ABSTRACT

Introduction: The pandemic does not stop, neither do the studies on it; This pandemic produces pain, sadness, despair and deaths, whose numbers are unmeasurable. Faced with this difficult and painful situation, laughter raises its flag of hope. Objective: The study aims to describe the levels and demographic factors of laughter, in the context of COVID-19. Methods: The study corresponds to a quantitative, descriptive, cross-sectional approach. The data were obtained through a virtual survey, whose participants were 101, between 20 and 60 years of age, participating voluntarily, from the three regions of Peru: coast, mountain and jungle. The data regarding laughter experience, within the survey, with Likert-type: never, sometimes and always. Results: Of the 101 participants, 87 (between 20 and 60 years old) are located in the high level and 14 in the medium level. 14 participants (among single, married, divorced and cohabitants) revealed laughter in the medium level and 87 in the high level. Of the three regions (coast, mountains and jungle), 14 were in the medium level and 87 in the high level. On the other hand, 6 men and 8 women practiced laughter in the medium level, in the high level 28 and 59, respectively. In the religion factor: 14 (among Catholics, Adventists, Evangelicals and others) reveal a laughter in the medium level, 87 in the high. According to the educational level factor: (primary, secondary and higher), 14 and 87 are located in the low and high level, respectively. In the family and friends circle, laughter is always experienced: 58.4% and 66.3%, respectively; for respondents it is easier to laugh, always, 54.5% and 66.3%, in the family environment and with friends, respectively. They declared that laughter prevents diseases, strengthens health, prevents covid-19, strengthens the immune system and limits the production of the cortisol hormone (responsible for stress), always 70.3%, 31.7%, 81.2; 31.7%, 71.3% and 83.2%, respectively. Conclusion: In the context of COVID-19, the most significant levels of laughter found in the study are two: medium and high; the most weighted demographic factors are: age, sex, religion, and employment status.

Keywords: Laughter, levels, demographic factors, COVID-19 (Source : MeSH - NLM).

RESUMEN

Introducción: La pandemia no se detiene, los estudios sobre la misma tampoco; esta pandemia produce dolor, tristeza, desesperación y muertes, cuyos números son incalculables. Ante esta situación difícil y dolorosa, la risa levanta su bandera de esperanza. Objetivo: El estudio tiene el objetivo de describir los niveles y los factores demográficos de la risa, en el contexto la COVID-19. Métodos: El estudio corresponde a un enfoque cuantitativo, de tipo descriptivo, de corte transversal. Los datos sobre los niveles de la risa se obtuvieron mediante una encuesta virtual, cuyos participantes fueron 101, de edades entre 20 y 60 años, quienes participaron voluntariamente, procedentes de las tres regiones del Perú: costa, sierra y selva. Los datos sobre la experiencia de la risa, con misma encuesta, con el tipo Likert: nunca, a veces y siempre. Resultados: De los 101 participantes, 87 (entre 20 y 60 años) presentan una risa en el nivel alto y 14 en el nivel medio. 14 participantes (entre solteros, casados, divorciados y convivientes) revelan una risa en el nivel medio y 87 en el nivel alto. De las tres regiones (costa, sierra y selva), 14 participantes se ubican en el nivel medio y 87 en el nivel alto. Por otro lado, 6 hombres y 8 mujeres practican una risa ubicada en el nivel medio, en el alto 28 y 59, respectivamente. En el factor: religión, 14 (entre católicos, adventistas, evangélicos y otros) revelan una sonrisa en el nivel medio, 87 en el alto. Según el factor: nivel de estudios (primario, secundario y superior), 14 y 87 ubican su risa en el nivel bajo y alto, respectivamente. En el círculo familiar y de los amigos, se experimenta siempre la risa: 58.4% y 66.3%, respectivamente; para los encuestados es más fácil reír, siempre, 54.5% y 66.3%, en el entorno familiar y de los amigos, respectivamente. Declararon que la risa previene las enfermedades, fortalece la salud, evita el covid-19, fortalece el sistema inmunológico y limita la producción de la hormona cortisol (responsable del estrés), siempre 70.3%, 31.7%, 81.2; 31.7%, 71.3% y 83.2%, respectivamente. Conclusión: En el contexto de la COVID-19, los niveles más significativos de la risa encontrados en el estudio son dos: medio y alto; los factores demográficos más ponderados son: edad, sexo, religión y estado laboral.

