Heliyon 10 (2024) e25297
A ailable online 1 Feb ua y 2024
2405-8440/© 2024 The Au ho s. Published by Else ie L d. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
Resea ch a icle
Risk pe cep ion o heal hca e wo ke s in he i s wa e o he
COVID-19 pandemic in B azil
Joana Mu agu i G iesi
a
, Jo˜
ao Ma cos Be na des
a
,
b
, Melissa Alonso
b
, Juan G´
omez-
Salgado
c
,
d
,
*
, Ca los Ruiz-F u os
c
,
d
, Ja ie Fagundo-Ri e a
e
, Daniel L´
opez-L´
opez
,
Juan Ca los Camacho-Vega
g
, Ad iano Dias
a
,
b
a
Depa men o Public Heal h, Bo uca u Medical School, S˜
ao Paulo S a e Uni e si y/UNESP, Bo uca u, 18618-687, B azil
b
Public (Collec i e) Heal h G adua e P og am, Bo uca u Medical School, S˜
ao Paulo S a e Uni e si y/UNESP, Bo uca u, 18618-687, B azil
c
Depa men o Sociology, Social Wo k and Public Heal h, Facul y o Labou Sciences, Uni e si y o Huel a, 21007, Huel a, Spain
d
Sa e y and Heal h G adua e P og am, Uni e sidad Espí i u San o, Guayaquil, 092301, Ecuado
e
Red C oss Nu sing Uni e si y Cen e, Se ille, Spain
Heal h and Podia y G oup, Depa men o Heal h Sciences, Facul y o Nu sing and Podia y. Indus ial Campus o Fe ol, Uni e sidade da Co u˜
na,
15403, Fe ol, Spain
g
Depa men o Building Cons uc ion II, Highe Technical School o Building Enginee ing, Uni e si y o Se ille, Se ille, Spain
ARTICLE INFO
Keywo ds:
Epidemiology
Risk pe cep ion
COVID-19
Sense o cohe ence
P e en i e beha iou s
Heal hca e wo ke s
ABSTRACT
Objec i es: To alida e he i ems o he Emo ional Impac Ques ionnai e co ona i us disease-2019
(COVID-19) ela ed o isk pe cep ion, es ima ing i s deg ee, among heal hca e wo ke s in he
i s wa e o COVID-19 pandemic, iden i ying possible associa ed ac o s.
Me hods: c oss-sec ional s udy in 1872 heal hca e wo ke s o B azil. The popula ion was cha -
ac e ized by sociodemog aphic and occupa ional in o ma ion, knowledge abou COVID-19,
quali y o in o ma ion ecei ed, isk pe cep ion and p e en i e measu es abou he disease,
and sense o cohe ence.
Resul s: Being di o ced, ha ing a ch onic disease, spending mo e han 1 h pe day ge ing
in o med abou COVID-19, and always o almos always wea ing a mask ega dless o symp oms,
as well as sel -pe cep ion o heal h we e associa ed wi h high- isk pe cep ion. An in e se asso-
cia ion was ound be ween isk pe cep ion, sense o cohe ence and no knowing i one has had
occasional con ac wi h con i med COVID-19 cases.
Conclusion: Risk pe cep ion is in luenced by emo ions, expe iences, and knowledge. Sense o
cohe ence and esilience ha e a ole in educing isk pe cep ion. Unde s anding isk pe cep ion is
c ucial o de eloping e ec i e s a egies o mi iga e he impac o he COVID-19 pandemic and
o he simila scena ios.
Key messages
* Co esponding au ho . Depa men o Sociology, Social Wo k and Public Heal h. Facul y o Labou Sciences, Uni e si y o Huel a. A enida T es
de Ma zo, s/n, 21007, Huel a, Spain.
E-mail add esses: [email p o ec ed] (J.M. G iesi), [email p o ec ed] (J.M. Be na des), [email p o ec ed] (M. Alonso),
[email p o ec ed] (J. G´
omez-Salgado), [email p o ec ed] (C. Ruiz-F u os), [email p o ec ed] (J. Fagundo-Ri e a), [email p o ec ed]
(D. L´
opez-L´
opez), [email p o ec ed] (J.C. Camacho-Vega), [email p o ec ed] (A. Dias).
Con en s lis s a ailable a ScienceDi ec
Heliyon
jou nal homepage: www.cell.com/heliyon
h ps://doi.o g/10.1016/j.heliyon.2024.e25297
Recei ed 15 July 2023; Recei ed in e ised o m 23 Janua y 2024; Accep ed 24 Janua y 2024
Heliyon 10 (2024) e25297
2
•This s udy highligh s he ele ance o he associa ion be ween isk pe cep ion and a i udes owa ds COVID-19 among
heal hca e wo ke s.
•The indings emphasize he subjec i e na u e o isk pe cep ion, in luenced by emo ions, expe iences, and knowledge.
•Risk pe cep ion emphasizes he ole o he sense o cohe ence and esilience.
•Unde s anding isk pe cep ion is c ucial o de eloping e ec i e s a egies o mi iga e he impac o he COVID-19.
1. In oduc ion
Li le o e h ee yea s a e he i s cases o COVID-19 eme ged and he Wo ld Heal h O ganiza ion (WHO) decla ed i a pandemic
[1,2], he disease has in ec ed nea ly 690 million people (88,455 cases pe million) and caused app oxima ely 6.9 million dea hs (883
dea hs pe million) [3]. Heal hca e wo ke s expe ienced a subs an ial bu den du ing his pe iod, cha ac e ized by high mo bidi y and
mo ali y a es, alongside a ious physical and men al heal h issues [4]. The demands placed on hese p o essionals, who we e a he
o e on o he pandemic esponse, combined wi h he inadequa e a ailabili y o pe sonal p o ec i e equipmen exposed hem o an
inc eased isk o in ec ion, esul ing in a highe in ec ion a e when compa ed o he gene al popula ion [4,5], inc eased odds o
COVID-19 dea h [6] and a high excess mo ali y a e [7,8], a leas un il accines became a ailable [9].
