Physicians’ Health-Related Quality of Life and Its Associated Factors During COVID-19 Pandemic in Jordan: A Cross-Sectional Study

Abstract

Healthcare workers worldwide have been exposed to extraordinary stress during COVID-19 pandemic. This study aimed to investigate health-related quality of life (HRQoL) level and its health and occupational associated factors among Jordanian physicians during COVID-19 pandemic. A cross-sectional design using an online survey was adopted targeting physicians at different Jordanian hospitals. The study survey included demographics, HRQoL measured by 12-item Short Form health survey (SF-12) mental and physical components, physicians’ evaluation of work conditions during COVID-19, Neck Disability Index (NDI), Depression Anxiety Stress Scale (DASS 21), and International Physical Activity Questionnaire (IPAQ). Descriptive analyses were conducted to summarize primary data. Factors associated with HRQoL were determined using a multiple variable regression analysis. In total, 326 physicians successfully completed the survey, 44.2% were males with mean age of 32.08 (±6.93). SF-12 mental component mean was 52.13 (±20.84) and physical component mean was 69.24 (±18.1). Physicians HRQoL level was significantly associated with levels of stress (β = −0.23, 95% CI −1.05 to −0.27), depression (β = −0.22, 95% CI −1.09 to −0.28), neck disability (β = −0.30, 95% CI −1.08 to −0.57), health self-evaluation (β = 0.14, 95% CI 1.66–7.87), sleep self-evaluation (β = 0.09, 95% CI 0.16–3.58), and physical activity level (β = 0.09, 95% CI 0.00–0.001). Jordanian physicians’ level of HRQoL was relatively low during COVID-19. Healthcare facilities administrators should take into consideration factors associated with physicians’ HRQoL level when planning for future healthcare emergencies.

Keywords

Introduction

A health pandemic might impose occupational risks on healthcare providers of various fields (Sassmannshausen et al., 2016; Wester & Giesecke, 2019). Examples of such pandemics included influenza H1N1 in 2009, followed by the Ebola virus in west Africa in 2014, and most recently COVID-19 in 2019 (De Brier et al., 2020; Wester & Giesecke, 2019; S. Y. Wong et al., 2012). The rapid increase in incidence of such emerging infectious pandemics can burden even well-developed healthcare systems (Arabi et al., 2020; De Brier et al., 2020; Xie et al., 2020).

Jordan is a small country in the Middle East region that owns well-established governmental and private healthcare systems (Sbeih & Asad, 2016). It is estimated that there are about 28.6 physicians for every 10,000 Jordanian citizens, which means that the total number of Jordanian physicians is about 28,000 (Nazer & Tuffaha, 2017). Early at the beginning of COVID-19 pandemic, Jordan started its COVID-19-related safety procedures on February 27^th, 2020. These procedures reached their peak by closing all public and private sectors components including schools, restaurants, and worshiping places on March 18^th (Almhdawi, Obeidat, et al., 2021; Malkawi et al., 2020). During COVID-19, the majority of Jordanian physicians particularly those working in the governmental sector (such as ministry of health) were directly or indirectly involved in serving COVID-19 patients. Consequently, extreme physical demand and mental distress were imposed on most Jordanian governmental and private healthcare physicians of all specialties (Almhdawi, Alsalem, et al., 2021; Almhdawi, Jaber, et al., 2021; Kheirallah et al., 2020; Saadeh et al., 2020).

Health pandemics usually evoke huge public concerns and exert psychological stress and discomfort in particular on the medical personnel and healthcare providers (De Brier et al., 2020). Hospitals healthcare providers are usually pressured due to the fact that they are susceptible to be infected and hence transmit the infection to their families (C. C. Zhang et al., 2020). Additionally, healthcare providers might experience stress, anxiety, and insomnia related to the stressful work-related conditions during pandemics (De Brier et al., 2020). High rates of mental health deficits and sleep problems among healthcare providers are frequently cited in the literature (Chong et al., 2004; Sassmannshausen et al., 2016). Similarly, the current COVID-19 pandemic showed high level of stress on the mental health of hospital physicians and other healthcare professionals (Almhdawi, Alazrai, et al., 2021; S. K. Brooks et al., 2020; Huang et al., 2020; Xiang et al., 2020).

