Trauma exposure among Pakistani media professionals: Translation and adaptation of the Journalist Traumatic Exposure Scale (JTES) and preliminary findings

Corresponding Author:

Sara Fatima Malik
National Institute of Psychology
Quaidi- Azam University, Pakistan
E-mail: sara.fatima@nip.edu.pk

Received: 22 February, 2022, Manuscript No. fmcp-22-55185 Editor assigned: 23 February, 2022, PreQC No. fmcp-22-55185 Reviewed: 04 March, 2022, QC No. fmcp-22-55185 Revised: 07 March, 2022, Manuscript No. fmcp-22-55185 Published: 15 March, 2022, DOI. 10.37532/ fmcp.2022.19(2).1897-1906

Abstract

Objectives: The study is designed to present statistics on trauma exposure faced by Pakistani media professionals. Additionally, it also included adaptation and translation of the Journalist Traumatic Exposure Scale (JTES) in Urdu language using standard procedures of backward translation method.

Method: The study includes a total of 487 media professionals from 3 provinces (Punjab, Sindh, Khyber Pakhtunkhwa), and the capital territory of Islamabad, ages ranging from 20 to 72 years (MÂ ± SD=36.02 Â ± 9.96). Along with a detailed demographic sheet, data was collected on the Journalist Traumatic Exposure Scale.

Results: Among the frequent reporting category i.e., 3-4 times, physical assault is the most prevalent incident with 21.4% of the sample having this experience, followed by street crimes (21.1%) and motor vehicle accidents (19.1%). It is also evidenced that electronic threats (phone calls, SMS), and verbal face-to-face aggression are the most common type of victimizations with a prevalence of more than 35% (n=178, and n=171 respectively). Intimidation through someone following or stalking has a prevalence of 27.5% followed by physical aggression with a prevalence of 21%. Comparatively low but surprisingly an equal prevalence of victimization by both state and non-state agencies is reported. The study also resulted in a valid and reliable instrument for measuring journalist exposure to trauma.

Conclusions: Journalist job nature includes frequent exposure to unpleasant incidents and consistent exposure to such events accumulates underlying pathologies. Hence, it is recommended that precise estimation of prevalence will help design interventions and training for coping.

Keywords

prevalence, exposure to trauma, journalist, victimization, adaptation, validation

Highlights

1. Physical assault is the most prevalent incident with 21.4% of the sample having this experience, followed by street crimes (21.1%) and motor vehicle accidents (19.1%).

2. Electronic threats (phone calls, SMS), and verbal face-to-face aggression are the most common type of victimizations with a prevalence of more than 35%.

3. Approximately an equal prevalence of victimization by both state and non-state agencies is reported.

4. The study also resulted in a valid and reliable instrument for measuring journalist exposure to trauma.

Introduction

Press freedom in Pakistan has been erratic. In sixty years of history, Pakistan has been ruled by the military more than the civilian governments. Different regimes used legal and constitutional means to control the press from presenting public debate and criticism. Press in Pakistan usually faces threats, violence, and economic pressure. Pakistan has been victimized by political instability since its formation which has affected the freedom of expression of the print media. Electronic media was governmentowned and remained completely under government control. In 2002, new dimensions of the role of electronic media towards politics were introduced and since then media started its journey towards gradual freedom and liberty. Further, a recent shift from centralized broadcasting to an open competition broadcast system in Pakistan enables the audience to enjoy more power of selective exposure.

Pakistan is facing several problems including terrorist activities, political unrest, and religious dogmatisms. Mob activities resulting from these problems are a consistent phenomenon. The Pakistani media (particularly electric media) is in a race and channels compete to show apprehensive situations and take lead in creating suspense. Journalists in such circumstances are forced to face day-to-day exposure to traumatic events as media owners are more interested in showing the tragedy rather than focusing on the positive aspects and progressive developments. Hence, media professionals face consistent exposure to traumatic events that may evoke negative mood states and accumulate stress resulting in mental health consequences for the media professionals. It is therefore important to tap risk factors of the mental health of media professionals, however, valid and reliable measurement tools are scarce. The present study is designed to translate and adapt the Journalist Traumatic Exposure Scale-JTES [1] and to present statistics on trauma exposure faced by Pakistani media professionals.

