FEAR OF CONTRACTING COVID-19: INFLUENCE OF INFORMATION SOURCES AND MESSAGE CONTENT ON FEAR- AROUSAL AMONG BODA BODA RIDERS IN NAIROBI COUNTY, KENYA

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INTRODUCTION
In the current 24-hours news and digital media environment, people constantly receive information from many sources which are widely available. Information sources can be individuals, groups, institutions or organizations. According to Walter et al. (2012) the main sources of information on pandemics are the internet and mass media, such as, television, radio, magazines and newspapers. Oh et al. (2015) assert that when people do not have firsthand experience or knowledge on an infectious disease, they are more likely rely on mass media to learn about the disease outbreak. Interpersonal relationships made through social ties such as friends, family, community organizations or those with healthcare providers may also be sources of health information (Nellis & Savage, 2012). According to Miller (1973) messages delivered through the mass media often stimulate interpersonal discussions about a health issue.
In recent years, the media as an information source, has shaped the coverage of disease outbreaks by heightening fear while serving as a useful tool for encouraging precautions and prevention (Moukaddam, 2019). The use of fear appeals in the form of threatening health messages, is a commonly used strategy for health promotion, disease prevention and adoption of behaviour within a population (Brown & Whiting, 2014;Simpson, 2017;Sweene & Stephens, 2013). This tactic involves using images or messages to elicit negative emotions such as fear and anxiety, in the expectation that the target audience will be motivated to adopt the recommended health behaviours (Brown & Whiting, 2014).
The coronavirus disease 2019 (COVID- 19), which was first discovered in December 2019 in Wuhan, the capital of Hubei Province in Central China, has aroused fear among people all over the world. The virus is highly contagious, which means it can be spread, directly or indirectly, from one person to another. Densely populated communities or cities enhance its quick spread (WHO, 2020). The virus is spread through respiratory droplets transmitted into the air from coughing or sneezing, which people nearby can take in through their nose, mouth or eyes. It can also be transmitted when human beings touch surfaces that are contaminated with the virus and further, with their unclean hands, touch their eyes, nose and mouth (Africa Center for Disease Control and Prevention, 2020).
COVID-19 is a new and an unknown disease that has neither cure nor vaccine. "Moreover, millions of people have been infected and hundreds of thousands have lost their lives to the virus, worldwide" (Kigatiira, 2020 Over the years, research on information sources and message content in health communication has increasingly gained impetus, worldwide. However, there is a dearth of knowledge in this area, as little if any research has investigated the influence of information sources and message content on fear arousal among commercial motorcycle operators, commonly known as boda boda riders. Specifically, there is no study that has investigated the influence of information sources and message content on COVID-19 in arousing fear among boda boda riders. Thus, the purpose of this study was to examine the influence of information sources and message content on COVID-19 in arousing fear among boda boda riders in Nairobi County, Kenya.

AGENDA-SETTING THEORY
The agenda-setting theory was developed in 1972 by two professors, Maxwell McCombs and Donald Shaw. The theory looks at how the media news coverage determines which issues become the focus of public attention (Alvernia University, 2018). When reporters give particular news prominence and attention, by giving the stories extensive media coverage, the audience automatically perceive it as such (Alvernia University, 2018; Wahl-Jorgensen, 2020). The agenda-setting theory is based on two major assumptions. First, the media filters what is happening by focusing on a few issues, making them more prominent, while ignoring other stories (Winters et al., 2020). Secondly, the more attention an issue is given by the media, the more likely the public will consider it to be important (Alvernia University, 2018). Therefore, the agenda-setting theory doesn't necessarily tell people what to think but what issues they should think about (Wahl-Jorgensen, 2020). Although the agenda-setting theory doesn't particularly examine how interpersonal and social media information sources make news stories the focus of public attention, the theory was critical in determining how the mass media made the COVID-19 pandemic the focus of public attention, thus arousing fear.

