COVID-19-Related Worries and Fears Scale (CoV-WoFe)

1. Abstract

The COVID-19-Related Worries and Fears Scale (CoV-WoFe) is a psychometrically validated, brief 6-item self-report questionnaire designed to measure and differentiate cognitive apprehension and physiological distress associated with the SARS-CoV-2 pandemic (Cuadrado et al., 2023). Developed amidst the global health crisis, the CoV-WoFe synthesizes core items adapted from the Fear of COVID-19 Scale (FCV-19S; Ahorsu et al., 2020) and the danger and contamination domains of the COVID Stress Scales (CSS; Taylor et al., 2020). The scale assesses two primary dimensions: Worry about the health consequences of COVID-19 (CoV-Wo), which captures cognitive concerns regarding infection vulnerability and the limits of protective health behaviors, and Fear of COVID-19 (CoV-Fe), which measures somatic, emotional, and visceral manifestations such as tachycardia, insomnia, and reactivity to media coverage. Items are rated on a 7-point Likert scale ranging from 1 (“Strongly disagree”) to 7 (“Totally agree”).

Psychometric evaluations conducted among adult community samples demonstrated robust internal consistency, with an overall Cronbach’s alpha of α = .85 to .86, and subscale coefficients of α = .81 to .86 for Worry and α = .85 for Fear. Exploratory Factor Analysis (EFA) resolved a clear bidimensional structure accounting for 77.99% of total explained variance following the removal of poorly correlating items. Confirmatory Factor Analysis (CFA) cross-validated this two-factor model across multiple independent samples, yielding excellent goodness-of-fit indices (Sample 1: χ²(6) = 8.240, p = .221, RMSEA = .035, CFI = .998, TLI = .994; Sample 2: χ²(6) = 15.014, p = .020, RMSEA = .068, CFI = .991, TLI = .977). Multigroup CFA established full metric and scalar measurement invariance across genders. Nomological validity is supported by significant associations with security values, generalized anxiety, direct viral experience, and adherence to preventive health behaviors. The CoV-WoFe provides a refined, brief psychometric tool suitable for epidemiological tracking, clinical screening, and behavioral research.

2. Keywords

COVID-19, CoV-WoFe, Fear of COVID-19, Health Anxiety, Psychometrics, Factor Analysis, Measurement Invariance, Somatic Anxiety, Cognitive Worry, Preventive Health Behaviors

3. Authors

The COVID-19-Related Worries and Fears Scale was developed by an international team of behavioral science and public health researchers:

• Esther Cuadrado, Ph.D. – Department of Psychology, University of Cordoba, Cordoba, Spain. Corresponding Author: [email protected]
• Alicia Arenas, Ph.D. – Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.
• Manuel Moyano, Ph.D. – Department of Psychology, University of Cordoba, Cordoba, Spain.
• Martina La Gamma, M.Sc. – Department of Psychology, University of Florence, Florence, Italy.

4. Purpose

The primary purpose of the COVID-19-Related Worries and Fears Scale (CoV-WoFe) is to deliver a theoretically grounded, psychometrically sound, and operationally efficient instrument capable of disentangling the cognitive and physiological components of pandemic-related distress. During major infectious disease outbreaks, psychological responses range along a broad spectrum from adaptive vigilance to debilitating psychological morbidities. While initial measurement tools collapsed these multifaceted reactions into undifferentiated constructs of “pandemic distress,” public health epidemiology and cognitive-behavioral clinical sciences require more granular distinctions.

In clinical contexts, distinguishing between cognitive worry and acute autonomic fear is essential for targeted intervention. Cognitive worry reflects perseverative, future-oriented thoughts concerning the health hazards of infection, potential transmission, and systemic vulnerabilities. When maintained at moderate levels, worry functions as an adaptive, problem-focused motivator that drives adherence to prophylactic measures such as hand hygiene, mask-wearing, and social distancing. Conversely, somatic fear involves autonomic nervous system hyperarousal, insomnia, palpitations, and visceral panic reactions triggered by media reports or environmental cues. This high level of physiological fear can trigger maladaptive avoidance, severe functional impairment, somatic symptom disorders, or profound depressive reactions.

