AnsT-19: Development and Validation of a Scale to Assess the Anxiety of Family Physicians during Teleconsultation
Keywords:Anxiety, Physicians, Family, Portugal, Remote Consultation, Surveys and Questionnaires
Introduction: Following the outbreak of the disease caused by the novel coronavirus it was necessary to increase the non-face-to-face care activity through alternative means such as teleconsultation in primary health care. The adjustment to a type of remote consultation could have generated anxiety among family physicians. The main aim of the present study was to develop and validate a scale to assess the anxiety of family physicians during teleconsultation.
Material and Methods: Observational, cross-sectional study involving a sample of family physicians working in Portugal. An online survey that evaluated anxiety in teleconsultation was developed.
Results: A total of 359 valid responses were included in an exploratory factor analysis, after determining the number of factors to retain. A four-factor structure was detected with loadings ranging overall, from 0.44 to 0.98. Correlations between factors ranged from 0.42 to 0.58. Exploratory factor analysis results varied between good and very good fit, with chi-square/df result = 2.448, root mean square error of approximation (RMSEA) = 0.062 [90% CI = (0.053, 0.073)], root mean square of the residuals (RMSR) = 0.030 and Tucker Lewis index (TLI) = 0.931. Composite reliability was higher than 0.7 for all factors and average variance extracted was close or above 0.5 for the extracted factors, confirming convergent validity. McDonald’s omega (ω) = 0.95 suggested the presence of a second-order factor, and thus a global measure for assessing anxiety during teleconsultation. Concurrent validity results were good, with correlations ranging from r = -0.277 to r = -0.393 with General Self-Efficacy scale (GSE) and r = 0.302 to r = 0.547 with Depression Anxiety Stress scales (DASS). Moderate correlations found between DASS and the dimensions of AnsT-19 suggest that AnsT-19 is capturing anxiety from the teleconsultation point of view. AnsT-19 factors and total score were significantly associated with gender, experience as a family doctor, psychotropic medication during the pandemic period and pre-pandemic experience of teleconsultation, indicating good construct validity. The limitations of the study are related to the convenience process, the use of an online survey and self-reported measurements.
Conclusion: AnsT-19 is a valid instrument to assess the anxiety of family physicians during teleconsultation.
Direção-Geral da Saúde. COVID-19: primeira fase de mitigação. Medidas transversais de preparação. Orientação nº 001/2020 de 16/03/2020. Lisboa: DGS; 2020.
Ferreira D. Papel da telesaúde em tempos de pandemia COVID-19: para grandes males, grandes remédios. Med Interna. 2020: Publicação Especial COVID-19 | Abril 2020. DOI: https://doi.org/10.24950/rspmi/COVID19/D.Ferreira/LuzLisboa/S/2020
Portnoy J, Waller M, Elliott T. Telemedicine in the era of COVID-19. J Allergy Clin Immunol Pract. 2020;8:1489-91. DOI: https://doi.org/10.1016/j.jaip.2020.03.008
Correia AM, Rodrigues AP, Dias C, Antunes D, Simões DG, Maltez F, et al. Plano nacional de preparação e resposta à doença por novo coronavirus (COVID-19). Lisboa: Direção-Geral da Saúde; 2020.
Espanha R, Fonseca RB. Tecnologias de informação e comunicação. Plano nacional de saúde 2011-2016. Lisboa: Direção-Geral da Saúde; 2010.
Ferreira D. Teleconsultas: ir ao hospital sem sair de casa - implicações na relação médico-doente. Med Interna. 2018;25:11-4. DOI: https://doi.org/10.24950/rspmi/Opiniao/1/2018
Baker J, Stanley A. Telemedicine technology: a review of services, equipment, and other aspects. Curr Allergy Asthma Rep. 2018;18:60. DOI: https://doi.org/10.1007/s11882-018-0814-6
Portugal. Despacho n.º 3570/2013. Gabinete do Secretário de Estado Adjunto do Ministro da Saúde. Diário da República, II série, n.º 46 (2013/03/06) p.8325.
Hull S, Hagdrup N, Hart B, Griffiths C, Hennessy E. Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice. Br J Gen Pract. 2002;52:712-16.
