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predictors for self-isolation adherence during COVID-19 pandemic. Nursing Practice Today. 2024; 11(3): 283-90
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Nursing Practice Today
Original Article
Big five personality traits and resilience as predictors for self-isolation adherence during COVID-19
pandemic
Kayvan Alimoradi1, Reza Ghanei Gheshlagh2, Ahmed Najeeb Albatineh3, Bahram Nikkhoo4, Farideh Nargesi5,
Khaled Rahmani6*
1Department of Clinical Psychology, Kurdistan University of Medical Sciences, Sanandaj, Iran
2Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
3Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Kuwait
4Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
5Department of Psychology, Islamic Azad University, Sanandaj Branch, Sanandaj, Iran
6Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
ARTICLE INFO
ABSTRACT
Received 15 May 2024
Accepted 01 July 2024
Available online at:
http://npt.tums.ac.ir
Background & Aim: Results of previous studies on the role of personality traits and
resilience in explaining health-oriented behaviors such as social/physical distance and self-
isolation were inconsistent. The present study was conducted to determine the role of the five
big personality traits and resilience in adherence to self-isolation during the COVID-19
pandemic.
Methods & Materials: A prospective longitudinal cohort study tracked 112 healthcare
providers who tested positive for SARS-CoV-2. Using GPS data from their cell phones,
researchers assessed self-isolation adherence over 14 days. Participants completed NEO-
Five-Factor Inventory (NEO-FFI) and Connor–Davidson Resilience Scale (CD-RISC)
questionnaires.
Results: Sixty-one (58.7%) of the subjects violated their self-isolation, and 43 (41.3%) did
not violate it during the 14 days after PCR positivity for COVID-19. After adjustment for
potential confounders, results showed that only two of the five big personality traits included,
conscientiousness (AOR=1.37; 95%CI: 1.15–1.63) and neuroticism (AOR=0.85; 95%CI:
0.74–0.98), were significantly related to the self-isolation adherence. This means a one-unit
increase in conscientiousness is associated with 37% higher odds of self-isolation adherence,
while a one-unit increase in neuroticism reduces self-isolation adherence by 15%. Resilience
was the main predictor for self-isolation adherence in which a one-unit increase in resilience
score, the odds of adherence to self-isolation significantly increased by 18% (AOR=1.18,
95%CI: 1.07–1.30) (P<0.001).
Conclusion: The study suggests that fostering conscientiousness and resilience among
individuals may enhance self-isolation commitment during pandemics. Further research is
needed to explore the influence of agreeableness, extraversion, and openness to experience
on self-isolation adherence.
Keywords:
COVID-19;
big five personality traits;
resilience;
self-isolation
Corresponding Author:
Khaled Rahmani, Liver and Digestive
Research Center, Research Institute for
Health Development, Kurdistan University
of Medical Sciences, Sanandaj, Iran.
E-mail: khaledrahmani111@yahoo.com
Introduction
In December 2019, SARS-CoV-2, a new
coronavirus causing COVID-19, emerged in
Wuhan, China, leading to a global pandemic (1).
The World Health Organization (WHO) declared
it a public health emergency in January 2020 (2).
To prevent the virus’s spread, containment
measures like social distancing and self-isolation
were implemented (3). WHO and Centers for
Disease Control and Prevention (CDC)
recommend infected individuals, symptomatic or
not, to self-isolate for 10-20 days to prevent further
transmission (4). Isolation helps prevent the spread
of SARS-CoV-2 to HCWs. As with all respiratory
virus outbreaks, isolating COVID-19 patients is a
vital precaution to safeguard HCWs, especially in
intensive care units (5). Failure to adhere to
isolation protocols can have severe health
consequences for infected healthcare workers
(HCWs). These consequences may include heart
disease, stroke, type 2 diabetes, depression,
anxiety, and even premature death. Additionally,
families of infected HCWs are at risk of exposure.
Tehran University of Medical Sciences
2024; Volume 11, No 3, pp. 283-290
DOI: 10.18502/npt.v11i3.16175
Copyright © 2024 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.
