COVID-19 Regulations Measure

Abstract

The COVID-19 Regulations Measure (Hughes et al., 2023) is an informant-report psychometric instrument designed to assess parental perceptions of young children’s comprehension of and emotional reactions toward non-pharmaceutical public health interventions during the COVID-19 pandemic. Developed by an international team within the i-FAM COVID-19 Consortium, the scale specifically targets children between the ages of 3 and 8 years across diverse geopolitical and cultural contexts, including Australia, China, Italy, Sweden, the United Kingdom, and the United States. The measure operationalizes two distinct psychological dimensions across five salient pandemic-related rules or situations: (1) Understanding, indexed by the frequency with which a child requires parental reminding to comply with public health mandates, and (2) Negative Feelings, indexed by the frequency of child anxiety or behavioral resistance toward those same rules.

Each of the five targeted situations—frequent handwashing for 20 seconds, physical distancing of two meters, staying at home, school closures, and prohibitions on visiting family and friends—is evaluated simultaneously across both dimensions using dedicated 3-point rating formats. For Sweden, an additional “not applicable” category was integrated to accommodate the country’s unique non-lockdown public health strategy. Psychometric evaluations demonstrate acceptable to good internal consistency across diverse national translations (English, Chinese, Italian, and Spanish), with Cronbach’s alpha coefficients for the Understanding subscale ranging from α = .66 in Italy to α = .75 in China, and for the Negative Feelings subscale ranging from α = .75 in the United States to α = .80 in China. By quantifying the cognitive and affective impact of community-level health restrictions on pediatric populations, the instrument serves as an essential tool in developmental psychopathology, family psychology, and pediatric epidemiology.

Keywords

COVID-19 Regulations Measure, Child Health Psychology, Health Knowledge, Comprehension, Negative Emotions, Anxiety, Compliance, Behavioral Resistance, Parent Report, Early Childhood, Social Psychology, Cross-Cultural Psychometrics

Authors

The COVID-19 Regulations Measure was formulated and validated by an international collaborative research team affiliated with the i-FAM COVID-19 Consortium:

• Claire Hughes, Ph.D. — Centre for Family Research, Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
• Luca Ronchi, Ph.D. — Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy ([email protected]).
• Jean Heng, Ph.D. (ORCID: 0000-0002-8083-0930) — Centre for Family Research, Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
• Chiara Basile, M.Sc. — Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
• Paola Del Sette, M.Sc. — Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
• Serena Lecce, Ph.D. — Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
• The i-FAM COVID-19 Consortium — Multi-institutional international network investigating familial resilience and child adaptation during the SARS-CoV-2 health crisis.

Correspondence regarding the instrument and its cross-cultural implementations should be directed to Dr. Luca Ronchi at the Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Piazza Botta 6, 27100 Pavia, Italy.

Purpose

The primary clinical and empirical purpose of the COVID-19 Regulations Measure is to provide a brief, psychometrically sound, parent-report assessment of how young children cognitively interpret and affectively navigate structural public health restrictions. The onset of the COVID-19 pandemic precipitated unprecedented global disruptions to normative childhood routines through non-pharmaceutical interventions (NPIs) such as mandatory quarantine, prolonged kindergarten and elementary school closures, rigorous sanitization protocols, physical distancing mandates, and severe limitations on physical socialization with extended family and peers (Hughes et al., 2023).

While extensive epidemiological and adult psychometric instruments rapidly emerged to quantify adult fear, disease vulnerability, and economic stress, standard developmental assessments lacked targeted mechanisms to quantify the subjective experience of preschool and early-elementary-aged children (ages 3 to 8). Children in this developmental bracket possess emergent but rapidly developing capacities for theory of mind, cognitive reappraisal, and causal reasoning regarding health and illness. Consequently, they experienced social distancing and institutional closures not merely as hygienic strategies, but as complex, disorienting shifts in their physical and relational ecologies.