Car J, Sheikh A. Telephone consultations. BMJ. 2003;326:966-9. DOI: https://doi.org/10.1136/bmj.326.7396.966
Demirgan S, Gemici EK, Çağatay M, Altınel Y, Demirgan EB, Güneyli HC, et al. Being a physician in coronavirus disease 2019 pandemic and alternative health care service: telemedicine: prospective survey study. Telemed J E Health. 2021;27:1355-62. DOI: https://doi.org/10.1089/tmj.2020.0546
Abraham HN, Opara IN, Dwaihy RL, Acuff C, Brauer B, Nabaty R, et al. Engaging third-year medical students on their internal medicine clerkship in telehealth during COVID-19. Cureus. 2020;12:e8791. DOI: https://doi.org/10.7759/cureus.8791
Silverman WK, Van Schalkwyk GI. Pediatric anxiety disorders. In: Compton SN, Villabø MA, Kristensen H. Pediatric anxiety disorders. Cambridge: Academic Press; 2019.
Beck A, Emergy G, Greenberg R. Anxiety disorders and phobias. New York: Basic Books, Inc. Publishers; 1985.
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-7. DOI: https://doi.org/10.1016/j.bbi.2020.05.026
Hou F, Bi F, Jiao R, Luo D, Song K. Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China: a cross-sectional study. BMC Public Health. 2020;20:1648. DOI: https://doi.org/10.1186/s12889-020-09738-7
Baptista S, Teixeira A, Castro L, Cunha M, Serrao C, Rodrigues A, et al. Physician burnout in primary care during the COVID-19 pandemic: a crosssectional study in Portugal. J Prim Care Community Health. 2021;12:1-9. DOI: https://doi.org/10.1177/21501327211008437
Pandey U, Corbett G, Mohan S, Reagu S, Kumar S, Farrell T, et al. Anxiety, depression and behavioural changes in junior doctors and medical students associated with the coronavirus pandemic: a cross-sectional survey. J Obstet Gynaecol India. 2021;71:33-37. DOI: https://doi.org/10.1007/s13224-020-01366-w
McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45:1027-35. DOI: https://doi.org/10.1016/j.jpsychires.2011.03.006
Romppel M, Herrmann-Lingen C, Wachter R, Edelmann F, Düngen H-D, Pieske B, et al. A short form of the General Self-Efficacy Scale (GSE-6): development, psychometric properties and validity in an intercultural non-clinical sample and a sample of patients at risk for heart failure. GMS Psychosoc Med. 2013;10:Doc01. DOI: https://doi.org/10.1037/t69316-000
Mamede S, Van Gog T, Van Den Berge K, Van Saase J, Schmidt H. Why do doctors make mistakes? A study of the role of salient distracting clinical features. Acad Med. 2014;89:114-20. DOI: https://doi.org/10.1097/ACM.0000000000000077
Bandura A. Self-efficacy in changing societies: Cambridge: University Press; 1995. DOI: https://doi.org/10.1017/CBO9780511527692
Muñoz ÁS, López MF, Vieitez JC. Self-efficacy and anxiety in female hospital healthcare workers. Ansiedad y Estrés. 2018;24:99-104. DOI: https://doi.org/10.1016/j.anyes.2018.08.002
Colbert GB, Venegas-Vera AV, Lerma EV. Utility of telemedicine in the COVID-19 era. Rev Cardiovasc Med. 2020;21:583-7. DOI: https://doi.org/10.31083/j.rcm.2020.04.188
Bashshur R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO. Telemedicine and the COVID-19 pandemic, lessons for the future. Telemed J E Health. 2020;26:571-3. DOI: https://doi.org/10.1089/tmj.2020.29040.rb
Beresin EM, Balon R, Coverdale JH, Louie AK, Roberts LW. Physicians wellbeing: a critical deficiency in resilience education and training. Acad Psychiatry. 2016;40:9-12. DOI: https://doi.org/10.1007/s40596-015-0475-x
Araújo M, Moura O. Estrutura factorial da General Self-Efficacy Scale (Escala de Auto-Eficácia Geral) numa amostra de professores portugueses. Laboratório de Psicologia. 2011;9:95-105. DOI: https://doi.org/10.14417/lp.638
Pais-Ribeiro J. Adaptação de uma escala de avaliação da auto-eficácia geral. In: Avaliação psicológica: formas e contextos. Braga: Apport; 1995. p. 163-76.
Pais-Ribeiro JL, Honrado A, Leal I. Contribuição para o estudo da adaptação portuguesa das Escalas de Ansiedade, Depressão e Stress (EADS) de 21 itens de Lovibond e Lovibond. Psicol Saúde Doenças. 2004;5:229-39.
Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1-55. DOI: https://doi.org/10.1080/10705519909540118
Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. Upper Saddle River: Prentice-Hall, Inc.; 2010.