Self-isolation adherence during COVID-19 pandemic
284 Nursing Practice Today. 2024;11(3):283-290
If HCWs do not isolate properly, they may
unknowingly transmit the virus to family
members, jeopardizing their health and well-
being. Furthermore, the failure to isolate HCWs
can contribute to community transmission,
overwhelming healthcare systems, straining
resources, and increasing the overall burden of
COVID-19 on society (6). Iran’s national
guidelines require a 14-day self-isolation
following a positive PCR test (7). However, these
measures can lead to psychological effects such as
anxiety and depression (8).
One of the most important ways to
understand the role of personality traits in adapting
to constraints is to examine the various dimensions
of the big five personality traits. These traits,
which include openness to experience,
conscientiousness, extraversion, agreeableness,
and neuroticism, significantly influence
community behaviors and acceptance of group
rules. They can predict health-oriented behaviors
and individual responses to challenges (9). One of
these concepts is conscientiousness, which
predicts health-promoting and risk-avoiding
behaviors. Conscientious people, who are defined
by responsible activities, find it less bothersome to
follow restrictions like self-isolation during the
COVID-19 pandemic (10). Openness to
experience, characterized by a desire for art and
empathy, can predict behaviors conforming to
social norms (11). The trait of agreeableness
reflects individual differences in the concern for
social harmony. Agreeableness is a personality
trait reflecting a concern for social harmony.
Agreeable individuals are generally kind,
generous, trusting, and willing to compromise
their interests for others, with an optimistic view of
human nature. Neuroticism, on the other hand, is
associated with experiencing negative emotions
and unpleasant experiences, such as anger,
anxiety, or depression (12). Extraversion, marked
by a wide range of activities and a preference for
social stimulation (12), may make it difficult for
extroverts to adhere to social distancing guidelines
(10). The widely accepted big five personality
traits framework was used in this study to assess
the participants’ personality traits and their
influence on adherence to self-isolation during
infection as per national health guidelines (13).
Resiliency, an important human ability in
stressful situations, helps increase problem
resistance and adapt effectively to stress (14). It’s
a dynamic process that involves enduring
hardship, bouncing back from difficulties, and
recovering from challenging situations (15).
Resilient individuals can thrive despite severe
stress. As per Connor and Davidson, resilience
isn’t just about withstanding harm or danger, but
also about actively and constructively engaging
with one’s environment (16). Two factors are
essential to describe resilience: exposure to
danger, injury, or threat, and positive adaptation in
handling stressors (17). During the COVID-19
pandemic, factors like social isolation and fear of
infecting others can affect the resilience of health
workers (18). Conscientiousness and openness to
experience are linked to health-oriented behaviors
and can predict adaptive behaviors like social
distancing (9). However, a study by German and
Dutch researchers found conscientiousness wasn’t
a predictor of compliance with health guidelines.
Neuroticism influences social distancing and rule-
following during a pandemic, but those with
higher neuroticism struggle more with coronary
heart disease (10).
The existing body of research presents
conflicting findings on the role of resilience and
personality traits in predicting adherence to self-
isolation during infectious disease outbreaks like
COVID-19. While some studies suggest that
resilience, high conscientiousness, openness to
experience, and low neuroticism may contribute to
compliance with health guidelines, others do not
support these conclusions. Furthermore, health
providers, due to their high exposure to and
involvement in the COVID-19 pandemic, and
their comprehensive understanding of the
disease’s transmission, transformability, and
lethality, present a unique population for studying
the impact of resilience and personality traits on
self-isolation adherence. However, this area
remains largely unexplored (19). Given these
inconsistencies and gaps in the literature, this study
aims to: 1) Examine the relationship between the
five major personality traits and adherence to self-
isolation. 2) Investigate the correlation between
health providers’ resilience and their adherence to
self-isolation during the COVID-19 pandemic.
