The association of care burden with motivation of vaccine acceptance among caregivers of stroke patients during the COVID-19 pandemic: mediating roles of problematic social media use, worry, and fear.

BACKGROUND: The aim of the present study was to investigate the relationship between care burden and motivation of COVID-19 vaccine acceptance among caregivers of patients who have experienced a stroke and to explore the mediating roles of social media use, fear of COVID-19, and worries about infection in this relationship. METHODS: A cross-sectional survey study with 172 caregivers of patients who had experienced a stroke took part in a Taiwan community hospital. All participants completed the Zarit Burden Interview, Bergen Social Media Addiction Scale, Worry of Infection Scale, Fear of COVID-19 Scale, and Motors of COVID-19 Vaccine Acceptance Scale. Multiple linear regression model was applied to construct and explain the association among the variables. Hayes Process Macro (Models 4 and 6) was used to explain the mediation effects. RESULTS: The proposed model significantly explained the direct association of care burden with motivation of COVID-19 vaccine acceptance. Despite the increased care burden associated with decreased vaccine acceptance, problematic social media use positively mediated this association. Moreover, problematic social media use had sequential mediating effects together with worry of infection or fear of COVID-19 in the association between care burden and motivation of vaccine acceptance. Care burden was associated with motivation of vaccine acceptance through problematic social media use followed by worry of infection. CONCLUSIONS: Increased care burden among caregivers of patients who have experienced a stroke may lead to lower COVID-19 vaccines acceptance. Moreover, problematic social media use was positively associated with their motivation to get COVID-19 vaccinated. Therefore, health experts and practitioners should actively disseminate accurate and trustworthy factual information regarding COVID-19, while taking care of the psychological problems among caregivers of patients who have experienced a stroke.

Burdens on caregivers of patients with stroke during a pandemic: relationships with support satisfaction, psychological distress, and fear of COVID-19.

BACKGROUND: Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic. METHODS: A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden. RESULTS: The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19. CONCLUSIONS: Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.

Factors associated with insomnia and suicidal thoughts among outpatients, healthcare workers, and the general population in Taiwan during COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Insomnia and suicidal thoughts are two of the negative impacts that have been caused by the COVID-19 pandemic. Identifying the factors that contribute to these psychological problems may help develop strategies to sustain the mental health of the public. The present study examined the psychosocial impacts caused by the COVID-19 pandemic among different populations in Taiwan, and investigated the relationships between these psychosocial variables, insomnia, and suicidal thoughts. METHODS: Between September 2020 and May 2021, online questionnaires including psychometrically validated scales were distributed to a convenience sample of outpatients (n = 205), healthcare workers (HCWs) (n = 500), and individuals in the general population (n = 1200) in Taiwan to collect data regarding their insomnia severity, suicidal thoughts, fear of COVID-19, trust of information, and resilience. Multivariate logistic regression methods were used to identify variables associated with suicidal thoughts and insomnia. RESULTS: Greater fear of COVID-19 was significantly associated with suicidal thoughts: odds ratios (ORs) with 95% confidence interval (CI) = 1.155 (1.002-1.330) for outpatients; 1.127 (1.035-1.228) for HCWs; and 1.100 (1.130-1.222) for those in the general population. Higher resilience was significantly associated with lower insomnia: OR (95% CI) = 0.819 (0.725-0.926) for outpatients; 0.803 (0.728-0.887), for HCWs; 0.829 (0.785-0.875), and for those in the general population. In addition, there was a statistically significant association between insomnia diagnosis and greater fear of COVID-19 among HCWs (OR [95% CI] = 1.102 [1.062-1.144]) and those in the general population (OR [95% CI] = 1.079 [1.053-1.106]). Among outpatients, there was a statistically significant association between suicidal thoughts and lower trust of information (OR [95% CI] = 0.794 [0.646-0.976]), while among those in the general population there was a statistically significant association between suicidal thoughts and higher insomnia severity (OR [95% CI] = 1.175 [1.13-1.222]). A statistically significant association was also found between insomnia diagnosis and higher suicidal thoughts among those in the general population (OR [95% CI] = 3.455 [2.338-5.106]). CONCLUSIONS: Trust of information, fear, and resilience were important factors for suppressing suicidal thoughts and insomnia among the three study populations. Health policies that monitor psychological status and build resiliency of the public are recommended to help develop tailored strategies for different populations affected by the COVID-19 pandemic.

Difficulties in Managing Children's Learning among Caregivers of Children with Attention-Deficit/Hyperactivity Disorder during the COVID-19 Pandemic in Taiwan: Association with Worsened Behavioral and Emotional Symptoms.