Hospitals work environment is thought to be a risk factor for poor level of health-related quality of life (HRQoL) (Kumar et al., 2018). Assessing health-related quality of life (HRQoL) is considered a valuable tool to evaluate the health status in healthy population of various occupational groups including healthcare providers (Oyama & Fukahori, 2015). The 12-item Short Form health survey (SF-12) is a widely used scale in the literature characterizing the level of different occupational groups’ HRQoL (Ware et al., 1996). A recent study used SF-12 scale suggested that physicians and healthcare workers demonstrated low levels of HRQoL particularly among female practitioners (S. X. C. Zhang et al., 2020). Similarly, many studies reported high levels of occupational stress and emotional distress among physicians (Mahmood et al., 2019; Mata et al., 2015; Romani & Ashkar, 2014; Tyssen & Vaglum, 2002). About 29% of physicians around the world are thought to have depressive symptoms (Mata et al., 2015). Furthermore, many studies cited a relatively low level of HRQoL among physicians worldwide even outside of pandemic periods (Pulcrano et al., 2016; Schwartzmann, 2007; Tong et al., 2012). It is important to understand the level of HRQoL among physicians along with its associated factors worldwide during COVID-19 pandemic. To our knowledge, such studies using a comprehensive set of standardized assessments have not been conducted in Jordan and are very limited in the world (Buselli et al., 2020; El-Hage et al., 2020).

This study aimed to assess HRQoL level among physicians in Jordan during the COVID-19 pandemic. Secondarily, this project aimed to identify HRQoL significantly associated factors out of the collected occupational, health, and demographical data. We hypothesized that physicians will demonstrate low levels of HRQoL during COVID-19. Additionally, we hypothesized that physicians’ HRQoL will be significantly associated by their mental and physical health status, work stressors, sleep quality, diet quality, and physical activity level. This study appeared warranted and could help in better planning for similar future pandemics.

Methods

Design and Sample

In this study, a cross-sectional descriptive-design survey was created and targeted physicians working at different hospitals and/or clinics in Jordan. Participants were eligible if they were full-time physicians of any specialty, working at private or governmental settings in Jordan, and aged between 24 and 75 years. Exclusion criteria for this study were self-reported long-term use of analgesic medications, chronic history of psychiatric disorder, or physical disability preventing ambulation or responding to the survey. Using G-power (with an average of 15 predictors and effect size of 0.15), a minimum sample size of 139 physicians was required to guarantee statistical power of 80% (Faul et al., 2009).

Procedures

An online survey utilizing Google Forms was prepared and its link was sent to physicians asking to participate in the study. The study link was posted on many social media pages and professional websites popular among Jordanian physicians. Furthermore, the study link was directly sent to potential participants using mobile messages applications. The respondents had to fill all of the survey sections as submissions required full responses for all questions. Potential participants were able to respond to the survey using their smartphones or personal computers and tablets. Participants had the option to withdraw from the study at any point without any consequences or responsibilities. All procedures of this study were approved by Institutional Review Board (IRB) at Jordan University of Science and Technology (JUST) - Irbid, Jordan, under approval number 127/132/ 2020. Participants were informed about the study aims and procedures and then were asked to sign the electronic consent forms prior to their participation.

Outcome Measures

All parts of the study questionnaire were self-administered. To safeguard content validity of the study questionnaire, literature review and expert research team discussions were used. Furthermore, the study questionnaire was piloted on 10 physicians whose data were not included in the final analysis of the study. Pilot study participants reported that the questionnaire was clear and easy to follow and it took them about 15 minutes to complete.

The first section of the questionnaire included sociodemographic data and questions evaluating lifestyle and work stressors during COVID-19. Work stressors during COVID-19 were assessed using nine Likert scaled statements with scores from 1 to 5 being 1 is extremely disagree and 5 is extremely agree. As demonstrated in Table 2, examples of used work stressors statements include “COVID-19 affected my daily life balance,” “COVID-19 increased my work stress,” and “COVID-19 increased my fears of infections”. A score of 3 indicates being neutral about the work stressors scale statement. This study Likert assessment of work stressors proved to be valid and internally consistent as Cronbach’s alpha coefficient was 0.74.

Furthermore, the following standardized outcome measures were included in the study questionnaire:

Medical Outcomes Study Short Form (SF-12): This self-administered assessment contains 12 questions and measures the level of HRQoL. The measure, which proved to be valid and reliable, has a total score (SF-12 total) out of 100, a physical component score (PCS) out of 100, and a mental component score (MCS) out of 100. Higher scores on SF-12 suggest better levels of HRQoL (Al Sayah et al., 2013; Ware et al., 1996).

