Effects of perceived risk of COVID-19 on fear among visiting workers: Mediating role of perceived stress

Abstract

With the creation of a social distancing policy due to coronavirus disease 2019 (COVID-19), home visit workers are under mental stress as they are treated as the source of infection for COVID-19. Since door-to-door rental equipment examiners and gas inspectors must perform their duties even in the COVID-19 situation, they are being discriminated against so severely. The purpose of study was to examine the mediating role of perceived stress on the relationship between risk perception and fear. Data was collected data through labor unions among 275 home visiting workers who examine rental home appliance equipment or inspecting gas. On-line survey was conducted to assess COVID-19 risk perception, fear, perceived stress, and demographic characteristics. The data was analyzed using PROCESS Macro (Model 4). The results of the study showed that stress plays an important role in increasing COVID-19 fears when COVID-19 risk perception increases. Meanwhile, it was found that COVID-19 fear decreased when the level of perceived stress decreased. To reduce the impact of COVID-19 risk perception on COVID-19 fears, appropriate educational programs to reduce stress should be developed for home visit workers. Policymakers need to develop online or mobile Infectious disease education programs for COVID-19 risk at work and establish policies to apply legal education.

Key points.

• Visiting workers may be more sensitive about the risk of infection because they have to visit multiple customer locations even during the pandemic.

• Empirical analysis results showed that high-risk perception of infection leads to high COVID-19 fears, and stress significantly mediated the effect of risk perception on fear.

• Therefore, managers should prevent sudden work changes or stressors to prevent excessive work stress.

• In addition, health officials should develop online or mobile education programs that can reduce the risk perception of infection.

• In particular, policymakers should try to lower the level of COVID-19 fear by legislating that visiting workers are required to complete COVID-19 education programs.

1. Introduction

Coronavirus (COVID-19) infects and kills essential workers every day^[1] and has made people around the world aware of risks and fears.^[2–4] The COVID-19 pandemic has had unprecedented global impacts on health, economy, and daily life, generating widespread concerns about the virus and its potential consequences. These concerns have led to heightened risk perception, increased stress, and elevated fear among individuals, particularly those who are most vulnerable to infection. Understanding the relationship among risk perception, stress, and fear during the pandemic is essential for developing targeted interventions to support mental health and well-being.

Humans instinctively perceive and try to avoid danger. Risk perception of infection is a key variable that induces people’s psychological and behavioral responses in public crises and has an important influence on decisions and behaviors in daily life.^[5–7] Risk perception refers to an individual’s subjective risk judgment based on objective crisis events, including uncertainty about the threat and the severity of the consequences.^[8] This perception of risk puts people in a state of distress and fear, which in turn motivates them to participate in problem-solving activities to address it.^[8]

It is well known that COVID-19 fears stem from uncertainty.^[9] Social skills correlate with reduced stress experiences. People with strong social skills gain more social support when they face stress.^[10] When individuals are afraid of COVID-19, they can communicate with family and friends over the phone or the Internet to encourage each other. They are also able to strengthen mutual mental support to relieve tension and psychological stress.^[5] In particular, COVID-19 fears are explained by concerns about infected individuals with COVID-19 spreading the virus to people as they approach a specific individual’s neighborhood.^[11] Individuals who have lower levels of fear towards COVID-19 may be more likely to engage in risky behavior, such as not wearing a mask in public or attending social gatherings with friends.^[3,4,12,13] Conversely, COVID-19 fears can mitigate certain threats, such as COVID-19 infection risks, while engaging in safe behaviors such as wearing masks, washing hands, and avoiding social events.^[14,15]

The COVID-19 fears of workers in their workplaces can be alleviated through education or support. This support can reduce morbidity and mortality, and regulate chronic stress conditions to enable psychological management.^[16] The risk of COVID-19 infection due to fear and contact with others has become a significant social problem.^[17] Consequently, national distancing policies have been implemented in each country, affecting social functions and work.^[18] Among several social measures, telecommuting has a significant impact on the safety, health, and well-being of essential workers in contact with the general public.^[1] Amid these social changes, workers who have to physically continue to visit or move have felt relatively more stressed.^[19] In Korea, the number of COVID-19 patients has surged since February 2020. The government’s social distancing policy has been strengthened, and the COVID-19 trend has repeatedly increased and decreased. Urban gas inspectors and rental product door-to-door inspectors, who have to visit each home, were often unable to work even if they rang the doorbell due to COVID-19 and were more often treated as a source of COVID-19 than consoled by customers.^[20] Their stress increased, especially when the workplace did not provide support or education, or materials for COVID-19, making them more afraid.^[21]

