2.1 Study Design
This study was conducted in a cross-sectional and online questionnaire-based design. The study population consisted of the HCWs working in any hospital in Turkey between August 31 and September 30, 2020, who agreed to respond to the questionnaire via social media sites. The sample consisted of 729 HCWs who voluntarily filled in the questionnaire in the specified period.
2.2 Data Collection
The Personal and Occupational Information Form, the Turkish Version of the Shorter Version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF-TR), the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale (BHS) were used as data collection tools. After the questionnaire was created with Google Forms, they were delivered to HCWs by the researchers via social media sites (Instagram, Facebook, and WhatsApp). Those who completed the questionnaire were encouraged to forward the questionnaire to other HCWs. Our questionnaire was designed to have forced choices.
The participants were informed about the purpose of the study, that the data would be used for scientific purposes, and filling out the questionnaire would mean to approved to participate in the study. Inclusion criteria were (1) to be a healthcare staff, (2) to be a social network user, (3) to a volunteer, and (4) to respond to questions once using the same IP. Exclusion criteria were (1) to respond to all the questions. In the power analysis based on the statistics obtained from Hacımusalar et al. study,20 it was accepted as "α = 0.05, 1-β = 0.94 and effect size = 0.1439"; As a result of the power analysis of the study, the total sample size was determined as n = 714 persons. The data of 729 participants were evaluated, but 52 participants were excluded as they did not complete the forms.
2.2.1 Personal and occupational information form: The form, developed by the researchers by reviewing the literature, includes 4 questions regarding the sociodemographic characteristics of HCWs including age, gender, marital status, and presence of chronic health problems. And 17 questions about the occupational characteristics such as the place of work, the weekly working hours, and the way of working7,23,24 to measure the HCWs' knowledge, awareness, and perceptions about the Covid-19 pandemic.
2.2.2 WHOQOL-BREF-TR: The Health-related Quality of Life Instrument developed by the WHO in 1996.25 The scale has two versions as long (WHOQOL-100) and short (WHOQOL-27) forms. It consists of 26 questions in four sub-dimension, physical, psychological, social relations, and environmental, including one question about the general perceived quality of life and one question about perceived health satisfaction. The scale is in the form of 1-5 points on a 5-point Likert scale, and the field scores are converted to scoring on the scale of 100. The Turkish validity and reliability of the questionnaire were carried out by Eser et al.26 The 27th question was added to the Turkish version and included in the calculation of the environmental sub-dimension. Therefore, the environmental sub-dimension score is named “Environment-TR”. The WHOQOL-BREF-TR scale does not have a total score; that is, a single quality of life score cannot be obtained by adding the scores of all four sub-dimensions. Four different sub-dimension scores were calculated with the scale:
The Physical (physical) sub-dimension evaluates daily living activities, needs for medical care, fatigue, mobility, pain, sleep, rest, and work capacity, etc.
The Psychological (spiritual) sub-dimension evaluates issues such as body perception, positive and negative thoughts, self-confidence, religious and personal beliefs, thinking, learning, memory, and concentration.
The Social Well-being sub-dimension evaluates interpersonal relationships and social support.
The Environment sub-dimension evaluates financial resources, physical security, accessibility and quality of health and social services, home environment, opportunities to access new knowledge and skills, physical environment (pollution, noise, traffic, climate), and transportation.
The Cronbach alpha's coefficients calculated for the internal consistency of the scale were 0.83 for the physical well-being (PH), 0.66 for the psychological well-being (PSH), 0.53 for the social well-being (SW), and 0.73 for the environmental well-being (E-TR). Pearson coefficients calculated for each question to determine test-retest reliability vary between 0.57 and 0.81. In scoring, the four sub-dimension scores were calculated separately, and the higher scores indicate a higher level of life quality.26
2.2.3 State-Trait Anxiety Inventory (STAI-I): Spielberger et al.27 divided anxiety into two as State and Trait Anxiety according to the Two-Factor Anxiety Theory. State Anxiety occurs when encountering a dangerous, undesirable situation. Trait anxiety occurs even when there is no reason, and it is disproportionately long-lasting and severe when there is a reason. The State-Trait Anxiety Inventory (STAI-I) is a self-assessment questionnaire consisting of short expressions. It was adapted to Turkish by Öner and Le Compte in 1983. The STAI-I has 20 items, and there is no time limit for responding to the scale. Emotions or behaviors expressed in the STAI-I items are answered by choosing one of the options such as (1) almost never, (2) sometimes, (3) often, (4) almost always, according to their severity of the experiences. In this study, only the State Anxiety subscale was used because it describes how the individual feels at a certain time and under certain conditions and the responses include the feelings about the current situation,27,28 which is consistent with our study. The internal consistency reliability coefficients of the Turkish version of the State-Trait Anxiety Inventory were calculated using Kuder–Richardson Formula 20 and range between 0.94 and 0.96. The scale consists of 20 items with scores ranging from 1-4. The total score to be obtained on the scale is between 20 and 80. A high score indicates a high level of anxiety.28
2.2.4 The Beck Hopelessness Scale (BHS): The Cronbach's alpha reliability coefficient of the BHS, which was developed by Beck, Lester, Trexler in 197429 and whose validity and reliability study was conducted by Seber in 199130 and Durak and Palabıyıkoğlu in 1994,31 was calculated as 0.75-0.85. The participants mark ‘true’ for expressions that are appropriate for them, and ‘false’ for the others. According to the scale, which includes 11 ‘true’ and 9 ‘false’ answers, correct answers get ‘1’ point, and wrong answers get ‘0’ point. A ‘yes’ response to the questions 2, 4, 7, 9,11, 12, 14,16, 17, 18, 20, and a ‘no’ response to the questions 1, 2, 5, 6, 8, 10, 13, 15 and 19 receive 1 point each. “0” is given to the opposite responses.
The items that make up the scale are examined in three sub-dimensions. Feelings about the future (items 1, 6, 13, 15, 19), loss of motivation (items 2, 3, 9, 11, 12, 16, 17, 20), and expectations for the future (items 4, 7, 8, 14, and 18). The total score shows the score of “hopelessness.29-31 The scores to be obtained from the 20-item scale varies between 0 and 20. High scores indicate hopelessness, and low scores indicate hope. 0-3 points indicate no or minimal level of hopelessness, 4-8 points indicate a low level of hopelessness, 9-14 points indicate a moderate level of hopelessness, and 15+ points indicate a high level of hopelessness.29
2.3 Ethical Statement
The written permissions were granted by the institution and nursing services directorate of the hospital before the study; the ethical committee approval was also obtained from XXX University's Non-Invasive Clinical Research Ethics Committee (Date: 28.08.2020, Number: GOKAEK-2020/14.11).
2.4 Statistical Analysis
The statistical analyses were made with IBM SPSS 20.0 (IBM Corp. Armonk, NY, USA) package program. The distribution normality was evaluated with the Kolmogorov-Smirnov Test. The numerical variables without normal distribution were presented as median (25th - 75th percentiles), and the categorical variables were presented as frequency (%). The Mann-Whitney U test was used to test the difference between the groups, Kruskal-Wallis One Way Variance analysis, and Dunn's Multiple Comparison Test for numerical variables that do not show a normal distribution. The relationships between the variables were determined by Spearman's Correlation Analysis. For the testing of two-sided hypotheses, p<0.05 was considered statistically significant.
2.5 Limitations of the Study
The limitation of this study is that an insufficient number of doctors and paramedics were included in the study. There are 1 million 61 thousand 635 HCWs in Turkey; however, in this study, only 729 HCWs responded to the questionnaire. The participation ratio was calculated as 0.07%.