Analysis of Drawings on Representations of COVID-19 among Senior High School Students: Case of the Dakhla-Oued Eddahab Region, Morocco

Abstract

Since the coronavirus COVID-19 was identified as an international public health emergency in 2020, many studies on the perceptions of students in higher education have been published concerning it. Although young students’ perceptions also influence decision making and actions, their perceptions of COVID-19 have, so far, been little studied. Therefore, to increase knowledge about their understanding of COVID-19, a cross-sectional and descriptive study was conducted as a drawing survey in two schools in the Dakhla-Oued Eddahab region, Morocco. The participants were 94 high school students (aged 14–19). The drawings were analyzed by inductive and deductive content analysis. The findings show that the majority of the students knew the archetypal representation of COVID-19. They had a good grasp of the COVID-19, how it spreads, and how to stop it from spreading. Some students were aware of the potential dangers associated with COVID-19. Admittedly, misrepresentations related to fear and unfamiliarity with COVID-19 lead to mental health issues that undermine the key factors in students’ academic success. Younger children’s representations were dominated by magical thinking that reduces COVID-19 to preventive measures. Overall, the results made it possible to deduce that COVID-19 is strongly associated with terms that are both characteristic and socially valued (disease, prevention, barrier measures, etc.) and, conversely, with rather negative terms (fear of dying, anxiety, sadness, helplessness, etc.). The identification of these representations is very useful because they make it possible to apprehend and understand the attitudes and behaviors of these students, which, therefore, implies the need to define the appropriate teaching methods to try to align these behaviors with the behaviors desired.

1. Introduction

COVID-19, a respiratory infection caused by SARSCoV-2, was first described in late 2019 and identified as an international public health emergency in January 2020 [1]. Micro-organisms are interesting objects for the study of representations. They have extraordinary impacts on human lives, as they cause disease and are historically responsible for a wide variation of human mortality and morbidity [2]. As COVID-19 has created a new global situation, and research on public representations relating to the pandemic is still at an embryonic stage, existing studies on microorganisms and infectious diseases can help identify similar or evolved ideas for understanding new infectious diseases [3].

Although most countries have increased health measures to curb the epidemic, it has not been possible to prevent the epidemic from spreading. Hope now rests on vaccination, which should ultimately promote herd immunity and offer the prospect of living with COVID-19 for a long time, without jeopardizing hospital services or disrupting the economy. The extent and severity of this pandemic has triggered an unprecedented crisis affecting health, economics, social relations, politics, and eventually, humanitarian qualities [4]. COVID-19 has also triggered a global mental health crisis, particularly among underserved populations, such as the elderly, healthcare professionals, and women [5]. In addition, research has shown that the pandemic has also caused mental problems among students [6,7].

In Morocco, the main cause of spread of the COVID-19 and transmission of the coronavirus disease within the local population is due to imported cases, the first case of which was recorded on 2 March 2020. It is a case imported by a Moroccan resident living in Italy [8]. Subsequently, the next cases of COVID-19 were either by Moroccan residents living abroad or by European national citizens visiting Morocco. Faced with the increase in cases, the Moroccan authorities have taken measures that have contributed to reducing the spread and the progression of the COVID-19 disease, namely the decision to suspend all flights from Morocco to these countries Europeans and vice versa. Subsequently, progressive measures of the containment policy were closing schools and economic activities of lesser importance and, finally, declaring the health emergency [8,9].

Since the emergence of COVID-19, public communication around the world has been inundated with messages about the risks of infection and transmission, as well as the prevention measures, such as social distancing, hand washing, disinfecting, and wearing a face mask [10]. At the level of social networks, the media and the means of communication, the topics of COVID-19 are essential; the statistics of mortality and cases of emergencies are displayed from time to time, and the information is popularized everywhere, even for young people, to broaden the awareness process. These health measures, despite their advantages in isolating COVID-19 and reducing the number of cases of infection, will have psychological impacts on individuals and populations. Although social isolation has proven useful in stopping the spread of the virus, it could, nevertheless, have a negative impact on the well-being of young people, particularly if not treated correctly. Indeed, it could trigger negative effects on their mental health in the medium- and long-term [11].

Research on social epidemiology shows that the comorbidity of physical illnesses and mental disorders is higher, especially without positive social relationships. Studies in psychology show that isolation could cause several complications, including anxiety and stress, sleep disorders, emotional disorders, and depressive syndromes [11,12]. Several studies, based on Piaget’s theory of development, have shown that children show different representations of the pandemic depending on their age and stage of development [13,14,15,16]. Social representations are important for such contexts because they are constructed based on the particular experiences each group is having during the pandemic and the information they receive from both media and social interactions [17].

