Contents Introduction
On March 12th, 2020, the World Health Organization (WHO) declared a pandemic status on n-CoV-2 virus disease (COVID-19), after it infected more than 114 countries [8]. A pandemic is an outbreak of a disease that occurs over a wide geographical area and affects an exceptionally high proportion of the population [6]. Every country on earth has the potential to be impacted by the virus, including Indonesia. In response, the Indonesian government, through the Ministry of Health, immediately responded by restricting entry access for citizens of China, Italy, Iran, and South Korea; preparing and securing a stock of Personal Protective Equipment (PPE), including masks and laboratory test requirements; contact tracing, and forming the national COVID-19 task force.
Since its first case appeared in Depok, West Java (a supporting area to the capital city, located not far from Jakarta), COVID-19 had sent people into a panic. Due to the vague instructions from the central government, the regional government, in this case, the Provincial Government of the Special Capital Region of Jakarta, had missed numerous chances to control the transmission link of COVID-19. As a result, a number of cases continued to increase, and DKI Jakarta became the epicenter of COVID-19 transmission in Indonesia.
The lockdown option was not considered until April 7th, 2020, when the Ministry of Health released the Decree of Ministry of Health HK.01.07/Menkes/239/2020 regarding Pembatasan Sosial Berskala Besar (Large-Scale Social Limitations, hereafter referred to as PSBB) in the Special Capital Region of Jakarta (hereafter referred to as DKI Jakarta) to accelerate COVID-19 mitigation efforts [9]. It put restrictions on the movement of people during the pandemic, especially in public areas or places that have the potential to attract crowds, such as markets or shopping centers, public transportations, schools, offices, worship places, entertainment areas, and other public facilities. The flow of movement in and out of DKI Jakarta was restricted as well.
Various responses emerged from the people of DKI Jakarta and its surrounding areas (i.e. Bogor, Depok, Tangerang, Bekasi; hereafter referred to as Bodetabek). Responses ranged from indifference to anxieties regarding continuity of work and business, and anxieties regarding the health risk factors of being in the epicenter of COVID-19 transmission. Cases of ignorance towards PSBB protocols, for instance, occurred at the now-permanently closed McDonald’s Sarinah, which was still filled with customers even until its last operating day; Soekarno-Hatta Airport, which was overrun by passengers; and hordes of patrons crowding shopping centers without practicing physical distancing before the year’s Eid [7]. In regards to mental health risks during the pandemic (including trepidations about the continuity of work and business), a virtual discussion held by the Faculty of Medicine of University of Pelita Harapan (FK-UPH) with Siloam Hospital themed "Can Brain Damage by Corona?" explained that restrictions posed by PSBB might result in several changes on one’s daily activities (specifically those done outdoors and/or related work), which in turn may trigger boredom, panic, stress, and depression [16].
The varying responses towards PSBB have exponential implications to the ever-continuing increase in the number of positive cases in DKI Jakarta, which has reached five thousand cases throughout April to May [13]. The increasing number of positive cases due to public indifference towards government appeals has contributed to the community anxiety factor for the existence of COVID-19, be it death anxiety and anxieties regarding the continuity of work or business during the PSBB. This paper aims to perceive the description of the anxiety of people in Jabodetabek (Jakarta, Bogor, Depok, Tangerang, Bekasi) during the PSBB period arising from the COVID-19 pandemic, specifically on anxieties regarding death and the continuity of work and business. This paper also considered several factors, such as the level of public knowledge about COVID-19 and socioeconomic vulnerability (which includes social carrying capacity, the food needs fulfilment, and health).
Literature Review
A body of literature has investigated the notion of anxiety, death anxiety, vulnerability and human cognition. This paper makes use of such terms in the context of the COVID-19 pandemic.
A. Anxiety
Spielberger [2] in his book "Anxiety and Behavior" explained that anxious feelings or anxieties have several dualisms. The first is objective anxiety versus neurotic anxiety, and the second is state anxiety versus trait anxiety. Freud considered anxiety as objective anxiety, which was synonymous with fear, involving a complex internal reaction to anticipated injury or harm from some external danger. A real danger situation existed in the perception of risk evoked an anxiety reaction. Neurotic anxiety, on the other hand, was characterized by feelings of apprehension and physiological arousal. Neurotic anxiety differed from objective anxiety in that the source of danger that evoked this reaction was internal rather than external, and that this source was not consciously perceived because it had been repressed. The next dualism is that anxiety is considered both a condition and a trait. Spielberger [2] furthermore denoted that while anxiety is perhaps most commonly used in an empirical sense to denote complex reaction or response (a transitory state or condition of the organism that varies in intensity and fluctuates over time, the term is also used to refer to a personality trait (to individual differences in the extent to which different people are characterized by anxiety states and by prominent defenses against such states.
This study considers an anxious feeling or anxiety as neurotic anxiety and not a trait—instead, an anxious feeling or anxiety is considered as a condition of someone responding to external stimuli; which, in this case, is the situation and conditions during the pandemic or PSBB. This concept is considered to be relevant to the situations and conditions of the people during the PSBB period, even more so since the description of dangers posed by the existence of COVID-19 is a rare and unique condition to describe.
B. Death Anxiety
Death anxiety is one of the variables researchers tried to visualize in this research. Researchers adapted the death anxiety measuring instrument created by Cai, Tang, Wu, and Li, which is believed to be able to comprehensively explain the ongoing phenomena regarding the condition of people in Jabodetabek who are anxious about the existence of COVID-19 cases.
The measuring instrument constructed by Cai, Tang, Wu, and Li [15] consists of four dimensions: dysphoria, death intrusion, fear of death, and avoidance of death. Dysphoria generally describes the somatic condition of a person experiencing anxiety, which is defined as a condition where someone feels isolated, anxious, and restless, which in turn will cause physical reactions arising in the form of feelings of being tired and emotional distress when thinking of death. Death intrusion emphasizes more on the cognitive aspect of death anxiety, referring to the visualizations and thoughts relating to one’s death repeatedly happening to the point where they may cause nightmares. Fear of death stresses on the aggravating emotional condition of feeling more scared of death or things that may cause death. Avoidance of death refers to the behavioral aspect of avoiding thoughts, situations, events, and experiences related to death.
The four dimensions contribute to each other in describing whether a person's condition can be judged to be in a state of anxiety about their death for a specific event. Every definition and question items in the measuring instrument were adjusted to the context and purpose of the study, which was to see the condition of a person during a pandemic or PSBB. The items used in this study will later be discussed in the methodology section.
C. Socioeconomic Vulnerability
Vulnerability is a group of conditions or repercussions (social, physical, economic, and environmental factors) that has a detrimental effect on disaster prevention and management efforts [20]. Vulnerability is associated with a human’s capability to protect itself and cope with the impacts of natural disasters without any external assistance. Vulnerability, toughness, capacity, and ability to respond to emergencies can be implemented at the individual, family, public, and institutional levels [1].
Vulnerability factors [20] include physical vulnerability: basic infrastructures, constructions, buildings; economic vulnerability: poverty, wage, nutrition; social vulnerability: education, health, politics, law, institution; environmental vulnerability: soil, water, plants, forests, and sea.
According to the TNP2K (National Team for the Acceleration of Poverty Reduction) narrative in Patunru [5], poverty is the inability to fulfil basic rights and the disparity of treatment towards a person or a group of people living a dignified life. As stated by Patunru [5], such basic rights include, among others, food, health, education, employment, housing, clean water, land, natural resources and environment, a sense of security from threats or acts of violence, and the rights to participate in both social and political life regardless of gender.
This study applied and adapted such concepts to fit the socioeconomic condition during the COVID-19 pandemic period. Researchers decided not to include the environmental vulnerability factors referred by Bakornas PB [20]. In respect of basic rights, researchers focused on the fulfilment of food, health, employment, and social environment needs; including a sense of security from threats or acts of violence and the ability to participate in social life.
This paper defines the chosen factors and aspects as follows. Food needs fulfilment factor addressed one’s ability to fulfil their daily food needs, including the number of times they eat and the nutritional value of their food, also the anxiety they experience in regards to fulfilling their food needs during the COVID-19 pandemic. Health fulfilment referred to one’s ability to access every form of health facilities, including their ability to pay for their health expenses. Employment addressed the types of work that can or cannot be done from home, including one’s ability to organize their work, also the presence of supporting policies implemented by their workplace or lack thereof. Social environment and community factor referred to one’s description or attitude towards their surrounding environment and the attitude of the community towards them, including social support, be it in the form of financial or emotional support.
D. Knowledge of COVID-19
Bloom pioneered the theory of human cognition level through Bloom’s Taxonomy in 1956 [17]. Bloom extracted the levels of human cognition into a taxonomy or levels consisting of several components: knowledge, comprehension, application, analysis, synthesize, and evaluation. After several decades, however, Anderson and Krathwohl (and other cognitive experts) felt the need to create some improvements. For instance, they changed the term of concept components; Bloom initially used nouns, which are now turned into verbs. They also repositioned the last two components, and provided levels for each component; consisting of factual, conceptual, procedural, and metacognitive levels. These changes are illustrated in the following diagram (the further down the table, the higher the level of cognition).
This study used the fitted version of remembering/ knowing, understanding and applying to describe the level of cognition of the community. Analyzing, evaluating, and creating was not considered, due to the nature of online questionnaires, which researchers did not deem to be able to describe or probe on respondents’ level of cognition regarding COVID-19. Researchers defined used concepts as follows. Remembering is one’s ability to recall experiences regarding COVID-19 (be it their own or other people’s). This included important facts, such as the number of positive cases, ‘Persons under Observation’—hereafter referred to as ODP, ‘Patients under Surveillance’—hereafter referred to as PDP, coping measures, red zone areas, referral hospitals, report channels, and official information channels. Understanding addressed one’s ability to understand experiences regarding COVID-19, including sharing such experiences to their nearest social circles, discussing the latest facts, and reflecting on the obtained information. Applying referred to one’s ability to apply all experiences they have had regarding COVID-19— specifically in preventive measures and appeals from the government concerning measures to prevent pandemic transmission.
Methodology
A. Research Type and Sampling Method
This study falls to the category of quantitative research. Data were obtained by distributing self-report online questionnaires through Google Forms. This was done due to the restrictions of PSBB during the time the study was carried out. The applied sampling method was convenience or accidental sampling, which selects willing samples fitting the characteristics set by researchers [12][14], i.e. citizens of Jabodetabek.
B. Research Questionnaire
The questionnaire used in this study consist of a) scale of death anxiety [15]; b) socioeconomic vulnerability; and c) level of cognition. All three of them were adapted to fit the situation and condition during the COVID-19 pandemic/PSBB period. Due to its special circumstances, reverse translation was done for the scale of anxiety metrics. Questionnaire items were translated from its original language (Mandarin) to English, to then be translated again into Indonesian all done under the expert judgment of people with an advanced level of proficiency in Indonesian, English, and Mandarin. The other two questionnaires (socioeconomic vulnerability and level of cognition) were drafted according to defined concepts and dimensions/ aspects. Each was then derived into questionnaire items according to indicators describing them.
Below are examples of items adapted to fit the situation and condition during the COVID-19 pandemic/ PSBB period.
The scale of death anxiety: In the past month, whenever I think about death due to Coronavirus infection, I have often thought that my life has no meaning; In the past month, I have often felt like I would soon die from Coronavirus infection; In the past month, whenever I think about death due to Coronavirus infection, I have often felt helpless because I did not know when exactly I would die
Socioeconomic vulnerability: During the Corona (COVID-19) pandemic, the situation of my surrounding environment was…; During the Corona (COVID-19) pandemic, the quality of my family’s and my food was…; During the Corona (COVID-19) pandemic, my workplace has demanded me to…
Level of cognition: I have tried to find thorough information from my family, closest social circles, or information media I knew of; I am aware of information regarding Coronavirus (COVID-19) cases (number of positive cases, implemented policies); I applied physical distancing (by working, studying, and worshipping at home)
C. Measuring Instrument Validity and Reliability
The scale of death and anxiety level was subjected to the validity and reliability test. After questionnaire items were drafted, pilot research was done to test their legibility (referring to the comprehensibility of the context to prospective respondents), validity, and reliability. Due to the nature of the scale of death and anxiety (it is an adaptation of the main work), these tests were necessary to perform.
Researchers applied internal consistency (item homogeneity), which referred to how well a measuring instrument measures a single construct by correlating items with total scores [11], to determine the validity of the items. Kaplan and Saccuzzo [10] stated that there was no rigid rule regarding the threshold of the validity coefficient. Items with validity coefficient within the range 0.3–0.4 are generally considered as having high validity. Results showed in this study that all but one item was considered valid—this one item was then revised.
Reliability is the degree to which an assessment tool produces stable and consistent results [4]. Anastasi and Urbina [18], on the other hand, referred to reliability as the consistency of scores obtained by the same individuals when the test was repeated using the same measuring instrument at different times or using different measuring instruments with equivalent items at the same time. The threshold value for validity is 0.7 [10]. The results showed that items from the dimensions dysphoria, death intrusion, and fear of death, were all considered to be reliable. All items from the avoidance of death dimension, in contrast, were considered to be unreliable. Consequently, none of these items was included in the test, seeing as they might disrupt the reliability of the whole measuring instrument.
D. Scoring System
The scoring system of each variable is described below.
The scale of death anxiety: Consisted of 14 items, five-point (1-5) Likert scale, divided into three dimensions: dysphoria (5 items), death intrusion (5 items), and fear of death (4 items). The maximal score was 70, while the minimum score was 14. A higher total scale of death anxiety score indicated higher COVID-19-related death anxiety level. Researchers would perform a norm-referenced categorization to sort each respondent into rankings before the research
Socioeconomic vulnerability: Consisted of 15 items divided into four aspects: food (6 items), health (3 items), employment (3 items), and social (3 items), nominal-scaled answer choices (respondents chose those fitting them best).
Level of cognition: Consisted of 23 items, five-point (1-5) Likert scale, divided into three dimensions: remembering/knowing (6 items), understanding (6 items), and applying (11 items). The maximal score was 105, while the minimum score was 23. The higher total level of cognition score indicated a higher level of cognition concerning COVID-19. Researchers would perform a norm-referenced categorization to sort each respondent into rankings before the research.
E. Analysis Method
This study applied the descriptive analysis to see the anxiety level of respondents during the pandemic or PSBB period. Results were then reviewed by socioeconomic vulnerability factor and level of cognition factor. This was done to give a more comprehensive description of the main variable (death anxiety). Every analysis within this research was done by IBM SPSS (Statistical Package for the Social Sciences) Statistics version 25.
Result
A. Demographic Analysis
A total of 554 respondents were involved in this research. After screening out for errors in the form-filling process, 520 valid data were obtained, consisting of 200 (38.5%) male respondents and 320 (61.5%) female respondents. A large number of the respondents were within the 20–24 (48.5%) and 25–35 (40.2%) age ranges. Most respondents held a bachelor’s degree (60%), while others either held a high school diploma (27.5%), an associate degree (7.7%), or a master’s degree (4.8%). Respondents were mostly private employees (47%) and students (21.7%)—the rest of them were either laborers, civil servants, service providers, merchants or entrepreneurs, or unemployed.
Based on the demographic data description, the majority of respondents were millennials, which are people of the age range 20–35 years with a bachelor’s degree or a high school diploma, and most of them were either private employees or students.
B. Death Anxiety Level
Before interpreting the death anxiety score, researchers performed a norm-referenced categorization. The results are shown below.
Each respondent’s total score was categorized into five groups, viz. very low (14–15), low (16–29), moderate (30– 38), high (39–49), and very high (50–70). The frequency of each total score was then computed. Results showed that 36 (6.9%) respondents had very low death anxiety level, 196 (37.7%) had low death anxiety level, 156 (30%) had moderate death anxiety level, 100 (19.2%) had high death anxiety level, and 32 (6.2%) had very high death anxiety level. Given that the data was obtained from April to May when the number of positive cases of COVID-19 continued to skyrocket, this can be interpreted in two ways. First, positively: respondents turned out to have optimist feelings and a considerably low level of anxiety during the COVID-19 pandemic, despite the ever-growing number of positive cases. It, however, can also be interpreted negatively: it was also likely that the low level of anxiety contributed to their indifference toward PSBB policies, which required them to limit their mobility and/or outdoor activities. This, of course, required further inspection.
C. Level of Cognition (COVID-19)
Similar to death anxiety level, a norm-referenced categorization was also carried out before interpreting the results (TABLE II). The total score for each dimension was categorized into five groups, viz. very low (6–20 for knowing; 6–19 for understanding; 11–40 for applying), low (21–24 for knowing; 20–23 for understanding; 41–46 for applying), moderate (25–26 for knowing; 24–25 for understanding; 47– 50 for applying), high (27–29 for knowing; 26–29 for understanding; 51–54 for applying), and very high (perfect scores for each dimension—30 for both knowing and understanding, and 55 for applying). The frequency of the total score of each dimension was then computed, and the results are shown below (TABLE III).
Despite the varying knowledge level, respondents generally had a high level of understanding and were able to apply preventive measures to avoid COVID-19 infection. This, however, did not go in line with the news circulating at the time, which reported that there were still a high number of Jabodetabek citizens who did not heed the COVID-19 prevention protocols. KedaiKOPI Survey Institute revealed that while citizens of Jabodetabek perceived the implementation of PSBB as an effective measure, their anticipative measures are considerably lacking [19]. Likewise, Purnama [3] reported that 3300 citizens of Depok violated PSBB policies. Officers detailed that 1500 of them left their houses without wearing masks, 1100 rode motorcycles carrying more than one person each, and 700 drove cars without heeding the seating policy. Altogether, it can be concluded that the respondents’ level of cognition regarding effective measures to avoid COVID-19 transmission fell on the remembering/knowing and understanding level, and had yet to reach concrete behavior (applying) level.
D. Socioeconomic Vulnerability
Each option on the items of socio-economic vulnerability (which described the situation, behavior, and attitude of the respondents) are of the nominal scale. Thus, norm-referenced categorization was not carried out. The analysis results are shown below.
Level of concern related to food needs fulfilment during the pandemic (food aspect): very concerned (10,8%), concerned (24%), slightly concerned (45,6%), not concerned (19,6%)
Level of concern related to adequate healthcare access during the pandemic (health aspect): very concerned (49,2%), concerned (31,3%), slightly concerned (15,6%), not concerned (3,8%)
Ability to take care of insurance and/or additional costs should they be infected by COVID-19 (health aspect): incapable (23,1%), slightly capable (43,8%), capable (31,2%), very capable (1,9%)
Confidence towards their social carrying capacity in facing the pandemic (social aspect): not confident in their ability to solve problems during the pandemic (4,4%), not quite confident in their ability to solve problems during the pandemic (23,8%), confident in their ability to solve problems during the pandemic (60,6%), highly confident in their ability to solve problems during the pandemic (11,2%)
Social support in facing the pandemic (social aspect): not supportive towards the respondent or their family (4,8%), slightly supportive towards the respondent or their family (16,7%), supportive towards the respondent or their family (50,4%), highly supportive towards the respondent or their family (28,1%)
It is important to emphasize the fact that respondents showed a high level of concern regarding their ability to fulfil their food needs and adequate healthcare access. Only 33% of respondents felt that they were capable of paying off their health expenses. In addition, respondents believed that they and their social and environmental condition, including their social carrying capacity and supports towards them and their family, showed mutual support during the pandemic or PSBB period.
In regards to the employment aspect, researchers chose to analyze them further on a separate section, seeing as not every respondent had a profession on their employment demographic attribute. In total, 140 respondents fit this category. The results of the employment aspect analysis are shown below.