Medisauskaite A, Kamau C. Reducing burnout and anxiety among doctors: randomized controlled trial. Psychiatry Res. 2019;274:383-90. DOI: https://doi.org/10.1016/j.psychres.2019.02.075
Dunphy BC, Cantwell R, Bourke S, Fleming M, Smith B, Joseph KS, et al. Cognitive elements in clinical decision-making: toward a cognitive model for medical education and understanding clinical reasoning. Adv Health Sci Educ Theory Pract. 2010;15:229-50. DOI: https://doi.org/10.1007/s10459-009-9194-y
Lerner J, Li Y, Valdesolo P, Kassam K. Emotion and decision making. Annu Rev Psychol. 2015;66:799. DOI: https://doi.org/10.1146/annurev-psych-010213-115043
Kozlowski D, Hutchinson M, Hurley J, Rowley J, Sutherland J. The role of emotion in clinical decision making: an integrative literature review. BMC Med Educ. 2017;17:255. DOI: https://doi.org/10.1186/s12909-017-1089-7
Garfinkel S, Zorab E, Navaratnam N, Engels M, Mallorquí-Bagué N, Minati L, et al. Anger in brain and body: the neural and physiological perturbation of decision-making by emotion. Soc Cogn Affect Neurosci. 2016;11:150–8. DOI: https://doi.org/10.1093/scan/nsv099
Alhaqwi AI, Babiker AM, Baraja MA, Alonazi JA, Alyosif LA, Alyousif SM, et al. Does physician distraction lead to diagnostic and management errors? An exploratory study in the primary care setting. J Taibah Univ Med Sci. 2019;14:502-7. DOI: https://doi.org/10.1016/j.jtumed.2019.10.005
Altulaihi BA, Alharbi KG, Alhassan AM, Altamimi AM, Akeel MA. Physician’s perception toward using telemedicine during COVID-19 pandemic in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Cureus. 2021;13:e16107. DOI: https://doi.org/10.7759/cureus.16107
Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, Byrd M, et al. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med. 2002;347:1087-93. DOI: https://doi.org/10.1056/NEJMsa020660
Pappas Y, Vseteckova J, Mastellos N, Greenfield G, Randhawa G. Diagnosis and decision‑making in telemedicine. J Patient Exp. 2019;6:296‑304. DOI: https://doi.org/10.1177/2374373518803617
Jain R, Jain Y. The importance of physical examination in primary health care provided by NPHW is being threatened in COVID19 times. J Family Med Prim Care. 2021;10:19-21. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1932_20
Salari N, Khazaie H, Hosseinian-Far A, Ghasemi H, Mohammadi M, Shohaimi S, et al. The prevalence of sleep disturbances among physicians and nurses facing the COVID-19 patients: a systematic review and meta-analysis. Global Health. 2020;16:92. DOI: https://doi.org/10.1186/s12992-020-00620-0
Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, et al. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry. 2020;11:306. DOI: https://doi.org/10.3389/fpsyt.2020.00306
Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based crosssectional survey. Psychiatry Res. 2020;288:112954. DOI: https://doi.org/10.1016/j.psychres.2020.112954
Bados A, Solanas A, Andrés R. Psychometric properties of the Spanish version of Depression, Anxiety and Stress Scales (DASS). Psicothema. 2005;17:679-83.
Wang K, Shi HS, Geng FL, Zou LQ, Tan SP, Wang Y, et al. Cross-cultural validation of the depression anxiety stress scale-21 in China. Psychol Assess. 2016;28:e88-100. DOI: https://doi.org/10.1037/pas0000207
Hussien R, Shahin MA. Coronavirus disease-19 quarantine experience in the middle east region: emotional status, health patterns, and self-efficacy survey. Open Access Maced J Med Sci. 2020;8:330-45. DOI: https://doi.org/10.3889/oamjms.2020.5256
Marôco J, Marôco AL, Leite E, Bastos C, Vazão MJ, Campos J. Burnout em profissionais da saúde portugueses: uma análise a nível nacional. Acta Med Port. 2016;29:24-30. DOI: https://doi.org/10.20344/amp.6460
Gold JA. Covid-19: adverse mental health outcomes for healthcare workers. BMJ. 2020;369:m1815. DOI: https://doi.org/10.1136/bmj.m1815
Taylora S, Landryb CA, Paluszekb MM, Fergusc TA, McKayd D, Asmundsonb GJ. Development and initial validation of the COVID stress scales. J Anxiety Disord. 2020;72:102232. DOI: https://doi.org/10.1016/j.janxdis.2020.102232
How to Cite
Copyright (c) 2023 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.