Original Article

Public Health

Kasmera 48(1):e48121092019, Enero-Junio, 2020

P-ISSN 0075-5222 E-ISSN 2477-9628

 https://doi.org/10.5281/zenodo.3732353

Fatalism due to the possibility of coronavirus infection: Generation and validation of an instrument (F-COVID-19)

Fatalismo ante la posibilidad de contagio por el coronavirus: Generación y validación de un instrumento (F-COVID-19)

Mejia Christian R (Autor de correspondencia). https://orcid.org/0000-0002-5940-7281. Continental University. Faculty of Human Medicine. Huancayo-Junín. Perú. Postal Address: Av. Las Palmeras 5713, Los Olivos, Lima, Perú. Zip Code: 15304. Phone: (511) 997643516. E-mail: christian.mejia.md@gmail.com

Rodríguez-Alarcón J Franco. https://orcid.org/0000-0003-4059-8214. Ricardo Palma University. Faculty of Human Medicine "Manuel Huamán Guerrero". Lima, Perú. Medical Association for Research and Health Services. Lima, Perú. E-mail: franco.investigacion.peru@gmail.com

Carbajal Macarena. https://orcid.org/0000-0003-1960-2952. Hermilio Valdizán University. Scientific Society of Medical Students of Huánuco. Huánuco-Huánuco. Perú. E-mail: macarena_cv10@hotmail.es

Pérez-Espinoza Pierina. https://orcid.org/0000-0003-3554-4713. San Martín de Porres University. Veritas Scientific Society of Medical Students. Chiclayo-Lambayeque. Perú. E-mail: pieriperezespinoza@gmail.com

Porras-Carhuamaca Luz A. https://orcid.org/0000-0002-9861-1699. National University of Cajamarca. Scientific Society of Medicine Students of Cajamarca. Cajamarca-Cajamarca. Perú. E-mail: lporrasc15@unc.edu.pe

Sifuentes-Rosales Jhesly. https://orcid.org/0000-0003-3740-2188. Hermilio Valdizán University. Scientific Society of Medical Students of Huánuco. Huánuco-Huánuco. Perú. E-mail: jhesly0131@gmail.com

Contreras-Cabrera Jhuliana M.  https://orcid.org/0000-0003-3618-6532. Antenor Orrego Private University. Trujillo-La Libertad. Perú. E-mail: jhullcontreras@gmail.com

Carranza Esteban Renzo Felipe. https://orcid.org/0000-0003-4059-8062. San Ignacio de Loyola University. Lima. Perú. E-mail: rcarranza@usil.edu.pe

Ruiz-Mamani Percy G. https://orcid.org/0000-0002-2245-9491. San Juan Bautista Private University. Lima. Perú. E-mail: percygruiz@hotmail.com

Abstract

Coronavirus has generated a kind of "mass hysteria" in various populations. A validation process was generated for a test that measures fatalism in the face of the possibility of infection by the coronavirus. A validation process was carried out in five phases: literature search and construction of the first draft, substantive judgement with 28 experts, formal evaluation with 280 people, pilot for exploratory factor analysis in 389 people (in both cases there were 17 cities in Peru) and confirmation of the validity of the final construct with 10 experts. The statisticians of KMO (0.779) and Bartlett (572.6; gl = 21; p < 0.001) presented acceptable and significant results. The total variance explained by the 7 items distributed in 2 factors is 58.9%, which is adequate. Robust analyses show that the factor structure is satisfactory (X2 = 21.161; p = 0.007; IFC = 0.984; GFI = 0.996; TLI = 0.957; RMSEA = 0.067 and RMSR = 0.033). A 7-item scale was generated to measure the fatalistic measures people might have or take if they became ill with the coronavirus.

