Validation of an original Behavioral Changes Scale on the Use of Digital Technologies During Social Distancing

Abstract Introduction The social distancing (SD) adopted during the coronavirus disease 2019 (COVID-19) pandemic has transformed the internet from a convenience into a necessity. The behavioral changes caused by isolation range from adaptation of consumption, work, and teaching routines to altered leisure options to occupy idle time at home. Such transformations can be positive, expanding use of digital technologies (DT), but they can also have serious future physical and emotional consequences if there conscious use of technological devices is lacking. Objectives The study aimed to validate the Behavioral Changes Scale on the Use of Digital Technologies During Social Distancing (BCSDTSD), an instrument for assessing behavioral changes related to use of DT during SD. Method Validation of the BCSDTSD in five phases: 1. construction of an initial scale with 10 questions; 2. evaluation of the questions by a panel of experts; 3. application to 1,012 volunteers via the internet; 4. statistical analysis of the results; and 5. preparation of the validated final version of the BCSDTSD. Data were analyzed using the dplyr, psy , and paran packages and the REdaS statistical program. Three statistical criteria were used in the factor analysis (FA). Results FA confirmed that all 10 questions in the questionnaire should be maintained, confirming its robust construction, and Cronbach’s alpha demonstrated its internal consistency with a value of 0.725, which is satisfactory for first-application questionnaires. Conclusion The BCSDTSD instrument was validated for assessment of behavioral changes related to the use of DT during SD.


Introduction
Prior to the pandemic, daily life had already become more dependent on interaction with digital technologies (DT) (computers, smartphones, tablets, etc.), 3 but SD changed cyberspace from a convenience to a necessity, occupying an unprecedented place as a means of disseminating information on the pandemic and its effects on the world, 1 but also potentially leaving it as the only remaining vector for maintaining social interactions. 4 From a technological point of view, the COVID-19 pandemic has caused massive and immediate changes in the use of digital media. 5 For the vast majority, use of DT is healthy when practiced in moderation, but for some individuals it can compromise interactions and habitual social activities and other activities of daily living. 1 Use of psychoactive substances and other reinforcing behaviors, such as playing videogames, watching TV series, using social networks (SN), consuming pornography, or surfing the internet are often used to reduce stress and anxiety and/or relieve depressed mood. 3 Since sources of recreation are limited to the domestic environment, the internet and television provide fertile ground for individuals to develop compulsive behaviors, because these sources are readily accessible, 6 and opportunistic marketing campaigns can encourage customers to spend more time in activities that can cause addiction. 1 Furthermore, the constant search for information on COVID-19 itself can become an obsession, a phenomenon called "cyberchondria." 7 It is thus necessary to study use of DT as compensation for the pandemic's effects, plus the positive and negative behavioral impacts 2

Data collection
Data were collected from May 6 to June 13, 2020, via the internet, using the Google Forms app, widely adopted in similar studies. The results of data collection were keyed into a database created in Excel from the application used, avoiding possible typographical errors by the researcher. The data then underwent statistical analysis to validate the scale and to characterize the sample profile according to its demographic data.

Inclusion and exclusion criteria
Inclusion criteria were individuals over 18 years of age who had their daily activities limited by isolation at home during the study period. Individuals whose work activities prevented them from remaining in total SD were excluded.

Data analysis
The criteria used to validate the scale were: chi-square tests, to identify relations between the questions on the scale and the demographic data of the sample; Bartlett's test of sphericity, to perform the factor analysis; the Kaiser-Meyer-Olkin (KMO) 19 statistic, to verify the adequacy of the factor analysis; the proportion of variance method, to determine the number of relevant factors; and Cronbach's alpha, to measure the questionnaire's internal consistency. Data were analyzed using the dplyr, 20 psy, 21

Results
From the initial sample, 975 participants' data were analyzed and 37 questionnaires that were not fully completed were excluded, since none of the questions were mandatory. Table 1 provides a summary of the sample.  31 The dataset described here was satisfactory, considering the number of items on the initial scale (10). The assessment of changes in digital behavior was necessarily based on participants' own perception, due to the lack of validated measures for comparison and the imposition of unprecedented SD in the digital age. 5 Although measures based on participants' perceptions have been used previously and given the relevance of perceived SD for health and the adaptation of basic daily needs, we do not know how these perceptions align with objective digital behavior. 32 The valid questionnaires employed in the analyses were quantitatively consistent and the demographic data did not seem to affect the response pattern of the BCSDTSD.

