1 INTRODUCTION

Coronavirus disease (COVID-19) has become a major public health problem in the world and in Turkey. Since first appearing as a new disease in Wuhan, China, the number of COVID-19 cases has increased rapidly (Roy et al., 2020; Torales et al., 2020). The World Health Organization (WHO) declared the pandemic on 30 January 2020, stating that the emerging COVID-19 disease was in the very high-risk category (WHO, 2020). In Turkey, the first cases of COVID-19 were announced by official authorities on 11 March 2020. As of this date, formal educational institutions had been suspended, working at home had been initiated, measures were taken to ensure social distance by declaring curfews at certain periods for the general population, and restrictions imposed for those under the age of 20 and over 65. Moving people away from others to limit infection is an important public health measure, while posing mental health risks as well (Lades et al., 2020).

Although taking physical protection measures during the pandemic, less attention is paid to the effects of the pandemic on mental health. The COVID-19 pandemic is seen as a serious threat to mental health in high, middle and low income countries (Xiong et al., 2020). In a study including the Americas, Asia and Europe, it was revealed that when physical symptoms resembling COVID-19 infection increase, the perceived psychological effect and depression, anxiety and stress levels increase (Wang, Chudzicka-Czupała, et al., 2021). In another study conducted in middle-income Asian countries, the societies with the highest stress levels during the COVID-19 pandemic were reported as Thailand, Pakistan and the Philippines, respectively (Wang, Tee, et al., 2021). These studies show that the pandemic affects societies at different levels in terms of mental health. One of the most important reasons for this difference may be the management policy of governments against the pandemic. A meta-analysis conducted by Lee et al. (2021) reported that the prevalence of depressive symptoms is lower in countries where COVID-19 pandemic measures are implemented rapidly and strictly. Wang, Chudzicka-Czupała, et al. (2020) found that depression, anxiety and stress were lower in participants who covered their mouth when coughing and sneezing, practiced hand hygiene, wore a mask, and spent most of their time (20–24 h) at home. Le et al. (2020) found that depression, anxiety and stress levels were lower during quarantine. It is seen that more compliance with pandemic measures has positive effects on mental health. The negative effects of measures that change living conditions, such as social distancing during the pandemic, should also be considered (Tran, Nguyen, et al., 2020).

The multiple roles and functions played by nurses are particularly important during this COVID-19 pandemic (Chen et al., 2020). Nurses provide public education regarding proper hand hygiene, cough etiquette, mask wearing and social distancing (Huang et al., 2020). Besides, it is important for nurses to provide mental health and psychosocial support to individuals as well as providing direct medical and social care for suspected and confirmed cases (Huang et al., 2020).

The fear of the unknown, the exclusion, stigmatization, and being declared guilty in all individuals in times of crisis cause a high level of anxiety (Torales et al., 2020; Xiang et al., 2020). As the COVID-19 outbreak is a new disease; fear, anxiety and stress about this situation can cause strong emotions in adults (CDC, 2020). Roy et al. (2020) determined that more than 80% of people's thoughts were busy with COVID-19, causing anxiety in these individuals to increase. In a study conducted in China, 32.1% of the participants experienced different levels of stress due to the COVID-19 outbreak (Wang, Pan, et al., 2020). Also, Lu and Zhang (2020) determined that communication and information flow was provided to individuals through an information network created on social media during COVID-19 process, so that negative emotions of individuals could be controlled.

Emotion level studies conducted during virus outbreaks are often based on past emotions and do not provide a snapshot during the outbreak (Lades et al., 2020). In COVID-19 process, which will be remembered as a pandemic that affected the whole world in the future, it is recommended to carry out due diligence studies in pandemic management through analysis of social concerns with media tools (Lu & Zhang, 2020). It is necessary to focus on the impact of the pandemic worldwide on the mental health of patients and the general population. The effects of media and social network information on the psychosocial health of individuals should be determined (Torales et al., 2020).

