate behaviour related questionnaire and assessment: Each individual was asked whether he was following the COVID-19 appropriate behaviour, “social vaccine”, (by wearing masks properly, using a sanitiser or washing the hands frequently for hand hygiene and maintaining social distancing), and scored on 0-10 for each of the three items. These three parameters were also scored on 0-10 for each item with a scale interval of 2, by actual observation by the clinician. The clinician observed the participants for the use of sanitiser/hand washing as they entered the consultation room. The same was available in the visibility range of the clinician. Ideal score was taken as 10 for each item [Annexure I].

Both the COVID-19 vaccine related questionnaire and COVID-19 appropriate behaviour related questionnaire were devised by the authors. The questions were taken and adapted from literature and guidelines issued by Government of India (11),(13),(14),(17),(22),(23),(24),(25),(26),(27),(28),(29). They were then subjected to extensive review by three experts to add to face validity.

Statistical Analysis

The data was of categorical variables and was reported as counts and percentages. Group comparisons (actual mask wearing, practicing hand hygiene and maintaining social distancing) were made with the Chi-square test or Fisher’s-exact test. Quantitative data were represented as mean±SD, median and interquartile range. The p-value <0.05 was considered signi?cant. All the statistical tests were two-sided and were performed at a significance level of α=0.05. Analysis was conducted using IBM Statistical Package for the Social Sciences (SPSS) version 22.0.


A 113/200 (56.5%) of the participants were between 18-40 years of age. Out of total, 94 (47%) were males and 106 (53%) were females. Total 130 (65%) belonged to an urban background. The socio-demographic details of the individuals are represented in (Table/Fig 1). An 80 individuals (40%) were vaccinated at the time of assessment, while 120 (60%) were unvaccinated. Majority of the participants (111,55.5%) had either inappropriate or no information of the benefits of vaccination. Amongst those unvaccinated, 38/120 (31.6%) wanted the clinician to decide for their vaccination. Amongst the vaccinated ones, majority 95% were vaccinated with Covishield. A 6% had history of family member/close relative suffering from COVID-19 or dying because of the disease in the past. A total of 15 (7.5%) participants had themselves suffered from COVID-19 in the past, 14 had mild illness and recovered at home while one had moderate illness for which they were hospitalised. In 7/15 patients, >3 months had already elapsed after recovery. Six were found worried due to increase in the interval between the two doses of Covishield. Out of the 120 participants who were unvaccinated, 86/120 (71.67%) planned to get vaccinated in future, while 34/120 (28.33%) did not want to get vaccinated even in the near future.

A 97.5% (195) patients had a GHQ-12 score of <3, and hence were not suffering from psychological morbidity (Table/Fig 1). The number of patients with a score of 0/1 for each of the 12 items is tabulated as (Table/Fig 2). More than 95% of the patients had a score 0 for most of the items of GHQ-12.

The beliefs of the patients regarding the protection provided by the COVID-19 vaccine and various reasons for the patients getting vaccinated or avoiding the same are shown in (Table/Fig 3). Amongst vaccinated individuals, protection of self/family members was the main reason for getting the vaccine (70/80=87.5%). Two patients quoted the mandate of vaccination for continuing their jobs (counted in ‘others’ in (Table/Fig 3)). Amongst unvaccinated participants, 34/120 (28.4%) were bothered for adverse reactions. A 4/120 (3.33%) even quoted that there were some other family issues which need to be attended before going for vaccination.

After becoming eligible, there was a mean delay of 4.20±3.509 weeks (median: 4 weeks) in individuals who got themselves vaccinated, and a mean delay of 13.40±3.334 weeks (median: 12 weeks) in the unvaccinated ones.

All the participants (100%) reported following the COVID-19 appropriate behaviour in the form of wearing the masks properly, practicing hand hygiene and maintaining social distancing. However, when these 3 behaviours were evaluated by close observation by the clinician, with 10 taken as the ideal score for each of these behaviours, the scores for mask, hand hygiene and social distancing were 7.54±3.250, and 2.32±1.243 and 9.55±1.466, respectively. There were statistically significant differences in the reported vs observed practices (p-value <0.001) as analysed by Wilcoxon Signed Ranks Test) for all the 3 behaviours. The exact scores of the participants in relation to the usage of mask, practicing hand hygiene and maintaining social distancing, as observed by the clinician are depicted in (Table/Fig 4). The clinician observed that 177/200 (88.5%) of the participants followed social distancing, 105/200 (52.5%) of the participants were using the mask appropriately; and only 2/200 (1%) were practicing hand hygiene. Taking appropriate ideal score as 10 for each of the three behaviours, relationship of the score as 10 and <10 with various socio-demographic and vaccine related variables was studied and the corresponding p-values are depicted in (Table/Fig 5). Significantly greater number of people who planned to get vaccinated in near future scored 10 in proper mask usage (p-value=0.011). Hand hygiene was significantly better in those who were living in families with >6 people per household (p-value=0.032). Social distancing was significantly better in those participants staying with 1-4 people per household than those staying with >6 people per household (p-value=0.006).

