INTRODUCTION

The COVID-19 pandemic, caused by the SARS COV-2 coronavirus, is described as a global public health emergency ¹ with diverse psychosocial and mental health consequences ^{2 , 3}. The quick spread in the population and its capacity to reach at-risk groups made it impossible for health services to respond properly ⁴. This is why the World Health Organization (WHO) indicated that the best way to stop and prevent COVID-19 is to be well informed about how the virus spreads in order to take protective measures ⁵.

Experiences in outbreak control of communicable diseases such as Middle East respiratory syndrome and swine flu showed that the strategies and the results obtained required, to a large extent, people’s risk perception ^{6 - 8}. In this sense, risk perception is a concept used in public health because of its association with preventive behavior in the face of events and diseases ⁹, and is of great interest for its application during the COVID-19 pandemic ^{( 7 , 10 , 11}.

Risk perception can be understood as the knowledge of the effects, damages and degree of susceptibility and consequences ¹²; it refers to the individual’s feeling and understanding of risks in the outside world, a subjective judgment that people create ¹³. Regarding the assessment of risk perception, there are two models, the disease model ¹⁴ and the disaster model ^{7 , 15}. The disease perception model focuses on the representations or perceptions that the individual has about the experience with a disease, the origin, consequences, treatment, causes, duration and cure; it is conditioned by experience, social and cultural context that influence preventive behavior ¹⁴. The disaster model follows three theories, psychometric, cultural and social reinforcement. According to the psychometric model, the key factors in people’s risk perception are fear and risk of the unknown ¹¹. The cultural theory focuses on social organizations and activities, and the social reinforcement framework theory communicates psychological, social, institutional, and cultural risk ⁷.

Worldwide, there are studies that evaluate the risk perception of COVID-19 infection based on the disease or disaster model. In Asia, particularly in China, risk perception was evaluated based on the disaster model, with the psychometric paradigm, and the risk characteristics were described with the dimensions: unknown and fearful ¹⁵. In Iran, a study was carried out with the dimensions: cognitive, political, social and cultural ⁷. In some European countries, such as Spain, researchers have validated the illness perception questionnaire (IPQ) for COVID-19 (perception of the threat of illness); other studies have evaluated health protection factors and psychological measures ⁵, information content, false news and ideologies based on the Morton and Duck scale ¹⁶ as well as the perceived threat ¹⁷. In Italy, researchers have evaluated the perceived risk and the severity of anxiety (concern about being infected and concern about infecting their family members) ¹⁸.

In Latin America, a Mexican descriptive study used the CPR-COVID19, a questionnaire on preventive and risk behavior, which evaluates knowledge of the disease, health history, risk behavior and preventive behavior during quarantine ¹⁹. In addition, another Mexican study on the perception of risk and media consumption of the coronavirus at the beginning of the pandemic was based on the Morton and Duck scale ²⁰. Meanwhile, a Colombian study aimed to determine the levels of risk perception regarding COVID-19 in university students, with three factors: susceptibility to illness, perceived severity in case of illness and protective behaviors ²¹. Thus, there is no consensus on which dimensions of risk perception should be assessed.

The aim of this study was to design and validate an instrument to assess the perceived risk of COVID-19 infection in the Colombian population.

MATERIALS AND METHODS

RESULTS

The main component of the instrument we designed is the perception of risk (susceptibility-vulnerability), defined as the probability of contracting a given disease in two dimensions, personal (probability of being affected by a hazard-threat) and comparative (in comparison to other people of the same sex and age) ²⁴, as shown in Table 1.

In this sense, we obtained the following dimensions of the PCR- CV19: cognitive vulnerability, emotional vulnerability, risk-protection behaviors and severity. Vulnerability was defined as the probability of contracting a given disease in two dimensions, personal and comparative, and was based on the disease model. The risk-protection behaviors dimension was associated with the disaster model due to the social, cultural and political perception of risk in following self-protection measures and biosafety protocols. The severity dimension was based on the disease model due to the conception of health damage (complications) and on the disaster model due to the socioeconomic impact and deaths caused by COVID-19.

