JMIR Publications

ABSTRACT

Background:

At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations and there was no standardised and validated scale to measure the fear associated with the pandemic.

Objective:

This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong.

Methods:

An online questionnaire platform was developed for data collection; the study instruments were an adapted version of the eight-item Breast Cancer Fear Scale (‘the Fear Scale’) and the four-item Patient Health Questionnaire (PHQ-4). The internal construct validity, concurrent validity, known-group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarise the participants’ fear levels.

Results:

A total of 2,822 study participants aged 18 or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach’s α coefficient of 0.93.The item-total correlations corrected for overlap were >0.4, confirming its internal construct validity. Regarding concurrent validity, a small to moderate correlation between the Fear Scale and the PHQ-4 scores was found. Regarding known-group validity, we found that study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear than the younger adults. Study participants who were separated/divorced/widowed had a higher level of fear than those who were single or married. Furthermore, having hypertension, liver diseases, heart diseases, cancer, anxiety and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy and depressed.

Conclusions:

To conclude, the adapted Fear Scale is a valid and reliable scale for measuring the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic.