JOURNAL OF EDUCATION PRIVATE VOCATIONAL SCHOOL, TANIN DON ESIA

e-ISSN 2477-3743 p-ISSN 2541-0024

Factors Affecting Anxiety in Health Workers in Covid-19

Prevention Efforts
Fadli 1 *, Safruddin 2, Andi Sastria Ahmad 3, Sumbara 4, Rohandi Baharuddin 5

1 Nurse Professional Study Program, STIKES Muhammadiyah, Sidenreng Rappang, Indonesia

2 Nursing Study Program, Indonesian Muslim University, Makassar, Indonesia
3 Nursing Study Program, STIKES Muhammadiyah, Sidenreng Rappang, Indonesia

4 Nursing Study Program, Bhakti Kencana University, Bandung, Indonesia

5 Kaltara Academy of Nursing, Tarakan, Indonesia

* Correspondence Email: * fadlietri@gmail.com

ABSTRACT
ARTICLE INFO

HOWTO CITED:
Fadli, F., Safruddin, S ,. Ahmad,
AS, Sumbara, S ,. & Baharuddin,
R (2020). Factors Affecting Speed
Health workers in carrying out their duties as the frontline for handling, preventing and caring for
Covid-19 patients experience anxiety because it is caused by several factors, one of which is
the availability of personal protective equipment. This research was conducted to determine the
factors that most influence the anxiety of health workers in preventing Covid-19. Quantitative
research uses analytical observational methods with a design

health workers in prevention

efforts
cross-sectional This was carried out in three Hospitals and nine Health Services in April 2020.
Covid-19. Journal of Education Determination of the sampling technique used cluster random sampling with a sample size of 115
Indonesian Nursing 6 (1), respondents. Pearson chi-square test
p. 57–65
was conducted to assess the relationship between anxiety and age, gender, family status,
DOI:
patient honesty, availability of personal protective equipment, and knowledge. Each
independent variable is evaluated using analysis
10.17509 / jpki.v6i1.24546
logistic regression test to determine the most influential variables. The results of this study indicate
that there is an effect of age (p = 0.024); family status (p = 0.022); patient honesty (p = 0.034);
ARTICLE HISTORY: availability of personal protective equipment (0.014); knowledge (p = 0.030) on officers' anxiety.
Received The results of the logistic regression test showed that the variable availability of personal protective
May 10, 2020 equipment had the most influence on anxiety (r = 0.517; CI = 1.34-8.06), which means that the
Revised availability of protective equipment had a 51.7% effect on the anxiety of health workers in efforts to
May 31, 2020 prevent Covid-19. Therefore, the government must pay great attention to health workers who are at
the forefront of preventing Covid-19 regarding the need for personal protective equipment
Accepted
June 03, 2020 according to the protocol from WHO.

Published
June 20, 2020

Keywords: Personal protective equipment, anxiety, health workers; Family status

ABSTRACT

Health workers in carrying out their duties as the frontliners in handling, preventing and caring of
COVID-19 patients experience anxiety caused by several factors and one of them is the availability of
personal protective equipment (PPE). This study is conducted to determine some factors that mostly
influence the anxiety of health workers in preventing Covid-19. Quantitative research is used by
analytical observation methods with cross-sectional design and is conducted in three Hospitals and
nine Health Services in April 2020. Sampling techniques used cluster random sampling (n = 115.
Person chi-square tests are conducted to assess the relationship between anxiety and age, family
status, availability of personal protective equipment,

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and knowledge. Independent variable is evaluated using logistic regression test analysis to determine the most influential variable.
The results of this study indicate that there are influences of age (p-value = 0.024); family status (p-value = 0.022); patient honesty
(p-value = 0.034); the availability of personal protective equipment (p-value = 0.014); knowledge (p-value = 0.030) on staffs' anxiety.
The logistic regression test result clarifies that the availability of personal protective equipment is the most influential on anxiety (r =
0.517; CI = 1.34-8.06), which means the availability of protective devices has a 51.7% influence on the anxiety of health workers in
preventing of Covid-19. Therefore,

Keywords: Anxiety Health workers, Family status, Personal protective equipment.