FRAMING THEORY
The concept of framing was first posited by Anthropologist Gregory Bateson, in 1972. Framing is the practice of thinking about news items and story content within familiar context. The theory explains that the media create the frame by introducing news items with predefined and narrow contextualization. "Frames can be designed to enhance understanding or are used as cognitive shortcuts to link stories to the bigger picture" (Arowolo, 2017). The framing theory suggests that the way news stories are presented to the audience (called "the frame"), determine how people understand and remember a news story, as well as how they evaluate and choose to respond to it (Entman, 1993;Goffman, 1974). Framing is also referred to as second-level agenda-setting because it focuses on the way the media draws the public's eye to specific topics-setting agenda, and then takes a step further to create a frame, through which the audience will comprehend the information (Arowolo, 2017). In this study, the framing theory was used in identifying the manner in which the mass media present news stories on the COVID-19 pandemic and subsequently aroused fear among boda boda riders in Nairobi County.

INFORMATION SOURCES ON INFECTIOUS DISEASE OUTBREAKS
When there is an outbreak of an infectious disease, people constantly receive information from multiple sources which are widely available. According to Walter et al. (2012) the main sources of information on pandemics include mass media, such as, television, radio, magazines and newspapers and the internet. For example, at the onset of the SARS outbreak, the global media reported dramatic stories from Asia in print media, television and the internet (Person et al., 2004). Oh, et al. (2015) asserts that when people do not have firsthand experience or knowledge on an infectious disease, they are more likely to rely on mass media to learn about the disease outbreak. The traditional mass media, play an enormously influential role in public responses to health issues (Leask et al., 2010). According to Gunther (1998) and McCombs and Shaw (1972) the mass media has an unparalleled reach as a communication mechanism and substitutional power in setting agendas on what people should be concerned about and take action on. In addition, mass media frames issues by influencing how people should think about the information given. However, mass media can be expensive and doesn't necessarily target specific populations (Wakefield et al., 2010).
Besides the traditional mass media, the internet is also a popular and important source of health information because it is available, affordable and versatile. In addition, it offers high quality, huge volume, current and relevant information (Lagoe & Atkin, 2015). According to Rains (2007) studies have found that many of those who use the traditional media and healthcare professionals as sources of health information, also turn to the internet as an alternative source of health information, in order to gain a different perspective from what they have read or heard. Social media and websites are internet platforms that more people are turning to as sources of health information. Social media are a potentially useful tool for effective dissemination of information to the public on emerging infectious disease (EID) outbreaks updates and important medical information (Tang et al., 2018). For instance, social media has been instrumental in informing the public about recent EID outbreaks such as the 2014 Ebola outbreak and the 2009 A(H1N1) Influenza pandemic (Biswas, 2013). Moreover, government agencies such as the Center for Disease Control and Prevention (CDC), used social media to inform the public about the Zika and Ebola outbreaks (Chan et al., 2018;Lazard et al., 2015). Social media, according to Jang and Baek (2019), functions as a firsthand information source from which the public obtain disease-related information which they share with their family, friends and neighbours in real time. Further, when traditional media does not provide relevant and timely information to the public, social media serves as a major immediate information source (Jang & Baek, 2019; Yoo, Chio & Park, 2016).
Official government websites are associated with high knowledge of diseases. However, a study by Koralek et al. (2016) revealed that the websites, as sources of information, have low popularity among college students. Previous research indicates that distrust in health information from government agencies may contribute to its low popularity. For example, two United States federal agencies charged with protecting publics' health, the Food and Drug Administration (FDA) and CDC, released conflicting statements and recommendations to the public about the use and efficacy of Tamiflu, a flu medication. The contrasting messages diminished the public's trust of the two agencies, presumed to present a united front on health issues (Mandrola, 2015). According to Koralek et al. (2016) distrust can affect audiences' receptivity and responses to public health information.
Interpersonal communication sources of information, such as healthcare providers, family and friends, are consistently ranked as reliable sources of health information. However, the sources have more limited reach compared to social and mass media and may be difficult to quantify or standardize (Leisen & Hyman, 2001; Sharma & Romas, 2016). According to Carlson and Goss (2016), people who live in rural areas and are in dire situations, rely on doctors as a source of health information because they have less internet access, lower device use and less participation in online activities compared to those living in urban areas. Clinicians are also a trusted resource for information on serous health concerns and support (Fox & Duggan, 2013).
Community meetings are common both in the rural areas and informal settlements in urban areas. They are used for sharing health information and gathering community opinions on health issues. The gatherings have been used with success to understand community perspectives on health programs (Naanyu et al., 2013). Families are also important in health promotion, not only within the family itself, but also in the larger society (Wong & Sam, 2010). Through observation and interaction, individuals in a family learn and sustain healthy or unhealthy behaviours practiced by their relatives (Huidobro & Mendenhall, 2015).