The Occupational Safety and Health Administration presented guidelines for workers who provide inspection services at home.^[22] According to the guidelines, workers should: (1) visit customers’ homes after checking the risk of infection at the location, (2) wear protective gear, open windows and perform repairs by checking ventilation, (3) carry out work after disinfection, and (4) perform non-face-to-face money transactions.^[22]

A study of visiting workers reported that workers perceived insufficient information about COVID-19 at work, and 64.9% did not receive infection training.^[21] Door-to-door rental equipment inspectors visit homes or offices to check the cleaning status of rental products purchased by customers or perform regular inspection activities for maintenance. Products subject to door-to-door inspection usually include water purifiers, bidets, air purifiers, and water softeners.^[23] Gas inspectors visit homes and businesses that use city gas or LP gas to check the safety of gas use, such as gas leakage, and in some cases, require necessary measures.^[23] They conduct safety inspections of gas facilities so that city gas users can use gas safely and conveniently. Specifically, they check the gas stove, gas boiler, and clothes dryer to verify that they are in a safe state. In addition, they visit places where gas, water, and electricity are used and record the amount of use by measuring the meter. In Korea, safety inspections should be conducted once a year for cooking-only households and twice a year for cooking-heating households.^[24]

Workers in these occupations must visit different locations to perform their work even during the COVID-19 pandemic.

COVID-19 fears include COVID-19 infections but are also linked to fears of social stigma and changes in quality of life.^[25] This study aims to understand the effect of COVID-19 risk perception of visit workers on COVID-19 fears. Thus, the purpose of this study was to identify the effect of COVID-19 risk perception on COVID-19 fear by city gas inspectors visiting homes and rental product inspectors to empirically analyze the mediating effect of perceived stress on the association between risk perception and fears. We perform analysis in the following order. First, we identify the general characteristics of the research subjects and measure their risk perception, stress, and fear. Second, this paper examines whether the study subjects’ perception of COVID-19 risk affects their COVID-19 fears. Third, this article investigates whether the subject’s perception of COVID-19 risk affects their stress levels. Finally, this research identifies whether stress acts as a mediator when risk perception affects fears of COVID-19. The results of this study will serve as basic data for developing effective mental health management measures during the pandemic. Based on this article, readers can understand various psychological changes experienced by visiting service workers in the event of another large-scale infectious disease outbreak and develop effective preventive measures to reduce the fear of COVID-19.

2. Literature review

2.1. COVID-19

The COVID-19 pandemic has profoundly impacted mental health and well-being worldwide, compelling individuals to adopt various coping strategies to manage the resulting stress and fear.^[26–28] The unprecedented nature of the pandemic has heightened risk perception, which in turn has significantly influenced stress levels and fear responses among different populations.^[29,30]

Risk perception during the COVID-19 pandemic is a critical factor that influences people’s behaviors and mental health.^[31] Studies have shown that heightened risk perception is linked to increased anxiety and precautionary behaviors. For instance, Vally^[32] found that individuals who perceived a high risk of COVID-19 infection were more likely to experience anxiety and adopt preventive measures such as wearing masks and social distancing. Similarly, several works reported that high-risk perception was associated with significant mental health challenges, including sleep disturbances and psychological distress.^[33,34]

Risk perception is also influenced by various demographic factors. Age and gender, for example, play crucial roles in shaping how individuals perceive the risk of COVID-19. Older adults generally report a higher perception of risk compared to younger adults, potentially due to the increased vulnerability to severe illness.^[35] Additionally, women tend to report higher levels of risk perception and associated anxiety than men.^[36]

The pandemic has introduced numerous stressors, including health concerns, economic instability, and social isolation, which have collectively exacerbated stress levels across populations.^[37,38] Stress during the pandemic is characterized by a heightened response to the various challenges posed by COVID-19. Adaptive coping strategies, such as problem-solving, seeking social support, and positive reframing, have been shown to mitigate the negative effects of stress. Pfefferbaum^[39] emphasized the importance of these strategies in maintaining mental health during the pandemic. In contrast, maladaptive strategies, including denial, substance abuse, and self-blame, can exacerbate stress and lead to poorer mental health outcomes.