In iew o he abo e ci cums ances, i should come as no su p ise ha heal hca e wo ke s p esen ed a highe isk pe cep ion o
COVID-19 han he gene al public [10,11]. Risk pe cep ion (RP) add esses he in ui i e isk assessmen ha people do when e alua ing
haza ds ha hey a e o migh be exposed o Re . [12]. E en hough isk is conside ed an objec i e s a e o he wo ld by a ious
disciplines, including heal h sciences [12,13], indi iduals may pe cei e isk di e en ly [13,14]. How someone will pe cei e a isk is
in luenced by h ee key ac o s: (I) haza d cha ac e is ics (bo h quali a i e and quan i a i e); (II) indi idual cha ac e is ics (including
sociodemog aphic cha ac e is ics, psychological ai s, wo ld iews, alue o ien a ions, speci ic knowledge, and scien i ic easoning
abili ies); and (III) he u iliza ion o simpli ying “sho cu s” known as heu is ics o in e p e isk in o ma ion [15–17].
P e ious esea ch indica es ha RP plays a signi ican ole in heal h- ela ed e en s by in luencing indi iduals’ adhe ence o
p e en i e measu es [18,19], a i udes and beha io s [20–22], including es ing [23] and social dis ancing [24], accina ion in-
en ions [25,26] and suppo o ec o con ol s a egies [27]. These ac o s, in u n, may impac he sp ead and con ol o epidemics
by a ec ing hei iming, dynamics, and o e all case numbe s [28]. Mo eo e , isk pe cep ion is in ica ely linked o men al heal h
ou comes [29]. High le els o pe cei ed isk can lead o inc eased ea , anxie y, dep ession, and psychological dis ess [29–31].
The e o e, unde s anding RP du ing a pandemic is c ucial, as i signi ican ly in luences bo h public heal h ou comes and indi idual
well-being. This impo ance is especially p onounced among heal hca e wo ke s, who play an essen ial ole in pandemic esponse.
Howe e , while in some ields, such as en i onmen al isks, isk pe cep ion has been s udied in ensi ely, he e is s ill much o un-
de s and abou RP o eme ging in ec ious diseases [32].
Consequen ly, nume ous s udies ha e in es iga ed se e al aspec s o COVID-19 RP [10,11,29–31,33–35]. Howe e , despi e he ac
ha he COVID-19 pandemic c ea ed a disas ous scena io in B azil, placing he coun y a he op o he anking o in ec ions and
dea hs alongside he Uni ed S a es [36], he e is a limi ed body o esea ch speci ically add essing COVID-19 RP in he coun y. This
knowledge gap is pa icula ly dis inc among heal hca e wo ke s, as exis ing s udies on hei RP we e limi ed o indi iduals om Rio
de Janei o [37,38] o o membe s o wo speci ic p o essional socie ies, namely he Socie y o In ensi e Ca e and he B azilian As-
socia ion o Eme gency Medicine [39]. Thus, his s udy aims o assess COVID-19 RP and i s associa ed ac o s among B azilian
heal hca e wo ke s ac oss he en i e coun y and a ious p o essions du ing he i s pandemic wa e.
2. Me hods
2.1. Design
This c oss-sec ional s udy ollowed he STROBE (ST eng hening he Repo ing o OBse a ional s udies in Epidemiology) guide-
lines and is pa o a b oade in e na ional esea ch p ojec , ha aimed o e alua e he psychological impac o he COVID-19
pandemic, bo h wi hin he gene al popula ion and among heal hca e p o essionals [40]. The coo dina ion o he s udy was cen al-
ized in Spain, and i was implemen ed in 16 coun ies ac oss La in Ame ica, Eu ope, A ica, and Asia. A consis en me hodology was
employed, albei wi h a ia ions due o he adap a ion o he ques ionnai e o each pa icipa ing coun y and di e ences in da a
collec ion imelines. In B azil, da a collec ion was ca ied ou om Ap il 23 o May 30, 2020 ( hus, encompassing he ini ial wo
mon hs ollowing WHO’s pandemic decla a ion), and ob ained o e 5500 esponses, o which 1872 we e om heal hca e wo ke s.
2.2. Pa icipan s
Pa icipa ion was limi ed o heal hca e wo ke s aged 18 yea s o olde who esided in B azilian e i o y. Conside ing he c ucial
need o social dis ancing measu es du ing his pe iod, all he ec ui men p ocess was needed o be conduc ed exclusi ely h ough
online means. The e o e, pa icipan s we e ec ui ed using a non-p obabilis ic snowball sampling me hod h ough e-mails, p o es-
sional ne wo ks, and digi al social channels such as Wha sApp, Facebook, Ins ag am, Twi e , and LinkedIn. Snowball sampling
echniques a e equen ly employed in cases whe e he s udy popula ion is unknown, p esen ing challenges in he selec ion o pa -
icipan s who sa is y he speci ied eligibili y c i e ia [41]. Thus, since he e is no a na ional egis y o B azilian heal hca e wo ke s
J.M. G iesi e al.
Heliyon 10 (2024) e25297
3
and i s demog aphy is unknown, snowball sampling was deemed a sui able me hod o he ec ui men o s udy pa icipan s.
2.3. Da a collec ion ins umen
The esea ch ques ionnai e (see Supplemen a y File 1), denomina ed Emo ional Impac Ques ionnai e COVID-19 B azil (EIQ-BR),
was ansla ed and cul u ally adap ed o he B azilian popula ion om a ques ionnai e ha had al eady been de eloped and alida ed
o use in he Spanish popula ion. Fu he in o ma ion ega ding he Spanish ques ionnai e de elopmen and alida ion is a ailable
elsewhe e [42]. The B azilian e sion o he ques ionnai e was ini ially analyzed by a panel o en expe s consis ing o psychologis s,
physical he apis s, physicians, nu ses, and public heal h p o essionals, and i ems ha p esen ed di icul y in e ms o unde s anding
we e subsequen ly modi ied. A e ha , i was made a ailable online (a h ps://cu .ly/IMPACT_COVID-19_BRASIL) and open o
anyone in e es ed in esponding. In addi ion o he ansla ion and cul u al adap a ion o he B azilian popula ion, EIQ’s Spanish
e sion was also ansla ed, alida ed, and used in se e al coun ies [43–47].