MESSAGE CONTENT
Public health initiatives use fear appeals in the form of threatening health messages, as a strategy for health promotion, disease prevention and adoption of behaviour within a population (Brown & Whiting, 2014;Simpson, 2017;Sweene & Stephens, 2013). This tactic involves using images or messages to elicit negative emotions such as fear and anxiety, in the expectation that the target audience will be motivated to adopt the recommended health behaviours (Brown & Whiting, 2014). The media has also shaped the coverage of disease outbreaks by heightening fear while serving as a useful tool for encouraging precautions and prevention (Moukaddam, 2019). For example, at the onset of the SARS outbreak, fear of the infectious disease was heightened by headlines from the English-language press (Person et al., 2004). The British Broadcasting Corporation in London, wrote, "Concern is mounting over the continuing spread of the deadly SARS virus. Some experts say it could have a similar impact to the 1918 flu epidemic that killed 50 million people or the current world HIV crisis" (British Broadcast Corporation, 2003). On the same note, the Cable News Network from Beijing, stated, "China has threatened to execute or jail for life anyone who deliberately spreads the killer virus" (Cable News Network, 2003).
During the 2013-2016 West Africa Ebola virus disease (EVD) outbreak, photographs of the virus most recognized mammalian "reservoir" the fruit bat, aroused fear by showing the creature hanging, inverted with its wings spread and fangs menacing. In addition, frightening visuals depicting the end stage of Ebola virus disease, scary messages such as "Ebola Kills," and pessimistic pronouncements that there was no cure, aroused public fear (Shultz et al., 2016). Britain's first national mass media campaign in response to the emergence of HIV/AIDS in the 1980's, used the images of tombstones and icebergs to emphasize the severe and potentially fatal threat of the disease. Moreover, the message that "AIDS Kills" aroused fear among those who engaged with the message (Bourne, 2010).
Stories on the ongoing outbreak of the novel coronavirus disease 2019 (COVID-19) have received extensive media attention and coverage, and have hence aroused fear among people all over the world (Judd, 2020; Wahj-Jorgense, 2020). Professor Wahl-Jorgensen of Cardiff University, asserted that since emotions are contagious and spread across populations, "the fear of coronavirus is far more contagious than the disease itself." "Fear of the new contagion has, paradoxically, become a global infection" (Judd, 2020). Major English-language newspapers around the world mention "fear" or related words, including, "afraid." In addition, such articles use frightening-language (fear-inducing language), for example, the use of phrases such as, "Killer virus," "Deadly disease" to refer to the coronavirus (Wahj-Jorgense, 2020).  (Das, 2001). Fear is a negative emotional reaction that is usually accompanied by heightened physiological arousal to a perceived threat on an individual's well-being (Gore et al., 1998). However, fear arousal as a reaction in response to infectious diseases, is considered normal and potentially adaptive or protective (McEwen, 2007). During the 2013-2016 EVD outbreak, fear was understandable, reality-based and almost universal (Van Bortel et al., 2016).

