The Psychometric Validation of FCV19S in Urdu and Socio-Demographic Association with Fear in the People of the Khyber Pakhtunkhwa (KPK) Province in Pakistan

Abstract

This study rests on two important considerations: the rapid increase of COVID-19 cases in Pakistan and also the marginalization of the people of the KPK province, which would make them more vulnerable in fearing COVID-19. We aim to translate and validate FCV-19S into the Urdu language and to identify the socio-demographic associations with fear in the people of the KPK. Using an online Google survey, we were able to sample 501 respondents from the KPK. The Cronbach alpha α value for the Urdu FCV-19S displayed good internal reliability at .846. The unidimensional structure of the FCV-19S in Urdu was confirmed, and all of the items were found to be statistically significant, ranging from 0.59 to 0.80. The results of the confirmatory factor analysis show that fit indices are all within an acceptable limit. The FCV-19S was also significantly and positively correlated with preventive behavior (r = .328, p < .01) and general anxiety (r = .458, p < .01). The results of independent sample t tests show that women (t = 4.086, p < 0.001), married people (t = − 2.709, p < .001), and unemployed people (t = − 3.199, p < 0.001) of the KPK experienced great fear of COVID-19. We conclude that that the Urdu version of the FCV-19S is a valid and reliable tool and must be used by healthcare practitioners, government bodies, and researchers, to identify the prevalence of fear and to subsequently plan improved social and health policies to reduce anxiety in the public. COVID-19 cases have increased drastically in Pakistan recently, with numbers estimated at 171, 665 as of 20 June 2020. Many argue that the prevalence is even higher due to inefficient governance and low detection. Low levels of reporting are also a consequence of great fear in hospitalization and isolation, mistreatment by practitioners, and facing stigma by society (Waris et al. 2020). Ahorsu et al. (2020) have made an essential contribution by developing a unidimensional scale, FCV-19S, to measure fear of COVID-19 among people in the English language (Pakpour et al. 2020; Ahorsu et al. 2020). Fear of COVID-19 has wide consequences in society (Lin 2020), including low reporting as mentioned earlier, but also an increase in mental distress (Ornell et al. 2020), low commitment to preventive behavior (Pakpour and Griffiths 2020), obsessive compulsive disorder (Fineberg et al. 2020), and discriminatory behavior against infected people (Ramaci et al. 2020). There is also recent worry of an association between the fear of COVID-19 and suicide or suicide ideation (Mamun and Griffiths 2020). Ultimately, unregulated fear of COVID-19 can exacerbate national and global problems related to management of the pandemic. Khyber Pakhtunkhwa (KPK) is a disadvantaged and conflict-ridden province of Pakistan (Ahmad 2010). As it neighbors Afghanistan, KPK land has been used for the War on Terror, leading to dismal rates of underdevelopment, poverty, and illiteracy (Mehboob 2011). The people of the KPK are known to suffer from lack of attention from the Federal government, provincial political and tribal rivalries and conflict, and inadequate opportunities for livelihood and well-being generally. The area has also been home to one of the largest refugee communities of South Asia due to the war in Afghanistan, adding to issues of unrest and instability (Grare and Maley 2011). Even prior to 9/11, the KPK, previously called FATA, had a history of terrorism, tribalism, and extremism, which has instilled fear and insecurity into the lives of the people living there for decades (Haider and Jameel 2017). Due to a combination of the above-mentioned life circumstances, the people of the KPK suffer from considerable mental health problems related to anxiety and depression (Khan et al. 2015) and identity crisis (Khan et al. 2017). This has built intergenerational insecurities and a lack of trust by the people, contributing to even greater risks of fear and anxiety in the age of coronavirus. In fact, research suggests that the highest incidence of death due to COVID-19 has been reported in the KPK province so far (Waris et al. 2020). It is therefore imperative to investigate the level of fear in the people of the KPK province with regard to COVID-19. With these factors in mind, the aim of this study is twofold: to validate the Urdu version of FCV-19S and to predict the association between the socio-demographic characteristics of the KPK people and their fear of COVID-19.