In epidemiological and behavioral research, the CoV-WoFe serves as a brief screening tool that avoids survey fatigue. Its 6-item length facilitates inclusion in comprehensive public health surveillance protocols, longitudinal cohort studies, and structural equation models evaluating health behavior compliance. By capturing both cognitive anticipation of threat and acute physiological arousal, the scale allows researchers to investigate how distinct psychological mechanisms mediate the link between socio-demographic determinants, personal values (such as Schwartz’s security values), and protective public health behaviors.

5. Psychological Construct

The CoV-WoFe models pandemic distress through two distinct, correlated psychological dimensions: cognitive worry and somatic fear.

Worry About the Health Consequences of COVID-19 (CoV-Wo)

Cognitive worry is defined as a chain of relatively uncontrollable thoughts, self-talk, and mental representations focused on anticipated negative outcomes (American Psychological Association). In the CoV-WoFe, the CoV-Wo dimension measures cognitive appraisals concerning personal vulnerability to viral infection and skepticism regarding whether standard behavioral countermeasures can guarantee personal safety. Unlike generalized trait worry, this factor focuses on the health risks of SARS-CoV-2.

Individuals scoring high on this dimension engage in continuous threat monitoring and cognitive calculation of infection risk. For example, respondents evaluate statements reflecting worry about contracting the virus (Item 1: “Me preocupa contagiarme del COVID”) and apprehension that basic preventive actions like ventilation, distancing, and sanitizing may prove insufficient to protect them (Item 4: “Me preocupa que las medidas básicas no puedan mantenerme a salvo del COVID”). This construct reflects the cognitive appraisal of threat severity and vulnerability conceptualized in health psychology models.

Fear of COVID-19 (CoV-Fe)

Fear is an innate, alarm-based neurophysiological response to an immediate or perceived imminent danger, characterized by autonomic nervous system activation, hyperarousal, and escape-oriented action tendencies. The CoV-Fe dimension of the scale captures visceral, affective, and somatic reactivity directly elicited by pandemic-related stimuli.

This factor extends beyond intellectual acknowledgment of risk to assess physical distress and emotional disruption. It evaluates subjective fear (Item 5: “Tengo miedo al COVID”), physiological sleep disturbance driven by viral preoccupation (Item 6: “No duermo bien porque contagiarme del COVID me preocupa”), autonomic cardiovascular reactivity such as palpitations or tachycardia when contemplating infection (Item 7: “Mi corazón late deprisa cuando pienso acerca de la posibilidad de contagiarme del COVID”), and acute affective reactivity to informational exposures (Item 8: “Cuando veo noticias o historias sobre el COVID en los medios me pongo nervioso o angustiado”). Consequently, CoV-Fe measures the acute emotional and somatic symptom burden that can lead to clinical anxiety disorders.

6. Theoretical Framework

The CoV-WoFe is grounded in two primary theoretical paradigms: Cognitive Appraisal Theory (Lazarus & Folkman, 1984) and the Dual-Process Model of Affect and Cognition (Loewenstein et al., 2001; Risk as Feelings).

Cognitive Appraisal and Protection Motivation

According to Lazarus and Folkman’s transactional model of stress and coping, when individuals encounter an environmental stressor such as a viral pandemic, they engage in two levels of appraisal: primary appraisal (evaluating threat severity and personal vulnerability) and secondary appraisal (evaluating coping resources, self-efficacy, and response efficacy). Protection Motivation Theory (PMT; Rogers, 1975) similarly posits that health-protective behaviors are driven by threat appraisals (perceived severity and vulnerability) and coping appraisals (response efficacy and self-efficacy). The CoV-Wo subscale captures primary threat appraisal — evaluating the severity of COVID-19 and personal vulnerability — alongside doubts regarding the sufficiency of preventative actions.