STUDY DESIGN
Case study research design which focused only on boda boda riders was used. The design was appropriate because the study sought to investigate the influence of information sources and message content on COVID-19 in fear arousal among boda boda riders in Nairobi County, Kenya.

POPULATION OF THE STUDY
The population of the study comprised of all the boda boda riders operating in Nairobi County. It is important to note that there were no official statistics on the exact number of boda boda riders operating in Nairobi County. According to the Independent Electoral and Boundaries Commission (2013), Nairobi County is divided into 17 constituencies namely: Westlands, Dagoretti North, Dagoretti South, Langata, Kibra, Kasarani, Roysambu, Starehe, Ruaraka, Mathare, Embakasi North, Embakasi East, Embakasi South, Embakasi West, Embakasi Central, Makadara and Kamukunji. All constituencies in Nairobi County were included, such that the study findings formed a representative section of the entire county.

SAMPLE AND SAMPLING TECHNIQUE
This study used qualitative sampling technique. A qualitative sample size is best determined by the time allocation, resources available, the objectives of the study (Patton, 1990) and data saturation (Fusch & Ness, 2015). Different scholars give varying numbers for participants to be interviewed in a qualitative study. For example, Guest et al. (2006) found that 12 interviews conducted from a homogeneous sample is enough to reach data saturation. Similarly, Kuzel (1992) recommended 6-12 interviews for a homogeneous sample. However, Green and Thorogood (2004) noted that most qualitative researchers experienced data saturation after interviewing approximately 20 participants belonging to one analytical relevant category. Therefore, based on Green and Thorogood (2004), Guest et al. (2006) and Kuzel (1992) recommendations, this study interviewed one boda boda rider from each of the 17 constituencies in Nairobi County, totaling to a sample size of 17 respondents. Convenience sampling was used in identifying boda boda riders who were available and willing to participate in the study. The respondents were identified by the researcher's friends, colleagues and relatives who reside in different constituencies in Nairobi County.

DATA COLLECTION
The researcher used qualitative data collection methods. The main data collection tool was telephone interviews with boda boda riders. Advantages of telephone interviews include ability to reach respondents who are dispersed in a large geographical area, enhanced interviewer safety, decreased cost and travel (Aday 1996;Bernard, 2006). In this study, telephone interviews were the most appropriate data collection tools because they enabled the researcher to work from home and have physical distance with the respondents. Abiding by these precautionary measures prevented the researcher and respondents from contracting and spreading the coronavirus disease during data collection.

DATA ANALYSIS
Qualitative data obtained through telephone interviews was coded and analyzed for themes. Data were transcribed manually. That is, the researcher listened to each of the recorded interviews and recorded them on Fear of Contracting Covid-19: Influence of Information Sources and Message Content on Fear-Arousal Among Boda Boda Riders in Nairobi County, Kenya paper. During the transcription process, the researcher took note of how the respondents expressed their feelings during the interview sessions. After transcription, the researcher read and made sense out of the collected data. The data for each question was put together, coded and categorized into relevant themes and sub-themes according to the objectives of the study. For easy identification and interpretation of themes, the researcher marked key phrases with different colored pens. Consistencies and differences in the data were identified by making systematic comparisons across categories of data. Finally, the researcher made possible and plausible explanations of the findings.

DEMOGRAPHIC INFORMATION
All the respondents in the study were male. This implies that the boda boda business sector is dominated by males. In terms of the age of the boda boda riders, most of them were youths because majority ranged between 30-39 years while a minority were between 40-49 years and one was 24 years. Most of the riders had an experience of between one to ten years in the boda boda business, while a minority had 11-20 years, experience. This implied that the respondents were in the boda boda business long enough to be able to provide relevant information for the study. Majority of the respondents were married while a minority were single. Most boda boda riders had attained primary school education followed by those with secondary school education. Further, one rider was a university graduate and another had no formal education. The low levels of education that most boda boda riders had attained, reduces their chances of getting jobs in the formal sector. Therefore, the operators rely on the boda boda business as a source of income to be able to take care of their family financial needs.

