Associations between the TV program preferences of older adults and their COVID-19-related fear during the pandemic: A quantitative study in China

Abstract The COVID-19 pandemic led to social distancing and lockdowns that severely affected individuals’ (especially elderly people’s) habits and mental health. The pandemic forced people to stay indoors, limiting their social interactions and increasing television viewing. However, little research has examined older adults’ television preferences during the pandemic. In this study, we examined the television program preferences of older Chinese adults during the COVID-19 pandemic and investigated the correlations between their preferences and their fear of the virus. We conducted a questionnaire survey among 405 older Chinese adults. The findings revealed that the participants preferred news, service, drama, and documentary programs, and they also favored family affection, friendship, current affairs, and health program topics. Notably, we found a negative correlation between a preference for dramas, and a positive correlation between preferences for literature and action programs, and the fear of the virus. These results provide valuable insights into the media preferences of older adults during pandemics and can be used to inform media strategies that cater to their needs.


Introduction
The global outbreak of COVID-19 has instilled fear and anxiety across the world, particularly among the elderly demographic.According to Mistry et al. (2021), research has demonstrated that older adults are more vulnerable to the virus and its ramifications, rendering them more prone to experiencing fear and anxiety.The mental health of individuals over 60 has been a significant concern during the COVID-19 pandemic, as reported by Lee et al. (2020).While COVID-19 can affect individuals of all ages, a majority of confirmed cases and deaths were observed among older adults, particularly those over 60 years old, who were at high risk of contracting the virus (Yang et al., 2020).Moreover, the repeated imposition of lockdown measures to curb the spread of COVID-19, along with the resulting social isolation and detachment, has raised concerns about the mental well-being of older individuals (Lee et al., 2020).
In response to the COVID-19 outbreak, the Chinese government implemented several preventative measures, such as social distancing, centralized isolation, and home isolation (Gan et al., 2022).Wang et al. (2020) conducted a study on the mental well-being of the Chinese population during this time and discovered that approximately 33% experienced moderate to severe levels of depression.
Moreover, the pandemic forced people to stay indoors and restricted their social interactions, leading to an increase in television watching (Altena et al., 2020).During the pandemic, television was an important source of entertainment and information, which people depended on to obtain the latest news and pass the time while confined to their homes (Dixit et al., 2020;Egielewa et al., 2023;Mohamad et al., 2020).Older adults' preferences for television programs possibly reflected their mental state and emotional health during this period.Research has revealed that media exposure moderated mental health, both positively and negatively, during the COVID-19 pandemic (Zhao & Zhou, 2020), and studies have also shown that mass media can promote and improve the mental health of the elderly (Heo et al., 2015;Pandele et al., 2021;Quintana et al., 2018).Despite the popularity of the Internet, older adults still prefer television over other forms of mass media (Van der Goot et al., 2012), and television is crucial in the daily lives of older adults who may use television watching to combat loneliness (Sobral et al., 2018).
Therefore, it was crucial to investigate the relationship between older adults' television program preferences during the pandemic and their related fear of COVID-19.Thus, we developed the following two objectives for our study: We aimed to explore whether older adults watched certain types of television programs due to COVID-19-related fear, and whether these programs had any impact on their emotional wellbeing.We also believed that the study could demonstrate the social and emotional value of television use among older adults and, for example, whether watching certain types of television programs could help reduce fear.By considering the association between television program preferences and COVID-19-related fear, policymakers, health-care professionals, and media organizations can develop appropriate strategies to reduce fear and promote mental health among older adults during pandemics.

TV Program Preferences of Older Adults
Watching television is the primary leisure and entertainment activity for the elderly, there are studies that have investigated the preferences of older adults for specific television programs.In this section, we summarize the relevant literature to provide a better understanding of older adults' preferences in terms of television watching.
Older adults commonly prefer news and current affairs programs and watch news programs more frequently than other types of programs (Purcell et al., 2010).Newman et al. (2021) also found that older adults reported a preference for news and current affairs programming.Other studies comparing older and younger people's television preferences found that older people watched television news more often than other age groups (Mares & Woodard, 2006;Van der Goot, 2009).
According to Choi et al. (2003), older women may prefer television programs that include health information.Kensaku (2010) found that Japanese seniors wanted a variety of shows that would entertain them, cheer them up, and provide information and knowledge.Studies have also shown that older adults prefer talk shows and game shows (Glass & Smith, 1985).
Overall, this literature reveals that older adults have specific preferences regarding television content, including news and current events and programs that address their specific interests and needs.Further research is needed to identify the television programs preferred by elderly during the pandemic.