Societies usually seek out information about national events to become informed of developments during times of crisis, such as the COVID-19 outbreak (Torales et al., 2020; Yao, 2020). A wide variety of media tools are used to follow social developments. Because COVID-19 makes interventions such as quarantine and social distance mandatory, social media is frequently used to follow quarantine procedures, to work for the benefit of the society and to reach individuals (Depoux et al., 2020; Wiederhold, 2020). The media should convey the information to the public in an efficient and effective manner. As the number of COVID-19 cases increased, the information circulating in media increased due to the rapid spread potential of technological tools (Wiederhold, 2020). However, irregular and misleading information from various media can affect individuals negatively (Torales et al., 2020). In a study by Pennycook et al. (2020), it was stated that individuals contribute to the dissemination of contradictory information because they believe in false information about COVID-19, do not know the correctness of the content they share, and are not sure about what information to share. As contemporary society embraces digital technologies, ways in which nurses communicate using digital media are being proposed (O'Leary et al., 2021). Nurses are increasingly using digital media for real-time health communication and promotion (Gabarron & Wynn, 2016). Therefore, nurses can play a role in correctly informing individuals, especially through social media.

Nurses are the frontline healthcare professionals who work across acute care hospitals, nursing homes, schools, community and government healthcare agencies (Chen et al., 2020). Nurses have become very visible during this outbreak, and they have become very vocal on social media. In this context, the role of nurses becomes important in accessing accurate information through media during pandemic and protecting the psychosocial health of individuals. The research was conducted to determine the media use, emotional changes, and perceived stress level of adult individuals during the COVID-19 pandemic. Research questions were as followed: What is the media use of the participants during the COVID-19 pandemic? Does the media use of the adults affect their positive and negative emotions during the pandemic? Does the media use of the adults affect their stress level during the pandemic? Do the socio-demographic characteristics of the adults affect their positive and negative emotions? Do the socio-demographic characteristics of the adults affect their stress level? 2 METHODS 2.1 Study design, sampling and recruitment strategies

The research was carried out using a cross-sectional design. Snowball sampling method was implemented to recruit adult individuals into the study. Snowball sampling is used for locating participants who would be difficult or impossible to obtain in other ways or who have not been previously identified for study. Snowball sampling takes advantage of social networks and the fact that friends tend to have characteristics in common (Grove et al., 2015). For the present study, 1585 adults were recruited from social media tools. Of these adults, 4 were under the age of 18, 35 adults refused to participate and 5 were reported as having a psychiatric disease. The study was completed with 1541 adults who met the inclusion criteria. In the power analysis performed after the study, the power was calculated as 0.99 in the case of alpha (α) = 0.05. This result showed that the sample size was sufficient.

Inclusion criteria were 18 years and older, using media tools, having the knowledge and skills to complete an online questionnaire, and willingness to participate in the research. Exclusion criteria were under the age of 18, and having any neuro-psychiatric problem.

2.2 Instruments

The questionnaire, prepared by the researchers, was used to collect the data. The questionnaire consisted of two parts. The first part included questions about determining the socio-demographic characteristics of the participants including age, sex, education level, marital status, income, working status, place of residence, having chronic disease, and features related to media use such as duration of daily media use, information sources related to COVID-19, media tools used during COVID-19, and frequency of following the developments regarding COVID-19 in media tools. The second part included the Positive and Negative Emotion Scale and the Perceived Stress Scale.

The Positive and Negative Emotion Scale was developed by Watson et al. (1988) and Turkish adaptation for adults was performed by Gençöz (2000). The scale consisting of 20 items, 10 positive and 10 negative. Each item of the scale was evaluated between 1 (very little or no) and 5 (very high). The total score of the scale was obtained by adding the numerical values corresponding to the answers. The scores that could be obtained on the scale range from 10 to 50 for each emotion. As the total score for each emotion increases, individuals' positive or negative emotion levels increase. Cronbach alpha coefficients of the scale were reported as 0.83 and 0.86 for positive and negative emotions, respectively.

The Perceived Stress Scale, developed by Cohen et al. (1983), based on two factors: self-efficacy and stress perception, consists of 14 items. Perceived Stress Scale, adapted to Turkish (Eskin et al., 2013), is designed to measure how stressful situations in a person's life are perceived. Its validity and reliability were determined in the adult group. Participants evaluate each item on the 5-point Likert scale as ‘Never (0), Almost never (1), Sometimes (2), Quite often (3) and Very often (4)’. Seven of the items containing positive statements are scored in reverse order. The total score that can be obtained from the scale varies between 0 and 56. As the total score obtained from the scale increases, the person's perception of stress increases. Cronbach alpha coefficient of the scale was reported as 0.84. In addition, the Turkish validity and reliability scale scores were positively associated with life events.

