key: cord-0973615-ckikksf3 authors: Özdil, Kamuran; Bulucu Büyüksoy, Gizem D.; Çatiker, Aslıhan title: Fatalism, fear, and compliance with preventive measures in COVID‐19 pandemic: A structural equation modeling analysis date: 2021-04-16 journal: Public Health Nurs DOI: 10.1111/phn.12898 sha: f031ab3613ac3ccd5091591175417819cff1ec82 doc_id: 973615 cord_uid: ckikksf3 OBJECTIVES: This study was conducted to develop and evaluate a theoretical model to explain the relationships among participation in individual and social activities, compliance with prevention guidelines, and the perception of fatalism and fear of COVID‐19. METHODS: Cross‐sectional survey of 1,067 participants who were >18 years of age living in different provinces of Turkey recruited between August 15, 2020 and October 15, 2020. We used covariant structural analysis to assess the relationships of the constructs of the theoretical model. RESULTS: Significant fits were detected for Model 1 (χ(2) = 924,389, p < .001, comparative fit index or CFI = 0.944), and for Model 2 (χ(2) = 2,253,751, p < .001, CFI = 0.926). The predetermination and luck subdimensions reduce the fear of COVID‐19, while the pessimism subdimension and compliance with preventive measures increase the fear. CONCLUSION: In public health crises such as COVID‐19, it is important to plan scientific knowledge‐based public education; take initiatives in accordance with the cultural, social, economic, religious, and local characteristics of the societies; and conduct public health studies covering the whole society. Known since December 2019, COVID-19 disease continues as a global public health crisis with over 68,000,000 cases and 1.5 million deaths (World Health Organization [WHO], 2020a; WHO, 2020b) . This process in which we continue to learn more about the disease and its control every day, successful management of the epidemic and the prevention of disease have become important public health topics. To protect against COVID-19, the World Health Organization (WHO) makes recommendations such as following personal hygiene rules, maintaining physical distance from other people, and using personal protective equipment such as masks in environments where transmission is a risk (WHO, 2020c) . Previous literature reports that several factors affect compliance with these rules for protection against COVID-19. For example, the belief that COVID-19 precautions will be effective in preventing disease and the fear of COVID-19 increase compliance with the restrictions (Clark et al., 2020; Harper et al., 2020) . In a study conducted in Australia, individuals adhered to precautions to support the authorities rather than sanction pressure or being sick due to COVID-19 (Murphy et al., 2020) . The importance of not only biological factors but also human behavior in the spread of the COVID-19 virus is well known (Belot et al., 2020) . Culture, an element that shapes human behavior, plays an important role in the transmission, diagnosis, and treatment of COVID-19; therefore, culturally appropriate interventions should be planned to prevent disease (Bruns et al., 2020) . One factor affecting compliance with the rules of protection against COVID-19 is the perception of fatalism. In a study conducted in the United States, the association of COVID-19 with death and the perception of fatalism negatively affected the intention of the society to exhibit preventive behaviors such as social distancing and hand washing (Jimenez et al., 2020) . Individuals who believe that COVID-19 is contagious were more reluctant to comply with social distancing rules; this has been called the fatalism effect (Akesson et al., 2020) . In the United States, participants ignored complying with the preventive measures because they believed that they were destined to be infected with the virus, and this behavior was associated with fatalism (Papageorge et al., 2020) . To encourage adherence to preventive measures, a study in Iran recommended reducing fatalistic beliefs and focused on individuals living in rural areas (Shahnazi et al., 2020) . Although the COVID-19 outbreak is global, interventions should be planned according to the countries and even regions (Bachem et al., 2020) . The overall restrictions that are applied in each country are important to prevent the spread of the COVID-19 virus; however, they have not been sustainable for humans, as we are social beings. For this reason, it is important to determine the factors that affect the behavior of an individual and the society under extraordinary conditions to both manage the current pandemic and to be prepared for possible future pandemics. In the fight against COVID-19, the importance of increasing the rate of compliance with preventive measures and public awareness about the disease must be emphasized to plan effective public health practices (Jimenez et al., 2020) . There are a limited number of studies investigating participation in individual and social activities during epidemics and their determinants. This study can help understand the determinants of participation in individual and social activities and solution suggestions that should be developed in these situations. Findings guiding public health interventions can be revealed by determining the compliance of the society with the measures during the pandemic and then by explaining the associated factors. From this viewpoint, this study was conducted with the aim of developing and evaluating a theoretical model that could explain the relationships among compliance behaviors for preventive measures against participation in individual and social activities, and the perception of fatalism and fear of COVID-19. In the first phase of this study, Guideline on Compliance with Preventive Measures Against