Many studies in psychology have considered drawings of children as expressions of meaning and understanding [18]. The drawings are used in clinical, forensic, educational, and therapeutic contexts to obtain information about how students feel [19]. Drawings have proven to be an effective way to explore students’ representations of the pandemic [20,21,22]. Admittedly, they represent a relatively accessible means of collecting information on social representations [23]. The creation of a drawing implicitly expresses all of the student’s past and present experiences, as well as imagination and emergent thought [24]. The use of drawings for assessment purposes is a powerful tool for measuring student production. Drawing tests can be completed quickly, easily, and in a pleasant way [25]. According to Chambers [26], the drawings avoid language barriers and allow comparisons between groups of different languages and abilities. Crook [27] argues that “it is widely recognized that the content of student drawings can provide insight into their feelings and thoughts about the world”. Students’ drawings provide a “window” into their thoughts and feelings, primarily because they reflect an image of one’s own mind [28,29].

Social representations are organized models of beliefs, attitudes, and actions that convey a certain position in a universe, that of common sense [30,31]. Additionally, a social representation can be conceptualized as a structured mental model shared by individuals within a social group, thus allowing for collective elaborations of social objects in their daily life [31]. Many researchers consider that representations are socially constructed during the process of exchanges and interactions with the reference social group [32,33,34].

Sauvé and Machabée [35] considered representation as a focal point for learning about an object. Other researchers [36] have argued that young people’s collective representations play an important role in decision making and are linked to the ways in which they may intend to act. In addition, Shepardson et al. [37] supported the idea of the existence of a correlation between representations and decision criteria. Lee [38] found that adolescents’ knowledge was a significant predictor of their behavioral intentions regarding green purchases. Moreover, didacticians and psychogeneticists [39,40,41] confirmed that the learner has his own representations, his ideas, and his prerequisites, which constitute “well established” explanatory models about content and objects. For didacticians, representations designate the conceptions that the learner has at the time of teaching a concept and are likely to influence learning. In other words, it is a personal model of conceptualization and structuring of knowledge from different sources, in relation to a well-determined subject. The importance given to representations stems from the fact that they function as explanatory models that can influence learning or even create an obstacle to it. Indeed, the learner does not easily abandon his own representations, particularly if it does not occur at home during the teaching–learning activities, an evolution and a real intellectual transformation. Certainly, erroneous representations can develop a kind of resistance to learning in the learner [39].

This descriptive study aims to understand how senior high school students perceive COVID-19, in relation to academic knowledge and public representations. Thus, in this current study, senior high school students’ drawings were used to discover the representations that students have of the pandemic, and consequently, to deduce the impacts on their mental health. This didactic and pedagogical work will serve as the actors of awareness, as well as psychic and social support, in order to create scenarios and pedagogical interventions capable of modifying erroneous representations. Our research questions are formulated as follows:

• How is COVID-19 represented in the senior high school students’ drawings?
• What is the predominant representation of these various representations?
• How do the drawings constructed by the senior high school students relate to the scientific image of COVID-19?

What are the different interpretations of the senior high school students’ drawings? The results of this study were expected to contribute to the development and support of teaching in health education, especially in high schools, as well as in teacher training, not only in Morocco, but also in other countries.

2. Literature Review

Previous studies show that students are interested in human biology and health [42]. Young people in Sweden [43], Finland [44], Slovakia [45], and Italy [46] are, besides health issues, also interested in diseases. Some micro-organisms are the less attractive item to students [47]. This disinterest may be related to a feeling of fear and repulsion or having little knowledge about these issues [47]. The themes of health and diseases are the most popular ones in Brazil [48], England [42], Sweden [43], Ireland [49], Finland [44], and Italy [46]. Girls are more interested in these themes than boys [43,44,46,48,50,51,52,53]. This finding supports the studies conducted during the COVID-19 pandemic that found that females followed protective guidelines [54,55] and had a higher risk perception than males [55]. It was also reported that higher-level undergraduate and graduate students showed greater faith and commitment to preventative measures than younger students [56,57]. This may reflect differences in age or level of education.

According to Bonoti et al. [3], children (4–10 years old) have a holistic understanding of COVID-19 and its medical, social, and emotional consequences for human life. Christidou et al. [58] clarified, based on the drawings and explanations of children (4–9 years old), that the children are familiar with practices to prevent COVID-19 infections, according to official guidelines. Bray et al. [59] showed in their drawing study that children (7–12 years old) in the United Kingdom, Sweden, Brazil, Spain, Canada, and Australia were aware of SARS-CoV-2 and COVID-19. There was no content in the drawings that reflected misunderstandings or misconceptions about COVID-19, as has been reported by children lacking information in previous pandemics [60]. Many of the children’s drawings also showed a good level of understanding of the ways COVID-19 spreads and the measures required to prevent virus infections. In the drawings, children also protected other vulnerable people in their community by helping to reduce the spread of the virus [59].

Kayemba et al. (according to Bonoti et al. [3]), stated that 10–13 years old students understand COVID-19 and the disease affected by it. The students know that cough and fever are symptoms of this disease, but that the disease can also be asymptomatic. In addition, they understand the value of COVID-19 prevention and the fact that the virus can be transmitted through droplets (Kayemba et al., according to Bonoti et al. [3]) and that it is highly contagious [14].