INFORMATION SOURCES ON COVID-19
All the respondents in this study asserted that the television and radio were the main sources of information on the coronavirus disease. Other sources of information on the disease were fellow boda boda riders, social media, that is Facebook and WhatsApp, public awareness campaigns, short message service (SMS) from Safaricom communications company and newspapers, respectively. For instance, one boda boda operator said, "I got to know about the coronavirus disease while watching the news in the television one evening. In addition, we discuss news stories reported in the mass media amongst us boda boda riders." Another respondent said: I first heard about the disease when it was announced by the Ministry of Health via the radio. I later received an SMS from Safaricom, informing me of the pandemic. The Kenya Medical Training College (KMTC) also created awareness of the coronavirus disease through a road show.
Findings of the study revealed that television and radio were the main sources of information. This finding is in agreement with Walter et al. (2012) who asserted that the mass media are key sources of information on pandemics. Findings further revealed that boda boda riders who received information about the coronavirus disease from the mass media, discussed the news stories amongst themselves. The interpersonal discussions, subsequently, made the riders key information sources to other operators who had not heard about the virus. This finding is in tandem with Miller (1973) who noted that messages delivered through the mass media often stimulate interpersonal discussions about a health issue.

MESSAGE CONTENT ON COVID-19
Study respondents reported that messages from information sources contained frightening phrases such as, "Coronavirus kills," "COVID-19 is a deadly disease," "Coronavirus is a dangerous disease," and "The virus is highly contagious." "I have heard that coronavirus kills," said a boda boda rider. Another respondent said, "I have heard that the disease is highly contagious and is spread from person to person when there is body contact like a hand shake." Moreover, the riders were in agreement that the messages on the coronavirus disease did not contain any images that aroused the fear of contracting the disease. Some of the boda boda operators said, "We have not yet been shown pictures of people who have contracted the disease. We would like to see how they look like when they are ill." The study revealed that messages on COVID-19 contained phrases that aroused fear. This finding is in agreement with that of Wahj-Jorgense (2020) who found that articles on the coronavirus disease use fear-inducing phrases, such as, "Killer virus," and "Deadly disease" to refer to the virus. Moreover, there were no images that aroused the fear of contracting the virus. Brown and Whiting (2014) asserted that images or messages are used to elicit negative emotions such as fear and anxiety.

Fear of Contracting COVID-19
All the respondents said that they feared contracting the coronavirus disease because the disease has neither cure nor vaccine and that one can either get well or lose their life. In addition, the boda boda riders asserted that they experienced high levels of fear. One respondent said, "Nobody wants to die. Contracting the coronavirus disease, according to me, is like a death sentence." Findings of the study revealed that boda boda riders feared contracting COVID-19. This finding is in tandem with Pappas et al. (2009) who asserted that the transmissible, imminent and invisible nature of emerging infectious diseases have a tendency to arouse fear. Moreover, fear arousal as a reaction in response to infectious diseases, is considered normal and potentially adaptive or protective (McEwen, 2007).

CONCLUSION
Information sources and message content aroused the fear of contracting COVID-19 among boda boda riders in Nairobi County, Kenya. Television and radio were the main sources of information on the coronavirus disease. Other sources of information on the disease were fellow boda boda riders, social media (Facebook and WhatsApp), public awareness campaigns, short message service (SMS) from Safaricom communications company and newspapers, respectively. Whereas messages on COVID-19 used frightening language, there were no images that aroused the fear of contracting the virus.

RECOMMENDATION
Journalists should exercise caution and discretion, considering that mass media are a main source of information on pandemics. News stories covering infectious disease outbreaks should be reported ethically and objectively. This will prevent the arousal of too much fear, which may result to mental breakdown among the receivers of the messages.

SOURCES OF FUNDING
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.