Depression Anxiety Stress Scale (DASS21): This is a self-reported measure which assesses the severity of mental health symptoms including sub-scores for depression, anxiety, and stress. Higher scores on this measure indicate worse levels of mental health symptoms. DASS21 cutoff scores indicating the presence of mental health symptoms are 9 for depression, 7 for anxiety, and 14 for stress. Any score higher than these points suggests a mild level or higher level of the corresponding symptoms (Lovibond & Lovibond, 1995; Patrick et al., 2010). DASS21 proved to be reliable, valid, and internally consistent (Almhdawi et al., 2018; Brown et al., 1997). Analyses on DASS21 scale in this study data set showed that it demonstrated acceptable to good internal consistency as its Cronbach Alphas were 0.84 for depression subscale, 0.77 for anxiety subscale, and 0.88 for stress subscale.

Neck Disability Index (NDI): This measure proved to be a valid and reliable tool to evaluate the effect of neck pain on daily activities functional limitations. The score of the measure ranges from 0−50, a score of 5 or greater indicates a mild neck disability with higher scores suggesting presence of more disability due to neck pain (Vernon & Mior, 1991). Analysis on NDI scale in this study data set showed that it demonstrated good internal consistency as its Cronbach Alpha was 0.82.

The International Physical Activity Questionnaire (IPAQ): This tool assesses physical activity level and has a total MET score with three categories of physical activity level including high, moderate, and low. The measure has shown good reliability and criterion validity (Citko et al., 2018; Craig et al., 2003; Powell et al., 2011).

Statistical Analysis

Data was analyzed using SPSS statistical software, version 23. Study data was presented descriptively using means and standard deviations or frequencies and proportions. Pearson bivariate correlations between HRQoL (measured by SF-12 total scores) and the proposed associated factors were conducted (see Supplementary Table 1). Each variable with a bivariate correlation significance of p ≤ 0.20 was included in the regression model (Marill, 2004; Stoltzfus, 2011). First, the collected data was checked for normal distribution and collinearity, by using the variance inflation factor (VIF) (Marquaridt, 1970). Then, a multiple variable linear regression analysis was performed to identify factors that have significant associations with HRQoL using a stepwise function. Beta coefficients along with 95% confidence intervals (95% CI) were reported for all significant associated factors, in which p-value of ( < 0.05) was considered statistically significant in all of the study analyses.

Results

Participants’ Characteristics

Due to the setup the researchers made, Google Forms only recorded fully completed submissions of all questions by respondents. In total, 326 physicians of all Jordanian medical sectors and specialties successfully completed all of the study survey sections with a mean age of 32.08 (±6.93) ranged between 24−70 years and 44.2% of them were males. Participants’ work experience ranged between 1 and 45 years (6.75 [± 6.32]). Participants reported about 14 hours drop in their weekly working hours during the pandemic and about 77.6% reported never receiving official infection control training.

Participants’ Health Characteristics During COVID-19

Out of participants, 38 (11.7%) physicians reported having medical comorbidities. Participants’ SF-12 MCS mean score was 52.13 (±20.84) and PCS mean score was 69.24 (±18.1). The overall DASS subscales mean scores were 17.75 (±5.67) indicating moderate depression, 15.76 (±3.61) indicating severe anxiety, and 18.13 (±6.04) indicating moderate stress. The overall NDI mean score was 7.83 (±6.25) suggesting a mild neck disability among the group. The majority of participants (61.0%) reported a low physical activity level, poor sleep quality (58,3%), and sort of healthy diet habits (75.8%) during the pandemic. Table 1 shows participants’ health characteristics during COVID-19 pandemic.

Table 1.

Participants’ Characteristics.