Keywords: coronavirus, validation studies, fatal outcome, pandemic, SARS-COVD

Resumen

El coronavirus ha generado una suerte de “histeria colectiva” en diversas poblaciones. Por lo tanto, nuestro objetivo fue validar un test que mida el fatalismo ante la posibilidad de contagio por el coronavirus. Se realizó un proceso de validación en cinco fases: Búsqueda de la literatura y construcción del primer borrador, juicio de fondo con 28 expertos, evaluación de forma con 280 personas, piloto para análisis factorial exploratorio en 389 personas (en ambas se contó con 17 ciudades de Perú) y confirmación de la validez del constructo final con 10 expertos. Los estadísticos de KMO (0,779) y Bartlett (572,6; gl = 21; p < 0,001) presentaron resultados aceptables y significativos. La varianza total explicada por los 7 ítems distribuidos en 2 factores es de 58,9%, lo cual es adecuado. Los análisis robustos muestran que la estructura factorial es satisfactoria (X² = 21,161; p = 0,007; CFI = 0,984; GFI = 0,996; TLI = 0,957; RMSEA = 0,067 y RMSR = 0,033). Se generó una escala de 7 ítems para medir las medidas fatalistas que las personas podrían tener o tomar si es que llegasen a enfermarse del coronavirus.

Palabras claves: coronavirus, estudios de validación, resultado fatal, pandemia, SARS-COVD

Received: 03-18-2020 / Accepted: 03-27-2020 / Published: 04-04-2020

How to cite: Mejia CR, Rodríguez-Alarcón JF, Carbajal M, Pérez-Espinoza P, Porras-Carhuamaca LA, Sifuentes-Rosales J, Contreras-Cabrera JM, Carranza-Esteban RF, Ruiz-Mamani PG. Fatalism due to the possibility of coronavirus infection: Generation and validation of an instrument (F-COVID-19). Kasmera. 2020;48(1):e48118032020. doi: 10.5281/zenodo.3732353

Introduction

Nowadays, Coronavirus is the infection that is producing more information worldwide, it is having the biggest spread in the world and it’s generating a lot of social–political and economic changes ^(1-5). It is known that its fatality rate is less than 5%, having a low impact among young and without comorbidities patients. In contrast, elderly individuals, oncologic patients, pregnant women and immunodeficient individuals are at greater risk ^(6-8). These facts have been transmitted through scientific research papers and official media as World Health Organization (WHO) ⁽⁹⁾.

In addition, this information has been spread by other media as newspapers, television, radio, etc ⁽¹⁰⁾. Even, social networking has been spreading official news ^(11,12). For these reasons, general population should be calm and take preventing measurements, since, this is not a disease with a high mortality rate problem ⁽⁷⁾. Even, there are other diseases with a higher mortality rate than coronavirus. Such as: Tuberculosis, Dengue, among others ^(13,14).

Despite all the information that circulates through various media, there are still some that are alarmist, that generate disinformation and that concern negatively the population. Therefore, there is a group of people who back up their knowledge on these unreliable sources leading to fatalistic or extremist thoughts. This has been observed also in the attitude towards other diseases; for example, when some people find out to know that are suffering some diseases (as HIV or cancer) they committed suicide for the fear of upcoming problems ⁽¹⁵⁾. For this reasons, the objective of our study was to validate a survey which measures the fatalism due to the possibility of coronavirus infection so that it could be used in other contexts and latitudes that are looking to appraise the sensation of fatalism due to the onset of new diseases with potential of pandemic.

Methods

Type and design of research: it was realized an instrumental cross–sectional study ⁽¹⁶⁾. The research was carried out in 17 Peruvian cities: Arequipa, Ayacucho, Cajamarca, Cerro de Pasco, Chiclayo, Chimbote, Cusco, Huancayo, Huanuco, Ica, Iquitos, Lima, Piura, Pucallpa, Puno, Tacna and Trujillo.

Population and sample: during the expert evaluation phase, 28 health professionals were assisted. These professionals had the following occupations: infectologists, public health practitioners, epidemiologist, nurses, psychologist, and others. These experts did not fill the instrument.

For the validation of the form and the questions (for explorative factorial analysis), for the validation of the survey all health professionals (doctors, nurses, interns and other professionals of first and highest attention level), patients at risk (elderly, oncologic patients, pregnant women and other medical conditions) and regular people (who was not included in previous groups) who agreed to participate in the research and to answered all questions appropriately were included. The sample of this pilot study consisted of 389 participants. Those who were under 18 years of age, those who answered the survey incorrectly or incompletely, and those who did not want to participate in the study were excluded. It was a non – probabilistic sample in all research stages (but we tried to take similar amounts of participants in coast, mountains and jungle; according to demographics of each region).