The theoretical rationale underpinning this measure centers on the assumption that child compliance and psychological adjustment during large-scale societal crises are governed by two distinct psychological pathways: cognitive internalization (comprehension and self-regulatory execution) and affective reactivity (anxiety, oppositional resistance, and emotional distress). By capturing parental observations across both dimensions, researchers can assess:

• The direct and indirect associations between governmental restriction stringency and child psychosocial well-being;
• The mediating and moderating roles of child understanding in mitigating or amplifying parental stress;
• The degree to which children’s affective resistance or compliance relates to their prosocial development, internalizing symptoms, and externalizing behaviors;
• Cross-cultural divergences in child adjustment, especially when comparing countries with strict legal enforcement (e.g., Italy, China, the UK) to regions utilizing voluntary, recommendation-based mitigation strategies (e.g., Sweden).

Psychological Construct

The instrument operationalizes two interrelated, yet functionally distinct, developmental dimensions across five standardized pandemic-related behavioral domains:

1. Child Understanding of Regulations

Within developmental cognitive psychology, rule comprehension in early childhood transitions from external behavioral scaffolding to internalized self-regulation (Vygotskian internalization). In the COVID-19 Regulations Measure, Understanding is operationalized behaviorally through the frequency of external parental reminders required for the child to execute the mandate. Higher scores reflect autonomous executive function and internalized health concepts, where the child adheres to the regulation without parental prompting.

This dimension evaluates the child’s ability to maintain cognitive representations of novel social expectations across five everyday health practices:

• Hygiene Behaviors: Remembering to wash hands thoroughly for a minimum of 20 seconds;
• Spatial Navigation: Actively monitoring and maintaining physical distance (2 meters / 6 feet) from non-household members;
• Confinement Compliance: Comprehending and accepting the physical boundary of remaining within the domestic home environment;
• Institutional Adaptation: Recognizing that physical school closure represents a health measure rather than routine vacation or permanent abandonment;
• Relational Distance: Integrating the social restriction against visiting or receiving visits from peers and extended family members (such as grandparents).

2. Negative Feelings Toward Regulations

The affective dimension captures the child’s emotional dysregulation, internalizing tension, or externalizing opposition provoked by public health mandates. Young children often manifest distress surrounding sudden rule enforcement through two primary affective modes: anxious withdrawal (hyperarousal, somatic complaints, fear of contamination, or fear of punitive consequences) and behavioral resistance (temper tantrums, defiance, oppositional protests, and intentional rule-breaking).

Rather than separating internalizing anxiety from externalizing defiance, the scale synthesizes these expressions into a single index of affective friction against regulatory control. A high score on this subscale indicates that the child experiences heightened psychological distress, perceived loss of autonomy, or emotional resistance when confronted with public health limitations on their mobility, hygiene habits, and interpersonal relationships.

Theoretical Framework

The COVID-19 Regulations Measure is grounded in a convergence of three major theoretical perspectives within developmental science and social epidemiology:

1. Bioecological Systems Theory

Under Bronfenbrenner’s bioecological model, child development is shaped by interactive layers ranging from the microsystem (family, home routines) to the macrosystem (governmental policy, cultural ideologies, pandemic containment laws) and the chronosystem (socio-historical crises). Pandemics disrupt the proximal processes within the child’s microsystem by altering the nature of parent-child interactions, schooling, and peer contact. The COVID-19 Regulations Measure evaluates how macrosystemic mandates permeate the child’s proximal interactions and behavioral routines.

2. The Family Stress Model and Emotional Transmission

Derived from Conger’s Family Stress Model, parental distress stemming from macroscopic crises (such as economic instability, health threats, and confinement) undermines parenting quality and escalates child emotional reactivity. Hughes et al. (2023) utilized this framework to demonstrate that children’s negative feelings toward and understanding of societal restrictions operate as key mediators between pandemic-induced family disruption and child behavioral outcomes, including prosociality and emotional stability.

3. Cognitive Developmental Theory and Conceptions of Illness

Drawing on Piagetian developmental stages and modern executive function research, children aged 3 to 8 are transitioning from pre-operational to concrete operational thought. Young children often view illness through phenomenism or contagion based on superficial perceptual cues. Complex biological mechanisms (e.g., asymptomatic viral transmission, airborne particles) are cognitively abstract. Consequently, requiring children to stay away from healthy-appearing grandparents or maintain precise physical distances challenges their early causal models of the physical and biological world, often provoking behavioral confusion or affective frustration.

