Procedure and participants
Prior to commencing the study, authorization was obtained from Bar-Ilan University’s Ethics Committee (approval No. 032003). To minimize personal contact during the outbreak, the questionnaires were administered through the Qualtrics online platform (www.qualtrics.com). A total of 1,435 Israelis visited the online survey between March 12, 2020 and March 21, 2020. Inclusion criteria for the study were: (1) individuals aged 18+; and (2) Hebrew speakers. Exclusion criteria were: (1) minors (under the age of 18), who require parental consent (n=14); and (2) responses to the items in a similar pattern (e.g., choosing the same answer across multiple consecutive items or within the whole questionnaire) or not completing the questionnaire in its entirety (n=14).
As can be seen in Table 1, the study included 1,407 participants. The majority of the respondents were female (80%), with a mean age of about 41 years (range 18–97) and an average education of approximately 16.5 years (range 9–30). Most were married (63%) with a mean of two children. About 85% did not have health problems and about 80% reported good health status. Only 5% were isolated in their homes since the outbreak of COVID-19 and the most favorable resource that participants reported which could ease their coping with COVID-19 was working from home.
Table 1 about here
Measures
Precautionary behavior was measured using a 4-item scale created by the authors following the precautionary guidelines issued by the Israeli Ministry of Health8. The scale’s validity was reached by expert validity, a form of content validity. In this validity process, the scale was reviewed by a panel of four expert physicians in order to eliminate totally irrelevant items from the instrument19 and to re-phrase or supply new wording for items related to the measured construct where necessary20. Participants were asked to indicate how often they perform various precautionary behavior on a 5-point scale (from 1 = not at all to 5 = very often). A composite index of the average of all items was created, a higher score indicating that participants display more precautionary behavior. Sample items include washing hands with soap and water or alcohol-based hand sanitizer, and avoiding close contact with people with symptoms such as coughing or sneezing. The internal consistency of the index was moderate (Cronbach’s α = 0.75).
Knowledge about COVID-19 was measured using a 6-item COVID-19 knowledge test assessing the symptoms, diagnosis, risk factors, ways of transmitting the infection, ways to protect oneself from COVID-19 and knowledge regarding where to refer a person who is suspected to have COVID-19. The scale’s validity was reached by expert validity (as detailed in the Precautionary behavior measure). Answers were rated on a 5-point Likert-type scale, ranging from 1 = don’t know at all to 5 = know very much. A composite index of the average of all items was created, with a higher score indicating higher levels of knowledge about COVID-19. The internal consistency of the index was very good (Cronbach’s α = 0.82).
Perceived susceptibility was assessed based on previous studies conducted among the general public (e.g.,13), with a one- item measure examining the extent to which the participant thinks he will contract the virus. “How likely do you think it is that you will contract COVID-19?” Answers were rated on a 5-point Likert-type scale, ranging from 1 = not at all likely to 5 = very likely.
Emotional reactions towards COVID-19 were assessed based on previous studies conducted among the general public (e.g.,13), with 3 questions concerning worry, fear and stress as a result of COVID-19 (e.g., “How much do you worry about COVID-19?”). Answers were rated on a 5-point Likert-type scale, ranging from 1 = not at all to 5 = very much. A composite index of the average of all items was created, with a higher score indicating higher levels of negative emotional reactions towards COVID-19. The internal consistency of the index was excellent (Cronbach’s α = 0.94).
Socio-demographic variables included gender, age, years of education, marital status (married/divorced/widow/single/other), number of children, medical problems (yes/no), health status (bad/reasonable/good), home insulation since the outbreak of COVID-19 (yes/no), resources that can make it easier to cope with COVID-19 (more information regarding COVID-19/professional support/non-professional support/working from home/other).
Statistical analyses
Data were analyzed using SPSS ver. 25. Descriptive statistics were used to describe the participants’ demographic characteristics and the research variables. Pearson correlations were calculated to assess the associations between the research variables. Strength of correlation was as follows: 0-0.20, weak; 0.21-0.50, moderate; 0.51-0.80, good; and 0.81-1-00, excellent. A multiple hierarchical regression was calculated with precautionary behavior as the dependent variable. Gender (1-males, 0-females) and age were entered in the first step, knowledge about COVID-19 in the second, perceived susceptibility in the third, and negative emotions in the fourth. As perceived susceptibility had a curvilinear relationship with precautionary behavior, all variables were standardized.