School closures during the COVID-19 pandemic have interfered with children's learning. The aim of this study was to investigate the difficulties in managing children's learning at home and attending afterschool learning programs and their related factors among caregivers of children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic. In total, 252 caregivers of children with ADHD completed a questionnaire collecting difficulties in managing children's learning, parenting styles, children's worsened symptoms of ADHD, oppositional defiant disorder (ODD) and emotion, and increased Internet use. Multivariate logistic regression models were used to examine the factors related to caregiver difficulties in managing children's learning and children's worsened ADHD, ODD, and emotional symptoms. In total, 85.3% of the caregivers had difficulty in asking their children to learn at home; 28.2% had difficulty in taking children to afterschool learning programs. Children's worsened anger was significantly associated with higher caregiver difficulty in asking children to learn at home, whereas parental overprotection was significantly associated with lower caregiver difficulty in asking children to learn at home. Worsened hyperactivity and opposition were significantly associated with higher caregiver difficulty in taking children to attend afterschool learning programs. Interventions for enhancing caregivers' skills to manage children's learning and children's behavioral and emotional symptoms should take the related factors found in this study into consideration.

Associations of Problematic Internet Use, Weight-Related Self-Stigma, and Nomophobia with Physical Activity: Findings from Mainland China, Taiwan, and Malaysia.

Insufficient physical activity is a common problem for university students because they may engage in sedentary lifestyle owing to excessive time spent on their smartphones and social media use. This may result in problematic internet use (PIU) and nomophobia (fear of not having a mobile phone). Moreover, prior evidence shows that weight-related self-stigma is an important factor contributing to low physical activity. Therefore, the present study examined the associations between PIU, nomophobia, and physical activity among university students across mainland China, Taiwan, and Malaysia. Participants (3135 mainland Chinese, 600 Taiwanese, and 622 Malaysian) completed the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), Nomophobia Questionnaire (NMPQ), Weight Self-Stigma Questionnaire (WSSQ), and International Physical Activity Questionnaire Short Form (IPAQ-SF). The measurement invariance of the assessed questionnaires was supported across the three regions. The present findings analyzed using partial least squares structural equation modeling showed that (i) greater nomophobia was associated with higher levels of physical activity, (ii) greater weight-related self-stigma was associated with higher levels of physical activity, and (iii) greater nomophobia was associated with greater weight-related self-stigma. Although the present findings suggest the possibility that experiencing some level of nomophobia or weight-related self-stigma appears to help improve physical activity, it is not recommended that these be encouraged, but reducing PIU should be targeted as a means to improve physical activity.

Internet-Related Instruments (Bergen Social Media Addiction Scale, Smartphone Application-Based Addiction Scale, Internet Gaming Disorder Scale-Short Form, and Nomophobia Questionnaire) and Their Associations with Distress among Malaysian University Students.

The present study evaluated the psychometric properties of four instruments related to internet use, namely the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), (nine-item) Internet Gaming Disorder Scale Short Form (IGDS9-SF), and Nomophobia Questionnaire (NMPQ) as well as their associations with psychological distress among Malaysian university students. A total of 380 Malaysian university students (71.6% females, mean age 24.0 years) were recruited through convenience sampling and completed an online survey including questions concerning socio-demographic background, social media addiction, smartphone addiction, internet gaming disorder, and nomophobia. Confirmatory factor analysis and Rasch analysis were applied to evaluate the psychometric properties of the instruments and Cronbach's alpha value and McDonald's omega value were used to confirm the internal consistency reliability of the instruments. The unidimensional structure was confirmed for the BSMAS, SABAS, and IGDS9-SF while the four-factor structure was confirmed for NMPQ. All instruments showed good internal consistency reliability. Promising validity and reliability were confirmed for BSMAS, SABAS, IGDS9-SF, and NMPQ. Therefore, they are useful to assess different types of problematic internet use among university students in Malaysia. Furthermore, a significant association was observed between internet use and psychological distress. The present study is the first to investigate the validity and reliability of BSMAS, SABAS, IGDS9-SF, and NMPQ among Malaysian university students using rigorous psychometric testing methods (i.e., Rasch analysis).