PRELIMINARY (Covid-19) still shows an increase of 2,491 cases. The death

Covid-19 is an infectious disease caused by a new
type of coronavirus with common symptoms of fever,
weakness, cough, seizures and diarrhea (WHO, 2020;
Repici et al., 2020). In December 2019, a number of
patients with mysterious pneumonia were reported for the
first time in Wuhan, China (Phelan, Katz, & Gostin,
2020). This virus has been named severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) and can move
rapidly from human to human through direct contact (Li et al.,
2020; Rothe et al.,
2020).
The incidence of Covid-19 cases continues to
increase day by day so that health workers as the front
line are increasingly depressed due to increased
workloads, worrying about their health, and their families
(Cheng et al.,
2020). One thing that can lead to health workers
will experience enhancement
anxiety, one of which is the lack of Personal Protective
Equipment (PPE) in his workplace (Ramadhan, 2020).
Health workers are at risk of experiencing psychological
problems in caring for Covid-19 patients because of
feelings of depression, the main cause is self-protection
which is still less than the needs of health workers (Lai et
al., 2020).
According to the World Health Organization (WHO) on
April 6, 2020, the number of sufferers in the world is
1,278,523 infected with Covid-19 cases. Of the 1.2 million
positive cases of corona,
69,757 (5.46%) Covid-19 patients have died and 266,732 (20.9%)
people have recovered from the total positive cases. Meanwhile in
Indonesia, the latest data is on the number of positive cases of the
corona virus
rate for Covid-19 patients also continued to increase, 209
people (8.39%) and 192 people (7.70%) recovered from the
number of positive sufferers. From the comparison of these
data, Indonesia is still experiencing an increase in the number
of deaths and the recovery rate of patients (WHO,
2020).
According to data from the Ministry of Health's
Crisis Center (2020), the highest number of sufferers or
cases in DKI Jakarta Province is 1,232 positive. cases,
with 99 deaths and 65 recoveries, West Java Province
was in second place with 263 positive cases, 29 died and
13 recovered, and East Java in third place with 189
positive cases, 14 died and 38 recovered. Meanwhile,
South Sulawesi Province occupies the sixth position with
113 positive cases, 6 died and 19 recovered (Kemenkes.
RI., 2020).
The highest incidence in South Sulawesi Province
was Makassar City with 49 positive cases, 125 PDP, 373
ODP with 16 people died (8 positive and 8 PDP) and 44
recovered (11 positive and 13 PDP). The second highest
number of cases in Gowa Regency was 12 positive cases,
34 PDP, 114 ODP cases with 2 deaths in PDP cases and 7
recovered (4 positive and 3 PDP). Meanwhile, Sidrap
Regency is in fourth place with 8 positive cases, 20 PDP
people, 50 ODP people without death cases and 3 people
recovering (2 positive and 1 PDP) (Pemprov. SulSel., 2020).
The availability of personal protective equipment for
health workers is still lacking, so that many health workers
have been exposed to the virus and some have even died
(Ramadhan, 2020). Psychological response experienced by
officers