Characteristic		Mean (SD) or n (%)
Age (years)		32.8 (6.93)
Gender	Male	144 (44.2%)
Gender	Female	182 (55.8%)
Work place	Ministry of Health	162 (49.7%)
	Military	65 (19.9%)
	University	58 (17.8%)
	Private	41 (12.5%)
Medical specialty	Family medicine	97 (29.8%)
	Ophthalmology	37 (11.3%)
	General practitioner	34 (10.4%)
	Pediatrics	27 (8.3%)
	Internal medicine	19 (5.8%)
	Radiology	17 (5.2%)
	Other specialties	95 (29%)
Experience (years)		6.75 (6.32)
Weekly working hours prior to COVID-19		42.8 (21.84)
Weekly working hours during COVID-19		28.44 (22.94)
Infection control training	No	253 (77.6%)
Infection control training	Yes	73 (22.4%)
BMI		26.28 (4.38)
Smoking cigarette	No	275 (84.4%)
Smoking cigarette	Yes	51 (15.6%)
Medical comorbidities	No	288 (88.3%)
Medical comorbidities	Yes	38 (11.7%)
Sleep quality self-evaluation	Uncomfortable/irregular	190 (58.3%)
Sleep quality self-evaluation	Comfortable	136 (41.7%)
Health status self-evaluation	Bad	8 (2.5%0
	Good	217 (66.6%)
	Excellent	101 (31%)
Diet self-evaluation	Unhealthy	58 (17.8%)
	Sort of healthy	247 (75.8%)
	Healthy	21 (6.4%)
DASS	Depression	17.75 (5.67)
	Anxiety	15.76 (3.61)
	Stress	18.13 (6.04)
SF-12	MCS	52.13 (20.84)
	PCS	69.24 (18.1)
	Total	59.15 (17.37)
NDI score		7.83 (6.25)
IPAQ total score		1165.41 (2427.19)
IPAQ category	Low	199 (61.0%)
	Moderate	97 (29.8%)
	High	30 (9.2%)

n: number, SD: Standard Deviation, BMI: Body Mass Index, DASS: Depression, Anxiety, Stress Scale, SF-12: 12-item Short-Form Health Survey, MCS: Motor Component Summary, PCS: Physical Component Summary, NDI: Neck Disability Index, IPAQ: International Physical Activity Questionnaire.

Work-Related Stressor During COVID-19

Physicians in this study perceived their work demands during COVID-19 as relatively stressful as their overall mean score of work-related stress scale was 3.37 (±0.68). Physicians’ biggest fear was related to getting themselves or families infected due to their work tasks during the pandemic (4.36 ± [0.95]). Table 2 demonstrates participants’ evaluation of their work-related stressors during COVID-19 pandemic.

Table 2.

Work-Related Stressors During COVID-19 Pandemic.

^aWork Stressor	Mean (SD)
COVID-19 affected my daily life activities balance	3.71 (1.21)
COVID-19 increased my work stress	3.29 (1.24)
COVID-19 increased my work load	2.4 (1.19)
COVID-19 increased my out of work consultations	3.39 (1.27)
COVID-19 increased my fears of infection	4.36 (0.95)
COVID-19 increased difficulty to reach work	2.53 (1.35)
COVID-19 increased difficulty of dealing with patients	3.5 (1.12)
There were no enough available medical supplies during COVID-19	3.37 (1.16)
There was no enough available infection control equipment during COVID-19	3.74 (1.21)
Total work-stressors mean score	3.37 (0.68)

SD: Standard Deviation.

^aQuestions answered based on a Likert scale from 1 to 5, in which 1 means strongly disagree and 5 means strongly agree.

Factors Associated With HRQoL Level

Pearson correlations between HRQoL and study variables identified factors used in the initial multiple variable regression model. These variables included gender, age, practicing level (specialist or GP), experience, type of work setting, sport hours/week, nigh sleep hours, cigarette smoking, sleep quality self-assessment, health status self-assessment, diet quality self-assessment, presence of physical illness, work hours/week prior to COVID, and work hour/week during COVID. Furthermore, the initial regression model included effects of COVID on daily life activities, workload, fear of infection, commuting to workplace, difficulties with patients, and availability of medical equipment and consumables. The initial regression model also included levels of depression, anxiety, stress, neck pain, neck disability, and physical activity.

The study final regression model significantly explained 51.5% of variance in HRQoL level among physicians during the pandemic (r2=0.515, F = 56.49, p < 0.001). It appeared that increased levels of depression (β = −0.22, 95% CI −1.09 to −0.28), stress (β = −0.23, 95% CI −1.05 to −0.27), and neck disability (β = −0.30, 95% CI −1.08 to −0.57) were negatively associated with HRQoL level. On the other hand, better health status (β = 0.14, 95% CI 1.66–7.87), sleep quality (β = 0.09, 95% CI 0.16–3.58), and physical activity level (β = 0.09, 95% CI 0.00–0.001) were positively associated with HRQoL level. Table 3 shows the factors were significantly associated with HRQoL level among Jordanian physicians during COVID-19.

Table 3.

Multivariable Regression Analysis Between Health-Related Quality Of Life Measured by SF-12 Total Score and Its Associated Factors.