The majority of Ugandan boys and young men (10–24 years) who participated in the study of Matovu et al. [61] knew how to prevent COVID-19, but their preventative use was very low. The COVID-19 blockade caused mental health problems and unhealthy behavior. The effects were stronger in older boys (15–19 years) than in young men (20–24 years) and those who attended school. Similar findings have been reported in other African countries, including Ghana [62] and Zambia [63].

In the study of Bray et al. [59], the majority of the children’s drawings did not indicate high levels of anxiety or sadness. However, many previous studies have showed that children and adolescents are anxious [64] and worry about COVID-19 [14,65]. They have had more mental health problems [66,67,68] and reductions in cardiovascular fitness [69,70] during the COVID-19 pandemic than before. Changes in children’s and adolescents’ health status may be related to their COVID-19 lockdown experiences [14]. One reason is also the lack of knowledge among children and young people about COVID-19 and the pandemic. During the pandemic, pandemic messages are targeted at the adult population, without identifying meaningful and distinct strategies for children and adolescents in many countries [71]. Thus, children and adolescents do not receive pandemic information [72]; therefore, they rely on the knowledge of their parents [59].

Numerous researchers had analyzed students and children’s representations of the coronavirus, as reflected in their drawings and verbal descriptions [3,73,74]. The researchers deduced that the content analysis of students and children’s production revealed different representations: coronavirus, medical, psychological, and social. The focus on one, or some, of these representations depends on the item of each research. Additionally, the findings of many studies showed that students confused the structure of viruses with other microscopic organisms, such as bacteria, viruses, and fungi (e.g., [74,75,76]), or with small creatures, such as insects, when they are underage [74,75,77]. These studies take it as a challenge for students to understand the structural properties of viruses and to distinguish them from other microscopic organisms. For this reason, the researchers considered the conceptions related to the confusion between viruses and other microorganisms as a whole theme. In the present study, the researchers adopted this theoretical framework with some modifications and adaptations. They used representations, instead of themes, and classified these themes into five representations as follows:

(a)

Representations that reduce COVID-19 to preventive measures. In this category of drawings, students’ representations may have a medical or a social meaning, so the researchers, therefore, decided that this category includes all drawings that indicate medical and social dimensions. It involved students’ drawings that express COVID-19 by preventive measures, behaviors related to virus transmission, and all recommendations or restrictions to limit social interactions with others: forbidden to greet others by shaking hands, face mask/put on the face mask, distancing, using sanitizer/disinfectant, handwashing, quarantine at home, intervention of doctors or medical staff, cooperation, etc.

(b)

Animistic and anthropomorphic representations that give COVID-19 a dynamic “hero” quality: this representation is related to a coronavirus hybrid theme—it gathers all the drawings when students gives anthropomorphic features and/or added a crown to their, otherwise realistic, drawings of the virus [3], and it includes illustrations as cartoons: face forms, who carries hands, fingers, mouth, eyes, nose, teeth, ears, with limbs (tentacles, legs, and arms), or expressions of a challenge.

(c)

Representations that link COVID-19 to fear and death: this representation is related to the psychological theme which involved items referring to psychological functions, such as emotions, by drawings expressing unhappiness/sadness/crying/colors, or drawings and expressions that are signifiers of danger, virus mutation, and virus polymorphism, drawings translating COVID-19 into death and the end of the world, the threat of life on the earth, and pollution.

(d)

Representations related to confusing COVID-19 with bacteria and living cells: this representation is related to coronavirus theme in its part as mythical/symbolic—it gathers all the drawings when students’ drawings ascribed animal-like or microscopic organisms’ characteristics to coronavirus, such as drawing a cell bounded by a membrane/cells with nuclei, the form of fragmented cells, and multiplying cells.

(e)

Scientific representations: this representation is related to coronavirus theme in its realistic part, and it has been considered when students’ drawings illustrated morphological characteristics of coronavirus, as commonly depicted in the media, i.e., its spherical scheme and/or spikes, circular shapes that have particles on the surface, and circular designs that bear thorns.

As shown in the literature review above, several previous studies have examined young people’s perceptions of the COVID-19 pandemic. However, there are few studies that focus on senior high school students’ perceptions of COVID-19 by comparing their perceptions to scientific knowledge, which is one of this study’s tasks, besides revealing students’ other perceptions of COVID-19. This point of view is important for the development of teaching in health education. Health-related knowledge and its understanding and appreciation are crucial aspects of health literacy [78] that help children and adolescents understand what is happening within the world [14]. Pandemic information and understanding are important in supporting that they can make sense of a situation [79] in their daily lives. It increases student’s self-esteem when they know how to explain everyday phenomena and advise their families and friends [42]. The purpose of this study is to help teachers and other actors to reduce misunderstandings about COVID-19 and to mitigate the spread of it. This study is based on an analysis of drawings created by students at the beginning of the pandemic.