Mental Health of Older Adults during the COVID-19 Pandemic
As the COVID-19 pandemic continues to affect populations around the world, various studies have been conducted to understand its impact on mental health.Some of these studies have highlighted the increased anxiety and depression experienced by elderly people during the pandemic (Herrera et al., 2021;Tyler et al., 2021).Social isolation, a consequence of the pandemic, has also been identified as a significant factor contributing to increased anxiety and depression among older adults in the UK (Robb et al., 2020).Furthermore, Callow et al. (2020) suggested that the increased risk of death associated with COVID-19 led to more severe anxiety and depressive symptoms among older adults.Similarly, De Oliveira Andrade et al. (2022) found a high prevalence of depression and anxiety symptoms among older adults in Brazil during the pandemic.
To measure fear of COVID-19, Ahorsu et al. (2020) developed the Fear of COVID-19 Scale (FCV-19S), a brief, validated instrument with good psychometric characteristics.The FCV-19S has been translated into several languages and is applied in several countries and contains fewer items than other scales (Chen et al., 2022).Researchers have used this scale to assess the mental health of older adults, and Savci et al. (2021) found that factors such as increasing age, ethnicity, living far from a health care facility, and feeling overwhelmed or worried about the COVID-19 pandemic were associated with the level of fear of COVID-19.In addition, Li et al. (2021) found that the news media had a negative impact on reducing fear of COVID-19 in older women.
In conclusion, there were some changes in the mental health of older adults during the pandemic, with several studies highlighting higher levels of anxiety and depression in this population.The FCV-19S has been shown to be a valid tool for measuring fear of COVID-19, and researchers have used it to identify factors contributing to this fear.However, few studies have verified links between TV viewing preferences and COVID-19-related negative emotions.

Participants and Procedures
A total of 405 older adults from across China participated in this study by completing an online survey from May 11 to 22 May 2022.Because Chinese society was severely affected by COVID-19 during the survey period under the zero-COVID-19 policy, all our surveys were disseminated through WeChat groups, which included elderly activity centers, nursing homes, and communities in urban and rural areas.
We disseminated the online questionnaire through WeChat because, since Tencent released the application in 2011, it has become one of the most widely used and popular messaging applications in China (Chen & Cheung, 2018;Tu, 2016), with over 1 billion active users per month.WeChat features include text, verbal and video chats, social photo sharing tools, interactive features, and public platform features, which were used to provide health information during the COVID-19 pandemic (Liu et al., 2020).Therefore, WeChat was essential for all Chinese people during the pandemic, and it made sense to use it to disseminate our online questionnaire.
The study sought to gather information on TV watching and COVID-19-related fear from individuals aged 60 or older through an online survey accessible via a website link.No specific inclusion criteria were set aside from the age requirement, allowing for a diverse pool of participants.Voluntary participation was emphasized throughout the study, and measures were put in place to ensure the anonymity and privacy of all participants.After completing the questionnaire, older adults were rewarded with a small monetary compensation of 1-2 RMB.Before proceeding with the survey, older adults were informed of the study's objective, scope, and the data collection methods utilized and signed an online consent form.Furthermore, participants had the option to withdraw from the study at any point in time.The study was granted ethical approval by the University of Malaya (UM) Research Ethics Committee (TNC2/UMREC_1840), affirming the study's compliance with ethical standards.

Measures
After providing their informed online consent, the participants completed the relevant survey, which consisted of four sections: a participant information sheet, preferences for TV program genres, preferences for TV program topics, and the COVID-19 Fear Scale (FCV-19S).The participating older Chinese adults were asked to give responses to the questions and scale items that best reflected their experiences during the pandemic.

Participant information sheet
The information sheet contained four items intended to capture the descriptive characteristics of older adults: age, gender, educational status, and occupation.

Preference for TV Program Genres
We designed this scale according to the national classification of Chinese TV programs, and it contained 11 items in total.According to the China National Radio and Television Administration's (2022) GY/T 360-2022 specification for the content identification and labeling of radio and TV network audiovisual programs, Chinese TV programs are divided into news, services, variety, dramas, movies, sports, advertisements, documentaries, and cartoons.We added traditional opera (Chen et al., 2020) and talk shows (Keane, 2015) to this classification to make the survey broader and to consider the viewing habits of older adults, resulting in a test scale containing 11 items (e.g., "I liked to watch the news during the pandemic").The instrument was administered using a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree.

Preference for TV Program Topics
To the aforementioned classification of radio and TV programs (China National Radio and Television Administration, 2020), which included 12 program topics (current affairs, military, economics, literature, arts, history, city, rural, leisure, sports, science, and health), we added 8 topics based on the literature review: family affection, love, friendship, war, action, comedy, literature, and myths (Keane, 2015;Zhu, 2013), forming a final scale that contained 20 items (e.g., "I liked to watch friendship topics on TV programs during the pandemic").The answers were given on a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree.Ahorsu et al. (2020) developed the FCV-19S, which was later translated into Chinese by Chi et al. (2021).The scale consists of seven items that measure an individual's fear of COVID-19.Examples of the items include feeling apprehensive or anxious while watching news and stories about COVID-19 on social media, and being afraid of losing their life due to the virus.Each item is rated on a five-point scale, ranging from strongly disagree (1) to strongly agree (5).The scores of the FCV-19S items were summed to obtain a total score, where a higher score indicates a higher fear of COVID-19.