2.3 Data collection

The research was carried out between 12 May and 25 May 2020. Instruments were prepared as online surveys with Google Forms and delivered to the participants via WhatsApp, Instagram, other social media platforms such as Facebook, and e-mail. The participants were informed about the study and their consents were obtained online. The sample was obtained through the snowball method by the people participating in the research by inviting the online survey through various channels. The application of data collection tools took a mean of 10–15 min.

2.4 Data analysis

The research data were evaluated with IBM SPSS (Statistical Package of Social Sciences) statistics for Windows version 25.0 (IBM Corp., Armonk, NY, USA). Number, percentage, mean, and standard deviation were used in presenting descriptive characteristics. The conformity of the data to the normal distribution was evaluated with the Kolmogorov–Smirnov test. Binary groups were compared with independent sample t test and more than two groups were compared with One-way ANOVA. Significance level was accepted as p < 0.05.

2.5 Ethical consideration

Before the data collection, young people were informed about the purpose of the study and their informed consents were obtained. This study was approved by the Ethic Commision of Ankara Yıldırım Beyazıt University (2020-15144).

3 RESULTS 3.1 Socio-demographic characteristics of the adults

The socio-demographic characteristics of the participants were presented in Table 1. Of the participants, 74% were between 18 and 24 years old, 83.3% were female, 83.1% were single, 66.7% spent most of their life in the city, 82.9% were university graduates, 78.8% were not employed, 57.8% of the income was equal to their expense and 89.9% of them did not have a chronic disease.

TABLE 1. Socio-demographic characteristics (n = 1541) Socio-demographic characteristics Number Percentage Age groups 18–24 years 1140 74.0 25–40 years 320 20.8 41 years and over 81 5.3 Gender Female 1283 83.3 Male 258 16.7 Marital status Single 1280 83.1 Married 261 16.9 The longest place of residence City 1028 66.7 District 399 25.9 Village 114 7.4 Education level High school and below 158 10.3 Undergraduate 1277 82.9 Master/doctorate 106 6.9 Working status Yes 327 21.2 No 1214 78.8 Income Income less than expense 376 24.4 Income equal to expense 891 57.8 Income more than expense 274 17.8 Having chronic disease Yes 156 10.1 No 1385 89.9 3.2 Media use during COVID-19

Approximately half of (51.7%) the participants used media tools for more than 4 hours daily, 86.4% of the participants obtained information about COVID-19 through social media, 84.4% via television, and 67.8% via websites. Among the media tools used in the COVID-19 pandemic, 92.4% were smartphones, 89.4% were internet and 81.7% were televisions. In addition, it was determined that 43.3% of the participants had a frequency of following the developments regarding COVID-19 several times a day (Table 2).

TABLE 2. Features related to media use (n = 1541) Features related to media use Number Percentage Duration of daily media use 1–2 h 319 20.7 3–4 h 425 27.6 More than 4 h 797 51.7 Information sources related to COVID-19a Social media 1332 86.4 Televison 1302 84.4 Internet sites 1046 67.8 Friends 583 37.8 Family members 551 35.7 Radio 62 4.0 Other 54 3.5 Media tools used during COVID-19a Smartphone 1425 92.4 Internet (general use) 1378 89.4 Television 1259 81.7 Newspaper 107 6.47 Radio 102 6.61 Frequency to follow COVID-19 in media tools Once a day 521 33.8 Several times a day 668 43.3 Often during the day 265 17.2 Continuously throughout the day 87 5.6 3.3 Positive and negative emotions and relationship with media use and socio-demographic characteristics

The Positive Emotion Scale mean of the participants was 24.26 ± 7.63; the Negative Emotion Scale mean was 22.34 ± 7.79. The Positive Emotion Scale mean score of the people whose daily media use time was more than 4 h and who followed the developments about COVID-19 once a day through the media were lower than others (p < 0.05). Adults with a daily media use time more than four hours and who followed the developments related to COVID-19 with media tools often during the day had higher negative emotion scores (p < 0.05) (Table 3).