Procedures: it was realized an exhaustive bibliographic search on different data bases as Google Scholar, Pubmed, Cochrane, Lilacs and Hinari with key words such as: COVID-19, SARS COVID, coronavirus. At the end of bibliographical search, researchers proposed the first draft of data collection instrument. After that, this draft was appraised and approved for all authors.

Technical and collection information: fatalism by COVID-19 scale (F-COVID-19) measures perception/belief about possible scenarios after coronavirus infection. It is made up of 7 items, which were defined by the authors of this research based on the definition or conceptual model of the articles that were published in 2020 ^(2,3-6). It has multiple choice answers (Strongly disagree, disagree, neutral, agree, strongly agree).

Data recollection: in first place, fatalism by COVID–19 scale was appraised and revised by the research team (according to available information found in specialized literature until February). By so doing, with the help of 28 experts the validity of scale content was analyzed in terms of relevancy, representativity, and clarity of items ⁽¹⁷⁾. Following, Fatalism by COVID–19 scale was applicated in homes, workplaces and study places. Before the application of the instrument, the participants were informed about the objectives of the research and verbal consent was solicitated in each case. The participation on survey was overt voluntary and anonymous. The last phase was the statistical analysis and there was a last verification of the questions, this through the judgment of 10 experts, where they verified the questions one last time.

Statistical analysis: first, evidence of content validity for each item was analyzed by 4 criteria (from 0 not relevant/representative/clear to 3 totally relevant/representative/clear) and the rate of relevancy, representativity and clarity was quantificate by V of Aiken coefficient and its confidence intervals (CI) at 95%. Thus, a V ≥ .70 and CI ≥ .59 indicated a positive assessment of the reactive.

Second, distribution of items was analyzed in order to identified possible excesses of asymmetry and kurtosis (>1). Third, explorative factorial analysis (EFA) was performed by robust ordinary least squares applicating a promin oblique rotation basing on a Pearson correlation matrix. Barlett Test and Kaiser-Meyer-Olkin index (KMO) was applied. Parallel analysis suggested 2 factors, this fact was coherent with the beginning model. All these analytical procedures were performed using statistical program FACTOR Analysis 10.1 version ⁽¹⁸⁾. Finally, scale reliability was calculated using statistical software SPSS 24.0 version.

Bioethical aspects: this study had ethical considerations for research. Considering that in emergencies (outbreaks and epidemics), investigations should be done as soon as possible, to help scientific community in understanding the phenomenon. Each of the participants gave their verbal consent.

Results

The results of explorative factorial analysis were based on information collected of 389 participants who answered the items of fatalism by COVID–19 scale voluntarily. Furthermore, 24 surveys were eliminated because were not completed or were with double answer. An evaluation was made based on the descriptive data of each item. Item 8 “I consider that if someone have a fatal case of coronavirus should be sacrificated/eutanasy or similar to avoid further infection” was eliminated for present a common variance <0.3 and corrected correlation coefficient of the item <0.3 (Table 1).

Table 1. Descriptive values of Fatalism by COVID-19 scale (F-COVID-19).

Variable	M	DE	As	K	h	r itc	α
Item1	2.332	1.035	0.657	-0.419	0.306	0.382	0.730
Item2	2.205	0.995	0.699	-0.462	0.641	0.458	0.717
Item3	2.337	1.072	0.541	-0.756	0.461	0.506	0.707
Item4	2.978	1.189	-0.164	-1.165	0.327	0.490	0.710
Item5	3.077	1.193	-0.197	-1.113	0.474	0.573	0.692
Item6	3.970	0.910	-1.097	1.367	0.498	0.464	0.717
Item7	3.740	1.184	-0.824	-0.272	0.340	0.432	0.722
Item8	4.027	1.077	-1.306	1.149	0.148	0.235	0.757

M = Media, SD = Standard deviation, As = Asymmetry coefficient, K = Kurtosis coefficient, h = Comunalidity

Sample adequacy was examined for exploratory factor analysis. Statistical results from KMO (0,779) and Bartlett (572.6; gl = 21; p < 0.001) were acceptable and significative. Therefore, factorial structured analysis of fatalism by coronavirus scale was performed based on a product moment correlation matrix (Pearson). Although items 4, 5, 6 and 8 have skewness and kurtosis coefficients, they are greater than 1 in absolute value. This was not a problem because the parallel analysis method (as published by Horn) was used to determine the number of factors and the robust method of ordinary least squares with average oblique rotation to analyze the factor structure or item saturation, where values less than 0.4 were omitted.