Gender Differences in the Associations Between Physical Activity, Smartphone Use, and Weight Stigma

Background Physical activity (PA) is important for health. However, there is little evidence on how weight stigma, time spent on sedentary activities (including smartphone, social media, online learning), time spent on outdoor activity, and nomophobia associate with PA among Chinese individuals with consideration of gender. The present study examined the aforementioned associations in the COVID-19 pandemic era. Methods University students (N = 3,135;1,798 females, 1,337 males) with a mean age of 19.65 years (SD = 2.38) years completed an online survey from November to December, 2021. The online survey assessed weight stigma (using the Perceived Weight Stigma Scale and Weight Bias Internalization Scale), PA (using the International Physical Activity Questionnaire Short Form), time spent on different activities (using self-designed items for time on smartphone, outdoor activity, social media, and online learning), and nomophobia (using the Nomophobia Questionnaire). Parallel mediation models were constructed (dependent variable: PA;mediators: perceived weight stigma, weight-related self-stigma, time spent on smartphone, time spent on outdoor activity, time spent on social media, and time spent online learning;independent variable: nomophobia) and evaluated using Hayes' Process Macro Model 4 (IBM SPSS 20.0). Results Weight-related self-stigma (β = −0.06;p = 0.03), time spent on outdoor activity (β = 0.21;p < 0.001), time spent on social media (β = 0.07;p = 0.02), time spent on online learning (β = 0.06;p = 0.03), and nomophobia (β = −0.07;p = 0.01) were all significant factors explaining the PA among female participants. Perceived weight stigma (β = −0.07;p = 0.01), time spent on outdoor activity (β = 0.27;p < 0.001), and time spent on online learning (β = 0.10;p = 0.002) were all significant factors explaining PA among male participants. Conclusion Chinese healthcare providers should design programs on weight stigma reduction and outdoor activity improvement to enhance PA among university students.

Psychological Distress and Protective Behaviors During the COVID-19 Pandemic Among Different Populations: Hong Kong General Population, Taiwan Healthcare Workers, and Taiwan Outpatients.

PURPOSE: The novel coronavirus disease 2019 (COVID-19) caused psychological distress and changed human living styles. However, rare studies have examined the psychological distress and protective behaviors across different populations. Therefore, the present study aimed to assess psychological distress, protective behaviors, and potential predictors of psychological distress and protective behaviors across the Hong Kong general population, Taiwan healthcare workers, and Taiwan outpatients. METHODS: A cross-sectional design was used to recruit participants from Hong Kong and Taiwan. Telephone interviews were carried out for Hong Kong participants (n = 1,067; 30.2% male participants); online surveys were used for Taiwan healthcare workers (n = 500; 8.0% male participants) and Taiwan outpatients (n = 192; 32.8% male participants). All the participants completed questions on psychological distress and protective behaviors. Multiple linear regressions and multivariable logistic regressions were employed to explore the potential predictors of psychological distress and protective behaviors, respectively. RESULTS: Hong Kong participants had significantly lower levels of psychological distress than Taiwan participants [mean (SD) = 0.16 (0.39) vs. 0.47 (0.59) in healthcare workers and 0.46 (0.65) in outpatients; p < 0.001]. Hong Kong participants (51.7%) and Taiwan outpatients had more people showing fear of COVID-19 (52.0%) than Taiwan healthcare providers (40.8%; p < 0.001). Moreover, Hong Kong participants engaged the most in protective behaviors, followed by Taiwan healthcare providers and Taiwan outpatients (p < 0.001). Moreover, being a female, fear of COVID-19 and worry about personal savings were associated with protective behaviors in general. CONCLUSIONS: Despite the greater COVID-19 severity and fear of COVID-19 in Hong Kong, the general population in Hong Kong experienced less psychosocial distress with higher compliance to protective behaviors than the other groups in Taiwan.

Examining the validity of the drivers of COVID-19 vaccination acceptance scale using Rasch analysis.

BACKGROUND: To well control the pandemic of COVID-19, herd immunity should be achieved. However, people, especially those with better physical conditions (e.g., young adults), may not accept COVID-19 vaccines. Understanding university students' willingness or reluctance to uptake COVID-19 vaccination is important. AIM: This study aimed to examine the psychometric properties of the DrVac-COVID19S, an instrument that helps assess motivations/drivers of COVID-19 vaccination uptake among university students. RESEARCH DESIGN AND METHODS: Using convenience sampling and cross-sectional design, university students (930 from Taiwan [38.0% males] and 1,244 from Ghana [63.3% males]) completed the DrVac-COVID19S using an online survey (Taiwanese students) or paper-and-pen method (Ghanaian students). Rasch analysis was used to examine the psychometric properties of the DrVac-COVID19S. RESULTS: All 12 items in the DrVac-COVID19S had a satisfactory fit in the Rasch models (infit MnSq = 0.74 to 1.49; outfit MnSq = 0.72 to 1.42). Moreover, the seven-point Likert scale used in the DrVac-COVID19S demonstrated monotonically increasing in their difficulties, which indicated the ordered category. Additionally, no differential item functioning was displayed in the DrVacCOVID-19S across Taiwanese and Ghanaian students. CONCLUSIONS: The DrVacCOVID-19S has good psychometric features to help healthcare providers assess individuals' (especially university students) motivations or drivers to get the COVID-19 vaccination.