Discussion
Although SD is a traditional public health measure, this is the first time that it has been imposed on such a large proportion of the world population 33 and on healthy individuals, since previously only the sick and/or those exposed to contagion were isolated. 2 One major difference in this pandemic is precisely the presence of the internet, which is why Yan  The prolonged duration of quarantine favors boredom, frustration, and concern about lack of basic supplies and about financial loss. 35 The long-term impact is considerable and wide-ranging, including anxiety, depression, anger, post-traumatic stress symptoms, 36 abuse of alcohol, tobacco, and other drugs, changes in sleep and/or eating patterns, difficulty concentrating, 37 mental confusion, 35 and behavioral changes, such as avoiding crowded places and washing hands excessively. 36 These psychological symptoms can last up to three years after the quarantine period. 38 It is thus predicted that there will be increases in mental disorders (MD) and psychiatric illnesses after the pandemic and that the impact on MH may even be lasting. 36  increase, at 71%, and with 64% of this group using some SN. 45 It is assumed that these numbers will reach even higher levels after the start of SD. Abusive use of digital spaces can lead to potentially compulsive exposures, 4 such as digital gaming (DG), compulsive shopping, overuse of SN, and pornography, reinforcing digital vicious cycles. 1 Disordered use of the internet generates marked distress and/or significant damage in the personal, social, educational, and occupational areas. 1 A good example of a lack of control in activities associated with technologies is DG, which, although it may be an adaptive strategy to deal with the pandemic, can evolve into long-term DD. 43 In general, digital addicts do not see themselves as such, especially because they deal with materials and activities that are widely used in modern times. 13 Mescollotto et al. 46 assessed 130 young Brazilians for smartphone dependence and the results showed that 33.1% were addicted, with an average use of 5 hours/day, and also showed high rates of wrist pain (31.4%) and cervical pain (44.6%) among volunteers.
These musculoskeletal changes demonstrate that a lack of guidance on correct use of DT can have serious physical consequences, 15 in addition to the emotional damage already reported. This is one of the reasons for the concern with constructing the BCSDTSD for assessment of these physical and emotional perceptions and, mainly, measuring the possibility of DD among the respondents. After all, the data from the study by Mescollotto et al. 46 are alarming, although they are minimized by the subjectivity of the participants, since the average time recorded represents almost 21% of the day using a device, even among those who were not dependent. Another key issue is the expected increase in new technology-dependent habits during SD that may persist after the pandemic, such as online shopping, food delivery, social interaction exclusively by DT, courses, and videoconference consultations. 47 It is with regard to these issues that the BCSDTSD scale is particularly important, since its questions 2 to 7 deal with these variations in technological activities.
Although SD is not necessarily synonymous with loneliness, early indications in the context of COVID-19 indicate that almost half of young people between 18 and 24 years of age are lonely during confinement. 35 Loneliness is also related to Hikikomori syndrome (HS), because, although it is not one of its mandatory diagnostic criteria, it is a very pronounced characteristic with continuous social withdrawal 47 and also a fundamental basis for the construction of an evaluation scale. 48 HS is currently seen as a socio-cultural phenomenon of MH, rather than a typical mental illness, characterized by prolonged and severe social withdrawal for a period of at least 6 months. 49 Prevalence of illness estimates in Asian community populations range from 0.87 to 2.3%. 47 In Brazil, prevalence is still unknown due to the lack of empirical research on the phenomenon, although there are already three reports in Brazilian patients. 47 Tateno et al. 50  Thus, COVID-19 also makes it more likely that serious damage to the MH of individuals will occur, which may last way beyond resolution of the pandemic. 53 One limitation of this study was the absence of other specific validated instruments for investigating behavioral changes in the use of DT during SD, which could have been used in constructing this scale. However, the methodological rigor dedicated to construction of the scale and the confirmation of the 10 questions proposed initially ratify the instrument's quality.
We recommend further studies on digital behavior and its consequences during quarantine periods, since DT are essential for dealing with crises like the COVID-19 pandemic. The internet can enable maintenance of the necessary social boundaries for people to remain "alone together" during the pandemic, as well as to compensate for the closing of schools and universities, thereby reducing some of the impacts of the economic crisis through remote work (home office), 5 disseminating reliable information on disease prevention and containment in real time, 53 and even facilitating medical, psychological, and psychotherapeutic consultations.
Future studies should also address the influence of DT on children 15 and inclusion of individuals and groups currently excluded from digital technologies, whether due to digital illiteracy, lack of connectivity in remote locations, or the impossibility of accessing technological devices. 4 It is essential to find creative ways to extend the reach of information technology to all aspects of society, including work and personal life. 8 It is thus necessary to unveil this comprehensive universe in order to plan preventative measures, treat disorders that have already developed, reduce future harm, and identify and propose solutions to the problems raised by this health crisis in our modern world.

Conclusion
The study achieved its objective of presenting a