Parallel analysis suggested a 2-factor structure. Items 4,5,6 and 7 presents saturations above 0.4 in factor 1 (called: Extreme fatal consequences due to the consequence of infection) and contributes 40.9% of the explained variance. Items 1,2 and 3 present saturations in factor 2 (called: Concern about coronavirus infection) contribute 17.9%. Thus, the total variance explained by the 7 items distributed in 2 factors is 58.9%, which is adequate. The correlation between these factors was significatively superior to 0.3 (r = 0.457; p = < 0.001). Robust analysis (X2 = 21.161; p = 0.007; CFI = 0.984, GFI = 0.996; TLI = 0.957; RMSEA = 0.067 y RMSR = 0.033) showed a satisfactory factorial structure (Table 2).

Table 2. Explorative factorial analysis for fatalism by COVID-19 scale (F-COVID-19).

Ítems	F 1	F 2
1. I believe that I wil get infected in my workplace or study place.		0.544
2. I believe that if I get infected, I will infect to my relatives/friends.		0.853
3. I believe that I will be submitted in a hospital for a complication.		0.603
4. I believe that If I get infected by this virus, I will depress.	0.424
5. I believe that If I get infected by this virus, I could die (I will die for the virus).	0.591
6. I believe that If I get infected by this virus, I could make a fatal decision (suicide).	0.698
7. I believe that this is evidence of the “end of the world”.	0.627

Interfactorial correlation = 0.457

About reliability of F–COVID–19 scale, the results showed that the 7 items that were part of the instrument possessed a reliability coefficient superior to 0.7. The factors 1 and 2, and the whole scale also showed coefficients values above 0.7; indicating that the instrument have internal consistency. In this way, this results in a scale with valid and reliable measurements (Table 3).

Table 3. Descriptive values for the 7 items of final Fatalism by COVID–19 scale (F-COVID-19).

Variable	M	DE	As	K	h	r itc	a
Factor 1:
Item4	2.978	1.189	-0.164	-1.165	0.348	0.512	0.719
Item5	3.077	1.193	-0.197	-1.113	0.465	0.553	0.709
Item6	3.970	0.910	-1.097	1.367	0.431	0.423	0.738
Item7	3.740	1.184	-0.824	-0.272	0.373	0.423	0.740
Total	13.764	3.279	-0.374	-0.056			0.703
Factor 2:
Item1	2.332	1.035	0.657	-0.419	0.308	0.401	0.742
Item2	2.205	0.995	0.699	-0.462	0.664	0.489	0.725
Item3	2.337	1.072	0.541	-0.756	0.454	0.525	0.716
Total	6.874	2.471	0.422	-0.254			0.709

M = media, SD = Standard deviation, As = Asymmetry coefficient, K = Kurtosis coefficient, h = Comunalidity

Discussion

The coronavirus has quickly become in the most important trouble in this early 2020. Almost every country in the world has reported at least one case at the end of this study ^(19,20). Thus, many nations have taken strict policies to stop this pandemic ^(21,22). Therefore, an instrument that could measure with reliability the fatalism that some people can get about this pandemic was validated through a simple survey with few questions.

The factor 2 of the survey measures the fatalism about the possibility of getting infected. The 3 questions contained in this factor evaluated the possibility of being infected in workplace and study place, the possibility of infecting to relatives and friends; furthermore, the possibility of having complications that may require hospitalization. These questions not only translate the very fatalistic possibility of getting infected; this is a real possibility, since there are projections that show that by 2021, 60–70% of the population will be infected with COVID-19 ⁽²³⁾. These estimations rely on the possibility of getting infected in workplaces and study places, in other words, indicates community transmission as the main way to acquire the disease ⁽²⁴⁾, so in these terms the fear feeling of the general population is understandable. Furthermore, participants manifested that they are sure that once they get infected, will infect their relatives and friends, without knowing, their fears correspond with R0 of transmission which indicates in this disease a transmission rate of 2 – 3 people by each infected ⁽²⁵⁾. Finally, the question that states that they have the possibility of suffering a complication was validated when it is known that it only happens in 5% of the population ⁽²³⁾, though this possibility enhances in the case of risk groups ⁽²⁶⁾. Thus, upcoming researches must evaluate these results according to of population where is performed, as, it is difficult to compare the data obtained among general population and risk groups ⁽²⁷⁾.

