COVID Stress Scales: A Cross-sectional Study of its Psychometric Properties among Africans with Chronic, Stable Medical Conditions

Background: The coronavirus 2019 pandemic (COVID-19) elicited in various populations, diverse psycho-behavioral responses. The COVID Stress Scales (CSS) was developed and validated in the general population, among US and Canadian adults, in response to the COVID-19 pandemic. Expectedly, population-specific variations in response are likely, hence, the need to validate psychometrically sound instruments across cultures and diverse populations. Aim: To determine the factor structure and reliability estimates of the CSS among participants with chronic, stable medical conditions in a Nigerian Tertiary Hospital. Methods: The cross-sectional study, involved 1047 consenting adults with chronic, stable medical conditions attending the out-patient specialist clinics of a foremost tertiary hospital in Nigeria. The participants were enrolled consecutively over a four-month period straddling the first and second waves of the COVID-19 pandemic. The CSS was administered to participants who fulfilled the study criteria. Exploratory Factor Analyses (EFA) using Principal Component Analysis and Oblimin rotation with Kaiser Normalization, was used to extract the factors. Results: A six-factor structure emerged: COVID-19-related socio-economic consequences; contamination; xenophobia; traumatic stress; compulsive checking and reassurance seeking; and danger. The internal consistency within items of each domain was acceptable (Cronbach alpha 0.85 and above) and correlation between the domains was moderate to strong. Conclusion: The CSS maintained a six-factor structure, corresponding to the six scales, among Nigerian participants with chronic, stable medical conditions. It has acceptable reliability estimates and can be used to assess COVID-19-related anxiety in this population. The inter-correlation of the various domains is a strong evidence for the existence of COVID stress syndrome.