TABLE 3. Mean scores of positive and negative emotions and perceived stress scales according to media use Using media tools Positive emotion mean (SD) Negative emotion mean (SD) Perceived stress mean (SD) Duration of daily media use 1–2 h 25.23 (7.59) 20.41 (7.14) 28.01 (7.80) 3–4 h 25.20 (7.62) 21.47 (7.39) 28.97 (7.90) More than 4 h 23.36 (7.55) 23.58 (8.04) 31.67 (7.91) F = 11.458, p < 0.001 F = 23.213, p < 0.001 F = 31.332, p < 0.001 Frequency to follow COVID-19 in media tools Once a day 23.32 (7.23) 21.45 (7.74) 29.91 (8.20) Several times a day 24.65 (7.32) 22.55 (7.44) 30.22 (7.72) Often during the day 24.02 (7.95) 23.41 (8.09) 30.63 (8.20) Continuously throughout the day 27.55 (9.97) 22.85 (9.30) 29.90 (8.92) F = 8.809, p < 0.001 F = 4.260, p = 0.005 F = 0.506, p = 0.678 Note: SD, standard deviation; F = One-way ANOVA.

The Positive Emotion Scale mean scores of adults between the ages of 25–40 were higher than those of other age groups, in males compared to females, in those who were married than those who were single, in those who lived in the city centre than those living in rural areas, in those who had masters/doctorate degrees rather than those who had graduated from high school or had undergraduate degrees, in those who worked rather than those who did not work, and in those whose income was more than their expenses rather than those whose income was lower than or equal to their expenses (p < 0.05) (Table 4).

TABLE 4. Mean scores of positive and negative emotion scale and perceived stress scale according to socio-demographic characteristics (n = 1541) Socio-demographic characteristics Positive emotion mean (SD) Negative emotion mean (SD) Perceived stress mean (SD) Age groups 18–24 years 23.66 (7.25) 23.02 (7.78) 31.04 (7.81) 25–40 years 26.06 (8.46) 21.14 (7.80) 28.22 (8.05) 41 years and over 25.56 (8.20) 17.55 (5.36) 25.66 (8.31) F = 13.897, p < 0.001 F = 24.137, p < 0.001 F = 29.815, p < 0.001 Sex Female 23.61 (7.31) 22.77 (7.76) 30.85 (7.95) Male 27.49 (8.35) 20.22 (7.62) 26.79 (7.62) t = 7.585, p < 0.001 t = 4.837, p < 0.001 t = 7.538, p < 0.001 Marital status Single 23.95 (7.45) 22.75 (7.76) 30.73 (8.01) Married 25.77 (8.29) 20.34 (7.66) 27.43 (7.59) t = −3.292, p = 0.001 t = 4.592, p < 0.001 t = 6.103, p < 0.001 The longest place of residence City 24.50 (7.77) 22.23 (7.74) 29.91 (8.21) District 24.11 (7.39) 22.32 (7.70) 30.59 (7.75) Village 22.61 (7.00) 23.41 (8.52) 30.97 (7.41) F = 3.261, p = 0.039 F = 1.167, p = 0.312 F = 1.638, p = 0.195 Education level High school and below 25.01 (8.56) 21.99 (8.46) 29.84 (8.10) Undergraduate 23.88 (7.44) 22.59 (7.74) 30.54 (7.83) Master/doctorate 27.64 (7.61) 19.95 (6.98) 26.16 (9.23) F = 12.895, p < 0.001 F = 5.818, p = 0.003 F = 14.900, p < 0.001 Working status Yes 26.37 (8.62) 20.51 (7.65) 27.45 (8.27) No 23.69 (7.24) 22.84 (7.76) 30.90 (7.82) t = 5.141, p < 0.001 t = −4.819, p < 0.001 t = −6.991, p < 0.001 Income Income less than expense 23.42 (7.42) 23.90 (8.20) 31.72 (8.30) Income equal to expense 24.01 (7.42) 22.01 (7.49) 30.09 (7.58) Income more than expense 26.22 (8.25) 21.30 (7.90) 28.29 (8.70) F = 12.018, p < 0.001 F = 10.948, p < 0.001 F = 14.755, p < 0.001 Having chronic disease Yes 24.38 (7.17) 22.30 (7.57) 29.83 (8.23) No 24.24 (7.68) 22.35 (7.82) 30.21 (8.02) t = 0.211, p = 0.833 t = −0.068, p = 0.946 t = −0.557, p = 0.578 Note: SD, standard deviation; F = One-way ANOVA; t = independent sample t test.

