|Year : 2023 | Volume
| Issue : 1 | Page : 18-23
The psychometric properties of the Arabic version of the fear of COVID-19 scale
Reem Al Khalifah1, Afnan Younis2, Hessah I Al Suwaidan2, Noor AlAnazi3, Leena R Baghdadi2
1 Department of Paediatrics, Paediatric Endocrinology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||14-Oct-2021|
|Date of Decision||05-Feb-2022|
|Date of Acceptance||17-Jun-2022|
|Date of Web Publication||3-Jan-2023|
Reem Al Khalifah
Associate Professor and Consultant Pediatric Endocrinologist, Division of Pediatrics Endocrinology, Department of Pediatrics (39), College of Medicine, P.O Box 2925, Riyadh 11461
Source of Support: None, Conflict of Interest: None
Aim: We aimed to translate and perform transcultural adaptation of the English version of the Fear of COVID-19 Scale (FCV-19S) to Arabic, and assess predictors of COVID-19 fear. Methods: We translated the original seven-item English FCV-19S to Arabic, then back-translated the scale to English. The scale was evaluated by a group of medical experts and participants from the general population to test for content and face validity. The final version of the scale was assessed in a cross-sectional study that included adults residing in Saudi Arabia, who participated in a study to assess the impact of COVID-19 fear on children's vaccination during the COVID-19 pandemic curfew March 24–July 6, 2020. Results: Overall, 577 participants responded to the survey. The mean age was 32.6 ± 5.7 years, and the majority had bachelor's or postgraduate university degrees. COVID-19 was diagnosed in 1.4% of the participants. The mean total score for the COVID-19 fear scale was 20 ± 5.4. The COVID-19 fear scale had excellent internal consistency and Cronbach's alpha 0.85 (95% confidence interval 0.93–0.96). Conclusions: The modified Arabic version of the FCV-19S is a valid and reliable tool to measure fear levels during the pandemic of COVID-19. Using an appropriate psychometric tool to measure the level of fear can help in monitoring changes in population fear levels, and implementing population-level measures to limit unwarranted fear.
Keywords: COVID-19, fear, pandemic, reliability, scale development, validity
|How to cite this article:|
Khalifah RA, Younis A, Al Suwaidan HI, AlAnazi N, Baghdadi LR. The psychometric properties of the Arabic version of the fear of COVID-19 scale. J Nat Sci Med 2023;6:18-23
|How to cite this URL:|
Khalifah RA, Younis A, Al Suwaidan HI, AlAnazi N, Baghdadi LR. The psychometric properties of the Arabic version of the fear of COVID-19 scale. J Nat Sci Med [serial online] 2023 [cited 2023 Jan 30];6:18-23. Available from: https://www.jnsmonline.org/text.asp?2023/6/1/18/366994
| Introduction|| |
The current COVID-19 pandemic is one of the toughest challenges facing the world. Similar to previous pandemics, it has shown a significant impact on the global economy and the health-care system, but also on mental well-being, especially during the lockdown; as these events propagate the individual erratic behaviors, worries, and fears.,, Indeed, fear may intensify the effect of COVID-19 complicating the diseases itself; as high levels of fear affect the thinking process and impact the decision-making. Fear of getting COVID-19 and the anticipation of possible complications of the infection has negatively impacted the person's health well-being and quality of life.
Many scales were developed to respond to the need of assessing the mental effect of the COVID-19 pandemic.,,,,, Currently, the seven-item Fear of COVID-19 Scale (FCV-19S) has been widely used., It is a good tool for assessing the fear triggered by the COVID-19 pandemic. However, one of the most important concerns for using such scales is the need for translation, cultural adaptation, and validation to achieve maximum utility. The FCV-19S had been validated in English in the UK (Harper et al., 2020) and New Zealand (Winter et al., 2020). It had been also assessed in different European languages including Italian, Russian, Turkish, and Greek. The scale had been also validated in Brazilian Portuguese,, Spanish, Cuban Spanish, Bangla, Hebrew, Chinese, Malay, and Arabic.
Although the FCV-19S has been translated into Arabic, however, the authors did not perform face validity of the scale. Proper face validity of any scale is important for the scale diagnostic value. Therefore, we aim to translate and perform transcultural adaptation of the English version of the FCV-19S to Arabic and assess predictors of COVID-19 fear. The examination of possible predictors of COVID-19 fear can help policymakers in controlling the population fear level to prevent mental illness.
| Methods|| |
Design and participants
We performed a cross-sectional study that included adults residing in Saudi Arabia, who participated in a study on the impact of COVID-19 fear on children's vaccination during the COVID-19 pandemic curfew March 24–July 6, 2020. We followed the recommendations for reporting the results of studies of instrument and scale development and testing. The study was approved by the King Saud University Institutional Review Board (approval number E-20-4795) in April 26, 2020. All the study procedures adhered to the ethical guidelines of the Declaration of Helsinki.