The EIQ-BR collec ed a a ie y o in o ma ion, including sociodemog aphic, occupa ional, heal h- ela ed and COVID-19 con ac
his o y, as well as da a ega ding he sense o cohe ence. Sense o cohe ence is a heo e ical cons uc ha desc ibes an indi idual’s
abili y o comp ehend, cope wi h, and ind meaning in s ess ul li e si ua ions. A high sense o cohe ence is associa ed wi h he
pe cep ion ha s esso s a e comp ehensible, p edic able, and manageable, and ha he pe son possesses esou ces o deal wi h hem
[48]. Sense o cohe ence was assessed h ough he 13 i em e sion o An ono sky’s sense o cohe ence scale (SOC-13) [49]. In addi ion
o he a o emen ioned in o ma ion, he EIQ-BR also included 9 ques ions abou RP conce ning COVID-19. Pa icipan s we e asked o
a e he ollowing ques ions on a scale o 1–10, e lec ing a spec um o inc easing RP: 1) How would you a e you le el o conce n
abou COVID-19? (scale: no a all o e y conce ned); 2) Wha p obabili y do you belie e you ha e o su i ing COVID-19 i you
become in ec ed o ha e al eady been in ec ed? (scale: e y likely o no likely a all); 3) How con iden a e you in he abili y o
heal hca e wo ke s o diagnose o ecognize COVID-19? (scale: e y con iden o no con iden a all); 4) How con iden a e you in he
abili y o he heal hca e sys em o diagnose o ecognize COVID-19? (scale: e y con iden o no con iden a all); 5) How likely do you
hink i is ha you will become in ec ed wi h COVID-19? (scale: no likely a all o e y likely); 6) Do you belie e ha ge ing in ec ed
wi h COVID-19 would ha e se ious consequences o you heal h? (scale: no a all o ce ainly); 7) Do you belie e ha COVID-19
in ec ion is di icul o ea ? (scale: no a all o e y di icul ); 8) To wha ex en a e you conce ned abou con ac ing COVID-19?
(scale: no a all o e y conce ned); 9) To wha ex en a e you conce ned abou being a ca ie and ansmi ing he i us o am-
ily membe s, close con ac s, o pa ien s? (scale: no a all o e y conce ned).
Likewise, he EIQ-BR encompassed 8 ques ions ega ding adhe ence o p e en i e measu es. These ques ions employed a i e-poin
esponse scale (ne e , a ely, some imes, almos always and always) o assess he le el o compliance o he ollowing p e en i e
measu es: 1) co e ing he mou h wi h he elbow when coughing o sneezing; 2) a oiding sha ing u ensils du ing meals; 3) washing
hands wi h soap and wa e ; 4) cleaning hands wi h alcohol-based solu ion; 5) washing hands immedia ely a e coughing, ouching he
nose, o sneezing; 6) washing hands a e ouching po en ially con amina ed objec s; 7) wea ing masks ega dless o he p esence o
symp oms; and 8) main aining a leas 1.5 m o dis ance om o he people.
2.4. Va iables
In he cu en s udy, he ollowing sociodemog aphic a iables we e elec ed o analyses: gende ( emale and male); age (comple e
yea s); ma i al s a us (single, ma ied o li ing wi h pa ne , sepa a ed o di o ced and widowed); ha ing child en (yes and no); ha ing
pe s (yes and no); educa ion le el (high school, college, specializa ion, mas e ’s deg ee, doc o a e); egion o esidence (No h,
No heas , Midwes , Sou heas , Sou h); ype o housing (apa men wi h balcony, apa men wi hou balcony, house wi h ga den o
backya d, house wi hou ga den o backya d and o he ) and ime spen pe day ge ing in o med abou COVID-19 (up o 1 h, 1–4 h,
4–8 h and mo e han 8 h).
While he occupa ional a iables we e: employmen s a us (pa ial wo k om home, pa ial wo k ou side home, ull- ime wo k
om home, ull- ime wo k ou side home, mixed and O he ); ype o employmen (sel -employed, public sec o employee and p i a e
sec o employee); heal hca e p o ession (nu se, physician and o he ); p o essional expe ience (up o 5 yea s, 6–10 yea s and mo e han
10 yea s); and being in ol ed in heal hca e p o ision (yes and no).
The heal h- ela ed and COVID-19 con ac his o y a iables we e: ha ing any ype o disabili y; ha ing a ch onic illness; cu en ly
aking medica ion; medical ca e a a heal hca e acili y in he pas 14 days; hospi aliza ion in he pas 14 days; cu en ly in isola ion;
unde wen diagnos ic es ing o COVID-19; expe ienced symp oms o COVID-19 ( esponses o his and he p e ious se en a iables
we e yes and no); numbe o symp oms expe ienced (none, 1, 2–4, 5–7, 8–10); pe cep ion o heal h in he las 14 days ( e y poo , poo ,
ai , good and e y good); close con ac - i.e. up o 15 min o less han 2 m - wi h a con i med in ec ed pe son (yes, no su e and no);
occasional casual con ac wi h a con i med in ec ed pe son (yes, no su e and no); con ac wi h a suspec ed in ec ed pe son o ma e ial
(yes, no su e and no); amily membe in ec ed wi h COVID-19 (yes, no su e and no); belie o ha ing con ac ed he i us (yes,
p obably yes and no).
To assess pa icipan ’s sense o cohe ence, a sco e was ob ained by he sum o he esponses om he SOC-13 i ems (disc e e
a iable anging om 13 o 91 poin s). The highe he sco e, he s onge he sense o cohe ence.
Wi h espec o p e en i e measu es, an adhe ence sco e (disc e e a iable anging om 0 o 8 poin s) was c ea ed by summing he
indi idual sco es o each o he 8 ques ion ha assessed he adhe ence o p e en i e measu es. To do so, he esponses “always” and
“almos always” we e bo h assigned one poin , while he o he esponse op ions we e assigned ze o poin s. The highe he sco e, he
g ea e he adhe ence.
J.M. G iesi e al.
Heliyon 10 (2024) e25297
4
Finally, an o e all RP sco e (disc e e a iable anging om 9 o 90) was c ea ed by summing he indi idual sco e o each ques ion
o he nine RP ques ions. Subsequen ly, he RP a iable was dicho omized. The cu o poin o dicho omiza ion was de e mined by he
median sco e. Consequen ly, indi iduals whose RP sco e ell a o below he RP sco e median we e ca ego ized as p esen ing a low RP,
while hose wi h RP sco es abo e he median we e ca ego ized as p esen ing a high RP.