3. Materials and Methods

In May 2020, we undertook a study on students’ representations of COVID-19. We opted for a qualitative approach. To do this, a drawing survey was conducted among senior high school students (14-19 years). The students studied in the first year of upper secondary education level course called common curriculum science in the Moroccan educational system.

The study focused on high school students, because adolescents are a group that is exposed to health problems both physically and mentally [80]. During the COVID-19 pandemic, adolescents are more vulnerable to infection because their health behaviors and adherence to treatment are not like that of adults [81]. At this sensitive age, behavior and attitudes are influenced by their perceptions of health issues, in general, and the COVID-19 pandemic, in particular. According to research, adolescents are worried about the COVID-19 pandemic [14,65]. In addition, scientific knowledge related to infectious diseases is not yet established in students of this age, and they have many misconceptions about infectious diseases.

3.1. Population and Study Sample

The study focuses on two different public senior high schools in the Dakhla-Oued Eddahab region in Morocco in spring 2020. All participants had studied the unit of immunology: microbes, the immune system, the immune response, the immune dysfunction, and immunity problems at the junior school level.

The sample consisted of 94 students who were randomly selected according to the groups present in the two schools, according to the timetable, with four different groups in each school. The drawing surveys were distributed and checked by four teachers in each school after having explained the procedure to them. The teachers gave some instructions, such as: each student must respond individually and respect the distance measurements, and the 15-min response time must be respected. The students did not ask any questions about the drawing task.

The distribution of the drawing surveys was carried out at the same time in each school, and the time for filling in the forms was fixed at 15 min. The students answered individually.

The gender ratio of the study participants was 47.87% female to 52.12% male (

Table 1. Numbers and percentages of students by school name and gender.

Schools	Gender				Total
	Girls		Boys
	N	%	n	%	N	%
Imam Malik High School	19	43.18	25	56.81	44	46.80
Al Fath High School	26	52	24	48	50	53.19
Total	45	47.87	49	52.12	94	100

). The students from Imam Malik High School represented 46.80%, and the students from Al Fath High School represented 53.19%. The numbers and percentages of students were distributed by school name and gender, as follows (Table 1).

The average age was 15.72, the standard deviation was low (0.966), and the dispersion was less important (

Table 2. Average and standard deviation of the age of the sample.

	N	Minimum	Maximum	Average	Standard Deviation
Age	94	14	19	15.72	0.966
N valid (list)	94

).

3.2. Ethical Research Practice and Data Collection

The permission to survey students was obtained in advance from the directors of the schools concerned after having introduced and explained to them the purpose and goals of the study. The students were invited to participate in the study and were reassured that anonymity is guaranteed. The students were also informed that they can refuse to participate in the survey. The questions were given on paper.

3.3. Data Collection and Analyses

3.3.1. Data Collection

Data collection was performed through the technique of drawings and written text about their drawings, which has been proven by research [20,21,22]. The validity of this instrument was established by subjecting the instruments to the judgment of experts in the field of psychology and didactics of biology. A total of 94 copies of the drawing surveys were introduced, according to the conditions of access to the schools and the availability of groups of students and teachers. The return rate was 100%; that ensured the validity of the instrument and no ambiguity in the questions asked. The drawing survey contained two parts. The first one included general student identification information (gender, age, etc.), and the second one included an instruction to draw COVID-19. The students were also given the opportunity to briefly explain what their drawings represented.

3.3.2. Coding of Data

In analyzing the students’ drawings, data comprised both the visual images and the text produced by participants in the description of their images. The students’ drawings were analyzed first by inductive and then by deductive content analysis [82].

The students’ drawings were content analyzed by two raters, which are researchers specializing in didactics of biology, each one separately. To classify the drawings, the researchers focused on methods elaborated and used in previous studies [73]. First, the researchers had converted drawings components to expressions by describing all the characters and parameters observed in all the drawings. In the analysis of students’ drawings, the raters took into account the following elements: the components of the image and the way of their arrangement; the relationships between these components; their meaning; their representation; the knowledge deployed; knowledge that is absent in this representation [83,84,85]. Secondly, they proceeded to a qualitative analysis—they classified the drawings in 5 groups, according to the characters and parameters they contain, using inductive content-based analyses, and then, the data were analyzed quantitatively by statistical tests [73,82].

The students’ drawings content analyzed by the two raters were compared, and to evaluate the extent to which there was agreement in the coding, Cohen’s kappa statistic was employed. Generally, kappa values between 0.41 and 0.60 are considered moderate, those between 0.61 and 0.80 are considered satisfactory, and those that are greater than 0.81 are considered perfect [86].

Table 3. Kappa coefficient similarity for the five categories.