The original English version of the FCV-19S consists of seven items. Responses are scaled on a 5-point Likert-type scale "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree." The scores were given as "1" for "strongly disagree," and "5" for "strongly agree." The total scores range between 0 and 35 with higher total scores indicating increased fear of COVID-19. The Cronbach's alpha reliability coefficient of the original total scale was 0.82 indicating good reliability.
The scale questions were translated into Arabic, then back-translated to English. To test content validity, the scale underwent two content validity testing. The first round was performed by 31 experts (methodology, infectious disease, psychiatry, pediatrics, community medicine, and medicine). Experts assessed the translated version for clarity on a scale from 1 to 10 and were asked to provide feedback on the item if it needs phrasing, in addition to the suggested modification. Respondents found three items lacking clarity and suggested modification. For the item "My hands become clammy when I think about coronavirus-19," respondents suggested adding fear as a trigger to the clammy hands. In addition, the sleep item "I cannot sleep because I'm worrying about getting coronavirus-19" was marked to be unclear because it lacks a time frame and the scale options were not applicable to sleep. The item was rephrased to "over the last week, I had difficulty sleeping because I'm thinking about COVID-19 virus infection." In addition, the scale options were modified to "none, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, and 7 days."
Then, the scale was tested for face validity among a sample of 27 participants through individual telephone-based cognitive interview. The participants scored each item for clarity on a scale from 1 to 10 and were asked to provide feedback on the item if they are not clear. Respondents found all items to be clear except for the sleep item. Respondents suggested adding a time frame in relation to the pandemic. The item was rephrased to "from the beginning of the COVID-19 pandemic, I had difficulty sleeping because I'm thinking about COVID-19 virus infection" and the scale options were modified to "non, 1–2 days, 3–7 days, more than 7 days, and almost every day" [Table 1].
Sampling, recruitment, and study procedures
The final Arabic version of the FCV-19S (AFCV-19S) and the English back-translated scale were tested among the general Saudi population. The sample was part of the cross-sectional nationwide study to assess the impact of the COVID-19 pandemic lockdown on routine childhood immunization in Saudi Arabia. The inclusion criteria were individuals aged 18 years or older, being able to answer self-administered questions through the online platform, and able to speak and understand Arabic or English. Participants were recruited through the snowball method of sending invitations through social media such as Twitter, Snapchat, Facebook, and WhatsApp groups, followed by a reminder message sent 2 days apart. This method was chosen due to difficulty accessing the intended population during lockdown, and to minimizes social desirability bias. Written online informed consent was obtained before the study participant opens the survey questions.
In the survey, we included the Arabic and the back-translated English version of the FCV-19S. In addition to questions about the participants' age, gender, educational level, marital status, socioeconomic status, history of COVID-19 infection, or exposure to COVID-19, fear of COVID-19 infection, admission to intensive care unit (ICU), exposure to social media, pandemic news, social distancing, and home quarantine.
The primary outcome was the reliability coefficient Cronbach's alpha. The secondary outcome was the impact of social media, and exposure to COVID-19 on fear of COVID-19 scores.
We described continuous data with mean ± standardized deviation (SD), and categorical data with n (%). We used Cronbach's alpha and 95% confidence intervals (CI) to determine the internal consistency of the scale scores for both the Arabic and the back-translated English version of the FCV-19S. In addition, we performed univariate linear regression analyses to assess predictors of FCV-19S scores. The variables included in the model were the effect of the level of participants' education, media exposure, presence of chronic disease, previous ICU admission, exposure to COVID-19, caregiver, caregiver, news and fear, social distancing. All analyses were done using Stata/SE 16.1 software for Mac.
| Results|| |
Overall, 577 participants responded to the survey of whom 17 participants filled in the back-translated English version of the FCV-19S. The mean age was 32.6 ± 5.7 years and the average number of children per family was 2.6 ± 1.5. The majority of the participants was Saudis married individuals with various levels of education; 5.4% had a diploma degree, 59.1% had a bachelor's degree, and 26.7% had a postgraduate university degree. There were 57.2% employed and 42.9% unemployed, whereas the income status showed 64.1% of high income and 29% of middle income. COVID-19 was diagnosed in 1.4% of the participants, 5.2% had admitted to the ICU or had a family member who was admitted to the ICU due to COVID-19 infection, and 39.9% reported acquaintance with someone diagnosed with COVID-19 [Table 2].