Palabras Clave: Risa, niveles, factores demográficos, COVID-19 (Fuente: DeCS BIREME).

INTRODUCTION

Laughter has accompanied men throughout the history of humans. When we talk about laughter, immediately synonyms come to mind such as smile, giggle, contraction, tickles, belly laugh, chuckle, cackle, laughter. We see that laughter has its source in comedy present in literature ⁽¹⁾. Concepts exist that are not disassociated, for example, “positive emotions, humor and laughter”, whose boundaries are complex ⁽²⁾.

Laughter is a physiological or psychological response or reaction generated by a stimulus: humor ⁽³⁾. For Torres ⁽¹⁾, laughter is “an inherent faculty of humans”, whose source is comedy, presents positive functions, generating benefits for men and society, provokes the reactions of muscles and nerves, including compromises intellect, mind, in a space where the mass participates. Laughter is social, not permanent, it is momentary, universal. According to Fernández-Poncela ⁽⁴⁾, laughter, semantically, does not divorce from humor, understood as a “multidimensional and complex phenomenon”. When we speak of emotions, a reference of “physical and mental, neurophysiological and biochemical, psychological and cultural, basic and complex processes” is built, “laughter is happiness, joy” ⁽²⁾. Laughter is a mechanism, reduces physical excitement, stress, emotional tension, unpleasant and negative situations, stimulates and improve blood flow, improve breathing, relaxes muscles, also improves them, and can “revert the effects of hormones such as cortisol and adrenaline, hormones that during stress increase to levels that suppress the immune system” ⁽³⁾. Laughter is a means to reach complete wellbeing in people ⁽⁵⁾.

Laughter has a “tension and passion releasing effect”, “a healing, therapeutic character”, improving mood and the organism, because they release endorphin and regulate heart function, for example ⁽¹⁾. The scope of laughter is complex for its emotional process and humor, in a scene where “perceptions, sensations, thoughts, emotions, feelings for it, needs and actions” stand out, whose humor consists of

“an attitude towards life” and is related with “pleasant sensations and emotions”, allows us to understand the cognitive, emotional, psychophysiological (breathing, nervous system, hormonal, and neuronal), behavioral or motor and social aspects. It has a function of distension, in the sense of “releasing tension, freeing pressure, dedramatizing, breaks up conflicts” ⁽⁴⁾. Laughter keeps a relationship with sensations, perceptions, thoughts and positive emotions: satisfactorily, pleasant. “Laughter is fundamental for health and life, it is also essential for the development of sensations and emotions that get us closer to wellbeing and happiness” ⁽²⁾. It possesses a conceptual variant, denominated laugh therapy, understood as a type of therapeutic technique, whose purpose is to generate laughter in patients, who reveal “emotional, mental, corporal that serve as a preventive tool against health deviations”, laughter generates physical and psychological benefits, in oncological patients ⁽⁶⁾. A person without laughter is not normal, every person expresses a smile or laughter, in this manner, it has the function of laughter therapy, whose experience was carried out in cancer and AIDS patients, generating feelings of happiness and joy, meaning, it has very positive effects on people’s health, exclusively facing stress, improves the psychological state, brain health, health in general, without excluding the benefits: immunological, respiratory, circulatory, hormonal, rest and sleep, digestive ⁽⁵⁾.

Laughter could be “festive, happy, lighthearted or sad, mischievous, sarcastic, taunting”.

The study’s objective is to describe the levels and demographic factors of laughter, in the context of COVID-19.

METHODS

Design and area of study

The study is quantitative, descriptive, cross-sectional ⁽⁷⁾. The quantitative data collection was carried out, the statistical description of levels of laughter was carried out, furthermore the information was collected in one moment and for one time. The study was not observational, and neither was it prospective or retrospective, because the phenomenon was not observed, much less has the denominated cohorts been determined.

Participants

The concepts population or sample are not used. A population or sample have not been determined. The concept of participants is used because these have collaborated with the study voluntarily. In this sense, the number of participants is 101, whose ages range between 20 and 60 years, originating from three regions of Peru: coast, mountain, and jungle. Therefore, no sample has been performed: not probabilistic or non-probabilistic. Better yet, the participation of subjects by convenience was determined, which is why a representative sample is not mentioned. Instead, inclusion criteria or participation of greater than 20 years of age were used. Exclusion criteria was not determined.