Symmetric Measeures
Measure of Agreement Kappa	Value	Asymptotic Standard Error a	Approximate T b	Approximate Significance
Reduce Corona to Preventive Measures	0.895	0.059	8.724	0.000
Animist and Anthropomorphic	0.894	0.052	8.716	0.000
Fear and Death	0.903	0.055	8.797	0.000
Confusion with Bacteria & living cells	0.863	0.066	8.447	0.000
Scientific Representations	0.936	0.036	9.092	0.000

Notes: ^a Not assuming the null hypothesis ^b Using the asymptotic standard error assuming the null hypothesis.

shows that the range of kappa values for the five categories of students’ drawing in the current study was 0.895–0.894–0.903–0.863–0.936; this shows that there is a great similarity between the analyses carried out by the two raters. Then, the 2 researchers shared the results of their analyses. If the interpretation of the students’ drawings differed between the 2 researchers, a discussion took place, and an agreement was reached on the adoption of a common interpretation.

3.3.3. Statistical Analysis of Data

For data coding, the value 1 was given in the case of the presence of a representation, with the value 0 in case of absence. Data processing was carried out using SPSS version 26. Since the study population did not have a normal distribution, non-parametric tests, such as the Mann–Whitney U test, were performed to test if there are differences statistically significant according to gender and age. In statistics, the Wilcoxon–Mann–Whitney test is a null hypothesis statistical testing procedure which allows two groups to be compared without making the assumption that values are normally distributed. The Mann–Whitney test is the non-parametric equivalent of the t-test for independent samples. The great advantage of this test is its simplicity, even if its use is therefore limited.

According to the

Table 4. Normality Test.

	Kolmogorov–Smirnov a			Shapiro–Wilk
	Statistics	f.d	Sig.	Statistics	f.d	Sig.
1-Reduce coronavirus to preventive measures	0.504	94	0.000	0.454	94	0.000
2-Animist and anthropomorph	0.465	94	0.000	0.543	94	0.000
3-Fear and death	0.494	94	0.000	0.480	94	0.000
4-Confusion with bacteria	0.504	94	0.000	0.454	94	0.000
5-Scientific representations	0.368	94	0.000	0.632	94	0.000

Note: ^a Lilliefors meaning correction. f.d: freedom degree.

, the population of study had not a normal distribution (p-value < 0.05) for the Kolmogorov–Smirnov test and the Shapiro–Wilk test (p-value < 0.02).

4. Results

4.1. Descriptions of Students’ Drawings and Identification of Their Representations

The drawing analysis shows that all students were able to express themselves through drawings, but the level of students’ drawing skills was uneven. The drawings show different representations of COVID-19. The grouping of the drawings and written descriptions of the students and the categorization of their representations are presented in

Table 5. Grouping of students’ responses and categorization of their representations.

Category	Drawing Descriptions		%	Representations
1	Drawings that translate COVID-19 into behaviors related to preventive measures, such as: - Forbidden to greet others by shaking hands - Face mask/put on the face mask - Distancing - Disinfectant - Quarantine at home - Intervention of doctors - Cooperation		11.25	Representations that reduce COVID-19 to preventive measures
2	- Cartoons: ✓ Face forms ✓ Who carries several hands with fingers ✓ Have a mouth ✓ Eyes ✓ The nose ✓ Teeth/long and sharp teeth ✓ The ears ✓ With limbs (tentacles, legs, arms, and hands) - Expressions of a challenge, such as: « I am corona », “it’s not visible to the naked eye” - The designs look like a worm that wears tentacles		29.6	Animistic and anthropomorphic representations that give COVID-19 a dynamic quality “hero”
3	- Drawings translating COVID-19 into death/the cemetery - Expressions of: COVID-19 blocking the world/COVID-19 is the end of the world - Drawings considers COVID-19 as a threat to life on earth/pollution - Some illustrate COVID-19 as dangerous/it affects the elderly/it is a contagious disease - Some drawings have comments such as: virus 1 and virus 2/corona and corona extra - Two different forms of virus, including virus 2 with more tentacles/or two viruses of different sizes - Drawings that illustrate unhappiness/sadness/crying… - Face drawing divided and colored differently (yellow and green)		15.50	Representations that link COVID-19 to fear and death
4	- Some have only drawn a cell bounded by a membrane/or cells with nuclei - Drawings in the form of fragmented cells/multiplying cells		10.50	Confusing COVID-19 with bacteria and living cells
5	- Drawings of viruses, such as circular shapes that have particles on the surface - Circular designs that bear thorns	identical	25.40	Scientific representations
		different	7.75

.

Table 5 shows that the students’ representations are various and that they settle into different frames of thought. The table contains five groups of types of answers that generate five representations with different percentages: scientific representations (33.15%), animistic representations that put, in addition to COVID-19, a dynamic characteristic or “hero” (29.60%), representations related to fear and death (15.50%), representations related to preventive measures (11.25%), and confusion of viruses with bacteria and living cells (10.50%).

4.2. Grouping of the Different Student Drawings According to the Predefined Representations

The five representations identified among students’ drawings are: (1) representations related to preventive measures, (2) animistic and anthropomorphic representations, (3) representations related to fear and death, (4) confusion of viruses with bacteria and living cells, (5) scientific representations.