K. Alimoradi et al.
Nursing Practice Today. 2024;11(3):283-290 285
Methods
Design and participants
This prospective longitudinal cohort
study was conducted in Sanandaj, the center of
Kurdistan province, Iran. Health providers with
SARS-CoV-2 positive who expressed willingness
to participate in the study and consented to the
installation of a unique tracking app (cell phone
GPS tracking app) on their mobile phones were
included in the study. They should not turn off
their mobile phones for 14 days. The GPS
program was owned by the telecommunications
company. During the COVID-19 epidemic, the
telecommunications company collaborated with
the Ministry of Health to trigger an alert if
someone violated quarantine. This GPS covered a
radius of up to 3 kilometers. Participants were 112
health providers who were SARS-CoV-2 positive
from 18 January to 18 February 2021.
Procedure
The list of all healthcare providers whose
PCR test was positive was obtained from the
National Health System (https://sib.muk.ac.ir),
which was only available to the public health
centers of the province. This project has been
assessed and approved by an ethics committee at
the Kurdistan University of Medical Sciences. The
registry code of the project was:
IR.MUK.REC.1400.220. Of the 112 healthcare
providers diagnosed with COVID-19 approached,
109 agreed to participate in the study and
completed the questionnaires. To protect their
personal information, special numerical codes
were assigned to each person and it was explained
to them that the researchers defined them based on
a set of codes and no one had access to their
identity information such as names, surnames, and
so on. During the follow-up of our cohort, it was
found that 5 out of 109 participants in the study
had turned their cell phone GPS tracking off
during the isolation period and their data was not
complete to determine if they were leaving or
staying at their home. As a result, they were
excluded from the study, and 104 healthcare
providers diagnosed with COVID-19 were
eventually included in our final analysis.
Questionnaires
Demographic form
Baseline demographic characteristics,
including age, sex, education, clinical data such as
pre-existing diseases (diabetes, cardiovascular
diseases, and psychological disorders), and prior
history of COVID-19, were gathered in a
checklist. Data related to the participants'
personality dimensions and resilience were
collected by NEO-Five-Factor Inventory (NEO-
FFI) (20), and Connor-Davidson Resilience
Scale (CD-RISC) (16) standard questionnaires,
respectively.
NEO Five-Factor Inventory (NEO-FFI)
The NEO-FFI-3 is a 60-item version of
the NEO-PI-3 that provides a quick, reliable, and
accurate measure of the five personality traits
including neuroticism, extraversion, openness,
agreeableness, and conscientiousness (20). This
questionnaire has been translated and validated in
Farsi by Garousi Farshi et al (2001). All questions
in this questionnaire were based on a five-point
Likert scale and ranged from strongly disagree to
strongly agree. In the psychometric evaluation of
the Farsi version of the NEO-FFI-3 questionnaire,
the Cronbach's alpha coefficient of each of the
main factors of neuroticism, extraversion,
openness to experience, agreeableness, and
conscientiousness were 0.86, 0.73, 0.56, 0.68,
0.71, respectively (21).
Resilience
Connor-Davidson Resilience Scale (CD-
RISC) is the most widely used scale, which
assesses psychological resilience. It was another
questionnaire that we used in our study. This scale
comprises 25 items rated on a 5-point Likert scale
(0-4), with higher scores reflecting greater
resilience (16) The results of its validity and
reliability in Iran by Samani et al. confirmed its
validity and reliability with Cronbach's alpha
coefficient =87% (22). Our interesting outcome
was the accuracy of self-isolation adherence
during the 14 days which was determined through
an alarming system of cell phone GPS of the study
subjects.
Self-isolation adherence during COVID-19 pandemic
286 Nursing Practice Today. 2024;11(3):283-290
Ethical considerations
This research has been performed in
accordance with the Declaration of Helsinki. The
proposal of the study has been evaluated and
approved by the ethics committee at the Kurdistan
University of Medical Sciences (Ethics code:
IR.MUK.REC.1400.22). written informed consent
was obtained from each participant before the data
collection.