The participants were further classified into two categories (unvaccinated and vaccinated), and the three parameters of observed COVID-19 appropriate behaviour viz., proper mask usage, hand hygiene and social distancing were compared in relation to the various socio-demographic and vaccine related variables (Table/Fig 6). It was seen that amongst the unvaccinated people, those educated >12 classes and those who planned to get vaccinated in near future scored 10 in proper mask usage and thus fared significantly better (p-value=0.006 and p-value=0.004, respectively). No such trend was seen with the vaccinated sub-group. Hand hygiene was significantly better in those vaccinated individuals who were living in families with >6 people per household (p-value=0.012). No such trend was seen in the unvaccinated sub-group. Social distancing was significantly better in those unvaccinated individuals living in families with 1-4 people per household than those with >6 people per household (p-value=0.003). No such trend was seen in the vaccinated sub-group.


Vaccination against COVID-19 and COVID-19 appropriate behaviour (social vaccine) are the two cornerstones to bring an end to this pandemic (22). In a developing nation like India, on one hand the authorities are fighting with the availability and efficacy of vaccines and sensitisation of the masses for getting vaccinated. On the other hand, they are fighting every now and then for imposition of COVID-19 appropriate behaviour. Nearing two years of the pandemic, enactment of a mask mandate, encountering a deadly second wave, facing the third wave and various mathematical models suggesting an advantage of the COVID-19 appropriate behaviour, the entire world is still struggling for acceptable use of the “social vaccine” i.e., proper use of masks, hand hygiene and social distancing practices (23),(24),(25),(26),(27),(28).

The socio-demographic representation of the participants showed an almost even distribution of age, gender and educational status. Majority (65%) of the participants belonged to an urban background. Additionally, majority (73.5%) did not belong to any special group for eligibility for vaccination. Most individuals scored <3 on GHQ-12, and hence were not suffering from psychological morbidity. With the second wave of the pandemic playing havoc in India, just in the preceding few weeks, it was surprising to find that the population had seemingly adapted to the ‘new normal’, and the disease had primarily stopped affecting the psychology of the general public in a negative manner, over a period of time (30).

Majority (60%) were unvaccinated at the time of assessment, though the whole sample had already become eligible for getting the vaccination. A mean delay of 13.40±3.334 weeks (median: 12 weeks), as calculated in this study provides some early insights into the vaccine hesitancy of the population. Majority (55.5%) had either inappropriate or no information of the benefits of vaccination. Many wanted the clinician to decide for them regarding vaccination, without being bothered about the advantages/disadvantages, as they had ‘heard’ about the doses being administered, from various sources. The actual vaccine uptake of 40% found in this study is reflective of the findings seen earlier in a nationwide survey in India before the launch of the vaccination drive where 70% of the participants had concerns regarding vaccines, with 20.63% being unaware about vaccines and 37% either unsure of getting the vaccine or 10% refusing for the same (31). Such findings signify the need for enhanced awareness regarding efficacy of the vaccine amongst the masses, so that people come forward in the COVID-19 vaccination drive voluntarily.

As was expected, majority (87.5%) of the people who got themselves vaccinated, held protection of their own self and their family members as the reasons. Few even quoted vaccine as a mandate in order to continue with their jobs properly.

Some people were afraid of adverse drug reactions while others were afraid of getting COVID-19 because of the vaccine itself. Many individuals quoted that nobody could give them satisfactory answers for any ill-effects of the vaccine on their pre-existing medical illness. Some quoted family issues to be sorted as the reasons for staying unvaccinated. Such a concern for adverse drug reactions and trust/mistrust in vaccination was found in an earlier study too, from the Indian background (32). In addition to the need for availability of the vaccines at the vaccination centres in abundance by meeting the demand supply chain, various such concerns at an individual level need to be discussed minutely and on priority.