4.2.1. Representations Related to Preventive Measures

Figure 1, Figure 2 and Figure 3 present three types of drawings. Figure 1 contains drawings that signify social distancing, confinement, and avoidance of a firm handshake. Figure 2 depicts drawings that reduce COVID-19 to face masks and putting them on. Figure 3 in its part shows students’ drawings mitigating all factors of COVID-19 spread.

Ways to prevent the spread of COVID-19 through behavioral and preventive measures were presented in 19 drawings (n = 94). Some students illustrated COVID-19 with symbols: social distancing, home confinement, and handshake avoidance (Figure 1). Some students described the prevention of the spread of COVID-19 with a drawing showing a face mask or the use of a face mask and disinfectant. One drawing showed that the cooperation of all people is essential to mitigating COVID-19 (Nb 33, girl, 15 years) (Figure 2). Figure 3 combines the texts with the drawings; it shows the factors that facilitate the spread of the virus. In Figure 1, the student (Nb13, boy, 15 years) replied with “it is not visible to the naked eye”. These students illustrated ways to contribute, individually or in combination, to the prevention against COVID-19.

4.2.2. Animistic and Anthropomorphic Representations That Give COVID-19 a Dynamic Character or as “Hero”

Animistic and anthropomorphic representations were identified in 24 of the 94 of the students’ drawings (Figure 4). They all had a head and face with eyes, most of them had a mouth and some also a nose and ears and long, sharp teeth. Some of the characters had human and animal features, e.g., arms, hands, sometimes fingers, legs, and tentacles. One drawing (Nb 88, boy, 17 years) presented COVID-19 as a worm with tentacles. The drawing of one student (Nb 24, son, 15 years) had the inscription: “I am corona”. Animistic and anthropomorphic drawings accounted for 25% of all drawings.

4.2.3. Representations Related to Fear and Death “The Thanatophobia”

The analysis of the results allowed for the collection of drawings related to fear and death, as shown in the figure below (Figure 5).

Fear and death were described in 13 percent of the drawings. One drawing depicted a cemetery (Nb 38, girl, 16 years old), and some drawings depicted complaints, tears, and crying from severe pain (Nb 27, girl, 16 years; Nb 1, boy, 15 years). Emotions were also described in different colors (e.g., Nb 40, girl, 17 years). In addition, comments were made that COVID-19 threatened the planet (Nb 71, boy, 15 years; Nb 57, girl, 16 years; Nb7, boy 17 years). In one drawing, COVID-19 was said to “block the world” and to be “the end of the world” (Nb 54, girl, 16 years old). Some students compared COVID-19 to industrial smoke that spreads into the air. They also stated that the coronavirus can be compared to pollution causing an imbalance and extinction.

Some drawings expressed the aspects of the change and mutation of COVID-19 by comments, i.e., “virus 1 and virus 2” (Figure 4. Nb 21, boy, 19 years) and “corona and corona extra” (Nb 85, boy, 16 years), by two different patterns of viruses of which virus 2 carries more tentacles, and by two different sizes. Other drawings expressed other characteristics of COVID-19, such as it is dangerous, it affects the elderly, and it is a contagious disease. These students appreciated the intervention of the doctors to keep the peace “R.I.P.” (Nb 29, girl, 15 years). This representation expresses the fear of death. This phobia hides the very real fear felt felt concerning COVID-19. It was revealed by the illustrations that are manifested by the possibility of going to a cemetery, by the systematic avoidance of risk, or by a terrible anguish evoked by death, such as the death of family members or close relatives.

4.2.4. Confusion of COVID-19 with Bacteria and Living Cells

In Figure 6, there are all the drawings that show the confusion between COVID-19 on the one hand and bacteria and living cells on the other hand.

Figure 6 shows that 19% of the drawings (n = 94) presented illustrations of COVID-19 as a living being that possesses a nucleus, which can multiply or is derived from other more complex variants, sometimes labeled by the years 19, 20. Some students drew only the cells delimited by membranes, sometimes with one nucleus or more nuclei, and one of these cells bore identical projections on its surfaces. Other students drew illustrations in the form of fragmented cells or multiplying cells. Some of the students’ drawings also showed that COVID-19 can travel through the air and then infect another person (Nb 83, boy, 15 years).

4.2.5. Scientific Representations

Figure 7 shows that 36% of sample’s students represented COVID-19 as a circle with a base on the surface made up of identical or different projections, either mushroom-shaped, “T”-shaped, or as cactus rackets or thorns.

These students have representations that resemble those disseminated by social networks, the media, awareness leaflets, and scientific literature, such as the diagram in Figure 8.

4.3. Student’s Representations According to Gender and to Age

The distribution of the students’ five representations by gender is shown in Figure 9.

Figure 9 shows that there were differences in the representations between boys and girls. Girls’ drawings were dominated by representations related to preventive measures, as well as animistic and anthropomorphic ones, while boys had more “thanatophobic” representations related to fear and death. Boys, more often than girls, mixed viruses with bacteria and living cells, but they also had more representations comparable to scientific ones than girls.