Factor	β Coefficient	95% Confidence Interval		p-value
DASS stress	−0.23	−1.05	−0.27	0.001
NDI-TOTAL	−0.30	−1.08	−0.57	<0.001
Health status self-evaluation	0.14	1.66	7.87	0.003
DASS depression	−0.22	−1.09	−0.28	0.001
IPAQ total	0.09	0.00	0.001	0.028
Sleep quality self-evaluation	0.09	0.16	3.58	0.033

SF-12: 12-item Short-Form Health Survey, DASS: Depression, Anxiety, Stress Scale, NDI: Neck Disability Index, IPAQ: International Physical Activity Questionnaire.

Discussion

This study primarily aimed to investigate the level of HRQoL among Jordanian physicians and identify its associated factors during COVID-19 pandemic. Although HRQoL was never studied among Jordanian physicians, this current study participants’ HRQoL level during COVID-19 (measured by SF-12) is considered relatively low compared to the general adult population around the world (Campolina et al., 2018; Gandek et al., 1998; Mols et al., 2009; Ware et al., 1998). Furthermore, this study’s participants’ average mean scores of DASS depression, anxiety, and stress suggested mild to severe levels of these mental health symptoms. Physicians in this study have also demonstrated significant level of neck disability and reported relatively poor lifestyle characteristics during the COVID-19 pandemic. This study also found that mental health symptoms, neck disability, and poor lifestyle habits were significantly associated with physicians’ HRQoL level during COVID-19 pandemic.

Many recent studies targeted exploring distress affecting physicians and other healthcare professionals during COVID-19 (Alanazi et al., 2021; Dehon et al., 2021; Froessl & Abdeen, 2021). Very few articles specifically evaluated physicians’ level of quality of life using standardized quality of life outcome measures (Chalhub et al., 2021; Ungureanu et al., 2020). However, this current study is unique as it has evaluated the level of HRQoL among physicians in COVID-19 and many of its potential influencing factors using a comprehensive set of standardized assessments better than similar recent studies. In addition to demographics and validated work stressors evaluation, this current study incorporated standardized outcome measures targeted HRQoL, mental health symptoms, neck pain and its related disability, and physical activity level. Possibly, this study provided the most comprehensive assessment of physical and mental health factors conducted on physicians during COVID-19. Although the used outcome measures might be interrelated, the used statistical model (stepwise multiple variable regression) secured controlling for shared variance in this study.

Many studies documented that physicians are subjected to high levels of burnout and occupational stress (Rotenstein et al., 2018). Participants of this current study perceived their work demands stressfully during COVID-19. Interestingly, the majority of Jordanian physicians in this study reported a high level of concern related to the possibility of getting themselves or beloved ones infected due to their work environment. At the same time, a surprising and relatively shocking finding in this study indicated that the majority of participants have never received official training on infection control prior to the pandemic. Recent COVID-19 reports similarly indicated a high mental stress level among physicians, nurses, and hospital-based personnel (Huang et al., 2020; Liu et al., 2020; S. Y. Wong et al., 2012; Xiang et al., 2020). Working at high risk environment was associated with poor mental health outcome (Brooks et al., 2018). Employees who worked at high-risk units during SARS reported high stress and avoidance levels (Chen et al., 2005; McAlonan et al., 2007; Wu et al., 2009).

Probably due to variations in outcome measures, culture, and healthcare systems, studies worldwide related to physicians’ HRQoL out of health pandemic periods have some controversy. Although most worldwide studies claimed that physicians level of HRQoL is relatively low, few studies claimed that their HRQoL level is good (Azevedo & Mathias, 2017; Hyman et al., 2017; Pulcrano et al., 2016). A recent study published in 2020 using SF-12 revealed that the Iranian physicians and healthcare workers showed very low levels of HRQoL particularly among females (S. X. C. Zhang et al., 2020). Pappa et al. stated in their review that the prevalence of depression and anxiety during COVID-19 were 22.8% and 23.2%, respectively, (Pappa et al., 2020). The same study showed that the prevalence of insomnia was 34.32% (Pappa et al., 2020).