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health against an infectious disease pandemic is
increasing because it is caused by feelings of anxiety
about one's own health and the spread of the family
(Cheng et al., 2020). Anxiety is a worry that is not clearly
felt by someone with a feeling of uncertainty and
helplessness (Stuart, 2016). Panic and fear are part of
the emotional aspect, while the mental or cognitive
aspect is the disruption of attention, worry, irregularity in
thinking, and feeling confused (Ghufron & Risnawita,
2014). So that from the Covid-19 incident, health workers
felt depressed and worried.
Research by Cheng et al. (2020) stated that out of
13 participants experienced anxiety because protective
supplies had not been fulfilled when taking action on
patients. Health workers are a group that is very
vulnerable to being infected with Covid-19 because they
are at the forefront of case management, therefore they
must be equipped with complete PPE according to WHO
protocols so that the anxiety experienced is reduced.
According to the IASC (2020) the cause of health workers
experiencing anxiety is high job demands, including long
working hours, the number of patients increases, it is
increasingly difficult to get social support because of the
community stigma against frontline officers,
self-protection tools that limit movement, lack of
information about exposure long-term in people who are
infected,
The results of Lai et al's (2020) study regarding
health workers at risk of experiencing psychological
disorders in treating Covid-19 patients, the results
showed that 50.4% of respondents had depressive
symptoms and 44.6% had anxiety symptoms due to
feelings of depression. The most important thing to
prevent anxiety problems is to provide complete personal
protective equipment, so that health workers in carrying
out their duties do not even feel worried about
themselves.
JPKI 2020 volume 6 no. 1
with their family members. Therefore, the aim of this
study is to determine the factors that most influence the
anxiety of health workers in efforts to prevent Covid-19 in
Sidrap Regency, South Sulawesi, eastern Indonesia.
METHOD
This research is quantitative with analytic
observational and use
draft cross-sectional. Variable that
used in this study, namely anxiety of health workers as the
dependent variable and the independent variable as a causal
factor, namely knowledge, family status, and availability of
personal protective equipment.
The population in this study were health workers,
namely nurses and doctors who were in charge of the
prevention, handling and care of Covid-19 patients in the
emergency room installation room, hospital isolation room and
those on duty at the Sidrap Regency community health center.
Determination
technique taking sample
use cluster random sampling. Of the 437 total population
of health workers who were targeted in the study
subjects, there were 115 who returned online-based
questionnaires that were randomly drawn at each health
service. So that the number of samples in this study were
115 respondents who were willing to be samples in this
study. The criteria for respondents who were the subjects
in this study were active health workers on duty, in good
health, 21 to 50 years old, at least three diploma
education, and willing to be respondents. All participants
agreed to the study protocol and provided written
consent. This research has been approved by the
STIKES Muhamadiyah Sidrap Ethics Committee
with
Number 043 / KEP / II.3.AU /F/ 2020 and
pay attention to the principles in the research process.
This study focuses on knowing the anxiety of
health workers as the dependent variable in providing
services to Covid-19 patients using instruments
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research developed by Zung (1997),
Zung-Self Anxiety Rating Scale ( ZSAS). Before this
instrument was distributed, first the validity and reliability
tests were conducted on health workers who were not
included in the subject of this study and the Cronbach
Alpha value was 0.682 with 25 total anxiety questions. valid use
Likert scale. The minimum threshold score on the anxiety
questionnaire was 25 and the limit score was 125 with a
criterion score of 25-50 symptoms without anxiety, 51-75 mild
symptoms, 75-100 moderate symptoms, and 101-125
symptoms of severe anxiety. The independent variables in this
study were the level of knowledge of health workers in
preventing Covid-19, availability of personal protective
equipment, patient honesty, and family status. This research
questionnaire uses online media, namely google form which is
divided into 4 parts
namely the first part is demographic data, the second part is the
anxiety questionnaire, the third part is the questionnaire about the
availability of personal protective equipment, and the last part is the
knowledge questionnaire for health workers which was conducted for
3 weeks.
Bivariate analysis was performed using
chi-square to determine the relationship between the variable
knowledge, availability of personal protective equipment, family
status to the variable anxiety health workers. Analysis logistic
regression
multivariate used to see the variables that most influence
the level of anxiety of health workers in preventing
Covid-19. R Square
calculated to assess the relative risk of the effect of the
independent variable with a significance value <0.05 was
considered significant. Data analysis was performed using
statistical software SPSS version 20.0 (IBM Corp).

RESULTS

Table 1.Bivariate analysis of factors causing anxiety among health workers in efforts to prevent Covid-19 (n = 115)

Health worker anxiety, n (%) Mild anxiety

Variable *p
Don't worry Medium Anxious Anxious
Gender 0.538
Man 18 (15.7) 38 (33.0) 6 (5,2) 0 (0,0)
Women 5 (4,3) 37 (32.2) 9 (7,9) 2 (1.7)
Age (Years) 0.030
≤30 13 (11.3) 45 (39.1) 7 (6.1) 2 (1.7)
> 30 10 (8,7) 30 (26.1) 8 (7.0) 0 (0,0)
Family status 0.014
Not married yet 7 (6.1) 22 (19.1) 3 (2,6) 0 (0,0)
Already married 16 (13.9) 53 (46.1) 12 (10.4) 2 (1.7)
Patient honesty 0.036
Dishonest 12 (10.4) 43 (37.4) 10 (8,7) 1 (0.9)
Honest 11 (9.6) 32 (27.8) 5 (4,3) 1 (0.9)
Availability of PPE 0.012
Not enough 18 (15.7) 55 (47.8) 13 (11.3) 2 (1.7)
Sufficient 5 (4.7) 20 (17.4) 2 (1.7) 0 (0,0)
Knowledge 0.025
Enough 4 (15.7) 13 (11.3) 5 (4,3) 0 (0,0)
Good 19 (43.5) 62 (53.9) 10 (8,7) 2 (1.7)

Table 1 shows that most of the level of anxiety
experienced by health workers is mild anxiety (65.2%),
while those who do not experience anxiety (20.0%).
Based on the results of the age characteristics, almost all
ages experience mild anxiety, namely ≤30 years (39.1%)
and> 30 years (26.1%). While
gender, on average almost all experience mild anxiety.
Based on the results of the research instrument using a
questionnaire about anxiety, the availability of personal
protective equipment, and knowledge, so that the factors
causing anxiety in health workers can be seen from the lack
of availability of personal protective equipment.