Trauma is defined as exposure to threatened or actual death, sexual violence, or serious injury [2]. It may include a direct experience in person or witnessing the traumatic event as the others experience it. It is also classified as knowing that any traumatic event is experienced by a close friend or close member of a family (in cases of the threatened or actual death of a friend or member of a family, a traumatic event must be accidental or violent). And finally, it also includes experiencing extreme or repeated exposure to aversive details of any traumatic event. Repeated or extreme exposure to negative detail is also consistent/persistent exposure to work-related graphic content.

Trauma is classified as primary and secondary trauma and similarly, exposure to traumatic events can be primary or secondary depending on the interaction with the traumatic events i.e., direct or indirect [3]. Commonly, sexual abuse victims, war veterans, domestic violence victims, and emergency care personnel have been observed to suffer from primary traumatization [4]. Secondary traumatization, via indirect, exposure may develop from seeing or hearing about a traumatic event or caring for someone who has experienced such an event [3]. Many firefighters, health care professionals, media professionals, and law enforcement professionals have been found to suffer from secondary traumatization [4].

Journalists’ work, particularly in news production involves ongoing exposure to traumatic events while trying to meet the demand for updated and direct coverage of crises, violence, and disaster. The term ‘journalist’ is usually used to describe a variety of roles in the news production industry, including reporters, camera operators, editors, sound technicians, and other technical and management staff [5]. Reporters and camera operators are being exposed to traumatic events directly (on-site coverage). On the contrary, TV newsroom staff including anchors, editors, producers, and other related technical staff is indirectly exposed to trauma through video footage of these traumatic events (i.e., editing and reporting from the newsroom).

The majority of media professionals witness trauma-related events in their routine work. Common events that journalists may witness include fires, automobile accidents, executions, different types of assaults, mass casualties, murders, war-related activities, disasters, and exposure to user-generated content [6- journalists have been exposed to work-related traumatic events [9-11] and this exposure is consistent or repeated to a significant number of media professionals. Studies suggested that 92% of the media professionals experience at least four traumatic events within the same week [12]. The average number of work-related traumatic events which are being exposed by journalists range from 4 to 81 [1,8,11,12]. Work-related trauma might be experienced via prolonged, frequent, and repeated exposure to video footage and/or violent graphics, including user-generated content [13,14].

Media professionals may also experience traumatic events directly through intimidation (physical or verbal threats focused on individual’s work as a journalist), violence, detained by police or other state agencies, and harassment (physical or verbal aggression) directed to an individual because of his/her profession [15-19]. In 2018, 348 media professionals were detained worldwide. Many of these captives faced extreme isolation, physical torture, and mistreatment [20]. In another study, 21.9% of female journalists reported physical violence about their work, and 14.3% reported sexual violence [21].

Moreover, 31% of journalists reported receiving threats over a year [22]. Risk factors of trauma exposure for media professionals are identified in a mounting body of literature.

Serval types of risk factors (including personal and/or work-related) increase the vulnerability among journalists for exposure to traumatic events. These include age, gender, ethnicity, length of work experience, type of beat, work duties (on the desk or in the field), and duration of exposure (shift/duty hours). Although some literature suggested that there is no statistically significant mean difference based on gender [23]. On the contrary, another study indicated that men journalists reported significantly more exposure to traumatic events compared to their women counterparts [24]. Regarding age as a risk factor, findings suggested that older journalists reported more on covering and exposure to traumatic events than younger journalists [25]. However, age may be a proxy risk factor and this difference among media professionals may better be explained by experience or years/time in the field [25]. It is argued that the longer media professionals work in the field, the more trauma exposure is expected to be experienced resulting in a cumulative collection of assignments related to stressful events [6,25]. Reporters covering certain types of stories/beats including but not limited to stories involving political agendas, war, and crime are being exposed to traumatic events more frequently than the beats which cover assignments related to entertainment, business, fashion, and sports [9]. Newman, et al. [11] showed that daily newspaper journalists were most likely to cover stressful events on-site (78.7%), been verbally threatened on assignment (61.8%), covered the same assignment multiple times in a week (54.3%), and covered a gruesome scene (53.8%).