COVID-19 has been prepared. Then, the theoretical model was drawn showing the predicted relationships among participation in individual and social activities, compliance guide score for COVID-19 preventive measures, Fatalism Scale score, and COVID-19 Fear Scale score ( Figure 1 ). This cross-sectional study uses covariant structural analysis to verify the appropriateness of the hypotheses and structural model developed for the causal relationships among participation in individual and social activities, compliance with COVID-19 prevention guidelines, and the perception of fatalism and fear of COVID-19. The research sample was made up of participants > 18 years of age living in different provinces of Turkey. Sample size calculation was not made at the beginning of the study. In total, 1,067 participants attended the study between August 15, 2020, and October 15, 2020. However, among these participants, eight questionnaires with missing data were not included in the analyses, with a final sample size of 1,059 participants. The power of the research was calculated as 0.2 effect size in silico and 99% at 0.95 confidence level according to the sample size (n = 1,059). The following were the inclusion criteria: >18 years, spoke Turkish, were literate, did not have physical/psychiatric disorders that prevent verbal communication, were able to use smart phones and complete online surveys, were living in different provinces and different settlements (rural/urban). Excluded from the study were health workers, hospital support services personnel, and teaching staff or students from health-related departments. Data collection instructions were the Introductory Information Form, Guideline on Compliance with Preventive Measures Against COVID-19 Form, Fatalism Scale, and COVID-19 Fear Scale. This form included questions about sociodemographic characteristics and participation in individual and social activities (going to health care institutions, using transportation means, attending sporting events, going on tours, going to public places, visiting someone at their home, attending collective ceremonies or celebrations such as weddings, participation in religious activities, and experiencing regret on participating in these activities). Table A1 ). The Cronbach's alpha coefficient of the guideline was 0.712 in this study. The Fatalism Scale was a 5-point Likert-type scale with 20 items; five response options were possible (ranging from 1 = strongly disagree to 5 = strongly agree) (Shen et al., 2009) . The scale had three subdimensions: predetermination (items 1-10), luck (items 11-14), and pessimism (items 15-20). Scale scores were totaled and divided by the number of items; higher scores indicated greater fatalistic attitudes. The scale has good Turkish validity and reliability study in Turkish, with Cronbach's alpha coefficient of 0.84 (Kızılarslan & Yıldız, 2020) . In our study, the Cronbach's alpha coefficient of the scale was 0.869. The newly developed COVID-19 Fear Scale has seven items (Ahorsu et al., 2020). Possible scores range from 7 to 35; higher scores on the scale, the higher is the fear of COVID-19. The Turkish validity and reliability study of the scale found the Cronbach's alpha coefficient of 0.88; in our study, the Cronbach's alpha was 0.877 (Bakioğlu et al., 2020) . Data in the study were collected through an online questionnaire. Before rolling out the questionnaire forms, the Introductory Information Form was finalized by using it on 10 people outside of the study sample. Study participants were reached using the snowball and chaining method; potential participants who met the study criteria were initially selected from individuals in the social environment of the researchers and their colleagues. Data were analyzed using SPSS 25 and AMOS 23, first using with an explanatory, then a confirmatory, and finally a structural equation Figures 2 and 3, respectively. The data from the developed models are provided in Table 3 . The relationships that emerged from Model 1 after the analysis following improvements are provided in Table 4 . Accordingly, although other variables also had some influences, the predeter- Table 4 ). The relationships that emerged from Model 2 after the analysis following improvements are provided in Table 4 . Although Table 4 ). the predetermination score was high, pessimism score was medium, and luck score was low (Table 2) . Hence, the belief that events such as illness or death are beyond the control of a person and that they are predetermined is more common, the pessimism related to the illness and suffering is moderate, and the belief that being healthy depends on luck is less common. According to the structural adjustment analysis conducted in the study, two models were developed in which the relationships among the fatalistic attitude of the individuals and fear of COVID-19, guideline on compliance with the preventive measures against COVID-19, and participation in individual and social activities were stipulated (Table 3 ). The structural adjustment analysis following adjustments made according to the modification indexes revealed that the predictive attitude regarding the predetermination of events decreased the fear of COVID-19 but increased the participation in individual and social activities (Table 4 ). Individuals' belief that events are predetermined might have also made it unnecessary to worry and fear about COVID-19, thereby reducing their fear of COVID-19. Moreover, despite the COVID-19 pandemic, participants took part in individual and social activities probably due to the belief that whatever happens will happen no matter what the person does and that the contagion may be more related to the destiny than participation in the activities. According