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of the needs, (47.8%) experienced mild anxiety, health workers in efforts to handle, prevent, and care for
moderate anxiety (11.3%), severe anxiety (1.7%), and Covid-19 patients.
only 15.7% experienced no anxiety. Most of the health In the multivariate analysis in table 2 shows the
workers already have wives and children, so this is a test results logistic regression on the level of anxiety as
factor causing them to be mildly anxious (46.1%). More the dependent variable, the variable availability of
than personal protective equipment (p = 0.014), family status
half power health have (0.022), and knowledge (p = 0.030) had a significant
good knowledge about how to prevent, treat, and treat effect on the anxiety of health workers on duty. Based on
Covid-19 problems. But there are still many who the results of the value r square, shows that
experience mild anxiety (53.9%), this is due to factors of
concern for family and the availability of personal variable independent that most
protective equipment. From the test results pearson effect is the availability of personal protective equipment (r =
chisquare, There is an influence between age (p = 0.517), which means that the availability of personal protective
0.030), family status (0.014), patient honesty (p = 0.036), equipment has an effect of 51.7% on the anxiety of health
availability of PPE (0.012), and knowledge (p = 0.025) on workers and 48.3% is influenced
anxiety by factor status family,
knowledge, and other factors.

Table 2. The results of the multivariate logistic regression test on the influence of factors causing anxiety among health workers in the effort

prevention of Covid-19 (n = 115).

Variable Coeff R 95% CI p-value

Family status
Not yet
1,082 0.150-0.806 0.022
have a family 0.380
Already married
Availability of PPE
Not enough 1,026 0.517 1.340-8,059 0.014
Sufficient
Knowledge
Enough 1,236 0.087 1.216-12.32 0.030
Good

DISCUSSION in a quarter of the time on respiratory disorders (Gates,

Coronavirus or covid-19 is a single positive,
encapsulated and unsegmented RNA virus that is
sensitive to heat and can be inactivated
with disinfectant
containing chlorine, a lipid solvent at 56 ° C for 30 minutes,
non-ionic detergent, formaling, and chlorophromes (Yuliana,
2020; Zhu et al., 2020). The most common symptoms that
occur in the SARS-CoV-2 disease called Covid-19 are fever,
weakness, cough, and diarrhea (Remuzzi, 2020) (Guo et al.,
2020). Another symptom is shortness of breath, this symptom
is an acute respiratory distress syndrome (Prompetchara,
Ketloy, & Palaga,
2020). After septic shock, metabolic acidosis and
coagulation dysfunction will lead to death with a reported
mortality rate of 3.5% (PDPI, 2020).
that
Our results reveal a relationship between anxiety
of health workers and several risk factors such as age,
family status, availability of personal protective
equipment, patient honesty, and knowledge of health
workers. Age in this study had an influence on anxiety (p
= 0.030), where almost all ages, both ≤30 years (39.1%)
or> 30 years (26.1%) experienced mild anxiety.
According to research

2020). British research states that Covid-19 is 10 times Puspanegara (2019), stated
the number of SARS cases that there is a relationship between late adulthood