Workplace demand during the pandemic: unable to work or dismissed due to the pandemic (3,6%), suspended during the pandemic (3,6%), remain working from the office as per usual (9,3%), Remain working from the office with alternative work arrangements (e.g. alternating between working day and off day) (20%), work from home (85%)
Workplace compensations or policies during the pandemic: unable to work or dismissed due to the pandemic (2,1%), announcements or issues regarding dismissals of some workers (0,7%), reduced basic salary with no benefits (4,3%), full basic salary and no benefits (23,6%), reduced both basic salary and benefits (2,1%), full basic salary and reduced benefits (11,4%), full basic salary and benefits or no visible change (53,6%)
Attitude towards workplace and government policies established during the pandemic: unable to work or dismissed due to the pandemic (2,1%), not fully following the policies, choosing to keep working every day by demanding full compensation (0,7%), would follow the policies and demand for full compensation (19,3%), completely followed the policies without demanding anything (77,9%)
The majority of the respondents’ workplaces had implemented PSBB protocols in a disciplined manner. Most of the respondents did not have their basic salary reduced, though there were reports of some offices adjusting their employee incentives (i.e. food and transportation allowances). This made the employees stick to complying with the appeals and protocols of health and virus transmission prevention from both their workplace and the government.
Discussion and Limitations
It is interesting to note that the convenience sampling researchers carried out attracted a majority of millennial respondents, whose ages were within the range of 25 to 30 years old. It is strongly suspected that this might be caused by the data collection method, which was limited to spreading online questionnaires due to the pandemic situation. In addition, it is also strongly suspected that the digital literacy level of this age group also played a part in their participation.
Recall that the results of norm-referenced categorization of the respondents’ total score of level of cognition were inconsistent with the news circulating at the time this research was conducted. This, coupled with the findings regarding the respondents’ death anxiety level, suggested that the low anxiety level of the respondents might be a form of their indifference towards COVID-19 prevention protocols, despite their understanding of those protocols. On the topic of socioeconomic vulnerability, researchers were only able to analyze those with professions on their employment demographic attributes. No description was able to be obtained from respondents who were not or never employed. These two notions, of course, require further research.
Conclusions and Future Work
Looking at the chosen research method, it turned out that researches have done online (due to a pandemic situation) by utilizing the access to technology, information, and communication that can act as suggestions to refine policies that have been drafted or issued by the government. Those policies could then be evaluated, not only on how the information reached the citizens, but also the impact of such information or interventions given by the government.
Technology certainly plays a significant role as feedback media on things that happened or the implementation of policies in the community. This is crucial, because it may be a benchmark to see if the flow and form of provided information have gone in the expected direction, or are counterproductive. Further research, however, is still needed to find out whether the information provided by the government so far has been enough to make the public aware and compliant towards the health protocols. Results of the research still need to be sharpened, specifically on whether the low level of respondent's anxiety when PSBB is positive feedback on the government policy—related to COVID-19 coping measurements—or it is an indication of indifference towards COVID-19, which in turn might result in the community not complying with the health protocols prepared by the government.
By utilizing technology as a bridge to provide and evaluate information, especially in pandemic periods that do not allow researchers to carry out field data collection, the government can still build a smart society climate. One way to do this is by using a data-based policy approach. For example, the results of this study (which was conducted in April and had the data presented in May) showed that the majority of respondents hoped that there would be a continuous improvement in the quality of service from the government to overcome the impacts of COVID-19, particularly in the aspect of food needs fulfilment and adequate access to health facilities. Until now, social works (meeting food needs) and the rapid increase in mass tests (health aspects) are the evidence that with the right data (such as the data this research provided), the government would still be able to create a smart governance climate in developing appropriate policies based on real evidence (data) from the community (in this case Jabodetabek), despite the existence of the pandemic.
ACKNOWLEDGEMENT
The contents reflect only the authors’ view and not the views of the Provincial Government of DKI Jakarta. The author declares there is no competing financial interest.