Statistical analysis
Means and standard deviations were used
to describe quantitative data and frequency and
percentage were used to summarize the categorized
data. The Chi-square test of independence/ Fisher's
exact test was used to examine the relationship
between qualitative variables. The mean difference
of quantitative variables between the two groups
(individuals who adhered to or did not adhere to
self-isolation) was evaluated using an independent
samples t-test when normality was ascertained,
otherwise, the Mann-Whitney U test was
implemented. To reduce the effect of potential
confounders, the relationship between the
independent variables, including different
dimensions of personality, resilience, demographic
and clinical characteristics of healthcare providers
diagnosed with COVID-19, and the study outcome
(adhered to or did not adhere to self-isolation) was
modeled using a multiple logistic regression model.
All analyses were conducted in SPSS version 24,
and a p-value of <5% was set for statistical
significance.
Results
The data of 104 subjects, including 53
(51%) women and 51 (49%) men, were analyzed
in the present study. The mean age of participants
was 34.5 years, and 73% had a bachelor's degree or
above. Sixty-one (58.7%) of the studied subjects
violated their self-isolation, and 43 (41.3%) did not
violate the self-isolation during the 14 days after
PCR positivity for COVID-19. Demographic
characteristics and past medical history of study
participants are shown in Table 1. As indicated in
Table 1, healthcare providers diagnosed with
COVID-19 with higher education degrees were
more committed to self-isolation.
Table 1. Demographic characteristics and history of pre-existing diseases of study participants (N=104)
* Independent T-test, **Chi-squared test, *** Fisher’s exact test
As detailed in Table 2, the results of
univariate analyses (logistic regression) revealed
that the odds of adherence to self-isolation in
healthcare providers diagnosed with COVID-19
who have education degrees of Master and above
was significantly (OR=2.95, 95%CI:1.05–8.30)
higher than those with diploma degrees (P<0.001).
Results indicated that four of the five big
personality traits, including conscientiousness
(OR=1.29; 95%CI: 1.15–1.44), neuroticism
(OR=0.85; 95%CI: 0.80 -.91), extraversion
(OR=1.15; 95%CI: 1.04 - 1.26), agreeableness
(OR=1.07; 95%CI: 1.01–1.14) were significantly
associated with adherence to self-isolation in the
univariates analysis. After adjustment to potential
confounders using a multiple logistic regression
model, results showed that only two of the five big
personality traits including conscientiousness
(AOR=1.37; 95%CI: 1.15–1.63) and neuroticism
(AOR=0.85; 95%CI: 0.74–0.98) were significantly
related to the self-isolation adherence. It is worth
noting that openness to experience was marginally
significantly associated with self-isolation
adherence (AOR=1.13, 95%CI: 0.94–1.35) with P-
value=0.07. Based on the multiple logistic
regression model, resilience was one of the most
important predictors of self-isolation adherence.
This means with an increase of one score in
P-value
Total
Adhered to Self-
isolation
Not adhering to self-
isolation
Variables
0.09*
34.5±7.6
34.42±7.89
34.56±7.49
Age (mean ± SD)
0.07**
51(%49)
22 (%51.2)
29 (%47.5)
Men
Sex, N (%)
53 (%51)
21 (%48.8)
32 (%52.5)
Women
0.04**
28 (%26.9)
9 (%20.9)
19 (%31.1)
Diploma
Education, N (%)
40 (%38.5)
13 (%30.2)
27 (%44.3)
Bachelor
36 (%34.6)
21 (%48.8)
15 (%24.6)
Master and higher
0.08***
3 (%2.9)
1 (%2.3)
2 (%3.3)
Diabetes
Pre-existing
Disease, N (%)
8 (%7.7)
4 (%9.3)
4 (%6.6)
Cardiac disease and Hypertension
93 (%89.4)
38 (%88.4)
55 (%90.2)
No pre-existing diseases
K. Alimoradi et al.
Nursing Practice Today. 2024;11(3):283-290 287
resilience, the odds of adherence to self-isolation
increased significantly by 18% (AOR=1.18,
95%CI: 1.07–1.30) (P-value<0.001). It is worth
mentioning that our multiple logistic regression
model was significant according to the Chi-square
omnibus test and the model fits the data well
according to the Hosmer-Lemeshow test for
goodness-of-fit. Furthermore, this model produced
an area under the Receiver Operating Characteristic
Curve of 0.78 indicating good discriminating
capability.