Research has also highlighted the differential impacts of stress on various demographic groups. Older adults, for instance, tend to employ more adaptive coping strategies and report lower stress levels compared to younger adults.^[40,41] Additionally, individuals with preexisting mental health conditions are more susceptible to heightened stress during the pandemic.^[42]

Fear is a fundamental emotional response triggered by the threat of COVID-19. It encompasses concerns about personal health, the health of loved ones, and broader societal impacts. Fear can motivate protective behaviors but can also lead to detrimental mental health outcomes if not managed properly. Studies have shown that fear of COVID-19 is closely linked to risk perception and stress levels.^[36,43] Ahorsu, Lin, Imani, Saffari, Griffiths, and Pakpour^[44] highlighted that workers, particularly those in close contact with others, experience considerable fear due to the high perceived risk of infection. This fear can lead to increased stress and anxiety, as well as behaviors aimed at mitigating perceived risks, such as strict adherence to hygiene practices. Yan, Kim, Zhang, Foo, Alvarez-Risco, Del-Aguila-Arcentales, and Yáñez^[45] found that hospitality workers with high risk perceptions reported significant fear, which in turn affected their mental health and job performance. Fear can also exacerbate existing mental health conditions and, in severe cases, lead to suicidal ideation. For instance, Sher^[46] reported an increase in suicide rates linked to fear of COVID-19 infection and associated social stigma. Somer scholars noted that intense fear of the virus can worsen mental health conditions and lead to severe psychological distress.^[47,48]

The COVID-19 pandemic has significantly influenced risk perception, stress, and fear, shaping the mental health landscape across various populations. Understanding these impacts is crucial for developing effective interventions and support mechanisms to enhance mental well-being during and beyond the pandemic.

2.2. Coping and stress theory

Coping and stress theory provides a framework to analyze how individuals manage the demands of stressful situations, such as the COVID-19 pandemic.^[49] The theory suggests that individuals employ different coping strategies, including problem-focused and emotion-focused coping, to navigate challenging circumstances and mitigate the negative effects of stress. Lazarus and Folkman^[49] argued that coping is a process through which individuals manage the demands of stressful situations.

Coping strategies are essential for maintaining mental health, particularly during crises such as the COVID-19 pandemic.^[50,51] The theory distinguishes between 2 types of coping: problem-focused coping, which involves directly addressing the problem, and emotion-focused coping, which involves managing the emotional response to the problem.^[52,53]

2.3. Theoretical foundation and hypotheses

The overarching theoretical framework for this study is grounded in Lazarus and Folkman stress and coping theory.^[49] This theory posits that individuals manage stressful situations through various coping strategies, which are divided into problem-focused and emotion-focused coping. Problem-focused coping involves addressing the problem directly, while emotion-focused coping entails managing the emotional response to the problem. This framework is essential for understanding how visiting workers perceive and respond to the risks associated with COVID-19.

COVID-19 risk perception significantly impacts mental health and behavior during the pandemic, influencing issues such as pain, sleep disorders, and fear.^[54–58] The stress and coping theory explains how these risk perceptions can exacerbate COVID-19 fears, as individuals process and respond to the perceived threat of infection.

Stress is defined as an individual’s response to stimuli, threats, or events and is linked to several mental health disorders, including anxiety, depression, and post-traumatic stress disorder.^[59,60] In the context of the COVID-19 pandemic, the increased workload and associated risks have led to heightened stress levels among visiting workers, such as couriers and inspectors.^[61] According to stress and coping theory, perceived stress can mediate the relationship between risk perception and fear, thereby influencing mental health outcomes.

