Quality of life (QOL) for older adults in Puerto Rico was significantly impacted during the COVID-19 pandemic, yet there has been little attention to this topic. This study examines the association between COVID-19-related attitudes and QOL and the mediating role of the psychological sense of community (PSOC) in this context. Data are from a COVID-19 knowledge, attitudes, and practices survey with a nonprobability sample of 213 Puerto Rican adults aged 60+ in 2021. We conducted a mediated linear regression model using Hayes’s PROCESS macro. Results showed that both COVID-19 attitudes and PSOC positively related to QOL. Additionally, COVID-19 attitudes also had a positive effect on PSOC and an indirect, positive effect on QOL through PSOC. These findings suggest that enhancing older adults’ positive attitudes and strengthening community connections should be central to public health strategies, especially in community-oriented cultures like Puerto Rico.
Al-HanawiM. K.AngawiK.AlshareefN.QattanA. M. N.HelmyH. Z.AbudawoodY.AlqurashiM.KattanW. M.KadasahN. A.ChirwaG. C.AlsharqiO. (2020). Knowledge, attitude and practice toward COVID-19 among the public in the kingdom of Saudi arabia: A cross-sectional study. Frontiers in Public Health, 8, 217. https://doi.org/10.3389/fpubh.2020.00217
2.
AntinyanA.BassettiT.CorazziniL.PavesiF. (2021). Trust in the health system and COVID-19 treatment. Frontiers in Psychology, 12, 643758. https://doi.org/10.3389/fpsyg.2021.643758
AuA. K. Y.NgJ. C. K.WuW. C. H.ChenS. X. (2023). Who do we trust and how do we cope with COVID-19? A mixed-methods sequential exploratory approach to understanding supportive messages across 35 cultures. Humanities and Social Sciences Communications, 10(1), 272. https://doi.org/10.1057/s41599-023-01747-2
5.
AzlanA. A.HamzahM. R.SernT. J.AyubS. H.MohamadE. (2020). Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One, 15(5), Article e0233668. https://doi.org/10.1371/journal.pone.0233668
6.
BaronR. M.KennyD. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037//0022-3514.51.6.1173
7.
Beaton-ComuladaD.Torres-LugoN. J.Serra-LópezV. M.Guevara-SerraC.Muñoz-MiroH.RamirezN.Otero-LópezA. (2022). Factors influencing graduating medical students in Puerto Rico to pursue a primary care residency in the continental United States. Family Medicine, 54(8), 629–633. https://doi.org/10.22454/FamMed.2022.546991
8.
Berg-WegerM.MorleyJ. E. (2020). Editorial: Loneliness and social isolation in older adults during the COVID-19 pandemic: Implications for gerontological social work. The Journal of Nutrition, Health & Aging, 24(5), 456–458. https://doi.org/10.1007/s12603-020-1366-8
9.
BrinkhofL. P.HuthK. B. S.MurreJ. M. J.de WitS.KrugersH. J.RidderinkhofK. R. (2021). The interplay between quality of life and resilience factors in later life: A network analysis. Frontiers in Psychology, 12, 752564. https://doi.org/10.3389/fpsyg.2021.752564
10.
BuckleyT. D.BurnetteD. (2023). Psychological sense of community, self-rated health and quality of life among older adults in Puerto Rico two years after Hurricane María. Journal of Gerontological Social Work, 66(4), 512–529. https://doi.org/10.1080/01634372.2022.2133200
11.
BurnetteD.BuckleyT. D.FabeloH. E.YabarM. P. (2021). Foregrounding context in the COVID-19 pandemic: Learning from older adults in Puerto Rico. In PutnamM.ShenH.-W. (Eds.), Gerontological Social Work and COVID-19: Calls for change in education, practice, and policy from international voices (pp. 224–227). Routledge. https://doi.org/10.4324/9781003138280
12.
ButelJ.BraunK. L. (2019). The role of collective efficacy in reducing health disparities: A systematic review. Family & Community Health, 42(1), 8–19. https://doi.org/10.1097/FCH.0000000000000206
13.