The Dual-Process Model: Risk as Feelings

Decision-making and behavioral adaptation under threat operate through two interrelated systems: an analytic, cognitive processing system and an experiential, affective processing system. The “risk-as-feelings” hypothesis (Loewenstein et al., 2001) posits that emotional responses to risk often diverge from cognitive evaluations. While cognitive evaluations are based on probabilities and anticipated consequences (reflected in CoV-Wo), emotional reactions such as fear, dread, and somatic arousal (reflected in CoV-Fe) respond rapidly to vivid imagery, media cues, and visceral conditioning.

By measuring both analytical worry and somatic fear within a unified psychometric framework, the CoV-WoFe accommodates this theoretical dual-process architecture. This enables researchers to observe how rational calculations of danger work alongside somatic emotional responses to drive behavioral adaptations or psychological distress.

7. Validity

Empirical validation of the CoV-WoFe (Cuadrado et al., 2023) established construct, convergent, criterion-related, and structural validity across multiple independent samples of Spanish adults.

Construct and Nomological Network Validity

Construct validity was demonstrated by evaluating the scale’s placement within its broader nomological network. CoV-WoFe scores correlated significantly and in expected theoretical directions with several psychological and behavioral constructs:

• Personal Values: Consistent with Schwartz’s Value Theory, individuals with strong personal security values exhibited significantly higher scores on both the CoV-Wo and CoV-Fe subscales, reflecting heightened vigilance toward personal and societal stability.
• Direct Experience: Personal or close-contact experience with COVID-19 infection was associated with elevated worry and fear scores.
• Generalized Anxiety: Both subscales correlated positively and moderately to strongly with standardized measures of generalized anxiety, confirming convergent validity while maintaining construct distinction.
• Protective Health Behaviors: CoV-Wo and CoV-Fe scores demonstrated significant positive associations with intentions to adopt preventive protocols and actual self-reported compliance with safety guidelines (e.g., mask-wearing, frequent handwashing, physical distancing).

Serial Mediation and Structural Validity

Structural equation modeling supported construct validity by examining the mechanisms linking values to behaviors. Cuadrado et al. (2023) confirmed a serial mediation model in which personal security values influenced behavioral compliance through the sequential mediation of CoV-Wo (cognitive worry) and CoV-Fe (somatic fear). Furthermore, this serial pathway explained variance in psychological anxiety, confirming the complementary roles played by both dimensions.

Known-Groups Validity

Known-groups validity was evidenced by significant gender differences: female respondents reported higher levels of both pandemic worry and fear than male respondents. This finding is consistent with broader epidemiological and psychological literature on anxiety and threat perception during public health emergencies.

8. Reliability

The CoV-WoFe exhibits strong internal consistency across its full composite score and individual subscales:

• Overall Scale (CoV-WoFe, 6 items): Demonstrates an overall Cronbach’s alpha of α = .85 in the final 6-item version (α = .86 in initial testing).
• Worry Subscale (CoV-Wo, 2 items): Displays a Cronbach’s alpha of α = .81 following the removal of poorly performing initial items (α = .86 in preliminary 4-item configurations).
• Fear Subscale (CoV-Fe, 4 items): Exhibits high internal consistency, with a Cronbach’s alpha of α = .85.

The internal consistency parameters satisfy psychometric standards (≥ .80) for both research applications and group-level clinical evaluations. Because validation studies utilized cross-sectional electronic designs, test-retest reliability across extended time intervals was not evaluated in the primary publication, leaving longitudinal stability open for future investigation.

9. Factor Analysis

The latent structure of the CoV-WoFe was developed and evaluated using Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA) across independent adult samples (Cuadrado et al., 2023).

Exploratory Factor Analysis (EFA)

The initial pool consisted of 8 items: 4 targeting health worries and 4 assessing somatic and emotional fear. Preliminary EFA revealed that Item 2 (“Me preocupa que mi familia se contagie del COVID”) and Item 3 (“Me preocupa que el sistema de salud no pueda protegerme a mí o a mis seres queridos del COVID”) exhibited low correlations and cross-loadings with the latent factors. Following the removal of these two items, the EFA yielded a clean, balanced two-factor solution accounting for 77.99% of the total variance.