I is wo h no ing ha , o assess he alidi y o he o e all RP sco e employed in his s udy as a alid measu e o RP, a c oss-
alida ion was conduc ed. This c oss- alida ion in ol ed examining he associa ion be ween he o e all RP sco e and he sco e o
adhe ence o p e en i e measu es by i ing an ad hoc simple linea eg ession model. The a ionale behind his was based on he
indings om p e ious s udies ha ha e ound a s ong associa ion be ween RP and compliance wi h p e en i e measu es [18,19]. The
esul s om he simple linea eg ession model e ealed a s a is ically signi ican associa ion be ween he o e all RP sco e and he
sco e o adhe ence o p e en i e measu es (p <0.01). Addi ionally, i indica ed a high deg ee o collinea i y (p <0.01), which
co obo a es indings in he exis ing li e a u e.
Fu he mo e, he in e nal consis ency o he nine RP ques ions was e alua ed using C onbach’s Alpha. The esul o he C onbach’s
Alpha es was 0.692. This indica es ha hese ques ions a e cohe en and adequa ely cap u e he dimension o RP assessed in he
s udy. I is impo an o no e ha C onbach’s Alpha alues ange om 0 o 1, wi h eliabili y ca ego ized as low (0–0.2), ai
(0.21–0.4), mode a e (0.41–0.6), subs an ial (0.61–0.8), and almos pe ec (0.81–1) [50]. Values abo e 0.6 o 0.7 a e ypically
conside ed eliable [50]. Based on his c i e ion, ou o e all RP sco e was deemed o be eliable.
2.5. Da a analysis
Ini ially, a desc ip i e analysis o he s udy a iables was conduc ed. Ca ego ical a iables we e analyzed using equency mea-
su es, whe eas nume ical a iables we e examined using measu es o cen al endency and dispe sion. Addi ionally, he Kolmogo o -
Smi no es was employed o assess he assump ion o no mali y o he nume ical a iables.
Finally, we in es iga ed he ela ionship be ween he independen a iables and he dependen a iable, RP (ca ego ized as low
and high), h ough logis ic eg ession models. To do so, simple logis ic eg ession models o each independen a iable we e pe -
o med. Va iables wi h p- alues less han 0.05 we e subsequen ly inco po a ed in o he mul iple logis ic eg ession model employing a
s epwise o wa d p ocedu e. In he inal model, a iables wi h p- alues less han 0.05 (using a wo- ailed es ) we e deemed associa ed
wi h RP.
Va iable coding and s a is ical analyses we e pe o med using he IBM/SPSS s a is ical package, e sion 27.0 (IBM, A monk, NY,
USA).
2.6. E hics app o al
This s udy was au ho ized by he Na ional Resea ch E hics Commi ee in B azil (CAAE 30437120.4.0000.5411, Ap il 23, 2020).
Pa icipan s only had access o he ques ionnai e upon con i ming hei eligibili y and exp essing hei willingness o pa icipa e by
p o iding explici consen h ough a digi al In o med Consen Fo m (ICF), which was ully p esen ed on he websi e’s homepage.
3. Resul s
The s udy included 1872 heal hca e wo ke s om B azil (see low diag am in Fig. 1). Mos o hem (61.9 %) we e engaged in di ec
pa ien ca e. Among he pa icipan s, 82.1 % we e emale, and hei a e age age was 39.99 yea s (±12.41 yea s). In e ms o hei
p o essions, 18.6 % we e nu sing wo ke s, 14.3 % we e physicians, while he emaining ep esen ed o he heal hca e p o essions.
Mos pa icipan s ollowed p e en i e measu es ecommenda ions, pe cei ed hei own heal h as egula o e y good, epo ed no
Fig. 1. S udy low cha acco ding o STROBE guidelines.
J.M. G iesi e al.
Heliyon 10 (2024) e25297
5
Table 1
Sociodemog aphic a iables, in o ma ion ela ed o COVID-19, p e en i e p ac ices, and isk pe cep ion o heal hca e wo ke s (EIQ-BR, B azil).
Va iable Ca ego ies n %
Gende Male 335 17.9
Female 1537 82.1
Ma i al s a us Single 640 34.2
Ma ied o li ing wi h pa ne 1041 55.6
Sepa a ed/Di o ced/Widowed 191 10.2
Educa ion le el High school 102 5.4
College 377 20.1
Specializa ion 609 32.5
Mas e ’s deg ee 429 22.9
Doc o a e 355 19.0
Region o esidence No h 26 1.4
No heas 145 7.7
Midwes 175 9.3
Sou heas 1275 68.1
Sou h 251 13.4
Type o housing Apa men wi h balcony 445 23.8
Apa men wi hou balcony 314 16.8
House wi h ga den o backya d 916 48.9
House wi hou ga den o backya d 128 6.8
O he 69 3.7
Ha e child en Yes 908 48.5
No 964 51.5
Ha e pe s Yes 1102 58.9
No 770 41.1
Employmen s a us Pa ial wo k om home 169 9.0
Pa ial wo k ou side 281 15.0
Full- ime wo k om home 332 17.7
Full- ime wo k ou side 561 30.0
Mixed 110 5.9
O he 419 22.4
Type o employmen Sel -employed 325 17.4
Public sec o employee 821 43.9
P i a e sec o employee 298 15.9
Heal hca e p o ession Nu se 345 18.4
Physician 266 14.2
O he 1248 66.7
In ol ed in heal hca e p o ision Yes 1158 61.9
No 714 38.1
P o essional expe ience Up o 5 yea s 545 29.1
6–10 yea s 448 23.9
Mo e han 10 yea s 879 47.0
Time spen pe day ge ing in o med abou COVID-19 Up o 1 h 323 17.3
1–4 h 776 41.5
4–8 h 327 17.5
Mo e han 8 h 265 14.2
Always o almos always co e ing mou h wi h elbow when coughing o sneezing No 160 8.5
Yes 1496 79.9
Always o almos always a oiding sha ing u ensils du ing meals No 295 15.8
Yes 1361 72.7
Always o almos always washing hands wi h soap and wa e No 22 1.2
Yes 1634 87.3
Always o almos always cleaning hands wi h alcohol-based solu ion No 127 6.8
Yes 1529 81.7
Always o almos always washing hands immedia ely a e coughing, ouching he nose, o sneezing No 350 18.7
Yes 1306 69.8
Always o almos always washing hands a e ouching po en ially con amina ed objec s No 105 5.6
Yes 1551 82.9
Always o almos always using a mask ega dless o symp oms No 406 21.7
Yes 1250 66.8
Always o almos always main aining a leas a 1.5-m dis ance om o he people No 248 13.2
Yes 1408 75.2
Cu en ly in isola ion No 1385 74.0
Yes 271 14.5
Pe cep ion o heal h in he las 14 days Ve y poo 6 .3
Poo 31 1.7
Fai 256 13.7
Good 775 41.4
Ve y good 510 27.2
(con inued on nex page)
J.M. G iesi e al.