Since the population does not have a normal distribution, non-parametric tests, such as the Mann–Whitney U test, were performed. According to the

Table 6. Difference between the 5 categories of representations, according to gender.

Statistic Test a
	1-Reduce Corona to Preventive Measures	2-Animist and Anthropomorphic	3-Fear and Death	4-Confusion with Bacteria	5-Scientific Representations
Mann–Whitney U	1002.000	904.000	1019.000	971.000	984.000
Wilcoxon W	2178.000	2080.000	2100.000	2052.000	2065.000
Z	−1.185	−2.003	−0.943	−1.545	−1.054
Asymp. Sig. (2-tailed)	0.236	0.045	0.346	0.122	0.292

^a. Grouping Variable: Gender.

, it seems that there is a significant difference according to gender related to the animist and anthropomorphic category (p-value 0.045), on the other hand, the differences are not statistically significant (at level of 0.05) for the other four categories of representations.

The distribution of the students’ five representations by age is shown in Figure 10.

Figure 10 shows that the percentages of students’ representations about COVID-19 vary according to age. In the age group 14–15, it seems that there was a predominance of representations “related to preventive measures” and “animistic and anthropomorphic” representations, while in the age group 16–19, there was a predominance of representations linked to fear and death (“the thanatophobia”), the representations related to the confusion between viruses and bacteria or living cells and scientific representations.

Table 7. Difference between the 5 categories of representations according to age.

Statistic Test a
	1-Reduce Corona to Preventive Measures	2-Animist and Anthropomorphic	3-Fear and Death	4-Confusion with Bacteria	5-Scientific Representations
Mann–Whitney U	963.500	916.500	963.500	1057.500	963.500
Wilcoxon W	2091.500	2044.500	2091.500	2185.500	2091.500
Z	−1.638	−1.882	−1.564	−0.546	−1.238
Asymp. Sig. (2-tailed)	0.101	0.060	0.118	0.585	0.216

^a. Grouping Variable: Age.

shows that the differences were not statistically significant (at level of 0.05) between the five categories of representations and the age of the students.

5. Discussion

This study examines senior high school students’ perceptions of COVID-19, based on the drawings they made at the beginning of the pandemic. According to the results, the representations of the students settled in various contexts, with some originating from common scientific schemes; others are related to behaviors of prevention and health measures, images of fear, and sadness. These representations are built on the basis of the particular experiences that students had during the pandemic and the information they received from both the media and social interactions [20].

Most of the students in this study drew COVID-19 as a circle with a sponge shape, with a T shape, that was cactus-like, or that had spiked protrusions on its surface. This is a good approximation of the common representation of SARS-CoV-2 particles in the media and in the scientific literature. This suggests that most students were familiar with the archetypal representation of SARS-CoV-2 [73]. Almost 1/3 of the students had animistic and anthropomorphic representations of COVID-19. Airenti [88] also found that adults associate anthropomorphic features with invisible and threatening causes of disease, such as bacteria or viruses, under certain conditions that create uncertainty, fear, or helplessness. It is related to childhood animistic-magical thinking and does not support the logical causal thinking needed to learn at the secondary education level. The students attributed a dynamic characteristic to COVID-19; they perceived it in their responses, either through drawings or comments, as being a super virus, a hero, smart, smiling, or the virus that is blowing up the Earth (cf. [73]). They are aware of the seriousness of the virus as a contagion agent. The result supports the previous studies [3,14,59]. Unlike the previous study, which found parents to be an important source of COVID-19 information [59], the representations of this study were influenced by the messages broadcast by the media, social networks, and television cartoons carrying messages of caution about COVID-19. This shows the importance of the media in building public opinion and values against the sensitization on the virus and about the need for everyone to cooperate in pandemic situations. These students were more likely to draw simple illustrations of SARS-CoV-2 particles through an animistic language that developed from childhood. This type of language appears particularly among younger students. The result supports the study of Martinerie et al. [73]. The representation of COVID-19 by animistic-magical thinking, instead of logical causal thinking, reflects that their thinking comes with an incomplete understanding of the pandemic [22], which was also reflected in the perceptions of the students concerning COVID-19 prevention.

Students’ drawings were also analyzed from perspectives related to the links between COVID-19 and health and the prevention of the spread of SARS CoV-2 virus. A total of 1/9 of the students suffered from the fear of dying because of coronavirus. They drew representations emanating from “thanatophobia”. These students represented COVID-19 as a destroyer of the Earth, highlighting the frightening aspects of the pandemic (cf. [73]). According to Larson et al. [89], emotional distress caused by pandemic among college and university students was widespread. Additionally, children and adolescents suffered negative emotions, primarily fear [47,57,64,90]. In addition, several research have reported that it has been warned that the confinement imposed in response to COVID-19 could generate feelings of fear, worry, sadness, or stress [11,91,92,93]. In some current studies, it was also found that children and students feel anxious, worried, and concerned about COVID-19 [14,64,65]. Feelings of fear of COVID-19 lead to stress and may result in various kinds of mental health problems [61,66,67,68]. Many factors are related to an individual’s stress, such as neuroticism [94]. According to Richardson et al. [95], psychological problems are the main obstacle to academic success in college students. They can impair all key factors for the success of student’s academic performance, especially motivation, concentration, and social interactions [96,97].

The analysis of students’ drawings has always been a systematic measure to assess their representations and attitudes towards environment of students. The drawings of children and students are emotional indicators of specific environmental issues and indicate their attitudes towards different environmental situations [28]. However, 20% of the students have representations related to preventive measures, which reduce the coronavirus with the attenuation of the interactions between man and COVID-19. The latter was always shown in a threatening attitude, and the face mask was presented in the drawings as a tool to fight against this virus. It is likely to be avoided by respecting the distance (1m) and the fact of staying at home. It, therefore, seems that this group of students was relatively unfrightened by the virus [73]. They did not feel worried, despite the fact that they described their actions during the pandemic as a means to protect themselves, their families, and society at large [59].

Almost 20% of the students had difficulties drawing COVID-19. However, their drawings also indicated their awareness of COVID-19, its spread, and how to mitigate its transmission. They represented COVID-19 as a living being that has a nucleus, that is capable of multiplying, and that can change into other, more complex variants. This shows that students are confusing the structure of viruses with that of bacteria and living cells. Although both viruses and bacteria can cause diseases, viruses differ from living cells and bacteria in many ways. They are not able to reproduce without hijacking the cellular machinery of another organism, while bacteria and living cells are single-celled organisms that can reproduce themselves and produce their own energy [98]. These students have not yet learned and understood the distinction between viruses and bacteria. Their knowledge is insufficient [99], at this grade level, about viruses, their biology, and their importance as causative agents of distinct infectious diseases distinguished from bacterial diseases [99]. The students know that viruses can travel through the air and then infect another person, with the distance of 1 m being present in the drawings of Figure 1 (cf. [59]). COVID-19 was generally portrayed and labeled as threatening, as in the study of Bray et al. [59].

The COVID-19 crisis generated several questions about the need, importance, and usefulness of certain content in school programs. It highlighted the relevance of certain curricular tendencies, in particular, the authenticity of learning situations, to correct erroneous representations, as well as the didactic transposition and adaptation of the content to be taught, according to contemporary challenges.

To ensure the trustworthiness of this study, the study was designed and conducted as a collaboration of the researchers. The research procedures were documented at different stages of the research and implementation was described holistically. The results were interpreted and explained based on the students’ drawings and by using their explanations of the drawings. Additionally, the results were compared with previous studies [100].

6. Limitations and Future Research

This study had a number of limitations. Because the answers provided by students were self-reported, there was an element of subjectivity in their answers. It should also be noted that the study focused on a small sample size and in a specific region of Morocco that was little affected by the COVID-19 pandemic; so, it is prudent to not generalize the findings of the study. The study also used the drawing technique as a data collection technique, which has many advantages, but respondents who are not used to expressing themselves through drawing may have found it difficult to answer the questions. So, future studies should consider using more in-depth interviews and observation analysis to identify students’ representations of COVID-19. It would also be interesting to carry out a quantitative study (survey by questionnaire) and to integrate other psychosocial aspects of the problem studied, such as well-being, anxiety, and the fear of the COVID-19 pandemic, as well as the parameters that could have influenced the answers of the students surveyed.

7. Conclusions

This research aimed to identify senior high school students‘ representations related to COVID-19 pandemic through the analysis of their drawings. Based on the results, the representations of the students were various. Depending on the students’ surroundings and life experiences, COVID-19 was represented in their drawings in the form of different themes related to the biological, medical, psychological, and social aspects of the coronavirus and the COVID-19 pandemic. Some students reduced COVID-19 to preventive means and measures, while others were aware of its possible seriousness. The students’ drawings indicated a good understanding of the virus, how it spreads, and how to mitigate transmission. The students described their actions during the pandemic as protecting themselves, their families, and society at large. The findings seem to show that the majority of students were familiar with the archetypal representation of SARS-CoV-2.

Some students’ representations were predominated by a magical thought that personified COVID-19 through animistic and anthropomorphic illustrations. These representations differ markedly from the scientific representations of COVID-19 that should have been acquired in school. Overall, the results made it possible to deduce that COVID-19 was strongly associated with terms that are both characteristic and socially valued (disease, prevention, barrier measures, etc.) and, on the other hand, with rather negative terms (fear of dying, anxiety, sadness, helplessness, etc.). The interpretation of these results was based on the fact that, in the face of certain issues considered to be sensitive, such as the COVID 19 pandemic, forms of normative social pressure were probably exercised on the students surveyed, leading them to modulate and adjust their responses, in order to hide their true representations. The identification of these hidden representations is very useful because they make it possible to apprehend and understand the attitudes and behaviors of these students and, therefore, implies the need to define the appropriate teaching methods to try to align these behaviors with the behaviors desired.