Confirmatory Factor Analysis (CFA)

The bidimensional 6-item model was cross-validated using CFA across two independent community samples. Both analyses revealed good to excellent fit indices:

• Sample 1: χ²(df = 6) = 8.240, p = .221; Root Mean Square Error of Approximation (RMSEA) = .035 [95% CI: .001, .088]; Comparative Fit Index (CFI) = .998; Goodness-of-Fit Index (GFI) = .994; Tucker-Lewis Index (TLI) = .994.
• Sample 2: χ²(df = 6) = 15.014, p = .020; RMSEA = .068 [95% CI: .025, .112]; CFI = .991; GFI = .986; TLI = .977.

The nonsignificant chi-square value in Sample 1 and high comparative fit indices across both cohorts confirm that the two-factor model provides a stable structural fit.

Measurement Invariance

Multigroup Confirmatory Factor Analysis (MGCFA) was conducted to examine measurement invariance across genders. The scale demonstrated both metric invariance (equal factor loadings across men and women) and scalar invariance (equal item intercepts across groups). This establishes that observed gender differences in scale scores reflect true differences in latent pandemic distress rather than measurement bias.

10. Instrument / Measurement Tool

• Instrument Name: COVID-19-Related Worries and Fears Scale (CoV-WoFe)
• Instrument Type: Self-report psychometric rating scale / Questionnaire
• Primary Dimensions / Subscales:
  • Worry about the health consequences of COVID-19 (CoV-Wo): 2 items (Items 1 and 2 in the final scale)
  • Fear of COVID-19 (CoV-Fe): 4 items (Items 3, 4, 5, and 6 in the final scale)
• Item Count: 6 items in the finalized scale (derived from an initial 8-item development pool)
• Administration Format: Self-administered; electronic online survey or paper-and-pencil delivery
• Target Population: General adult population (18 years and older; Young Adults, Middle Age, and Older Adults)
• Authentic Response Scale: The CoV-WoFe consists of items rated on a seven-point Likert scale, where ‘1’ represents “Strongly disagree” and ‘7’ represents “Totally agree.” The administration method is electronic.
• Scoring Procedures:
  • Subscale scores are calculated by summing or averaging the items corresponding to each latent factor: CoV-Wo (mean/sum of Items 1 and 2) and CoV-Fe (mean/sum of Items 3, 4, 5, and 6).
  • An overall CoV-WoFe composite score can be derived by summing all 6 items (range: 6 to 42) or averaging them (range: 1.0 to 7.0).
  • No reverse-keyed items are present; higher scores reflect greater levels of pandemic-related cognitive worry and somatic fear.

11. Permissions & Fee and Test Year

• Year of Initial Publication: 2023
• Licensing: Creative Commons Attribution 4.0 International (CC BY 4.0)
• Permissions: Free for use in academic, research, and educational settings without explicit written authorization, provided appropriate scholarly citation is credited to the original authors (Cuadrado et al., 2023).
• Commercial Use: Prohibited or requires explicit author consent depending on organizational frameworks.
• User Fee: No fee is required for non-commercial research or educational administration.

12. References

Ahorsu, D. K., Lin, C.-Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The Fear of COVID-19 Scale: Development and initial validation. International Journal of Mental Health and Addiction, 20(3), 1537–1545. https://doi.org/10.1007/s11469-020-00270-8

Cuadrado, E., Arenas, A., Moyano, M., & La Gamma, M. (2023). Development and validation of the COVID-19 Worries and Fears Scale. International Journal of Public Health, 67, Article 1604600. https://doi.org/10.3389/ijph.2022.1604600

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.

Loewenstein, G. F., Weber, E. U., Hsee, C. K., & Welch, N. (2001). Risk as feelings. Psychological Bulletin, 127(2), 267–286. https://doi.org/10.1037/0033-2909.127.2.267

Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. The Journal of Psychology, 91(1), 93–114. https://doi.org/10.1080/00223980.1975.9915803

Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., McKay, D., & Asmundson, G. J. (2020). Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders, 72, Article 102232. https://doi.org/10.1016/j.janxdis.2020.102232

13. Items of the Scale