Physicians from Spain and Brazil have also reported significant levels of compassion fatigue, burnout, income reduction, and poor health and lifestyle changes (such as weight gain and decreased physical activity) during COVID-19 (Gomes et al., 2020; Ruiz-Fernández et al., 2020). Many studies published recently showed that high level of psychological distress was found among physicians and healthcare workers during COVID-19 pandemic (Chen et al., 2020; Chew et al., 2020; Lai et al., 2020; W.-R. C. Zhang et al., 2020). A systematic review of SARS pandemic-related studies encouraged healthcare workers to be prepared to face the serious health challenges of potential infectious health pandemics. The review stated that individuals at risky environments are more likely to report poor sleep quality, fear of social contact, health worries along with significant depression, anxiety, and stress levels (Brooks et al., 2018). Another study conducted in Germany reported that about 28% of health care providers were willing to skip work during the Influenza pandemic to protect themselves and their families (Ehrenstein et al., 2006). Similar results were found in other studies demonstrating increased fear of infection and high levels of mental stress during previous health pandemics (Balicer et al., 2006; Qureshi et al., 2005; Wong et al., 2008).

This current study determined HRQoL level among Jordanian physicians along with its associated occupational and health predictors during COVID-19 pandemic. Our findings might help improve the understanding of physicians’ occupational health under extraordinary stressful situations and to enhance future healthcare emergency planning. To our knowledge, this is the first study of its kind to evaluate Jordanian physicians’ level of HRQoL and its associated factors during COVID-19.

Healthcare administrators and stakeholders should consider physicians’ health and quality of life when planning for future pandemics and emergencies. One option that might decrease stressors imposed on physicians during such health emergencies is utilizing remote health delivery methods such as websites, mobile applications, and telemedicine (Cannon et al., 2021; Nudi et al., 2021). Furthermore, mental health interventions and counseling services should be available for physicians to improve their mental health status and quality of life in similar future emergencies (Fiest et al., 2021; Kisely et al., 2020).

Limitations and Future Directions

The first limitation of this study is that it could have a potential bias toward physicians with good technological skills enabled them to access the online survey. Secondarily, the representation of various medical specialties could have been improved adopting a cluster sampling technique. Additionally, researchers of this study were not able to report response rate using the online survey, as there were no records of those who did not agree to participate, did not fit inclusion/exclusion, or dropped. The study was also limited due to the lack of data collected on the exact involvement of each physician with COVID-19 patients and data on COVID-19 infections among physicians and their families. Furthermore, the majority of collected data was self-reported. However, all of the used outcome measures were standardized as self-administered tools with robust psychometric properties and were a good fit for the online survey. As COVID-19 is still the focus of the healthcare systems worldwide, longitudinal studies (with ecological or cohort designs) that might assess the progressive nature of HRQoL and well-being among physicians are encouraged in addition to studies that target clinical interventions aiming to enhance physicians’ health and well-being.

Conclusions

This study found a relatively low HRQoL level among Jordanian physicians during the COVID-19 pandemic. Study participants have also showed poor sleep quality, low physical activity levels, high level of work-related stress, high levels of mental health symptoms (depression, anxiety, and stress) and mild level of neck disability. The study also demonstrated that HRQoL level was significantly associated with mental health symptoms, neck disability, and lifestyle habits. Physicians’ health and well-being and its associated factors should be carefully considered by healthcare administrators and stakeholders in Jordan. The study findings might also help in healthcare planning for similar future pandemics. Clinical studies targeting improving physicians’ HRQoL and occupational health are encouraged in the future.

Supplemental Material

sj-pdf-1-ehp-10.1177_01632787211068899 – Supplemental Material for Physicians’ Health-Related Quality of Life and Its Associated Factors During COVID-19 Pandemic in Jordan: A Cross-Sectional Study

Supplemental Material, sj-pdf-1-ehp-10.1177_01632787211068899 for Physicians’ Health-Related Quality of Life and Its Associated Factors During COVID-19 Pandemic in Jordan: A Cross-Sectional Study by Khader A. Almhdawi, Hassan Alrabbaie, Alaa Arabiat, Ahmad T. Alhammouri, Mohamed Hamadneh, Donia Obeidat, Alza Alazrai, Hanan Jaber, and Khaled M. Almousa in Evaluation & the Health Professions

Footnotes

Acknowledgments

We would like to express our deep appreciation for participating physicians for sharing their valuable time responding to our study survey.

Author Contributions

All authors contributed in the conceptual foundation of the study in terms of its rationale, design, data collection, analyses, discussion, and interpretation. All authors read and approved the final manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by Jordan University of Science and Technology under grant number 20200380.

Ethical approval

All procedures performed in this study were in accordance with Helsinki Declaration and institutional review board at Jordan University of Science and Technology (JUST) - Irbid, Jordan ethical standards under approval number 127/132/ 2020.

Informed consent

Written informed consent was obtained from all participants prior to their participation.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

ORCID iD

Khader A. Almhdawi

Supplemental Material

Supplemental material for this article is available online.

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