Table 2. Results of the multiple logistic regression model to assess the association between the outcome (Adhered/not adhered to
self-isolation) and several independent variables (N=104)
Variable
Crude OR* (95% CI**)
P-value
Adjusted OR (95%CI)
P-value
Age
0.99 (.94–1.05)
92
.90 (.82–1.00)
0.6
Sex
Male
1
1
0.90
Female
0.86 (.39–1.88)
.71
1.10 (0.227–5.36)
Education
Diploma
1
-
1
-
Bachelor
1.01 (.36–2.85)
.97
.57 (.09–3.55)
0.55
Master and higher
2.95 (1.05–8.30)
.04
1.50 (0.24–9.24)
0.65
Pre-existing disease
1.20 (0.33–4.16)
0.76
1.23 (0.34–4.28)
0.49
Resilience
1.16 (1.08–1.24)
<0.001
1.18 (1.07–1.30)
<0.001
Personality
Conscientiousness
1.29 (1.15–1.44)
<0.001
1.37 (1.15–1.63)
<0.001
Neuroticism
0.85 (0.80 -.91)
<0.001
0.85 (0.74–0.98)
0.02
Openness
1.06 (0.99-1.14)
0.07
1.13 (0.94–1.35)
0.07
Extraversion
1.15 (1.04 - 1.26)
0.003
1.13 (0.94 - 1.35)
0.16
Agreeableness
1.07 (1.01–1.14)
0.024
0.96 (0.82–1.11)
0.60
*OR: Odds Ratio, **CI: Confidence interval
Discussion
This study examined whether personality
traits and resilience are associated with adherence to
self-isolation during the COVID-19 pandemic.
According to the univariate analysis results, among
the studied demographic factors, only the level of
education has a significant relationship to
compliance with national guidelines regarding self-
isolation. Increasing individuals' education increased
their adherence to self-isolation. However, multiple
logistic regression modeling demonstrated that only
postgraduate and higher education were significantly
associated with increased adhesion to self-isolation.
Among the other independent variables, resilience,
conscientiousness, and neuroticism were significant
predictors of adherence to self-isolation. Some
personality traits, such as agreement, and
extraversion had no significant relationship with
adherence to self-isolation, while openness to
experience had a marginal significant association.
The pandemic influenced individuals’ personality
traits. For instance, heightened stress and uncertainty
may have exacerbated neurotic tendencies, while
social isolation could impact extraversion and
openness (23).
The results showed that conscientiousness
is strongly associated with self-isolation among the
five big personality traits. This finding is consistent
with the concept that conscientiousness is entirely
related to each person's responsibilities, and people
who display conscientious qualities have healthy
habits and effective decision-making (24). Our
findings show that people with higher consciences
were usually better and more efficient in performing
their duties and following care instructions to limit
disease transmission and spread (25).
Findings showed that as individuals'
neuroticism decreased, their commitment to staying
at home and adhering to self-isolation increased.
Similar to our findings, peek et al., and Aronson et al.
indicated that people with neurotic fears and
anxieties have a strong tendency to use the defense
mechanism of denial and use this mechanism to
overcome their inner anxiety and fear and do more
risky actions (26, 27). In addition, high neuroticism
leads to undesirable coping behaviors (28).
Additionally, other studies have shown that the
reason for the negative effect of neuroticism on
disease care and prevention behaviors is the
depressive aspect of the concept of neuroticism (29).