Heliyon 10 (2024) e25297
6
disabili ies, ch onic diseases, hospi aliza ions, o medical ca e a a heal hca e acili y in he wo weeks p io o da a collec ion.
Rega ding COVID-19, a mino i y o he pa icipan s epo ed exposu e o po en ially isky si ua ions in ol ing con ac wi h
in ec ed indi iduals o con amina ed objec s, and ha ing amily membe s who we e in ec ed wi h he co ona i us. In con as , he
majo i y ei he denied any such con ac o we e unsu e abou i . Fu he mo e, mos o hem ei he denied o exp essed unce ain y
abou ha ing con ac ed COVID-19. Howe e , app oxima ely 67 % o he pa icipan s expe ienced a leas one lu-like symp om wi hin
he wo weeks p eceding da a collec ion, while only 6.4 % o all pa icipan s unde wen diagnos ic es ing o COVID-19. Table 1
desc ibes he cha ac e is ics o he o e all pa icipan s.
In e ms o he o e all RP, he a e age sco e was 58.61 poin s (±9.82), wi h a median o 59 (ou o a maximum o 90). Table 2
Table 1 (con inued)
Va iable Ca ego ies n %
Ha ing any ype o disabili y Yes 81 4.3
No 1497 80.0
Symp oms
a
expe ienced in he las 14 days No 313 16.7
Yes 1265 67.6
Numbe o symp oms
a
expe ienced in he las 14 days 1 337 18.0
2–4 752 40.2
5–7 158 8.4
8–10 18 1.0
Ha e a ch onic illness No 1016 54.3
Yes 562 30.0
Cu en ly aking medica ion Yes 752 40.2
No 826 44.1
Hospi aliza ion in he las 14 days Yes 10 0.5
No 1568 83.8
Medical ca e a a heal hca e cen e , hospi al, o clinic in he las 14 days? Yes 126 6.7
No 1452 77.6
Close con ac wi h a con i med in ec ed pe son (up o 15 min o less han 2 m) Yes 162 8.7
No su e 699 37.3
No 709 37.9
Occasional casual con ac wi h a con i med in ec ed pe son Yes 141 7.5
No su e 1256 67.1
No 173 9.2
Con ac wi h a suspec ed in ec ed pe son o ma e ial Yes 222 11.9
No su e 1150 61.4
No 198 10.6
Family membe in ec ed wi h COVID-19 Yes 87 4.6
No su e 1417 75.7
No 66 3.5
Unde wen diagnos ic es ing o COVID-19 Yes 119 6.4
No 1446 77.2
Belie o SARS-CoV-2 in ec ion Yes 61 3.3
No 627 33.5
P obably yes 768 41.0
Va iable mean SD median
Age 39.99 12.42 38
Final sco e o he isk pe cep ion scale 58.61 9.82 59
Final sco e o he p e en i e measu es scale 6.96 1.21 7
SOC-13 sco e 60.52 14.36 61
a
Fe e , cough, headache, muscle pain, nausea, dia hea, so e h oa , unny nose, chills, and di icul y b ea hing. EIQ-BR: Emo ional Impac
Ques ionnai e COVID-19 B azil. SOC-13: Sense o cohe ence scale.
Table 2
I em esponse s a is ics, mean and s anda d de ia ion alues o answe s o isk pe cep ion ques ions o COVID-19 among heal hca e wo ke s (EIQ-
BR, B azil).
Mean SD
How would you a e you le el o conce n abou COVID-19? 8.78 1.574
Wha p obabili y do you belie e you ha e o su i ing COVID-19 i you become in ec ed o ha e al eady been in ec ed? 3.23 2.004
How con iden a e you in he abili y o heal hca e wo ke s o diagnose o ecognize COVID-19? 3.56 1.902
How con iden a e you in he abili y o he heal hca e sys em o diagnose o ecognize COVID-19? 4.29 2.134
How likely do you hink i is ha you will become in ec ed wi h COVID-19? 6.81 2.486
Do you belie e ha ge ing in ec ed wi h COVID-19 would ha e se ious consequences o you heal h? 6.72 2.481
Do you belie e ha COVID-19 in ec ion is di icul o ea ? 7.64 2.071
To wha ex en a e you conce ned abou con ac ing COVID-19? 8.13 2.200
To wha ex en a e you conce ned abou being a ca ie and ansmi ing he i us o amily membe s, close con ac s, o pa ien s? 9.44 1.392
EIQ-BR: Emo ional Impac Ques ionnai e COVID-19 B azil.
J.M. G iesi e al.
Heliyon 10 (2024) e25297
7
de ails he desc ip i e s a is ics o he nine COVID-19 RP ques ions. Among he pa icipan s, he mos signi ican RP was ela ed wi h
he ea o being a ca ie and po en ially ansmi ing he i us o amily membe s, close con ac s, o pa ien s. Con e sely, he leas
p ominen conce n among hem was ela ed o hei pe cei ed likelihood o su i ing a COVID-19 in ec ion.
Table 3 p esen s he independen a iables ha me he c i e ia o inclusion in he mul iple eg ession model. Acco ding o he
esul o he mul iple logis ic eg ession model (Table 4), he odds o expe iencing a high RP was 183 % highe when pa icipan s
pe cei ed hei heal h s a us as being poo . Di o ced indi iduals also had a 77 % inc eased likelihood o p esen ing high RP, a
magni ude like ha o ha ing a ch onic disease o consis en ly wea ing a mask ega dless o symp oms. Finally, de o ing 1–4 h pe day
o acqui ing in o ma ion abou COVID-19 was associa ed wi h a 56 % highe likelihood o expe iencing high RP. This likelihood ose o
85 % and 62 % o indi iduals ha epo ed spending 4–8 h and mo e han 8 h daily acqui ing in o ma ion abou COVID-19,
espec i ely. Addi ionally, an in e se associa ion was ound be ween he sense o cohe ence and RP, whe e each one-poin inc ease
in he SOC-13 sco e was associa ed wi h a 3 % educ ion in he likelihood o ha ing high RP. Fu he mo e, no knowing i one has had
casual and occasional con ac wi h con i med COVID-19 cases educed he odds o ha ing high RP by app oxima ely 52 %.