Fear is a basic and intense emotion triggered by the detection of a threat, such as COVID-19.^[62] Visiting workers, including electronic product repair workers and hospitality workers, often experience significant fear due to the high perceived risk of infection.^[44,45] This fear can worsen existing mental health conditions and, in severe cases, lead to suicidal behavior.^[63–65]

Based on the stress and coping theory, we hypothesize that COVID-19 risk perception affects COVID-19 fears directly and indirectly through perceived stress. This theoretical framework provides a comprehensive understanding of how visiting workers navigate the psychological challenges posed by the COVID-19 pandemic, offering a basis for developing targeted interventions to support their mental health and well-being. Figure 1 shows the research model.

Figure 1.

Research model.

2.4. COVID-19 risk perception

Risk perception generally refers to people’s subjective judgment of the nature and severity of a risk.^[66] People are concerned and anxious about lockdowns, quarantine, and isolation caused by the ongoing COVID-19 pandemic, and continue to be aware of the risk of COVID-19 infection.^[67] COVID-19 risk perception has a significant impact on various mental health issues and behaviors during the pandemic.^[54–57] In particular, risk perception has been shown to be strongly associated with pain, sleep disorders, fear, and fear.^[58] This study explains COVID-19 fears based on stress and coping.^[49,68] Based on the above discussion, we assume that COVID-19 risk perception exacerbates COVID-19 fears.

Hypothesis 1. COVID-19 risk perception is significantly associated with COVID-19 fears.

2.5. Perceived stress

Stress is an individual’s response or experience to stimuli, threats, or events in various situations and is one of several mental health disorders such as anxiety, depression, phobia, post-traumatic disorders, and even psychotic disorders.^[59,60] The stress and coping theory recognizes that stress is not a stressor itself, but rather becomes a coping strategy, and an appropriate theoretical framework could be correlated with workers’ risk perception.^[69] A study reported that couriers with increased work due to COVID-19 are experiencing more severe work-related stress.^[61] Therefore, this study suggests that COVID-19 risk perception has a stress effect.

Hypothesis 2. COVID-19 risk perception is significantly associated with perceived stress.

2.6. COVID-19 fear

Fear is an immediate alert response, triggering a series of physiological changes due to COVID-19. Fear is defined as a basic and intense emotion induced by the detection of a threat. These fears can also be affected by preventive management guidelines that impact the spread of infectious diseases in the community.^[70] Ahorsu et al^[44] stated that electronic product repair workers who visit homes and perform their work are feeling considerable fear about COVID-19. Yan et al^[45] argued that hospitality workers, who perceive a high risk of COVID-19 based on the stress and coping theory, regard the COVID-19 pandemic as a risk perception. Fear of COVID-19 can worsen existing mental health conditions and, in severe cases, can affect mental health and lead to suicidal behavior.^[63–65] Risk perception has a significant effect on perceived stress under pandemic.^[71] Thus, this study proposes the following:

Hypothesis 3: COVID-19 risk perception is significantly associated with COVID-19 fears through perceived stress.

3. Method

This study was conducted after receiving approval (MC20QISI0123) after deliberation by the C University Clinical Research Ethics Committee.

3.1. Participants

The study analyzed workers classified under urban gas inspectors, meter inspectors, and rental product inspectors according to the Korean Standard Classification of Occupations.^[23] In collaboration with the Korean Confederation of Trade Unions, the survey targeted employees from 6 organizations performing in-home services, including home appliance repair technicians, inspectors, homecare aides, and visiting consultants. This diverse participant pool offered a comprehensive view of the experiences of visiting workers during the COVID-19 pandemic.

To enhance data integrity and reliability, we implemented a rigorous data filtering procedure during the preprocessing phase. Responses that were insincere, incomplete, or consistently marked with the same answer were excluded to eliminate potential biases or inaccuracies. This careful screening ensured that only genuine and complete responses were considered for analysis. Additionally, participant demographics, including age, gender, employment type, and working hours, were collected to control for potential confounding variables. Data collection was conducted through online surveys distributed over 2 weeks in late May 2020, ensuring anonymity and informed consent. This methodological approach enhances the transparency and replicability of the research, providing a solid foundation for understanding the psychological impact of COVID-19 on visiting workers.