Journalist Traumatic Exposure Scale-JTES [1], is a self-report measure consisting of 23-items and assesses potential traumatic events which journalists may experience while covering their assignment over one year. The first 14 items measure the range and frequency of work-related trauma exposure (frequency scale) such as exposure to mass causalities, accidents, war zone, murder, torture, kidnapping, natural disasters, physical, and sexual assault. The remaining 9 items measure if specific traumatic events have occurred (dichotomous) at work such as an attack, verbal threat, and facing injuries while covering several types of assignments.

Composite scores on JTES can be calculated by adding the scores on frequency scale and event occurrence scale It also asks for physical attack, verbal threat, and facing injuries while covering several types of assignments. JTES is a comprehensive measure of trauma exposure for journalists having several variants to address cultural diversity across geographic locations. However, blasphemy is a critical phenomenon that none of the variants has addressed. Hence one of the objectives of the study was to adapt the instrument to meet the cultural variation in exposure to traumatic events of Pakistani journalists.

Method

■ Adaptation of JTES

In the present study, JTES was used to measure potential traumatic events covered by journalists (on the desk/in the field) during the last three months. As a prerequisite, the JTES needed to be adapted and translated into the Urdu language. For content validation, the instrument was reviewed by a panel of five content experts. The reviewers recommended modification and adaptation of scale. Based on an extensive review of literature, 10 additional questions were generated for JTES (e.g., events related to kidnapping, train accidents, injured children, blasphemy, etc.). Following this, five independent subject matter experts were approached to get opinions on the relevance to the concept and the unique contribution of each additional indicator. Instructions were given to SME to read the items carefully, rate each question statement from very relevant=4 to not relevant=0, and provide feedback on items that may require modifications. Based on the feedback, 2 items were modified, and six were discarded. Only four of the additional items were retained based on 80% agreement for relevance and their unique contribution to the concept. The response format of the frequency scale was also modified. The original openended response options were replaced with Likert-type response options with 0=“Never”, 1=“1-2 times”, 2=“3-4 times” and 3=“More than six times”. The instructions of the JTES were also modified and participants were given the following instructions: “Please indicate how often you have experienced the following events in the course of your job during the last three months. In other words, think about the time frame within the last three months and estimate the number of times you covered the following events on the desk or in the field”.

■ Translation of JTES

Translation of JTES was carried out in five steps. First, permission from the authors was taken to translate the journalist traumatic exposure scale in the Urdu language. Second, 5 bilingual experts were approached to translate JTES into the Urdu language, and translators were instructed to consider the cultural appropriateness while translating the items. In the third step translations received for each item were scribbled down under respective items and were reviewed in a committee approach. The committee consisted of three experts (researcher, and two bilinguals). Translations with the most appropriate semantic equivalence to the original items were selected for backtranslation. The fourth step included translation of items into source language i.e., English. Three independent translators were approached for back-translation. These translators had no familiarity with the original version of the JTES. For the final selection of items, the committee approach was employed to assess the similarity between the original and back-translated versions of the scale. In the last step, the finalized version of the scale was administered to a group of ten journalists for piloting. Participants were instructed to identify comprehension problems and difficult words and suggestions were incorporated.

■ Sample

The sample included 487 media professionals from 3 provinces (Punjab, Sindh, Khyber Pakhtunkhwa), and the capital territory of Islamabad, with ages ranging from 20 to 72 years. The mean age of media professionals was 36.02 (SD=9.96) years. Data were collected from both male (n=432) and females (n=55) participants from different media houses and press clubs. A total of 102 (20.9%) of media professionals were undergraduates, 167 (34.3%) of media professionals were graduates and 218 (44.8%) of media professionals had postgraduate qualifications. The average monthly income of participants was 33.51 thousand Pakistani rupees. A total of 148 (30.4%) participants were single and 339 (69.6%) were married. Ethnic distribution of the sample showed that a larger group of participants i.e., 259 (53.2%) were Punjabi, followed by 117 (24%), Pathan, and 24 (4.9%) Sindhi. Only 4 (0.8%) were Baluchi, whereas 78 (16%) were categorized as others (including, Kashmiri, Hindko, and Urdu Speaking). Media professionals with less than one year of experience and those working with the fashion industry and mainly covering fashion-oriented news were not included in the study. Job experience of the media professionals ranged from 1 to 50 years (Mean=13.10, S.D=9.23). Media professionals who were reporting from fields constituted 186 (38.2%) of the sample followed by participants working on desk 146 (30%). Additionally, a large group of participants i.e., 155 (31.8%) were those who had to cover assignments both on the desk and in the field. The majority of the participants 472 (96.9%) were permanent staff, and only 15 (3.1%) of the sample constituted freelancers.