Validity

Initial validation of the COVID-19 Regulations Measure was conducted within the international multisite study led by Hughes et al. (2023), which gathered data from large cohorts of parents across six countries (Australia, China, Italy, Sweden, the UK, and the USA). Although formal exploratory and confirmatory factor analyses specifically dedicated to this brief five-item measure were not published independently in the primary report, the scale demonstrates robust psychometric validity across multiple dimensions:

Content and Face Validity

The five items were developed by international developmental psychologists to directly mirror the standard Non-Pharmaceutical Interventions (NPIs) recommended by the World Health Organization (WHO) and implemented by national health agencies during 2020–2021. The dual-stem approach ensures high face validity, as parents routinely observe both behavioral adherence (need for prompting) and overt emotional displays (distress, pushback) during their daily routines.

Construct and Criterion Validity

Construct validity is substantiated through structural equation modeling (SEM) and regression analyses in Hughes et al. (2023). Children’s understanding and emotional reactions functioned as coherent psychological indicators within broader models examining family disruption, parental stress, and child adjustment:

• Mediation Effects: The subscales successfully mediated the relationship between pandemic-related family disruption and child prosocial behavior, confirming that the measure captures meaningful variance in pediatric socioemotional functioning;
• Convergent Associations: Heightened Negative Feelings correlated positively with parental reports of child emotional difficulties, conduct problems, and overall household chaos;
• Developmental Sensitivity: Age gradients emerged predictably, with older children (6–8 years) exhibiting higher Understanding (requiring fewer reminders) compared to younger preschool children (3–5 years), consistent with known developmental trajectories of executive function and memory capacity.

Ecological and Cross-Cultural Validity

A critical psychometric strength of the instrument is its adaptability to divergent cultural and legal landscapes. The inclusion of a “Not Applicable” category for the Swedish cohort reflects high ecological validity, recognizing that Sweden did not enforce mandatory school closures or national stay-at-home orders for children in this age range, avoiding artificial response distortion.

Reliability

Internal consistency for both subscales was systematically evaluated across diverse language adaptations and geographic cohorts by Hughes et al. (2023). Despite the brief length of each subscale (5 items per dimension) and the restricted 3-point rating format, the scale demonstrated acceptable to good reliability across international samples:

Internal Consistency Coefficients

• Understanding Subscale:
  • Italy: α = .66
  • China: α = .75
  • Across other international subsamples (Australia, UK, US), values consistently fell within the α = .66 to .74 range, acceptable for short 5-item screening scales within developmental field studies.
• Negative Feelings Subscale:
  • United States: α = .75
  • China: α = .80
  • Across European and Australasian cohorts, internal consistency remained stable between α = .73 and .79, reflecting high item homogeneity in capturing child emotional resistance and anxiety across public health contexts.

Because the measure was deployed during a fluctuating global crisis characterized by rapid changes in government restrictions, test-retest reliability was intentionally not calculated over long temporal windows; shifts in scores over time reflected genuine changes in community-level quarantine mandates rather than psychometric instability.

Factor Analysis

The five items of the COVID-19 Regulations Measure were conceptualized within a two-dimensional, cross-classified framework where each situational rule is evaluated along two primary psychological axes: Cognitive Regulation / Comprehension and Affective Distress / Resistance.

In the primary empirical investigation (Hughes et al., 2023), the scale was incorporated into structural mediation models rather than standalone factor-analytic studies. Theoretical modeling and psychometric evaluations of analogous parent-report compliance scales suggest a two-factor oblique structure:

• Factor 1: Cognitive Adherence (Understanding): Defined by the five items rated on the need-for-reminding spectrum. The highest factor loadings typically center on items requiring active behavioral memory and self-monitoring, such as “washing hands often and for 20 s” and “keeping 2 m apart.”
• Factor 2: Affective Reactivity (Negative Feelings): Defined by the five items rated on the anxious/resistant spectrum. Highest loadings typically cluster around disruptions to relational connection and autonomy, specifically “school closure” and “no visits from friends/family.”