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 Fadli, F., Safruddin, S ,. Ahmad, AS, Sumbara, S ,. & Baharuddin, R. | Factors Affecting Anxiety ...
on coping mechanisms with anxiety (p = 0.005). most of
the ages 21 to 45 have anxiety disorders. During the
Covid-19 pandemic, health workers feel depressed and
worried so that anxiety increases in carrying out their
duties due to the availability of personal protective
equipment.
The results of this study indicate that there is a
significant effect of the availability of personal protective
equipment on the anxiety of health workers in charge of
health services. For this reason, the provision of proper
personal protective equipment is very important (Lockhart,
Duggan, Wax, Saad, & Grocott, 2020). With the lack of
availability of complete personal protective equipment
according to WHO protocol, health workers tend to have
anxiety disorders compared to personal protective
equipment as needed (r =
0.517; 95% CI = 1.34-8.06). So that the factor of the availability of
personal protective equipment has an influence
51.7% of health workers' anxiety in efforts to prevent
Covid-19.
Similar research shows that out of 13 participants
experience anxiety because protective supplies have not
been fulfilled when taking action on patients (Cheng et al.
2020). Lack of personal protective equipment facilities
adequate for nurses who work in an acute physical health
environment, they are a group that is very vulnerable to
Covid-19 infection because they are at the forefront of
case management, therefore they must be equipped with
complete personal protective equipment according to
WHO protocols so that the anxiety experienced is
reduced & Bridges, 2020). Another study from Canada
stated that the 3 functions of personal protective
equipment are for droplets and contact precautions, for
precautions through air, droplets, and general contact,
and for those performing or assisting with high-risk
aerosol-producing medical procedures (Lockhart et al. ,
2020).
Human-to-human transmission occurs primarily
through direct contact or droplets
(Heymann, 2020; Zhu et al., 2020) (Shereen, Khan,
Kazmi, Bashir, & Siddique, 2020). Risk
62
higher transmission is about 1 meter (about 3 feet) from
an infected person (Repici et al., 2020). The maximum
distance to avoid the virus is about 2 meters from the
patient or sufferer (Razai, Doerholt, Ladhani, &
Oakeshott,
2020). So that health workers who carry out examinations
of Covid-19 patients are required to use complete
personal protective equipment, to avoid exposure to the
Covid-19 virus (WHO, 2020). Personal protective
equipment includes gloves, medical masks, goggles or
face shields, and protective clothing, as well as special
procedures, respirators (e.g. N95 or FFP2 standard or
equivalent) and aprons (WHO,
2020).
The availability of personal protective equipment for
health workers is still lacking, so that many health workers
have been exposed to the virus and some have even died
(Ramadhan, 2020). Based on the results of this study, the
average respondent answered that the availability of
personal protective equipment at the location where they
provided services to Covid-19 patients was still lacking
(76.5%) and respondents who had the availability of
personal protective equipment were (23.5%). If there is not
adequate personal protective equipment, it can endanger
first-line healthcare workers (Wu, Chen, & Chan, 2020).
Another study used a survey-based study of
mental health from
1,257 health workers treating Covid-19 patients in 34
hospitals in China. As a result, most of them reported 50%
depressive symptoms, 45% anxiety, 34% insomnia and
71.5% psychological distress (Lai et al 2020). Another
study found that during the acute SARS outbreak, 89% of
health workers were involved
high risk
experiencing symptoms of psychological disorders, one
of which is anxiety (Chua et al., 2004). In overcoming
mental health problems for health workers, it is necessary
to intervene by forming a medical team in psychological
treatment and applying a health belief model for health
workers (Cheng et al.,
2020). Psychological response experienced by
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 Fadli, F., Safruddin, S ,. Ahmad, AS, Sumbara, S ,. & Baharuddin, R. | Factors Affecting Anxiety ...
Health workers regarding this contagious disease
pandemic have increased due to feelings of anxiety about
their own health and the spread to the family.
Most of the health workers who were respondents
in this study were already married with 83 people (72.1%)
while those who were not married were 32 people
(27.8%). This is one of the factors they experience
anxiety because when treating positive patients with
Covid-19 or conducting examinations for people who
have symptoms of Covid-19. Health workers are worried
that they will transmit the Covid-19 corona virus to their
families (Shanafelt, Ripp, Sinai, & Trockel, 2020). They
also feel stigmatized because they feel themselves
connected with patients who are infected with the virus.
The results of this study indicate that the status of health
workers who have families with anxiety tends to have a
greater influence than unmarried health workers (r = 0.38;
95% CI = 0.15-0.81). This virus can move rapidly from
human to human through direct contact (Li et al., 2020;
Rothe et al., 2020) (Wu et al., 2020). Therefore,
knowledge is needed about how to prevent transmission
of this virus.
Most of the health workers have good knowledge
of 93 people (80.9%) on the prevention of virus
transmission. But there are still many who experience
mild anxiety (53.9%). This could be influenced by higher
job demands, including
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