Results

Confirmatory factor analysis was conducted in MPlus version 8.0 to establish construct validity of the revised Journalist Traumatic Exposure Scale using the estimation methods Maximum Likelihood (ML) for the Frequency Scale (items 1-18), and Weighted Least Square Mean and Variance Adjusted (WLSMV) for the Event Occurrence Scale (items 19-27). Model fit was assessed on the Comparative Fit Index (CFI), Tucker Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). Good fit criteria are specified that the value of CFI and TLI should be greater than 0.90 and the value of RMSEA should be less than 0.08 [26]. Further, an item is considered as a valid indicator with item loading ≥ 0.30 on their respective factors TABLE 1.

TABLE 1. Model fit indices of CFA for Journalist Traumatic Exposure Scale-JTES (N=487).TABLE 1. Model fit indices of CFA for Journalist Traumatic Exposure Scale-JTES (N=487).

For the frequency scale, the results showed a poor fit of the default model; however, the addition of a few co-variances between residuals resulted in substantial improvement of the fit indices. The addition of the co-variances significantly reduced chi-square (i.e., Δχ² (df)=446.67 (19), p=0.00). The final model showed a good fit of the model to the data with χ² (df)=271.28 (116), CFI=0.97, TLI=0.96, and RMSEA=0.05. Further, the final model as presented in FIGURE 1A showed that all items are valid indicators of the construct with item loadings for the Journalist Traumatic Exposure Scale-Frequency ranging from λ=0.53 to λ=0.79. For the Journalist Traumatic Exposure Scale-Event Occurrence, the results showed good fit indices of the default model to the data (i.e., χ² (df )=59.65 (27), CFI=0.98, TLI=0.98, and RMSEA=0.05). Further, the model as presented in FIGURE 1B showed that all items are valid indicators of the Journalist Traumatic Exposure Scale-Event Occurrence with item loadings ranging from λ=0.53 to λ=0.80.

Figure 1: CCFA model for Journalist Traumatic Exposure; A): Scale-Frequency; B): Event Occurrence.

Cronbach’s alpha was computed to check the reliabilities of the Journalist Traumatic Exposure Scale. The results showed that the scale has good internal consistency with a=0.89 for the whole scale, and a=0.94, and 0.81 for Frequency, and Event Occurrence subscales, respectively.

To estimate the prevalence and a detailed description of various types of traumatic exposure as experienced by the Pakistani journalist, the frequency and percentage of each item of the JTES for each response category are presented in TABLE 2. The table shows the frequency of the coverage of events by journalists during the “Last Three Months”. Results show that war zone reporting is the rarest kind of experience with 69.4% of the sample having no experience or exposure to war zone reporting followed by blasphemy (53.2%) and airplane/train crash (52.6%). Among the incident with occasional reporting i.e., once or twice, 40.5% of the sample experienced assignment includes covering dead child followed by physical assault within a family, and individual hurt/killed (both 30.6%). However, physical assault outside the family is the most prevalent incident among the frequent reporting category i.e., 3-4 times with 21.4% of the sample having this experience, followed by street crimes (21.1%) and motor vehicle accidents (19.1%). Among the most common reporting category i.e., more than 6 times, street crime reporting is most prevalent (20.9%) followed by murder (19.1%) and life-threatening illness (18.3%). Among the indicators of the Event Occurrence Scale, the highest exposure includes covering at the scene (62.8%) followed by witnessing gruesome events while coving assignment (50.9%) and covered multiple traumatic assignments within the same week (47.2%).