The corrected item-total correlations for the COVID-19 fear items were all >0.60 [Table 3]. The mean total score for the COVID-19 fear scale was 20 ± 5.4, ranging from 7 to 35 points [Figure 1]. The COVID-19 fear scale had excellent internal consistency and Cronbach's alpha 0.85 (95% CI 0.93–0.96). Subgroup analysis based on the language showed similar Cronbach's alpha value. The Cronbach's alpha for the Arabic and the English language was 0.85.
In univariate analysis, the COVID-19 fear scores increased with social distancing measures by 4.03 points, news 4.9, and reduced with higher educational level by −0.50. While the scores were not affected by the individual's age, sex, chronic illness status, exposure to COVID-19, being admitted to the ICU, or length of media exposure [Table 4].
|Table 4: Univariate regression analyses to assess factors impacting fear of COVID-19 scale|
Click here to view
| Discussion|| |
The modified AFCV-19S demonstrated strong reliability and internal consistency (Cronbach's alpha 0.85, item-total correlation >0.6), as well as the back-translated English scale. Overall, our Arabic and back-translated English scale had higher reliability scores compared to the original English (Cronbach's alpha 0.82), and similar to the other translated scales (0.80–0.89).,,,,,, While, the item-total correlations obtained in our scale were higher than the previous Arabic translation.
Sleep is an important aspect of assessing fear scores. The sleep item in the original FCV-19S and the first Arabic translation of the scale "I cannot sleep because I'm worrying about getting coronavirus-19" lacks the orientation to time and frequency of sleep disturbance. This was identified by the expert group and the patient group who performed the face validity of the scale posttranslation. It is important to phrase the item and the options correctly to measure the fear level accurately. As a result of the modification, the sleep item had an item-total correlation of 0.60 which is better than the original scale of 0.51. This also reflects the changes made to the scale options to an improved scale option that fits sleep better.
Univariate analysis showed increased AFCV-19S scores with exposure to COVID-19 news by 4.9 (95th CI 4, 5.7), and social distancing measures by 4.03 (95th CI 3.12, 4.95). While exposure to social media per se was not a factor for increased level of fear of COVID-19. In addition, our study showed that the participant's age, sex, underlying chronic illness, educational level, being exposed to COVID-19, or being in the ICU due to COVID-19 did not affect the fear scores. This is contrary to the previous literature that reported higher COVID-19 fear level in female gender, younger age, and lower educational level.,,,,, This observation may be related to the modification we made on the sleep item.
Our study has some strengths. First, our sample included middle age group participants which are comparable to the Saudi general population. Second, we performed multilevel face validity by involving different stakeholders, i.e., physicians and patients that led to improved scale face validity. Third, we compared the performance of both the Arabic and the back-translated English version of the scale. A future study is needed to assess the English scale psychometric properties among larger sample size. Although we received an adequate sample size for the Arabic version, we had expected a higher response rate. This is expected because recruitment happened during a period of stress leading to limited survey response, especially from those with possible high fear level or survey fatigue. Moreover, we did not perform concurrent validity with the anxiety and depression scale or factor analysis because those were already established in the literature.
| Conclusions|| |
The modified AFCV-19S is a valid and reliable tool to measure fear level during the pandemic of COVID-19. Worse mental health outcomes including anxiety, depression, posttraumatic stress, and suicide have been linked to the fear of the COVID-19 pandemic.,, Therefore, using an appropriate psychometric tool to measure the level of fear from COVID-19 can help in monitoring changes in population fear level during the pandemic, implementing population-level measures to limit unwarranted fear through tailored news, and use of social distancing cautiously are necessary to allow for the continuation of basic life needs.
Special thanks for the support by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.
The authors would also like to thank the following physicians for their generous contribution in preforming content validity of the scale:
Dr. Fatmah Alshahrani, Assistant professor of infectious diseases, infection control.
Prof. Lubna Al-Ansary, college of Medicine, King Saud University.
Dr. Maha alrajeh, college of Medicine, King Saud University.
Dr. Mona Philby, Pediatric Pulmonologist, college of Medicine, King Saud University.
Dr. Sarah Alsubaie, Pediatric infectious diseases consultant, college of Medicine, King Saud University.
Nooralhuda Ali bakhsh, college of Medicine, King Saud University.
Razan Baghdadi, college of Medicine, King Saud University.
Prof. Yousef Al Turki, Professor and Consultant Family Medicine, college of Medicine, King Saud University.
Dr. Zobaida Alsum, allergy immunology consultant, King Saud University Medical City
Dr. Saad M. Alsaad, college of Medicine, King Saud University.
Dr. Yasser S. Amer, King Saud University Medical City, college of Medicine, King Saud University.
Dr. Aynaa Ibrahim Alsharidi, Infectious Diseases Consultant, King Saud University. Medical Cit
Dr. Amr A. Jamal, Family and Community Medicine Department, college of Medicine, King Saud University.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]