4. Discussion
Ou indings indica ed ha B azilian heal hca e wo ke s p esen ed a mean sco e o 58.61 poin s ou o 90 on EIQ-BR’s o e all RP
sco e. When examining indi idual RP ques ions, hei highes le el o conce n was ela ed o he ansmission o COVID-19 o amily
membe s, iends, and pa ien s. P e ious s udies ha e also shown ha heal hca e wo ke s we e mo e conce ned abou in ec ing o he s,
especially amily membe s and lo ed ones, han abou being in ec ed hemsel es [33,51–53]. The e o e, he go e nmen and/o
employing o ganiza ion should p o ide heal hca e wo ke s wi h essen ial esou ces (e.g., masks and hand sani ize s) o p o ec hei
amilies o al e na i e housing a angemen s o p e en ansmission. Go e nmen au ho i ies and employing o ganiza ions should
also p o ide eassu ance ega ding he medical ca e o heal hca e wo ke s’ amily membe s in case hey de elop he disease.
Ou indings also sugges ha RP was associa ed wi h a ious ac o s, including sociodemog aphic cha ac e is ics (being di o ced),
pe sonal ai s (ha ing ch onic diseases, pe cei ed heal h s a us, and sense o cohe ence), in o ma ion seeking beha io (daily hou s
spen acqui ing in o ma ion abou COVID-19), pandemic expe iences (unce ain y ega ding casual o occasional con ac wi h
con i med COVID-19 cases), and adhe ence o p e en i e measu es (mask wea ing ega dless o symp oms). This aligns wi h RP
heo y, which s a es ha RP is in luenced by di e en ac o s [15–17]. And ha RP ep esen s an assessmen o he likelihood o an
ad e se e en (such as in ec ion, illness, o dea h) occu ence, which can be mo e a ional and sys ema ic when based on scien i ic
in o ma ion bu is no ee om he in luence o subjec i eness, such as emo ions and pe sonal li e expe iences [20,54].
The associa ion be ween ma i al s a us and a high COVID-19 RP, is co obo a ed by wo p e ious s udies, one conduc ed in China
[55] and ano he also in B azil [37]. One possible explana ion o his inding is ha indi iduals li ing wi h a pa ne may possess a
mo e obus social suppo ne wo k, wi h whom hey can sha e daily ca egi ing esponsibili ies and conce ns, including hose ela ed
o COVID-19. Con e sely, single o sepa a ed indi iduals may expe ience a g ea e bu den o indi idual decision-making and
Table 3
Odds Ra io, con idence in e als, and p- alues es ima ed in he adjus men s o he simple logis ic eg ession models o high- isk pe cep ion o
COVID-19 among heal hca e wo ke s (EIQ-BR, B azil).
OR 95 % CI p- alue
LL UL
Di o ced ( e . single) 1.638 1.133 2.369 0.009
Mas e ’s deg ee ( e . high school) 0.579 0.347 0.359 0.968
Nu se ( e . o he ) 1.326 1.024 1.718 0.032
Time spen pe day ge ing in o med abou COVID-19 ( e . Up o 1 h)
1–4 h 1.629 1.237 2.145 0.001
4–8 h 2.199 1.594 3.035 <0.001
Mo e han 8 h 2.205 1.562 3.113 <0.001
Always o almos always using a mask ega dless o symp oms ( e . no) 1.722 1.362 2.178 <0.001
Pe cep ion o heal h in he las 14 days ( e . e y good)
Poo 5.051 2.215 11.519 <0.001
Fai 3.185 2.329 4.357 <0.001
Good 1.664 1.324 2.092 <0.001
Ha ing any ype o disabili y ( e . no) 1.812 1.145 2.869 0.011
5-7 symp oms expe ienced in he las 14 days ( e . none) 2.437 1.640 3.623 <0.001
Ha e a ch onic illness ( e . no) 2.047 1.660 2.524 <0.001
Cu en ly aking medica ion ( e . no) 1.539 1.262 1.878 <0.001
Medical ca e a a heal hca e cen e , hospi al, o clinic in he las 14 days? ( e . no) 1.730 1.193 2.509 0.004
Close con ac wi h a con i med in ec ed pe son ( e . no)
Yes 1.820 1.289 2.568 0.001
No su e 1.569 1.271 1.938 <0.001
No knowing i he e was occasional and casual con ac wi h a con i med case ( e . no) 0.452 0.325 0.629 <0.001
No knowing i he e was con ac wi h a pe son o ma e ial suspec ed o con amina ion. ( e . no) 0.577 0.425 0.783 <0.001
No knowing i one may ha e con ac ed COVID-19 ( e . did no con ac ) 0.644 0.521 0.797 <0.001
SOC-13 sco e 0.974 0.966 0.981 <0.001
EIQ-BR: Emo ional Impac Ques ionnai e COVID-19 B azil. SOC-13: Sense o cohe ence scale.
J.M. G iesi e al.
Heliyon 10 (2024) e25297
8
ca egi ing, which could po en ially con ibu e o an inc ease in hei RP. Howe e , i is impo an o no e ha he li e a u e on his
associa ion is s ill inconclusi e, since wo o he s udies, conduc ed in I an [56] and E hiopia [57], did no ind his associa ion. This
di e ence may be a ibu ed o he ac ha hese s udies we e ca ied ou in dis inc coun ies, each wi h i s unique cul u al con ex .
And RP may no be uni o mly in e p e ed ac oss di e se cul u es [32]. Ano he possible in e p e a ion is ha hese dis inc ions may be
a esul o cul u al a ia ions in he way su ey ques ions a e answe ed a he han ac ual di e ences in isk pe cep ion [32]. Howe e ,
he limi ed a ailabili y o compa a i e s udies on eme ging in ec ious diseases RP makes i challenging o comp ehensi ely in e p e
di e ences be ween coun ies [32].
Rega ding he associa ion be ween ha ing a ch onic disease and a highe likelihood o pe cei ing a high isk o COVID-19, i is
suppo ed by p e ious s udies conduc ed in China [19], he Uni ed S a es [58] and Po ugal [59]. This inding aligns wi h he
well-es ablished unde s anding o a highe isk o se e e o ms o COVID-19 and/o he need o addi ional ca e in he p esence o
como bidi ies o ch onic condi ions.