The extreme variations in the reported versus observed scores of the COVID-19 appropriate behaviours should be taken as an eye-opener during preparations of the subsequent waves of the pandemic (33). With majority of the study population not reporting psychological morbidity (GHQ-12 <3), it is naturally expected that they will follow COVID-19 appropriate behaviour. However, this study demonstrates and highlights the biggest threat: the false sense of security the masses are harbouring within. Every study participant felt that they were following the social vaccine behaviour (COVID-19 appropriate behaviour) and hence, were safe from COVID-19. However, their observed behaviour, as noted by the clinician was just the opposite. Though 88.5% of the participants followed social distancing, only 52.5% of the participants were using the mask appropriately; and only 1% was practicing hand hygiene strictly. Such inappropriate/undesirable behaviour of individuals (as noted in reality); but with a “subjective” feeling of ‘being safe within’ needs immediate attention in our considered opinion. It may not be unbefitting in our assumption that the results so obtained in this study can be generalised to the masses and steps need to be taken accordingly to ensure the efficacy of the “social vaccine”. This “social vaccine” is effective in not only preventing the spread of the infection, but also fighting against the new mutant strains, as they appear and pose challenges to the strategy of vaccination and overall management of the disease (34).

It was also seen that proper usage of masks, hand hygiene practices and social distancing was independent of a majority of the socio-demographic and vaccine related variables that were studied. Gender bias, with lesser males following the COVID-19 appropriate behaviour, has been reported in the past (35),(36). Those who are lesser educated and have lower income were also found not following the required behaviours (35). However, similar findings were not seen in the present study. Proper mask usage was found to be significantly better in those people who planned to get vaccinated in near future, depicting their self-protective behaviour till vaccination. Education was found to play a significant role with respect to proper usage of mask, in those individuals who were unvaccinated, but not in those who were vaccinated. Overall, hand hygiene was significantly better in those who were living in families with >6 people per household. Similar significantly better trend for hand hygiene was seen in unvaccinated individuals, but not in vaccinated ones. Social distancing was significantly better in those participants living in families with 1-4 people per household, overall, and also in unvaccinated individuals, but not in vaccinated ones (when sub-categorised). This could be a habitual behaviour cultivated in general over time because of the number of people staying in a single household in such families.

Various Information, Education and Communication (IEC) activities are aggressively needed for concrete knowledge regarding vaccine. Taking the help of the locals in dissemination of information can be a giant leap in motivating the public. The third/booster vaccination has started, however, there have been reports of very less number of people vaccinated with the second dose even (37). Vaccine hesitancy needs to be dealt with early, and strict COVID-19 appropriate behaviour is needed to achieve herd immunity and deal with new variants (38). Emphasising again, COVID-19 appropriate behaviour is indeed the best “social vaccine” till we succeed in formulating an ideal drug and an ideal vaccine for the disease (39).


This study had certain limitations. it was carried out in only one part of a state from North India. The sample size was small. No major psychological correlates were examined. However, it is surprising to note that no study has evaluated the vaccine behaviour in real life conditions till date. The factual observation and recording of the COVID-19 appropriate behaviour by the clinician and its comparison with the behaviour as reported by the participant emerged as the biggest strengths of this study. A true picture of the COVID-19 appropriate behaviour being actually followed by the individuals, all of whom otherwise reported following the required behaviours fully, was deciphered.


There were few takers for the medical COVID-19 vaccine, even weeks after eligibility. The knowledge regarding efficacy of the vaccine and its advantages was missing amongst general public. The COVID-19 appropriate behaviour was largely not being followed properly, and the false sense of following the same complicated the issues further. Leaving aside a few, the vaccine behaviour was largely found to be unaffected by majority of the socio-demographic variables. Community based national sampling surveys are required to yield more information on the experiences and perceptions of population of different areas regarding the uptake of “social vaccine” behaviour. Lastly, there is an urgent need to sensitise the population at the grass root level regarding the COVID-19 vaccination and COVID-19 appropriate behaviour to fight this pandemic, by employing various IEC activities.


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DOI and Others

DOI: 10.7860/JCDR/2022/54897.16142

Date of Submission: Jan 11, 2022
Date of Peer Review: Jan 29, 2022
Date of Acceptance: Feb 22, 2022
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jan 14, 2022
• Manual Googling: Feb 16, 2022
• iThenticate Software: Feb 24, 2022 (3%)

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