The sample size for the study was calculated using the G-power 3.1 program. When the effect size was set to 0.15, the significance level was set to 0.05, and the power was set to 0.95, the program outputted that a total of 184 samples were required. To obtain a sufficient number of samples considering the dropout rate, we conducted an online survey of 290 people. After removing insincere responses (such as inconsistent response and straight lining answer), a total of 275 responses were used for the final analysis.

3.2. Setting and sampling

We employed a stratified sampling technique to ensure a representative sample of urban gas inspectors, meter inspectors, and rental product inspectors. This method allowed us to capture a diverse range of experiences and perspectives within these occupational groups.^[72] We contacted labor union representatives from 6 organizations to understand the current situation and secure their cooperation.

We explained the study’s purpose and methodology to workplace managers and obtained approval from 5 out of 6 organizations. Written notifications detailing the study’s purpose, methods, procedures, anonymity, and withdrawal process were provided to potential participants. Informed consent was obtained from all participants, ensuring voluntary participation. The online survey, which took about 10 minutes to complete, was administered to those who agreed to participate. To maintain data security, the collected responses were encrypted and stored on the researcher’s personal computer, and all data was discarded after the study’s completion. This approach ensured ethical standards were upheld and participants’ privacy was protected, enhancing the study’s validity and reliability.

3.3. Measure

We organized the questionnaire with 36 questions about COVID-19 risk perception, stress, and COVID-19 fear.

3.3.1. Independent variable: COVID-19 risk perception

We used modified items from previous studies (Lee and You, 2020) that investigated COVID-19 infection risk perception to measure infection risk perception for COVID-19. The survey items were “How dangerous COVID-19 feel while working,” “How anxious you are about the risk of COVID-19 infection,” “How serious you think physical and mental damage is if you are infected with COVID-19,” and “Are there many difficulties in performing your work after the outbreak of COVID-19?” The items were measured using a scale ranging from “Not dangerous at all = 0” to “Very dangerous = 10.” Total score of COVID-19 risk perception ranged from 1 to 10. with a high score indicating dangerous perception of COVID-19 infection.

3.3.2. Mediator: perceived stress

The questions about stress consisted of fatigue, overall health status, and general stress factors. The items were measured using a scale ranging from “Don’t feel at all = 1” to “Feel very much = 5.” A high score indicates a higher level of COVID-19 stress.

3.3.3. Dependent variable: COVID-19 fear

Regarding COVID-19 Fear, we used a questionnaire from the “COVID-19 National Mental Health Survey” report (KSTSS, 2021) conducted by the Korean Trauma Stress Society to measure the level of COVID-19 fear. This study was measured by dividing it into (1) fear of COVID-19 confirmation, (2) fear of criticism or damage due to COVID-19 confirmation, and (3) fear that will be criticized in the workplace due to COVID-19 confirmation. The items included “I’m afraid I’ll become a confirmed patient,” “I’m afraid I’ll be asymptomatic,” “I’m afraid I’ll have a confirmed person in self-quarantine,” “I’m afraid I’ll be criticized by people around me,” and “I’m afraid I’ll be a confirmed patient.” The items were measured using a scale ranging from “Not at all = 1” to “Very much = 5.” A high score indicates a higher fear of COVID-19.

3.3.4. Counfonders

Demographic characteristics (gender, age) and occupational characteristics (occupational type, employment type, and weekly working hours) were also collected.

3.4. Data analysis

This study employed SPSS 23.0 to analyze the data empirically in the following order based on the research objectives. Firstly, we utilized descriptive statistics to analyze the general characteristics and occupational characteristics of urban gas inspectors, meter inspectors, and rental product inspectors. Secondly, we computed the mean and standard deviation of infection risk perception, stress, and COVID-19 fear among urban gas inspectors, meter inspectors, and rental product inspectors by their COVID-19 situation and calculated Cronbach alpha (reliability coefficient). Thirdly, we used an independent sample t-test and variance analysis to examine risk perception according to general characteristics, and Scheffé posttest was used for the posttest analysis. Fourthly, we conducted a Pearson correlation analysis to explore the relationship between infection risk perception, stress, and COVID-19 fear of the situation. Finally, we used PROCESS Macro Version 3.3 (Model 4) proposed by Hayes^[73] to analyze the direct and mediating effects, verifying the relationship between infection risk perception, stress, and COVID-19 fear. We employed a bootstrapping technique with 5000 resamples to ensure robust results.^[73] To address potential confounding variables, demographic and occupational characteristics were controlled in the analysis, enhancing the validity of our findings.^[74] By taking these measures, we aimed to mitigate biases and provide a comprehensive understanding of the studied relationships.