Procedure and variables

To gather data, we used the technique called survey, whose questionnaire was elaborated by collection information at the level of laughter and experience of laughter in those surveyed, whose corresponding variables are age, marital status, region of origin, sex, religion, educational level, work status. The survey was taken virtually, prior authorized consent declaration.

Technique and instrument

With the purpose of gathering data required for the study, we used a technique denominated survey, according to the universal parameters of the scientific research. This survey was carried out virtually. The instrument was denominated: Questionnaire: “Laughter and COVID 19”, whose link is https://docs.google.com/forms/d/1vpsaCzgDxK13OEkh3iAj1PM27hkz2X8K6zdGhtPNcpI/edit. This instrument was created by researchers, also validated through expert judgment on content and consistency of the same, applying the pilot study, who resulted in 72.4% confidence through Cronbach’s alpha coefficient. Afterwards, it was applied du

ring two months: January and February of 2021. The instrument had 16 items: 7 corresponded to demographic variables: age, marital status, region of origin, sex, religion, educational level, work status, with their respective ranges and dimensions. 9 corresponded to knowledge, whose responses were established through the Likert-type scale guidelines, with denominations: none, sometimes, and always.

Statistical analysis

For the effect of analysis, we used Excel, whose data was processed through SPSS version 26 program, to describe the levels of laughter, allowing descriptions and corresponding analysis. Through the statistical system mentioned, we determined absolute frequencies that reference the exact number of times a data is repeated, as is shown in the respective tables.

RESULTS

The study was carried out with 101 participants. Three levels of laughter were considered (low, medium and high) in relation to variables: age, marital status, region of origin, sex, religion, highest level of education, and work status.

With respect to age, we considered five age groups: 1st group: from 20 to 29, 2nd group: from 30 to 39, 3rd group: from 40 to 49, 4th group: from 50 to 59 and 5th group: greater than 60 years. For the study the high level is of most interest and its respective percentages. In this level, the highest percentage was obtained by participants 40 to 49 years, 25 participants (28.7%); the lowest, was 60 years or above: 4 participants (4.6%). Between 20 and 39 years of age, a laughter potential exists: 48 participants (47.6%). Of the total participants (101), 87 were found in the high level, 14 in the medium level (see table 1).

Regarding marital status of those surveyed, the highest levels of laughter were presented by married and single, whose respective numbers and percentages were: 34 participants (39.1%) and 35 participants (40.2%); the lowest numbers and percentages were obtained by widowed and cohabitating respectively: 5 participants (5.7%) and 4 participants (4.6%), respectively. 14 fourteen of all participants find their laughter in a medium level and 87 in a high level (see table 2).

We also considered relevant to address the variable: region of origin. Meaning, coast, mountain, and jungle. The highest level and its respective percentage is in the coast: 68 participants (78.2%); the lowest is in the jungle: 8 participants (9.2%). Of the three regions, 14 are in the medium level and 87 in the high level (see table 3).

Regarding the sex variable, the highest level of laughter is in the feminine sex: 59 participants (67.8%), unlike the masculine sex: 28 participants (32.2%). 6 men and 8 women are found in the medium level and in the high 28 and 59, respectively (see table 4).

The variable religion also has a significant presence in relation to laughter. In this context, four dimensions were considered: catholic, adventist, evangelical and other. In the high level, the ascending order is: evangelical: 6 participants (6.9%), other:10 participants (11.5%), catholic: 13 participants (14.9%) and adventist: 58 participants (66.7%). 14 participants (among catholics, adventists, evangelical and others) are found in the medium level, 87 in the high level (see table 5).

In studying the variable level of study, we observe that 92 of surveyed had higher education level, 78 are in the superior level (89.7%) (see table 6). Work status allows us to describe the independent work of 46 that constitute 52.9%, in the highest level. According to educational level (grade school, high school, and higher education), 14 and 87 were in the low and high level, respectively (see table 7).