Cameron-MaldonadoS.PérezC. M.Fernández-RepolletE.López-CeperoA. (2023). Age-related differences in anxiety and depression diagnosis among adults in Puerto Rico during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 20(11), 5922. https://doi.org/10.3390/ijerph20115922
14.
CampbellC. L.CadarD.McMunnA.ZaninottoP. (2023). Operationalization of intrinsic capacity in older people and its association with subsequent disability, hospital admission and mortality: Results from the english longitudinal study of ageing. The Journals of Gerontology: Series A, 78(4), 698–703. https://doi.org/10.1093/gerona/glac250
15.
CantareroR.PotterJ. J.LeachC. K. (2007). Perceptions of quality of life, sense of community, and life satisfaction among elderly residents in Schuyler and Crete, Nebraska. Architecture Program: Faculty Scholarly and Creative Activity, 4, 35–40.
16.
Carmona-GonzálezM.Flores-GarnicaA.Sánchez-RamosM. Á.Ortiz-RodríguezM. A.Arenas-OcampoM. L.García-SerranoL. A.Camacho-DíazB. H. (2022). Impact of the COVID-19 pandemic on the quality of life of older adults. Journal of Global Health Reports, 6, Article e2022032. https://doi.org/10.29392/001c.37468
FerreiraL. N.PereiraL. N.da Fé BrásM.IlchukK. (2021). Quality of life under the COVID-19 quarantine. Quality of Life Research, 30(5), 1389–1405. https://doi.org/10.1007/s11136-020-02724-x
19.
FerschB.Schneider-KampA.BreidahlK. N. (2022). Anxiety and trust in times of health crisis: How parents navigated health risks during the early phases of the COVID-19 pandemic in Denmark. Health, Risk & Society, 24(1–2), 36–53. https://doi.org/10.1080/13698575.2022.2028743
20.
FilkukováP.AytonP.RandK.LangguthJ. (2021). What should I trust? Individual differences in attitudes to conflicting information and misinformation on COVID-19. Frontiers in Psychology, 12, 588478. https://doi.org/10.3389/fpsyg.2021.588478
21.
FinkelsteinD. M.HardingJ. F.PaulsellD.EnglishB.HijjawiG. R.Ng’anduJ. (2022). Economic well-being and health: The role of income support programs in promoting health and advancing health equity. Health Affairs, 41(12), 1700–1706. https://doi.org/10.1377/hlthaff.2022.00846
22.
FisherA. T.SonnC. C.BishopB. J. (Eds.). (2002). Psychological sense of community: Research, applications, and implications. Springer Science & Business Media.
23.
GarcíaC.RiveraF. I.GarciaM. A.BurgosG.ArandaM. P. (2021). Contextualizing the COVID-19 era in Puerto Rico: Compounding disasters and parallel pandemics. The Journals of Gerontology: Series B, 76(7), e263–e267. https://doi.org/10.1093/geronb/gbaa186
24.
GarmezyN. (1985). Stress-resistant children: The search for protective factors. In StevensonJ. E. (Ed.), Recent research in developmental psychopathology: Journal of child psychology and psychiatry book supplement (pp. 213–233). Pergamon Press.
25.
GattinoS.RizzoM.GattiF.CompareC.ProcenteseF.GuarinoA.Di NapoliI.BarbieriI.FediA.AresiG.MartaE.MarzanaD.PratiG.RochiraA.TzankovaI.AlbanesiC. (2022). COVID‐19 in our lives: Sense of community, sense of community responsibility, and reflexivity in present concerns and perception of the future. Journal of Community Psychology, 50(5), 2344–2365. https://doi.org/10.1002/jcop.22780
26.
GeorgeD.MalleryP. (2022). IBM SPSS statistics 25 step by step: A simple guide and reference (17th ed.). Routledge. https://doi.org/10.4324/9781351033909
27.
GisondiM. A.BarberR.FaustJ. S.RajaA.StrehlowM. C.WestaferL. M.GottliebM. (2022). A deadly infodemic: Social media and the power of COVID-19 misinformation. Journal of Medical Internet Research, 24(2), Article e35552. https://doi.org/10.2196/35552
28.
GratzK. L.MannA. J.TullM. T. (2021). Suicidal ideation among university students during the COVID-19 pandemic: Identifying at-risk subgroups. Psychiatry Research, 302, 114034. https://doi.org/10.1016/j.psychres.2021.114034
29.