The results of multiple regression analysis
revealed that resilience is the main predictor of self-
isolation behavior. Based on the available scientific
evidence, resilience can help improve mental health,
and ultimately, the commitment of individuals when
faced with anxious and critical situations and play an
effective role in positive confrontation and effective
adaptation to these situations (30). In addition, in line
Self-isolation adherence during COVID-19 pandemic
288 Nursing Practice Today. 2024;11(3):283-290
with our finding, in Santangelo's study, resilience had
a significant relationship with the duration of
separation in patients, so people with higher
resilience scores showed a greater ability to tolerate
the duration of separation (31).
The data modeling results did not show a
significant relationship between agreeableness and
commitment to maintaining self-isolation. In some
other studies, contrary to the findings of this study,
agreeableness has been cited as a predictor factor for
social distance as well as adherence to disease
prevention guidelines due to the individual's desire
for social acceptance and empathy (10, 32). Studies
by Abdelrahman (33) and Tim Bogg (25) have
shown that the relationship between adherence to
health guidelines and social distance has been
insignificant. A possible justification of the
present study results, it can be said that using a
precise instrument (electronic monitoring by GPS)
to measure the outcome/ behavior and not using
self-reported data has caused patients not to worry
about social acceptance, and their behavior is
probably based on their real personality.
According to the results, extraversion did
not significantly correlate with the adherence to
self-isolation, while openness showed marginal
significance. In several studies, contrary to our
findings, extraversion (25) and openness to
experience (34) showed a positive and significant
relationship with social distancing and
commitment to the national guidelines. Hence,
people with higher extroversion are less likely to
adhere to social distancing and self-isolation (9).
In Asselmann's study, consistent with our results,
extraversion, and openness to experience could
not show a significant relationship with social
distancing (10). Probably, the desire of extroverts
to communicate extensively and not to leave their
place of isolation can be justified by their creativity
in inventing alternative methods of
communication.
Strength and limitation
The main advantage of the present study
is the higher precision of the instrument we used
to measure the outcome variable. In this study,
Adhered/ not adhered to self-isolation was
measured by tracking study subjects via GPS, and
participants' self-expression regarding staying at
home was not considered. Although researchers
tried to enter more COVID-19 participants into the
present study, only 104 health providers
participated in our cohort. Accordingly, it can be
said that the first limitation of the present study is
the generalizability of the results to the entire
population providing health services and that such
a sample size may not have had enough power to
detect effects when it exists. The second limitation
of this study is that this project was conducted on
healthcare providers who are naturally more
aware of the coronavirus transmissibility and the
importance of self-isolation as an important way
to prevent infection spreading so that the results of
this study could not be generalized to the general
population. Indeed, non-adherence to self-
isolation in the general population may be higher
than in health care providers.
Conclusion
The results of this study suggest that
increasing conscientiousness in individuals can
increase the level of commitment and adherence
of individuals to self-isolation and not leave the
place of isolation during the transmissibility of
disease. In addition, people who were more
resilient in the face of stressful situations were
more committed to preventing the transfer of
infection to others. It is also possible to increase the
commitment to stay in isolation by reducing
people's neuroticism level, which includes
feelings of fear, depression, perfectionist irrational
beliefs, and negative attitudes. Although
agreeableness, extraversion, and openness to
experience did not significantly predict the
commitment to isolation in our study, there is
scientific evidence about the impact of these traits
on the formation of health-oriented behaviors.
Further studies are needed to clarify the role of
these personality traits. To enhance resilience,
health professionals should receive training in
stress management, coping mechanisms, and
emotional well-being. Additionally, they should
be encouraged to establish social connections,
even in virtual settings, to combat loneliness and
bolster resilience.
Acknowledgments
This study was part of an approved
research proposal at the Kurdistan University of
Medical Sciences. In this regard, the researchers
K. Alimoradi et al.
Nursing Practice Today. 2024;11(3):283-290 289
thanked the Research Deputy of the Kurdistan
University of Medical Sciences for approving this
proposal. We also thank all the health providers
who participated in this research.
Conflict of interests
The author(s) declared no potential
conflicts of interest concerning this article’s
research, authorship, and publication.
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