DISCUSSION

This study has designed the PCR-CV19 questionnaire and the results show it to be a valid and reliable instrument for assessing the perception of risk of COVID-19 infection through 40 items distributed in four dimensions: cognitive vulnerability, emotional vulnerability, risk-protective behaviors and severity. Therefore, it is a questionnaire that could be adapted to other realities or countries, since these dimensions make it possible to identify, understand and analyze the conditions of risk, as well as the process that leads to its occurrence ¹⁰. All these dimensions interact with each other contributing to the adoption of preventive measures ²⁸, as well as in the mental health of the general population ^{2 , 15 , 29}.

The PCR-CV19 questionnaire (Annex 1) assesses dimensions of risk perception in accordance with studies based on the disease model ^{5 , 19 , 21} and the disaster model ^{( 16 - 17}. However, in comparison with these studies, the PCR-CV19 is an instrument that, in addition to integrating the risk perception assessment models, presents greater sensitivity and can be adapted to different population groups and contexts (e.g., educational, occupational, health), as well as presenting its scoring and interpretation rules.

Regarding the PCR-CV19 dimensions, this instrument distinguishes between cognitive vulnerability and emotional vulnerability in contrast with others ^{5 , 19 , 21 , 16 , 17}, in terms of the probability of being affected by COVID-19. People with an invulnerability bias perceive that they are unlikely to be infected and worry less about the infection, so risk behaviors may increase, increasing the probability of contagion and infecting others ³⁰. Cognitive vulnerability assesses the risk of contagion, infecting others, as well as the risk of reinfection, while emotional vulnerability assesses fear, uncertainty, stress and feelings of sadness in the face of contagion and the pandemic.

The risk-protective behaviors dimension in the PCR-CV19 suggests that a high-risk perception would be related to an increase in protective behaviors against COVID-19 infection, which could have an important influence on the coronavirus transmission and could play a fundamental role in public health efforts ³¹. In addition, the items in this dimension allow the evaluation of adherence to WHO guidelines to mitigate the spread of COVID-19 ²², where greater self-care and adherence to these guidelines could lead to a decrease in the rate of infection ^{15 , 28 , 30 , 32}.

The severity dimension in the PCR-CV19 is understood as the worst credible consequence resulting from COVID-19 infection and resulting in a loss ¹⁰. Therefore, the PCR-CV19 evaluates the perceived severity of death from COVID-19, complications of the disease ^{9 , 21 )} and economic loss; while in other studies, such as the one by Germani et al. ²⁹, severity is evaluated in relation to anxiety or perceived severity in the event of becoming ill ²¹.

It should be noted that knowledge regarding the prevention of infection has been updated as knowledge of the virus has increased. Therefore, when the PCR-CV19 questionnaire is replicated, it is recommended that items should be modified in line with current scientific information, as reflected in the WHO guidelines.

The study has limitations in that the study population is older, not being able to account for the perception of risk in children or adolescents, and the lack of a statistical package to determine the PCR-CV19 index automatically.

The strength of the study is that, by defining the index in the compact interval, it can be characterized as a random variable and it will be the data, by means of statistical adjustments, that will provide evidence in favor of the best model, thus making it possible to find an adequate way of summarizing the data and the availability of inferential tools for the process of analysis and quantification of impacts or group comparisons.

One of the limitations of our study was that the study population was older, thus we were not able to evaluate the perception of risk in children or teenagers. Another limitation was the lack of a statistical package to determine the PCR-CV19 index automatically.

The strength of our study is that, by defining the index in the compact interval, it can be characterized as a random variable; and the data, by means of statistical adjustments, will provide evidence in favor of the best model, thus making it possible to find an adequate way of summarizing the data and the availability of inferential tools for the process of analysis and quantification of impacts or group comparisons.

In conclusion, the PCR-CV19 is considered as a valid and reliable instrument to assess the perceived risk of COVID-19 infection in the Colombian population, and could be adapted to different groups and contexts, through its four dimensions (cognitive vulnerability, emotional vulnerability, risk-protective behaviors and severity) that show theoretical and methodological coherence.