HayesA. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford Press.
30.
KhoraniH.MohammadiF.HosseinkhaniZ.MotalebiS. A. (2022). Predictive factors of quality of life in older adults during the COVID-19 pandemic. BMC Psychology, 10(1), 176. https://doi.org/10.1186/s40359-022-00882-w
31.
LeeM.KangB. A.YouM. (2021). Knowledge, attitudes, and practices (KAP) toward COVID-19: A cross-sectional study in South Korea. BMC Public Health, 21(1), 295. https://doi.org/10.1186/s12889-021-10285-y
32.
LeeS. (2022). Subjective well-being and mental health during the pandemic outbreak: Exploring the role of institutional trust. Research on Aging, 44(1), 10–21. https://doi.org/10.1177/0164027520975145
33.
LiM.XuY.LiuX.ChiclanaF.HerreraF. (2022). A trust risk dynamic management mechanism based on third-party monitoring for the conflict-eliminating process of social network group decision making. IEEE Transactions on Cybernetics, 53(6), 3399–3413. https://doi.org/10.1109/TCYB.2022.3159866
34.
MannariniT.RizzoM.BrodskyA.BuckinghamS.ZhaoJ.RochiraA.FediA. (2022). The potential of psychological connectedness: Mitigating the impacts of COVID‐19 through sense of community and community resilience. Journal of Community Psychology, 50(5), 2273–2289. https://doi.org/10.1002/jcop.22775
35.
National Center for Immunization and Respiratory Diseases (U.S.) Division of Viral Diseases. (2020). Clinical questions about COVID-19: Questions and answers. https://stacks.cdc.gov/view/cdc/89817
36.
PalloniA.DavilaA. L.Sanchez-AyendezM. (2013). Puerto Rican elderly: Health conditions (PREHCO) project, 2002–2003, 2006–2007. Inter-University Consortium for Political and Social Research. https://doi.org/10.3886/ICPSR34596
PetersonN. A.SpeerP. W.McMillanD. W. (2008). Validation of a brief sense of community scale: Confirmation of the principal theory of sense of community. Journal of Community Psychology, 36(1), 61–73. https://doi.org/10.1002/jcop.20217
ReubenR. C.DanladiM. M. A.SalehD. A.EjembiP. E. (2020). Knowledge, attitudes and practices towards COVID-19: An epidemiological survey in North-Central Nigeria. Journal of Community Health, 46(3), 457–470. https://doi.org/10.1007/s10900-020-00881-1
41.
Rivera-SegarraE.Rivera-MedinaC. L.Varas-DíazN. (2016). Validating the factor structure of the brief sense of community scale with a musical community in Puerto Rico. Journal of Community Psychology, 44(1), 111–117. https://doi.org/10.1002/jcop.21745
42.
RoyD.ShuvoS. D.HossainM. S.RiazuddinM.MazumdarS.MondalB. K.ZahidM. A. (2022). Knowledge, attitudes, practices, and its associated factors toward COVID-19 pandemic among Bangladeshi older adults. PLoS One, 17(12), Article e0275065. https://doi.org/10.1371/journal.pone.0275065
43.
RugarabamuS.IbrahimM.ByanakuA. (2022). Knowledge, attitudes, and practices (KAP) towards COVID-19: An online cross-sectional survey among Tanzanian residents. Journal of Community Medicine and Public Health Reports, 3(4). https://doi.org/10.38207/JCMPHR/2022/JUN03040247
44.
SchmidtS.MühlanH.PowerM. (2006). The EUROHIS-QOL 8-item index: Psychometric results of a cross-cultural field study. The European Journal of Public Health, 16(4), 420–428. https://doi.org/10.1093/eurpub/cki155
45.
SiahP. C. (2023). Social networking sites usage and quality of life among senior citizens. Asian Journal of Social Health and Behavior, 6(2), 79–85. https://doi.org/10.4103/shb.shb_138_22
46.
SiltanenS.IlmarinenK.LuomaM. L.LeppäahoS.KehusmaaS. (2022). Changes in older people’s quality of life in the COVID-19 era: A population-based study in Finland. Quality of Life Research, 31(11), 3177–3187. https://doi.org/10.1007/s11136-022-03210-2
47.