Data Analysis
We used SPSS 23 software to determine the reliability, validity, and usability of the scale and the data, and we further employed an analytic hierarchy process (AHP) to determine older adults' preferences for television viewing and rank their preferred genres and topics based on the weight values.We used regression analysis to examine the associations between the independent variables (older adults' TV program preferences) and the dependent variables (FCV-19S scores).The significance level was p < .05.

Reliability and validity
Before analyzing the data, we tested the reliability and validity of the observed indicators using SPSS ® (Table 1).The KMO values were all greater than 0.8 (p = .000),and the α values were all more than 0.8.Thus, the data passed the reliability and validity tests and could be used for further analysis.

Ranking the TV Program preferences of older adults
The survey of participants' preferences included 11 program genres and 20 program topics for their evaluation, and the results of the AHP obtained through SPSS ® analysis were as shown in Figures 1 and 2. AHP is usually used to measure the weight value of an indicator by having experts score the importance of the indicator and perform a consistency test.Data were analyzed by first calculating the mean values of the analyzed items, dividing the means to obtain judgment matrices, and then comparing the mean values: the greater the mean value, the higher the importance and the weight (Brunelli, 2014).
The CI value for the eleventh-order judgment matrix was 0.000, and the table RI value was 1.520, so we calculated the CR value as 0.000 < 0.1, meaning that the judgment matrix for this study satisfied the consistency conditions and the weights were consistent.

Association of TV program preferences with COVID-19-related fear
Finally, we examined the interrelations between the investigated variables using multivariate linear regression.In the first step, we examined the associations between older adults' TV program genre preferences and COVID-19-related fear (Table 3), and the results showed that a preference for dramas had a significant negative effect on COVID-19-related fear.However, preferences for news, variety, traditional opera, talk shows, documentaries, sports, movies, services, cartoons, and advertisements did not influence fear.This study passed the F-test (F = 1.844, p = .045-.05), meaning that the model construction was meaningful.In the second step, we examined the associations between older adults' TV program topic preferences and COVID-19-related fear, and the results showed that literature and action topics had a significant positive effect on COVID-19-related fear (Table 4).However, there was no effect of affection, friendship, love, family, war, history, myths, science, current affairs, military, comedy, rural, city, leisure, art, sports, health, or economics on fear.The model passed the F-test (F = 2.612, p = .000<.05),meaning that the model construction was meaningful.

