Validation of risk perception questionnaire for covid-19: Indonesian version for critical care nurses

Background : The high need for intensive care in COVID-19 patients often has an impact on large workloads, long-term fatigue, and exposure to infections. Perception plays an important role in the desire to Objectives: This study aims to examine the validity and reliability of the nurse's risk perception questionnaire in the care of Covid-19 patients in the Intensive Care unit according to the situation in Indonesia. Methods: This study was conducted on nurses who treat COVID-19 patients in the ICU. The research design was carried out in a cross-sectional manner. The sampling technique used was total sampling, with a total of 35 respondents. The researcher conducted an analysis through five stages, namely translation and cross-cultural adaptation of the instrument in order to obtain the Indonesian version of the Risk Perception questionnaire. After that, a retrial was carried out on 15 nurses who worked in the COVID-19 room. The statistical test was used to test the validity and reliability using Cronbach's alpha and reliability analysis. Results: The results of the validity test with Cronbach's alpha of 0.379 - 0.766 with a reliability test using analytical reliability of 0.943. The value of the r table is 0.3338. There are 5 items from the risk perception questionnaire that are not valid after the construct validity test. The researcher then issued 5 invalid items. So that there are 42 out of 47 questionnaire items that are relevant to the condition of nurses caring for COVID-19 patients in the ICU in Indonesia. Conclusions: This risk perception questionnaire is valid and reliable, so the risk perception questionnaire can be used in Indonesia to evaluate nurses' risk perceptions in treating COVID-19 patients in the ICU. Researchers recommend health care providers evaluate nurses' risk perceptions using this questionnaire.


Coronavirus infection (CoV) is a respiratory
virus that can cause illnesses such as the common cold to acute respiratory distress syndrome (1). CoV is a zoonotic pathogen that can be transmitted from animals to humans and from humans to humans (2). About eight years after the MERS-CoV epidemic, the current novel coronavirus (COVID- 19)  Therefore, the risk of being exposed to the Coronavirus is very high (5).

All interventions given by health workers,
especially nurses in the ICU, can also cause a large workload, long-term fatigue, a large threat of infection, and stress on patient death (8)  Research by Koh, et al (2005) also showed that 76% of medical personnel stated that they were afraid of being sick due to being infected with SARS infection. Also, 82% expressed concern about transmitting the SARS infectious disease to their family and relatives. About 56% also stated that they felt more stressed at work during the outbreak (13). Concerns that occur to these health workers can affect their overall effectiveness (14).
Research conducted by Koh, et al (2005) states that although appreciation is often given to health workers for their courage in dealing with infectious diseases for which there is no specific treatment, social stigmatization such as exclusion from the community still appears in some cases (13). In a study by Koh et al (2005), it was shown that 31% of health workers stated that people stay away from family members because of their profession as medical personnel (13).

MATERIALS AND METHODS
To obtain an instrument with internal consistency, validity, and reliability that can be maintained according to the original version, a Cross-Cultural Translation and Adaptation Process is carried out. This process uses a special methodology to obtain similarities between the original version and the target language. This cross-cultural measuring tool to be used in a new country is not merely translating into a new language literally, but an adaptation process has been carried out to maintain the validity of the contents of the instrument. The meaning of 'cross-cultural' adaptation refers to the process between the two languages (translation) and cultural adaptation in the process of preparing the instrument so that it can be used in a new place.
The first stage of cross-cultural adaptation is forward translation. The instrument was translated from English to Indonesian by two translators. This aim is the two translations can be compared, words that have multiple meanings on the original instrument or that appear as a result of the translation process are detected.
The two translators then discussed and identified the choice of words that were not quite right.
The first translator produces a more reliable translation from both a clinical perspective and a measurement perspective will result in an early translation The second translator is not affected by academic goals and his translation results are a reflection of the language used by the general population will produce the initial translation.
In this translation synthesis stage, the two translators and an observer will discuss to make a combined translation. The combined translation week after the first questionnaire was done. In the final stage, respondents will be asked to fill out the final version of the instrument.   preceding the online survey questionnaire. After being reviewed, it will proceed to the expert committee review stage. The results of the expert committee's study found several sentences that were not clearly defined, such as workplaces that have a high risk of being exposed to COVID-19 on "object surfaces" which should be given an example of "object surfaces such as doors, tables, medical records and telephones", replacing the word " most" with "very". Changed the word "out as a nurse" to "out of work in the COVID-19 unit".   In this questionnaire, there are 5 subaspects, where the first sub-aspect is the perception of risk and coping of nurses against COVID-19. Previous studies have identified a major source of concern and anxiety for nurses, one of which is due to exposure to workplace infections (18). The first sub-aspect of the "Risk Perception" questionnaire contains statements of perceptions and coping of nurses on exposure to COVID-19, which were statements in this sub-aspect total 18 statement items. The statement items include the perception that the nurse's workplace is a place of high risk of exposure to COVID-19 due to close contact with COVID-19 patients, exposure due to inhaled air, exposure from coworkers exposed to COVID-19 patients, and exposure from surface objects such as doors, table, patient medical records, and telephone. The first sub-aspect of the questionnaire also identifies sources of concern for nurses about the inability to control exposure, Research conducted by Shaukat et al. (2020) found that health workers have potential physical and mental risks directly as a result of providing care to COVID-19 patients (27).

RESULT
As many as 50% of health workers reported symptoms such as depression, insomnia, and anxiety due to COVID-19 (28). Research conducted on nurses also found similar results.
Where three-quarters of all nurses felt the fear of being infected while providing care for COVID-19 patients and two-thirds reported severe anxiety (29). Other impacts that can occur are an increase in workload, physical fatigue, emotional disturbances, mental stress, community isolation, and discrimination between health workers and the community (30). In the last sub-aspect, the researcher focused on anxiety about the COVID-19 pandemic felt by nurses with a total of 4 statement items.
As stated in the previous discussion, anxiety often arises in nurses who care for patients with COVID-19 (28) (30). Several statements in this sub-aspect consist of statements that describe feelings of anxiety and tension when thinking about the COVID-19 pandemic. Anxiety about the possibility of another outbreak besides COVID-19 and sources of anxiety was also expressed in this sub-aspect. There is 1 item that is invalid in this sub aspect because it has an r count which is lower than the r table, this item is related to the statement of the source of anxiety.
It may be due to the varied sources of anxiety felt by the nurse during the COVID-19 pandemic.

CONCLUSION AND RECOMMENDATION
This questionnaire is valid and reliable for