The correlation between these two factors typically ranges from low to moderate negative associations; children with higher cognitive understanding often show lower behavioral resistance, though children with high cognitive awareness may also experience elevated health-related anxiety under conditions of heightened household stress.

Instrument / Measurement Tool

The COVID-19 Regulations Measure is structured as follows:

• Instrument Name: COVID-19 Regulations Measure
• Alternate Name: Child Understanding of and Feelings toward COVID-19 Regulations Questionnaire
• Target Population: Parents or primary caregivers of children aged 3 to 8 years
• Administration Format: Parent-report questionnaire (administered via pen-and-paper or digital survey platforms such as Qualtrics and REDCap)
• Administration Time: Approximately 3 to 5 minutes
• Structure: 5 behavioral situations/rules evaluated across 2 distinct dimensions, yielding 10 total item-responses
• Subscales:
  • Understanding Subscale (5 ratings)
  • Negative Feelings Subscale (5 ratings)
• Response Formats:
  • Negative Feelings: 3-point ordinal scale (1 = never anxious or resistant, 2 = sometimes anxious or resistant, 3 = often anxious or resistant).
  • Understanding: 3-point ordinal scale (1 = often needs reminding, 2 = sometimes needs reminding, 3 = never needs reminding).
  • Swedish Cultural Adaptation: Includes an optional fourth category (4 = not applicable) for jurisdictions without national school closures or formal lockdown enforcement.
• Scoring Procedures:
  • Subscale scores are typically calculated by averaging or summing item responses within each dimension.
  • Understanding Score: Higher scores reflect greater internalization, autonomous behavioral recall, and comprehension of rules.
  • Negative Feelings Score: Higher scores reflect greater pediatric emotional distress, anxiety, and behavioral defiance.
  • If the “not applicable” category is selected in modified versions, the item is omitted from total score computation or treated as missing data in mean-item scoring.

Permissions & Fee and Test Year

The COVID-19 Regulations Measure was developed and published in 2023 by Claire Hughes, Luca Ronchi, Jean Heng, Chiara Basile, Paola Del Sette, Serena Lecce, and the i-FAM COVID-19 Consortium. The instrument is designated for open-access academic research and educational teaching purposes.

No licensing fee or commercial payment is required to use or translate the questionnaire for non-commercial research projects. Investigators utilizing the measure are requested to cite the original empirical publication (Hughes et al., 2023) in all resulting manuscripts, theses, and presentations. For institutional inquiries or permission regarding adaptations, contact Dr. Luca Ronchi at [email protected].

References

The following academic sources document the conceptualization, validation, and empirical findings associated with the COVID-19 Regulations Measure and its related developmental frameworks:

• Hughes, C., Ronchi, L., Heng, J., Basile, C., Del Sette, P., Lecce, S., & the i-FAM COVID-19 Consortium. (2023). What mediates the effect of family disruption in the COVID-19 pandemic on children’s prosocial behavior: A multisite study. Social Psychology, 54(1-2), 52–65. https://doi.org/10.1027/1864-9335/a000485
• Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press. https://doi.org/10.4159/9780674028845
• Conger, R. D., & Conger, K. J. (2002). Resilience in Midwestern families: Selected findings from the first decade of a prospective, longitudinal study. Journal of Marriage and Family, 64(2), 361–373. https://doi.org/10.1111/j.1741-3737.2002.00361.x
• Prime, H., Wade, M., & Browne, D. T. (2020). Risk and resilience in family well-being during the COVID-19 pandemic. American Psychologist, 75(5), 631–643. https://doi.org/10.1037/amp0000660
• Spinelli, M., Lionetti, F., Pastore, M., & Fasolo, M. (2020). Parents’ stress and children’s psychological problems in families facing the COVID-19 outbreak in Italy. Frontiers in Psychology, 11, Article 1713. https://doi.org/10.3389/fpsyg.2020.01713
• Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Harvard University Press. https://doi.org/10.2307/j.ctvjf9vz4

Items of the Scale