4. Results

4.1. General characteristics of the subjects

Of the 275 subjects, 13 (4.7%) were men and 262 (95.3%) were women. The frequency of those under the age of 40 was 26 (9.5%), 108 (39.3%) for those aged 40 to 45, and 141 (51.3%) for those aged 50 or older. One hundred forty-seven respondents (53.3%) had <5 years of experience, and 128 (46.5%) had more than 5 years of experience. One hundred forty-five respondents (52.7%) worked <40 hours, and 130 (47.3%) said they worked more than 40 hours. In terms of employment type, 49 were regular workers (17.8%), 49 were contract workers (17.8%), and 177 were others (64.4%). As for positions, 186 (67.6%) were clerks, 11 (4.0%) were deputy managers or higher, and 78 (28.4%) were others. As for the occupation, there were 100 city gas inspectors and meter inspectors (36.4%) and 175 rental product inspectors (63.6%). In terms of the size of the workplace, 216 people (78.5%) worked in workplaces with <50 employees, 39 people (14.2%) worked in workplaces with 50 to 300 employees, and 20 people (7.3%) worked in workplaces with more than 300 employees. Table 1 details the sample demographics.

Table 1.

Demographic characteristics of participants.

Demographics		N (%)
Gender	Male	13	(4.7)
	Female	262	(95.3)
Age	<40	26	(9.5)
	40–49	108	(39.3)
	50 or older	141	(51.3)
Tenure	<5 years	147	(53.3)
	5 years or more	128	(46.5)
Working hours per week	40 hours or less	145	(52.7)
	>40 hours	130	(47.3)
Type of employment	Permanent	49	(17.8)
	Contract	49	(17.8)
	Other	177	(64.4)
Position	Clerk	186	(67.6)
	Deputy manager or higher	11	(4.0)
	Other	78	(28.4)
Job title	City gas inspector or meter inspector	100	(36.4)
	Rental product inspector	175	(63.6)
Number of employees in the company	< 50	216	(78.5)
	50–299	39	(14.2)
	300 or more	20	(7.3)
Labor union	Exist	237	(86.2)
	None	38	(13.8)

Note: Other type of employment includes temporary worker and special employment type.

4.2. Reliability analysis

In the research model, the independent variable is COVID-19 risk perception, the mediator is perceived stress, and the dependent variable is COVID-19 fear. The Cronbach alpha value, an index of internal consistency reliability, for COVID-19 risk perception is .803, for perceived stress is .595, and for COVID-19 fear is .877. The reliability index value for stress was lower than the standard value, but the difference was acceptable, so we retained the corresponding variable (Churchill, 1979). Table 2 presents the descriptive statistics and reliability information.

Table 2.

Descriptive statistics and reliability analysis results.

Variable	Number of items	Mean	St. dev.	Cronbach α	Skewness	Kurtosis
COVID-19 risk perception (independent)	4	4.072	0.513	0.803	‐0.389	‐.633
Stress (mediator)	3	8.762	1.364	0.595	‐1.050	.408
COVID-19 fear (dependent)	8	4.523	0.530	0.877	‐1.145	.565

4.3. Correlation analysis

The results of the correlation analysis are shown in Table 3. Risk perception has a significant correlation with perceived stress (r = .32, P < .001) and COVID-19 fear (r = .53, P < .001). Perceived stress is significantly correlated with COVID-19 fear (r = .34, P < .001).

Table 3.

Correlation matrix.

	COVID-19 risk perception	Stress	COVID-19 fear
COVID-19 risk perception	1
Stress	.32***	1
COVID-19 fear	.53***	.34***	1

^***P < .001.