In the family circle it is always experimented (58.4%), in friend circles (66.3%); it is easier to laugh always, in the family circle and in the friend circle, respectively (54.5% y 66.3%). Laughter prevents disease, always (70.3%), strengthens health (31.7%), avoids covid-19, always (81.2%); strengthens the immune system, always (71.3%), limits the production of the hormone cortisol (responsible for stress), always: 83.2% (see table 8 to table 16)

DISCUSSION

The study was performed with 101 participants, whose participation was voluntary, whose ages were determined between 20 and 60 years of age, all of legal age, avoiding this way some problems of legal and ethical character, understanding, on the other hand, that decisions and declarations are not exposed to observations. The study remained within the field of research of quantitative, diagnostic, descriptive cross-sectional focus, whose data were collected through a survey applied to 101 people, originating from three regions: coast, mountain, and jungle, regarding level of laughter and demographic factors: age, marital status, region of origin, sex, religion, highest educational level, and work status.

Of the total of 101 participants, 87 (ages 20 to 60 years) perceived, according to their declaration in the survey, that they experienced a high level and 14 a middle level. This data obtained signifies that a significant number exists that requires help and orientation about the importance of laughter for personal health and public or collective health, more so in these times of the pandemic named COVID 19. The factors of age and marital status, in high and low levels have the same number: 87 and 14 participants, respectively. Which means that 14 (among singles, married, divorced and cohabitating) require interiorizing the importance of laughter for preventive health. A similar situation also occurs with the participants of the three regions: coast, mountains and jungle, which means with the region of origin factor, including with those who profess a religion (catholic, Adventist, evangelical or other). In other words, the religion factor has a significant presence, and we also include the factor of educational level: grade school, high school, and higher studies.

Considering the importance of age on health ⁽⁸⁾, we propose to carry put interventions in humor and laughter, for the health benefit of older people. Laughter has a therapeutic function for the health of patients ⁽⁵⁾. Patients need a dose of laughter ⁽³⁾, positive emotions and laughter are necessary ⁽²⁾, for health effects it is very important to have education focused on the emotional process of humor and laughter ⁽⁴⁾, including laughter and literature, through comedy stories ⁽¹⁾, humor and laughter are palliative for patients ⁽⁹⁾. Given the importance of humor, during COVID-19 studies have been carried out using the analysis on digit ⁽¹⁰⁾ about humor speeches in social media ⁽¹¹⁾, avoiding panic from press media ⁽¹²⁾, the distrust on the system ⁽¹³⁾, the negative impact of the pandemic on mental health ⁽¹⁴⁾.

Regarding the sex factor: masculine or feminine, 6 men and 8 women were found in the medium level, and in the high level 28 and 59, respectively. This means that 14 (among men and women) need to move from the middle level to the high level, whose results would be beneficial for personal and public health, in addition to prevent and face COVID-19. On the other hand, this data awakens the unrest of analyzing and researching that women have the experience of a greater level of laughter than men, in this sense, there is the question: who have been affected by COVID-19, men or women?

In reality, this study has various purposes. To serve as a diagnosis and motivation for carrying out future research work, For example, those who are more susceptible to COVID-19, the young or adults, women or men, those born in the coast, mountain or jungle, people with grade school, high school or higher education, people with dependent or independent work services. For example, what role has religion had on prevention and treatment of COVID-19, whose studies and research should be performed through the construction of pertinent instruments and scientific procedures., with the purpose of generating very valid results for personal health and collective health.

CONCLUSION

In accordance with the study’s objective, it is concluded that the levels of laughter, in the context of COVID-19, are two: medium and high, these are the most significant, found and revealed by 101 participants in three regions of Peru: coast, mountain, and jungle, on the one hand, on the other hand, the demographic factors related to laughter are age, sex, religion, and work status. These are the most ponderous and significant. Likewise, it is concluded that the family circle and the circle of friends allow a greater laughter experience, which strengthens health, avoids COVID-19, strengthens the immune system and limits the production of the cortisol hormone, responsible for stress in people.

RECOMENDATIONS AND LIMITATIONS

It is recommended that the health entities (Ministerio de Salud – Ministry of Health) and the State consider that laughter, as a preventive factor, strengthens personal and collective health, furthermore, helps to weaken COVID-19 because it strengthens the immune system, also limits the production of the hormone cortisol, which generates stress in people. In this sense, it is recommended to establish programs of collective health, where laughter in vulnerable communities is worked on, including in hospital settings, to favor the health of patients.

This study has had many limitations, for example, the participation of people in filling out the instrument, it was very difficult to find the participation and collaboration. In this respect, a population culture does not exist. We were not able to determine a population and a representative sample, which is why a bias sample is needed. The presence of instruments are not left out of limitations.

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