The factor 1 collects extreme fatalist questions. One of these questions inquire the probability of getting depressed in case of knowing that you are a COVID patient, which it’s coherent with results reported in other papers where it was observed that many people get depressed when they get to know that are suffering a chronic disease or a high lethality illness ⁽²⁸⁾. Another question in the survey analyze the opinion of the participants on the possibility of dying if they get infected; currently it is known that lethality rate is 2–3 deaths by each 100 infected ⁽²³⁾. Albeit, there are some countries like Italy where this rate is almost of 10 by each 100 infected ⁽²⁹⁾; so, these facts enhance the fear feel by population about the lethality of COVID–19. Future researches must measure the real risk of this population, as, it will be important to make situational analysis between whom presents more fear and concern about this possibility. If these concerns take place among real risk groups, it will be because they are informed even though in a minimum way ⁽³⁰⁾. However, if these concerns take place among general population, instead of help this can cause an unnecessary fear that can generate another effect ^(31-33).

One of the questions contained in the survey that was extremely interesting was the one about the probability of taking a fatal decision when the participants get to know that they are infected. This is, indeed, a big public health trouble, but a background in other diseases, as, it is known that many that suffers HIV or cancer committed suicide when they receive the news about their medical condition ⁽¹⁵⁾. Furthermore, there are reports that other diseases can trigger this kind of reactions between these patients ^(34-36). It is also important to feature whom are more propense to take these kinds of fatal decisions in order to identify and evaluate them with other tests that can measure global depression and even self–esteem, as, both have been identified as principal factors that influences in suicide ideation ^(37,38).

At last, it was proposed a question that has measured the perception of the participants on the fact that arise of coronavirus is evidence of “end of the world”, knowing that this aspect can be influenced by magical or religious beliefs ^(39-41). There are some people that base their perceptions on their beliefs or magical experiences that predisposed them to be influenced by comments of their relatives and friends who share their same beliefs or ideas ⁽⁴²⁾, which it’s additionally influence by images spread by media promoting apocalyptical ideas (religious beliefs) that makes in this population to feel a loss of hope and an increasing fear to death ⁽⁴³⁾. So, this aspect has to be evaluated with other questions in order to know which religions or beliefs think that these events are omen of “end of the world”, so that, the beliefs which are more propense to these thoughts can be identified ⁽⁴⁴⁾.

The principal limitation of this research was only performed among Peruvian citizens, therefore, other researchers who wants to apply this scale and survey in their own contexts need to be cautious. However, we believe that this survey is suitable because of the great and diverse population that take part of this research (hundreds of people in coast, highlands, jungle from different social – economic incomes in groups A, B, C and D). For that reason, this scale can be quickly applied among countries with similar characteristics to Peru like Bolivia, Ecuador, Colombia and other countries of Latin America.

In conclusion, an instrument that measures the fatalism in people who can get infected by coronavirus SARS–COVID 2 was validated. Two factors were identified, one was related to the concern for the infection by coronavirus and the other to the extreme fatal consequences for getting the infection.

Conflict of relationships and activities

The authors declare not to have any relationships or activities conflict.

Financing

This research was financed by the authors.

Acknowledgments

We like to thank to Alan Wenceslao Quispe Sancho who helps us in the collection the information for this project. We also like to thank COVID–19–GIS–Peru research group that help to collect the data in each evaluated city.

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Authors Contribution:

MJR, RAJF, CM, PEP, PCLA, SRJ, CCJM, CERF and PGRM: participated in conceptualization, methodology, software, validation, formal analysis, research, resources, data curation, writing-preparing the original draft, writing-reviewing and editing.

©2020. The Authors. Kasmera. Publication of the Infectious and Tropical Diseases Department. Faculty of Medicine. Zulia University. Maracaibo-Venezuela. This is an open access article distributed under the terms of the Creative Commons non-commercial attribution (https://creativecommons.org/licenses/by-nc-sa/4.0/) license that allows unrestricted non-commercial use, distribution and reproduction in any means, as long as the original work is duly cited.