StevensE.GuerreroM.GreenA.JasonL. A. (2018). Relationship of hope, sense of community, and quality of life. Journal of Community Psychology, 46(5), 567–574. https://doi.org/10.1002/jcop.21959
48.
TakesueA.HiratsukaY.InoueA.KondoK.MurakamiA.AidaJ. (2021). Is social participation associated with good self-rated health among visually impaired older adults? The JAGES cross-sectional study. BMC Geriatrics, 21(1), 592. https://doi.org/10.1186/s12877-021-02554-7
49.
TangF.ChiI.XuL.DongX. (2018). Exploring relationships of psychological sense of community with self-rated health and depressive symptoms among older Chinese Americans. Gerontology and Geriatric Medicine, 4, 2333721418778183. https://doi.org/10.1177/2333721418778183
50.
ThoresenS.BlixI.Wentzel-LarsenT.BirkelandM. S. (2021). Trusting others during a pandemic: Investigating potential changes in generalized trust and its relationship with pandemic-related experiences and worry. Frontiers in Psychology, 12, 698519. https://doi.org/10.3389/fpsyg.2021.698519
51.
TiernanC.LysackC.NeufeldS.LichtenbergP. A. (2013). Community engagement: An essential component of well-being in older African-American adults. The International Journal of Aging and Human Development, 77(3), 233–257. https://doi.org/10.2190/AG.77.3.d
Van BredaA. D. (2018). A critical review of resilience theory and its relevance for social work. Social Work, 54(1), 1. https://doi.org/10.15270/54-1-611
55.
WareJ. E.Jr.KosinskiM.KellerS. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. https://doi.org/10.1097/00005650-199603000-00003
56.
WeidaE. B.PhojanakongP.PatelF.ChiltonM. (2020). Financial health as a measurable social determinant of health. PLoS One, 15(5), Article e0233359. https://doi.org/10.1371/journal.pone.0233359
57.
WendlandtR.CowlingB. J.ChenY.HaversF.ShifflettP.SongY.ZhangR.IulianoD.XuC.YuH.ZhangJ.ZhangH.TangF.ThompsonM. (2018). Knowledge, attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China. Vaccine, 36(19), 2673–2682. https://doi.org/10.1016/j.vaccine.2018.03.052
58.
WHOQOL Group. (1995). The world health organization quality of life assessment (WHOQOL): Position paper from the world health organization. Social Science & Medicine, 41(10), 1403–1409. https://doi.org/10.1016/0277-9536(95)00112-K
59.
WisterA.KlasaK.LinkovI. A. (2022). A unified model of resilience and aging: Applications to COVID-19. Frontiers in Public Health, 10, 865459. https://doi.org/10.3389/fpubh.2022.865459
60.
WolfM. S.SerperM.OpsasnickL.O'ConorR. M.CurtisL.BenaventeJ. Y.WismerG.BatioS.EiflerM.ZhengP.RussellA.ArvanitisM.LadnerD.KwasnyM.PersellS. D.RoweT.LinderJ. A.BaileyS. C. (2020). Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. Outbreak: A cross-sectional survey. Annals of Internal Medicine, 173(2), 100–109. https://doi.org/10.7326/M20-1239
61.
ZabaniotouA. (2020). A systemic approach to resilience and ecological sustainability during the COVID-19 pandemic: Human, societal, and ecological health as a system-wide emergent property in the Anthropocene. Global Transitions, 2, 116–126. https://doi.org/10.1016/j.glt.2020.06.002
62.
ZhangJ.YuN. X.ZhangJ.ZhouM. (2017). Sense of community and life satisfaction in Chinese older adults: Moderating roles of personal and partner resilience. Journal of Community Psychology, 45(5), 577–586. https://doi.org/10.1002/jcop.21878
63.
ZhongB.-L.LuoW.LiH.-M.ZhangQ.-Q.LiuX.-G.LiW.-T.LiY. (2020). Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. International Journal of Biological Sciences, 16(10), 1745–1752. https://doi.org/10.7150/ijbs.45221
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