4.4. Mediating effect test

We hypothesized that COVID-19 risk perception affects COVID-19 fear through perceived stress. In step 1, COVID-19 risk perception had a statistically significant effect on perceived stress (B = 0.121, P < .001). The explanatory power of risk perception for perceived stress was 10.3%. In step 2, risk perception had a significant effect on COVID-19 fear (B = 0.204, P < .001). The explanatory power of the risk perception for fear was 27.7%. In step 3, risk perception (B = 0.181, P < .001) and perceived stress (B = 0.197, P < .001) had a significant impact on COVID-19 fears. The explanatory power of independent variables for dependent variables was 30.9%. Since step 3 with a mediator reduced the value of the non-standardization coefficient (B = 0.1181) compared to step 2 without a mediator (B = 0.204), perceived stress partially mediates the relationship between risk perception and fear. In summary, COVID-19 risk perception has a direct impact on COVID-19 fears, and also indirectly through stress. The analysis results are shown in Table 4.

Table 4.

Mediating effect analysis.

Variable		Step 1 (risk perception → perceived stress)				Step 2 (risk perception → fear)				Step 3 (risk perception + perceived stress → fear)
		B	SE	β	t	B	SE	β	t	B	SE	β	t
(Constant)		3.014	.191		15.770	2.733	.177		15.413	2.139	.240		8.914
Independent	Risk perception	.121	.022	0.321*	5.606	0.204	0.020	0.526*	10.220	0.181	0.021	0.465*	8.734
Mediator	Perceived stress									0.197	0.055	0.191*	3.585
R 2		0.103				0.277				0.309
F		31.425				104.450				60.918

^*Adjusted for gender, age category, occupational type, employment type, and weekly working hours were applied as control variables for each of the COVID-19 risk perception, stress, fear of situation.

5. Discussion

COVID-19 is causing a serious situation and confusion in the lives of ordinary workers, leading to psychological and financial impacts. This, in turn, causes mental stress in workers and forms COVID-19 fears. Among various occupations, city gas inspectors and rental product visit inspectors are essential workers in the COVID-19 era and must perform face-to-face work.^[22] In this context, this study explored COVID-related psychological factors of city gas inspectors visiting homes and rental product inspectors. We identified the significant effect of COVID-19 risk perception on COVID-19 fears and identified the mediating role of stressors.

The descriptive statistics study results showed that many women were in the study and were over 40 years of age. The most common type of work was not regular or contractual. There were many clerks in positions, and the size of the workplace was <50. There were also several subjects with labor unions. Due to the lack of studies related to visiting inspectors that can be compared with the results of this study, we compared the results of this study with former works on workers in other occupations. Many scholars have demonstrated that hospitality workers’ risk perception of infection affects their chances of experiencing depression.^[45,49,68] They explained risk perception based on stress theory. Additionally, studies have shown that a large number of children can lead to stress and worsen depression.^[45]

The correlation matrix reveals a significant positive association between COVID-19 risk perception and stress (r = .32, P < .001). This finding aligns with previous research indicating that individuals who perceive higher risks related to COVID-19 tend to experience greater stress levels.^[75,76] This relationship can be interpreted to suggest that visiting workers’ stress levels rise as they perceive higher risks in their work environments. This result underscores the need for interventions aimed at reducing perceived risks through better workplace safety protocols and education, thereby potentially mitigating stress levels among these workers.

Furthermore, COVID-19 risk perception shows a strong positive correlation with COVID-19 fear (r = .53, P < .001). This result is consistent with findings in past works,^[36,77] which highlighted that high risk perception significantly contributes to fear and anxiety about the virus. The significant correlation between risk perception and fear suggests that the psychological impact of perceived infection risk is profound, leading to heightened fear responses. This underscores the importance of addressing risk perceptions in public health communications and interventions to alleviate fear and promote mental well-being among workers who must continue their duties amid the pandemic.