Adults who were between the ages of 18 and 24 compared with other age groups, females compared with males, those who were single compared with those who were married, those who graduated from undergraduate programmes compared with high school and masters/doctorate degree graduates, those who did not work compared with those who worked, and those who had less income than their expenses had higher Negative Emotion Scale mean scores (p < 0.05) (Table 4).

3.4 Perceived stress level and relationships with media use and socio-demographic characteristics

The Perceived Stress Scale mean score of the participants was 30.17 ± 8.04. Adults with a daily media use duration more than 4 h had higher perceived stress scores than others (p < 0.05) (Table 3). Adults aged between 18 and 24 compared with other age groups, females compared with males, those who were single compared with those who were married, those who graduated from undergraduate programmes compared with high school and masters/doctorate degree graduates, those who did not work compared with those who worked, and those who had less income than their expenses had higher Perceived Stress Scale mean scores (p < 0.05) (Table 4).

4 DISCUSSION

Media use, changes in mood and stress levels of adults in the COVID-19 pandemic were examined in this study. Previous studies found that the use of social media and internet increased in the COVID-19 pandemic (Elhai et al., 2020; Gao et al., 2020). Consistent with previous studies (Chao et al., 2020; Gao et al., 2020; Lades et al., 2020; Yao, 2020), approximately half of the participants had more than 4 h of media use per day in the present study. Also, adults whose daily media use time was more than 4 h had lower positive emotions and higher negative emotions and stress. It is thought that individuals use the media more frequently to learn about the COVID-19 pandemic. Tran, Dang, et al. (2020) reported that it is necessary to convey current information on the COVID-19 pandemic through mass media as the most accessed information source. However, it can be said that the increasing number of cases of COVID-19 disease and related deaths increase the negative emotions and stress level of individuals. Evaluating primary and useful sources of information about the outbreak is essential to help individuals make informed decisions to prevent and control COVID-19 (Tran, Dang, et al., 2020). In this context, it is thought that nurses can help individuals reach the right resources about the pandemic through the media by increasing their health literacy levels.

People are busy with various media contents related to the COVID-19 outbreak, and these media use behaviours are associated with acute psychological consequences (Chao et al., 2020). In this study, adults who followed the developments about COVID-19 continuously with the media tools had higher positive emotions. Chao et al. (2020) reported the speeches made by experts and authorities through the media caused higher positive emotions on individuals. When recommended quarantine measures were implemented in Turkey, people staying at home started to use various media tools such as television, radio, social media and internet more frequently. Therefore, nurses could increase the awareness of individuals for pandemic measures through media tools and support them for the implementation of these measures. It is believed that people who followed the information and developments about COVID-19 continuously throughout the day had more positive feelings because they had comprehensive information about the COVID-19 pandemic. Fear of uncertainty that negatively affect individuals in pandemic could be mitigated by frequently following the process through media tools.

Infectious disease outbreaks like COVID-19 can cause emotional stress and anxiety (Montemurro, 2020). In pandemics, which is a periodic phenomenon, people may feel inadequate to overcome these difficulties by encountering various difficulties. Therefore, individuals may experience changes in emotions and stress levels (Roy et al., 2020). In the current study, the positive emotions of the participants were higher than the negative emotions, and the perceived stress level was high. A systematic review by Vindegaard and Benros (2020) revealed that the psychological well-being of adults was worse, and anxiety and depression were higher than before COVID-19. In a study by Zhang and Ma (2020), 52.1% of adults were found to be worried about the outbreak. In the COVID-19 process, other feelings such as fear, boredom, loneliness and anger may also be felt against the results of patients in quarantine, confirmed or suspected patients (Xiang et al., 2020). Although physical health needs are a more urgent priority in outbreaks, it should be taken into account that mental health problems in the surviving population can have far more and longer-lasting effects (Rajkumar, 2020; Wiederhold, 2020). Nurses have a pivotal role in providing contact tracing and care as part of self-health management, home quarantine, home isolation, and community care services (Huang et al., 2020). In addition to this, it is a necessity for nurses to take an active role in determining the long-term psychosocial effects of the pandemic.

In the pandemic process, individuals may experience emotional changes due to increased media use, conflicting information, anxiety about the health of ind