Journal of Preventive Medicine

Extended Abstract
Introduction
Health anxiety occurs when a person interprets feelings or perceived physical changes as symptoms of illness. Almost all people have a normal level of health anxiety, which has a protective effect and leads to the improvement of health-promoting behaviors; however, its higher levels will be harmful. Continuous and excessive fear or severe worry about the disease not only leads to suffering and dysfunction in the individual but also causes a significant increase in health and social costs. Psychological factors play a vital role in public health strategies, including social distancing, health practices, providing information, and vaccination to control disease epidemics, and health anxiety plays an essential role in the success or failure of each of these strategies. During the epidemic of viral diseases, such as COVID-19, people who have high health anxiety mistakenly consider their physical changes as symptoms of infection. This issue increases their anxiety and affects their behavior, including social isolation and excessive shopping. Such behaviors are recommended by health officials during an epidemic, but people with high health anxiety perform these behaviors in an exaggerated manner, which can be harmful to society. Housewives have had the highest level of anxiety during the COVID-19 epidemic compared to other groups. Therefore, this research was conducted to investigate health anxiety and identify its predictors in housewives during the COVID-19 epidemic.
Methods
This cross-sectional descriptive-analytical study was conducted from April 3 to May 20, 2019, on 258 housewives in Hormozgan province using the available sampling method. To invite housewives to participate in the study, the link to the electronic anxiety assessment questionnaire was sent through social media, such as ITA, WhatsApp, Telegram, and email. Inclusion criteria were the age of at least 18 years and no history of mental illness. At the beginning of the questionnaire, the demographic characteristics of housewives, such as marital status, age, place of residence, level of education, smoking, duration of exercise per week, underlying disease, and economic status were asked. The Salkovskis and Warwick Health Anxiety Inventory (SHAI) designed in The UK was used to collect data. Scoring the questions of this questionnaire is based on the four-point Likert scale. The score of zero indicates at all, score one indicates sometimes, score two indicates most of the time, and score three indicates always. The score range of this test is between 0 and 54, where a higher score indicates more health anxiety. Considering the results of previous studies, a score of more than 15 was considered health anxiety. After collecting data, the Kolmogorov-Smirnov test was used to check the normality of data distribution. The data were analyzed by SPSS v. 21. Descriptive statistics of percentage, mean and standard deviation were calculated. ANOVA, t-test, and regression analysis were used to analyze the data. A significance level of 0.05 was considered.
Results
The percentage of married cases and those living in the city, and smokers was 93.7, 87.2, and 1.6%, respectively. Also, 51.6% of the participants had a university degree. Their average age was 35.77 years. The mean total anxiety score of housewives was 20.26. Also, the average health anxiety scores of urban and rural housewives were 20.42 and 19.18, respectively, which showed no statistically significantly different between them (P>0.05). According to the considered level for people with health anxiety, 68.6% of housewives were anxious. In this study, a multiple regression model was used to determine predictors of health anxiety among housewives. Based on the results, economic status, exercise, and suffering from the chronic disease were significant predictors of health anxiety (P<0.05). 
Discussion 
The results of this study showed that the health anxiety level of housewives was very high during the epidemic of COVID-19 and more than two-thirds of the studied women experienced a high level of health anxiety, which is much higher than the levels of health anxiety reported in normal conditions. Factors, such as age, place of residence, marital status, smoking, and education were not predictors of health anxiety. The results of multiple regression analysis showed that economic status is one of the predictors of health anxiety. 
Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval code IR.HUMS.REC.1399.019 of the Research Ethics Committee of Hormozgan University of Medical Sciences.

Funding
This study was supported financially by deputy of Research and Technology of Hormozgan University of Medical Sciences (Code: 990045)
Authors' contributions
Design of the study: Mehdi Zare, Musa Soleimani Ahmadi, Hadi Eshaghi, Marzieh Khademian, Mohammad Reza Zare and Shahrokh Zumardi; Collecting information: Mehdi Zare, Hadi Eshaghi, Marzieh Khademian, Mohammad Reza Zare and Shahrokh Zumardi; Revision of the article: Musa Soleimani Ahmadi and Hadi Eshaghi; The article was written by: Musa Soleimani Ahmadi, Marzieh Khademian, Mohammad Reza Zare, Shahrokh Zumardi and Mehdi Behjati Ardakani; Statistical analysis, article editing: Mehdi Behjati Ardakani.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors of this article would like to thank the deputy of research and technology of Hormozgan University of Medical Sciences for the financial support. 

 

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