This easoning may also explain he associa ion be ween sel -pe cep ion o heal h and a high RP, which co obo a es indings om
Japanese [60] and Ame ican [61] s udies. No ably, a Po uguese s udy [59] did no obse e his associa ion when con olling o
unde lying ch onic diseases. The au ho s o his s udy sugges ha RP may be mo e in luenced by he knowledge o ha ing a ch onic
illness han by how an indi idual eel abou hei heal h. Howe e , bo h he Japanese s udy [60] and ou s ound a signi ican asso-
cia ion be ween sel -pe cep ion o heal h and RP e en when con olling o he p esence o ch onic diseases. The same in e p e a ions
used be o e o explain a ia ions in he ela ionship be ween ma i al s a us and a high RP, as obse ed in di e en s udies, may be
applied o his a iable.
The cu en s udy also iden i ied a nega i e associa ion be ween sense o cohe ence and RP. A high sense o cohe ence is cha -
ac e ized by he belie ha s esso s, such as COVID-19, a e comp ehensible, p edic able, and manageable [48,62,63]. Indi iduals wi h
a s ong SOC end o pe cei e hei en i onmen as o ganized and comp ehensible, while also being mo e likely o pe cei e ha hey
possess adequa e esou ces o cope wi h hese s esso s [48,62,63]. These a ibu es enable hem o app oach chao ic si ua ions as
challenges a he han obs acles, acili a ing be e adap a ion and educed ea and su e ing [48,62,63]. Consequen ly, i is
easonable o expec ha an inc ease in he sense o cohe ence is associa ed wi h a dec ease in RP. I is also wo h no ing ha he
obse ed associa ion seems no only heo e ically plausible bu has also been empi ically alida ed in Polish [63] and Japanese [64]
s udies.
In ela ion o he posi i e associa ion ound be ween ime spen acqui ing in o ma ion abou COVID-19 and RP, i is impo an o
no e ha in he ea ly s ages o he COVID-19 pandemic, he e was a subs an ial le el o unce ain y su ounding a ious aspec s o he
disease. Gi en his con ex , i is easonable o hypo hesize ha heal hca e wo ke s who p esen ed g ea e COVID-19 RP spen mo e
ime seeking in o ma ion abou i . P e ious s udies lend c edi o his hypo hesis, since i has al eady been obse ed ha high le els o
in o ma ion seeking we e associa ed wi h highe le els o RP [65,66].One in iguing inding in his s udy was he obse ed nega i e
associa ion be ween unce ain y ega ding casual o occasional con ac wi h con i med COVID-19 cases and isk pe cep ion (RP),
despi e he absence o an associa ion be ween casual o occasional con ac wi h con i med COVID-19 cases and RP. This is con a y o
expec a ions based on exis ing RP li e a u e. Di ec con ac wi h he i us is ypically assumed o make he isk mo e salien and
pe sonal, po en ially inc easing indi iduals’ RP [67]. No ably, widesp ead es ing o COVID-19 was no conduc ed in he B azilian
popula ion du ing he esea ch pe iod [36]. A ha ime he B azilian Minis y o Heal h ecommended es ing p ima ily in se e e
cases [68], con ibu ing o an unde epo ing o con i med cases. I is es ima ed ha he ac ual numbe o SARS-CoV-2 in ec ions was
app oxima ely 15 imes highe han o icial s a is ics, esul ing in ewe con i med cases in B azil a he ime o he su ey [36]. The
low numbe o con i med cases has al eady been sugges ed by a p e ious s udy as a po en ial explana ion o unexpec ed esul s
ega ding di ec con ac wi h COVID-19 and RP in Aus alia and Sweden [67].
The inal associa ion obse ed in his s udy was be ween consis en mask usage, ega dless o symp oms, and RP. Mask usage was
widely ecommended as an e ec i e p e en i e measu e in he ea ly s ages o he COVID-19 pandemic. When he e we e ew known
Table 4
Odds Ra io, con idence in e als, and p- alues es ima ed in he adjus men s o he mul iple logis ic eg ession models o high- isk pe cep ion o
COVID-19 among heal hca e wo ke s (EIQ-BR, B azil).
OR 95 % CI p- alue
LL UL
Di o ced ( e . single) 1.775 1.143 2.755 0.011
Pe cep ion o heal h in he las 14 days ( e . e y good)
Good 1.330 1.023 1.731 0.034
Fai 2.465 1.697 3.580 <0.001
Poo 2.832 1.020 7.864 0.046
Always o almos always using a mask ega dless o symp oms ( e . no) 1.688 1.283 2.220 <0.001
No knowing i he e was occasional and casual con ac wi h a con i med case ( e . no) 0.482 0.328 0.707 <0.001
Time spen pe day ge ing in o med abou COVID-19 ( e . Up o 1 h)
1–4 h 1.561 1.139 2.140 0.006
4–8 h 1.858 1.278 2.702 0.001
Mo e han 8 h 1.624 1.075 2.453 0.021
Ha e a ch onic illness ( e . no) 1.648 1.294 2.099 <0.001
SOC-13 sco e 0.977 0.969 0.986 <0.001
EIQ-BR: Emo ional Impac Ques ionnai e COVID-19 B azil. SOC-13: Sense o cohe ence scale.
J.M. G iesi e al.
Heliyon 10 (2024) e25297
9
esou ces o con ol he i us, masks we e iden i ied as one o he main o ms o p e en ion, e en in he absence o isible symp oms.
P e ious esea ch has demons a ed a posi i e associa ion be ween mask usage and inc eased RP, indica ing ha indi iduals ecognize
i s impo ance in educing con agion and p o ec ing bo h hemsel es and o he s [69,70]. Addi ionally, i is also well-known ha no
only mask usage, bu also gene al p e en i e beha io s a e posi i ely associa ed wi h RP. Acco dingly, se e al s udies on COVID-19 RP
conduc ed in di e en coun ies - such as Boli ia [18], China [24], Poland [35], Uni ed S a es [61] and Canada [19] - as a s udy ha
su eyed pa icipan s in he Uni ed Kingdom, Uni ed S a es, Aus alia, Ge many, Spain, I aly, Sweden, Mexico, Japan, and Sou h Ko ea
[67], and a sys ema ic e iew [10] ha e suppo ed his ela ionship.