Discussion
Recent literature has claimed that COVID-19 and the associated quarantine measures posed many risks for the mental health of individuals, making people (especially the elderly) fearful of the virus (Mistry et al., 2021)  meeting their needs during periods of isolation due to epidemics.The purpose of this study was to explore elderly Chinese people's preferences for TV program genres and topics during the COVID-19 lockdowns and to verify their associations with COVID-19-related fear.
Based on the findings, older adults in China greatly preferred news, service programs, dramas, and documentaries during the COVID-19 lockdowns.This finding is not surprising, as these types of programs provide informative and engaging content that can keep older adults informed and entertained during times of isolation.
News programming is particularly important during pandemics because it provides the latest information and updates on those pandemics, which is consistent with previous research that found older adults tended to watch more news and informational programs than younger generations (Mares & Woodard, 2006;Van der Goot, 2009).Older adults are more susceptible to viruses and may be more willing to follow news reports to keep abreast of the latest developments and safety measures (Ng et al., 2023).In addition, service programming can provide older adults with valuable information about healthcare, government services, and other resources (Silva et al., 2016(Silva et al., , 2017) ) that may be essential during a pandemic.The preference for dramas and documentaries also highlighted older adults' desire for engaging and informative content that could help them pass time and stay connected to the outside world since dramas and documentaries provide windows into different cultures, lifestyles, and experiences (Nichols, 2017;Panda & Pandey, 2017).Especially during periods of restricted social activity and travel, people spend more time watching television series (Boursier et al., 2021); hence, dramas can help older adults expand their horizons and keep their minds active.Interestingly, previous findings have suggested that older Chinese adults prefer traditional opera (Chen et al., 2020), but our results showed that traditional opera was ranked in the bottom third of programs.
The finding that family affection, friendship, current affairs, and health were the preferred television program topics for older adults during the pandemic period provides valuable insight into the needs and interests of this demographic group.Since many older adults were separated from their family and friends due to social distancing, television programs that focused on family dynamics and friendship may have provided a sense of connection and comfort.This highlights the importance of social relationships in the lives of older adults and the role that the media can play in facilitating social connections (Zaine et al., 2019).During the pandemic, older adults preferred current affairs programs, which is consistent with the literature revealing older adults' preferences for news programs (Ng et al., 2023).Since pandemics typically dominate news content, it is not surprising that older adults were interested in television programs that provided information about COVID-19 and its impact on society.However, it is worth noting that older adults are a diverse group, and their interest in current events may have extended beyond the pandemic.Therefore, television programs covering a wide range of current events may appeal to this population.Health was also identified as a critical topic for older adults during the pandemic.Older adults are more susceptible to COVID-19, but many did not access quality information or services online during this period (Xie et al., 2020).They may have had greater access to health information through television programs that provided information about COVID-19 and other health-related topics, and such programs may particularly appeal to older adults during pandemics.
Overall, the findings suggest that, in general, older adults in China have a great demand for informative, engaging, and relevant television programs during pandemic lockdowns.The survey highlighted the importance of family affection, friendship, current affairs, and health to this demographic group, suggesting that television programs addressing these topics may particularly appeal to older viewers.These insights can be used to guide the development of television programs tailored to the needs and interests of older adults during epidemics and to help ensure that this demographic is not overlooked in TV programming.
The second objective of this study was to examine the relationships between TV program preferences and COVID-19-related fear in older adults.The results showed a negative correlation between a preference for dramas and COVID-19-related fear.This finding suggests that people who prefer dramas may be less susceptible to COVID-19-related fear.According to Boursier et al. (2021), a possible explanation for this result is that watching television dramas seems to distract people from pandemic distress by helping them enter different worlds in their minds.Furthermore, the tendency to cope via escapism is usually more closely associated with drama viewing patterns (Flayelle et al., 2019(Flayelle et al., , 2020)).Therefore, watching dramas during a pandemic may reduce fear in older adults.Another result showed a positive correlation between preferences for literary and action topics and COVID-19-related fear.This finding suggests that older adults who prefer to watch programs about these topics may be more susceptible to the fear associated with COVID-19.An explanation for this result is that people who prefer to watch literary programs may have greater empathy and self-reflective tendencies, while viewers who enjoy action programs tend to be highly strung.When watching literature, viewers often place themselves in the positions of the characters based on empathy and self-reflection (Koopman & Hakemulder, 2015), but this higher level of empathy may make these individuals more susceptible to anxiety and fear.Research has shown that people who are highly strung prefer action movies (Winoto & Tang, 2010), which may explain why they were associated in this study.
Overall, our results suggest that elderly Chinese people's preferences for certain television programs were associated with COVID-19-related fear.However, it is important to note that we measured correlations, meaning that we could not infer causal relationships.Future research should investigate the underlying mechanisms that may explain these relationships and their potential implications for public health advice and policies.

Conclusion
In conclusion, this study sheds light on the television program preferences of older Chinese adults during the COVID-19 pandemic and highlights the correlations between these preferences and fear of the virus.The findings indicate that older adults prefer programs that provide useful information and emotional support during pandemics.The negative correlation between COVID-19-related fear and a preference for dramas suggests that older adults may use dramas as a means of distraction and escape from isolating situations.However, the positive correlation between the fear of COVID-19 and preferences for literature and action programs suggests that older adults who enjoy watching programs on these topics may have greater empathy or be more highly strung.This is the first study to investigate the television program preferences of older adults during the COVID-19 pandemic and the associations between them and COVID-19-related fear.These findings have important implications for media strategies aimed at catering to the needs of older adults during pandemics.Program producers and TV station managers should consider the preferences and fears of older audiences and strive to provide content that is both informative and entertaining.Additionally, the results of this study may be useful for public health campaigns aimed at promoting healthy aging and mental health during pandemics.Overall, this study provides a valuable contribution to the literature on the media preferences of older adults and their mental health during pandemics.

Limitations and recommendations
This study was conducted among older Chinese adults only, and items for program genre and topic preferences were derived from Chinese TV program classification criteria, so the results may not be generalizable to other cultures.Although the researcher collected questionnaires from participants who would use digital media and those who would not as much as possible, it may need to be better balanced.The study focused specifically on television preferences during the COVID-19 pandemic and did not explore other factors that may influence television program preferences and fear levels.Future research could explore the television program preferences of older adults across cultures and age groups, as well as other factors that may influence preferences and fear levels during pandemics.

Objective 1 :
To identify Chinese older adults' TV program preferences during the pandemic.Objective 2: To examine correlations between Chinese older adults' TV program preferences and COVID-19-related fear.

Ranking of TV pro- gram genre preferences.
. Exploring older adults' preferences for television programs is important for

Table 4 . Regression for TV program topic preferences and COVID-19-Related Fear
7. During the lockdown due to the COVID-19 pandemic, I preferred the following TV program topics.8.Level of fear of Covid-19