to a study, individuals' belief that they are destined to be infected can lead them to ignore preventive measures against COVID-19 (Papageorge et al., 2020). Another study identified that individuals who believed that COVID-19 is contagious were more reluctant to comply with social distancing rules-this situation has been called the fatalism effect (Akesson et al., 2020) . attitude, which equated being healthy with luck, reduced the fear of COVID-19 (Table 4 ). This may be due to the fact that individuals explained their health and longevity outside and beyond themselves through luck, an inexplicable abstract concept, denying the determinacy of the contagiousness and virulence of COVID-19. On the other hand, this study identified that the pessimistic fatalistic attitude regarding being sick and suffering increased the fear of COVID-19 (Table 4) . Accordingly, the pessimistic attitudes of individuals lead them to see themselves as possible patients for COVID-19, a known deadly and contagious disease. One recent study found that the pessimism and tendency to associate COVID-19 with death negatively affected individuals' intention to comply with social distancing and exhibit protective behaviors such as hand washing (Jimenez et al., 2020) . In this study, no relationship was predicted among individuals' fatalistic attitude, fear of COVID-19, and their compliance with preventive measures against COVID-19 (Table 4 ). On the other hand, adherence to COVID-19 preventive measures increased the fear of COVID-19 and decreased participation in activities (Table 4 ). One study reported that the fear of COVID-19 was the only variable that determined compliance with preventive measures (Harper et al., 2020) . Another study found that those who do not believe in conspiracy theories have a lower fear of COVID-19 and follow preventive measures more (Jovančević & Milićević, 2020) . This study had limitations. Collecting data through online surveys might have contributed to participants' inability and/or refusal to answer, only those sensitive to the subject answering, problems accessing the questionnaire, and not understanding the importance and sensitivity of the study. However, some measures were taken by the researchers to overcome these problems, including anonymizing the questionnaire, sharing the researcher contact information, and notifying the participants that they can contact the researchers whenever they want. Another limitation was that only those with internet access could participate, limiting generalizability. We acknowledge that participation in individual and social activities and compliance with preventive measures against COVID-19 are not independent of the factors addressed in this study and may be influenced by several variables outside the scope of this study (having to go to work, government policies, inefficient audits and measures, etc). In line with these results, recommendations include plan public education that will provide an opinion and attitude based on scientific knowledge instead of a fatalistic attitude regarding diseases such as COVID-19 that influence and affect the whole society. A second recommendation is to plan initiatives in accordance with the cultural, social, economic, religious, and local characteristics of the societies, although it is a global problem, and conduct public health studies covering the whole society. The guideline on compliance with preventive measures against COVID-19 developed in this study may be used to evaluate other factors (news, social media, religion, etc.) that affect the behavior of different societies in social communicable diseases. No conflict of interest has been declared by the author(s). K.Ö., G.D.BB, and A.Ç. were responsible for the study conception and design. A.Ç., and K.Ö. performed the acquisition of data. G.D.BB performed the data analysis. K.Ö., G.D.BB, and A.Ç. were responsible for the drafting of the manuscript. K.Ö., G.D.BB, and A.Ç. made revisions to the paper for important intellectual content, and supervised the study. All authors contributed equally to this study. Permissions for the scales used in the study were taken from related persons. The data that support the findings of this study are available form the corresponding author [KÖ] upon reasonable request. 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Turkish Validity and Reliability Study of the Fatalism Scale Why people comply with COVID-19 social distancing restrictions: Selfinterest or duty? Culture and health Socio-demographic factors associated with self-protecting behavior during the COVID-19 pandemic Assessing preventive health behaviors from COVID-19: A cross sectional study with health belief model in Golestan Province, Northern of Iran The psychometric property and validation of a fatalism scale Coronavirus disease (COVID-19) dashboard. https://covid 19.who.int/ World Health Organization (WHO) (2020b). WHO Timeline COVID-19 advic e-for-public How to cite this article: Özdil K, Bulucu Büyüksoy GD, Çatiker A. Fatalism, fear, and compliance with preventive measures in COVID-19 pandemic: A structural equation modeling analysis A PPEN D I X 7. I try to cancel or postpone my travels.8. If there is an alcohol-containing disinfectant in the places I go, I will definitely use it.9. I prefer cashless or contactless payment options whenever possible.10. I try to use disposable materials wherever I go.11. I always carry alcohol-based hand disinfectant with me and use it when necessary.12. I avoid meeting with people who have chronic illnesses or older people to avoid contagion.13. When I get together at events such as weddings, engagements, etc., I pay more attention to social distance.14. I warn people around me about social distancing and the use of masks.