As a inal poin o in e es , no associa ion was obse ed be ween in ol emen in heal hca e p o ision and COVID-19 RP. While his
may appea su p ising, his esul is consis en wi h hose o p e ious s udies conduc ed in Egyp [71] and he Philippines [72]
Howe e , i is wo h no ing ha ha o he s udies ha e iden i ied such an associa ion [73].
The limi a ions o his s udy include i s sampling and da a collec ion s a egy, which makes i di icul o es ablish a p ecise
o e iew o he gene al casuis ic and he speci ic p o ile o heal hca e wo ke s. Since snowball sampling is no a non-p obabili y
samples i may ha e limi ed ep esen a i eness. This means ha pa icipan s migh ha e ec ui ed o he s who we e mo e likely o
ha e simila COVID-19 isk pe cep ion, p opaga ing pa icipa ion among a homogenous g oup o esponden s [74]. This can in oduce
an unknown and immeasu able selec ion bias in he da a, al hough i is iden i iable. In his case, e en a la ge sample size may no ully
mi iga e his po en ial limi a ion. The e o e, e en hough ou esul s insigh s migh be aluable, i is possible ha hey o e es ima e
he ac ual ex en o isk pe cep ion among B azilian heal hca e wo ke s. I should be no ed ha , despi e i s po en ial o biased es-
ima es, snowball sampling me hods we e employed by mos o he published s udies ha assessed isk pe cep ion and men al heal h
p oblems o di e en popula ions du ing he COVID-19 pandemic ini ial s ages.
Rega ding he s a egy o online da a collec ion, i is impo an o no e ha despi e common conce ns, he li e a u e sugges s ha
he e a e ew di e ences be ween da a collec ed online and hose ob ained h ough adi ional sel - epo me hods. Addi ionally, he e
is e idence ha pa icipan s ec ui ed online a e mo e demog aphically di e se and equally mo i a ed o p o ide iable da a [75,76].
The e o e, while he e a e speci ic limi a ions associa ed wi h online da a collec ion, i is possible o ob ain alid and ep esen a i e
in o ma ion h ough his me hod.
I is also impo an o ci e ha he c oss-sec ional s udy design does no allow he examina ion o empo al sequences in a iables
ha change o e ime. Consequen ly, i is impossible o cla i y he di ec ion o he associa ions o such a iables, and he associa ions
ound canno be assumed o be causal.
The e o e, i is c ucial o acknowledge he limi a ions o he s udy and in e p e he esul s wi h cau ion, conside ing he possible
biases and inhe en es ic ions o he me hodology used. These conside a ions highligh he impo ance o eplica ing he indings in
di e en con ex s and wi h mo e di e se samples o ob ain a comp ehensi e and obus unde s anding o he phenomena unde
in es iga ion.
These limi a ions a e pa ly balanced wi h some o he s udy’s s eng hs, such as he la ge na ional sample size, as well as he
di e si y o he pa icipan s ha we e no limi ed o heal hca e wo ke s om only a hand ul o o ganiza ions, a ci y, o a s a e. I is also
impo an o s ess ha , al hough RP abou eme ging in ec ious diseases a y signi ican ly among coun ies [10,32,67], exis ing
e idence sugges s ha RP may be simila ac oss clus e s o coun ies ha sha e some common ea u es [77]. One such clus e is ha o
“de eloping coun ies”, cha ac e ized by a “s ong desi e o economic g ow h, and ew conce ns o human heal h and sa e y” [77].
The e o e, ou esul s may ha e ele ance no only o B azil bu also o o he de eloping coun ies.
5. Conclusions
The COVID-19 pandemic highligh ed he indispensabili y o analy ical esea ch, pa icula ly in he i s six mon hs o he pandemic
when many in es iga ions we e based on analogies, and nume ous epidemiological pa ame e s speci ic o he disease we e es ablished.
Beyond ein o cing es ablished me hodologies and in oducing new ones, he ad ancemen o knowledge abou COVID-19 cons i u ed
eno mous academic con ibu ions. These con ibu ions had almos ins an aneous epe cussions o heal h p o ocols and he indus y o
supplies, medica ions, and accines. They con ibu ed o unde s anding ulne able popula ions, he dynamics o wo k du ing he
pandemic, especially o heal hca e p o essionals, i us e olu ion and mu a ions, modes o ansmission, se e i y, and he apeu ic
al e na i es on a global scale.
Real- ime assessmen ools using a i icial in elligence and da a lea ning me hodologies we e p ominen ly ea u ed du ing his
pe iod. Addi ionally, he dissemina ion o knowledge h ough p ep in mechanisms, albei ou side he exis ing knowledge p oduc ion
s uc u es, aided no only he con inued accu a e de elopmen bu also acili a ed he dissemina ion o e idence in a mo e agile and
lexible manne . This allowed o mo e e ec i e cou se co ec ions and a educ ion in po en ial sou ces o ha m o people.
In his nea ly unp eceden ed and apidly e ol ing heal h con ex his s udy has con ibu ed o he unde s anding o COVID-19 RP
among heal hca e wo ke s. F om an academic pe spec i e, his s udy iden i ied key i ems o B azilian heal hca e wo ke s COVID-19
RP, along wi h a ious ac o s associa ed wi h hei RP. These ac o s encompass sociodemog aphic cha ac e is ics, pe sonal ai s,
in o ma ion seeking beha io s, expe iences du ing he pandemic, and adhe ence o p e en i e measu es.
F om a p ac ical s andpoin , ou indings sugges h ee key s a egic ac ions o people, o ganiza ions, and coun ies du ing a
pandemic. The i s is ensu ing he well-being o heal hca e wo ke s, hei amilies and lo ed ones by p o iding e ec i e p o ec ion
means and ensu ing access o imely medical ca e in case o illness. Indeed, o heal hca e p o essionals, sa e y p io i ies a e immedia e
and o en conce n hei amilies, pa ien s, as well as hemsel es. The e o e, unde s anding, ecognizing, accep ing, and ollowing
heal h and sa e y ecommenda ions, including social dis ancing, will keep he en i e amily sa e and educe s ess o he heal hca e
p o essional, which could be an impo an ac o o esilience. Also, i ual con ac has become indispensable and, acili a ed by
J.M. G iesi e al.