The analysis reveals a significant mediating effect of perceived stress on the relationship between COVID-19 risk perception and COVID-19 fear. This finding indicates that as visiting workers’ perception of the risk increases, their stress levels also rise, which in turn amplifies their fear of COVID-19. The significant mediation effect implies that interventions aimed solely at reducing risk perception may not be sufficient to alleviate COVID-19 fear. Instead, comprehensive strategies that also address stress management are essential. For instance, providing stress reduction programs, such as mindfulness training or cognitive-behavioral therapy, could help mitigate the fear that arises from high-risk perception. This is crucial as high levels of fear can negatively impact mental health and work performance, as noted by previous studies.^[44,63] Furthermore, these findings underscore the need for organizational policies that prioritize both safety measures and psychological support. Employers should implement regular stress assessments and provide resources to help workers cope with the ongoing stress of the pandemic. This dual approach could significantly improve the overall well-being and mental health of visiting workers, ensuring they can perform their duties effectively even in challenging times. Future research should explore the long-term effects of these interventions to better understand their impact on worker health and productivity.

Comparing these findings with the theoretical framework of stress and coping,^[49] we see that both problem-focused and emotion-focused coping strategies are vital in managing perceived risk and stress. Practical implications of this study suggest that training programs focused on effective coping mechanisms could be beneficial. These programs could include skills for risk assessment and emotional regulation, helping workers to manage their stress and reduce their fear of COVID-19.

6. Conclusion

This study confirms the effect of COVID-19 risk perception on COVID-19 fears among city gas inspectors and rental product inspectors. The results demonstrate that risk perception has a direct effect on COVID-19 fears, with stress mediating this relationship. The study is valuable because it analyzes visiting workers who are required to work during the COVID-19 pandemic and provides a basis for understanding the relationship between concepts in more depth through the demonstration of the mediating effect of perceived stress.

To reduce COVID-19 risk perception and fear, workers who travel frequently should actively participate in online or mobile education programs on COVID-19 disease risks. Policy officials should develop standard programs and make legal education mandatory.

The paper suggests that managers should conduct COVID-19 risk training for visiting workers and create detailed guidelines to alleviate COVID-19 fears. Regular online education should also be provided to reduce work-related stress. Policy designers need to establish working conditions and institutional policies to ease pressure on visiting workers. Guidelines should be devised for each situation depending on the increase or decrease of COVID-19. Finally, the government should continually design detailed quarantine policies and regulations for essential visiting jobs to prepare for unpredictable situations in the future.

The findings of this study offer valuable insights for addressing future pandemic scenarios. By understanding the significant role of covid-19 risk perception and stress in influencing fear, policymakers and organizations can develop targeted interventions to support mental health. Implementing stress reduction programs, such as mindfulness training and cognitive-behavioral therapy, can help mitigate fear among essential workers. Additionally, improving workplace safety protocols and providing clear communication about risks can reduce perceived stress. These strategies will not only enhance the well-being of visiting workers but also ensure better preparedness and resilience in facing future pandemics.

This study has several limitations that should be acknowledged. Firstly, the sample was conveniently selected through labor unions, which may introduce selection bias and limit the generalizability of the findings. Future research should adopt random sampling methods to enhance the representativeness of the sample. Secondly, the measurement of variables relied on self-reported data, which can be subject to response biases such as social desirability and recall bias. Utilizing a mixed-method approach, including qualitative interviews and objective measures, could provide a more comprehensive understanding of the phenomena. Additionally, the cross-sectional design of the study limits the ability to infer causality between COVID-19 risk perception, stress, and fear. Longitudinal studies are recommended to establish temporal relationships and causality. Lastly, the study focused on a specific group of visiting workers in Korea; hence, future research should explore similar issues in different cultural and occupational contexts to generalize the findings more broadly. Addressing these limitations in future studies will provide deeper insights and enhance the robustness of the conclusions.

Author contributions

Conceptualization: Eun-Mi Baek, Hye-Sun Jung, Suyoung Kwon, Jee-Hyun Hwang, Ji-Young Park.

Data curation: Eun-Mi Baek.

Formal analysis: Eun-Mi Baek.

Methodology: Eun-Mi Baek.

Writing – original draft: Eun-Mi Baek.

Correction

This article was originally published with an incorrect International Review Board number (MC21QISI0035). The International Review Board number has now been corrected to (MC20QISI0123) in the online version.