TABLE 2. Frequency and Percentage of Journalist exposed to various work-related potential traumatic events on JTES (Frequency-Event Occurrence) (N=487).

TABLE 3 indicates mean differences on each traumatic exposure item for those media professionals who endorsed exposure compared to those who did not indicate exposure. The media professionals were asked to indicate incidents of trauma exposure that they directly experienced due to their work. It is evidenced that electronic threats (phone calls, SMS), and verbal face-to-face aggression are the most common type of exposure with a prevalence of more than 35% (n=178, and n=171 respectively). Intimidation through someone following or stalking has a prevalence of 27.5% followed by physical aggression with a prevalence of 21%. Comparatively low but surprisingly an equal prevalence of victimization by both state and non-state agencies is reported. The results indicate that 17.2% (n=84) journalists reported being detained by police or other state agencies, and 16.6% (n=81) journalists reported kidnapping by criminals or militants. Results showed that media professionals experiencing verbal face-to-face aggression scored significantly high on both components of JTES (Frequency, and Event Occurrence) as compared to the media professionals with no experience of verbal faceto- face aggression. Similar findings also emerged for the victimization of intimidation through someone following or stalking. Almost all types of direct victimization experiences resulted in high reporting on the event occurrence component of the JTES. These results also support the validity of the JTES to measure the journalist’s exposure to traumatic events.

TABLE 3. Mean Differences in JTES across experience of traumatic events (N=487).

Discussion

Journalists repeatedly witness human sufferings, whether covering mass casualties or individual atrocities and at times experience direct violence. Empirical literature showed that over 90% of the journalists reported being exposed to traumatic events including reporting on the injured or dead child, mass casualties, murder, and lifethreatening illness [27,28]. Likewise, a similar range of trauma exposure has been reported in many other studies conducted on journalists [1,7- 9,11] Freedom Network Pakistan postulated at least 148 violations or attacks against media professionals across the country in the last year, including seven attempted assassinations, six murders, 5 kidnappings, 15 assaults, 25 arrests or detentions, and 27 legal cases. Persistent exposure and victimization may accumulate chronic stress among journalists resulting in mental health consequences. However, there is the absenteeism of standard instruments resulting in scarcity of empirical literature on the prevalence of journalist exposure to traumatic events and professional victimization in Pakistan. Therefore, the objective of the present study includes translation, adaptation, and validation of JTES. Additionally, the study also aimed at collecting data for the prevalence of victimization and frequency of exposure to traumatic events among Pakistani journalists.

The Journalist Traumatic Exposure Scale (JTES) was developed in 2003 to measure specific traumatic events to which journalists may have been exposed while covering an assignment. JTES is used in several studies with various modifications and adaptation as it is not inclusive of all types of trauma exposure [15,21,24,29,30]. In the present study, 4 items were included as JTES did not incorporate some important indicators that Pakistani journalists cover frequently. For instance, JTES do not include cyber harassment, train accidents, street crimes, blasphemy, and mob activities whereas due to the geopolitical and sociocultural circumstances, mob activities/mob-justice, and blasphemy are among the frequently observed phenomenon in Pakistan. This practice and resignation to its eternity seem to be fabricated in Pakistani society as the social system is transited from tribal and feudal to democratic forms of justice.

A deadlock is observed in the formal justice system due to an increase in corruption. This usually results in mistrust and findings alternated by the general public at a mass level by looking toward mullahs, waderas, and sardars to uphold honour, settle disputes, and meet out swift justice. Not just societal issues bring out the mob, but religious matters (blasphemy) can also evoke mob activities. The key indicators of street crimes include robbery, dacoity, burglary, and mugging. In a report of the National Police Bureau, the Ministry of Interior (2019) documented a total of 786339 street crimes all over Pakistan. By reviewing the literature and finding the immense significance of these events in Pakistani culture, items related to cyber harassment, mob activities, blasphemy, and street crimes were developed and retained based on percentage agreement. Moreover, the response format of the instruments was also modified from frequency scale to categorical/ Likert type scale. Additionally, instructions were modified by specifying, events covering “at Desk” or “in the field” and the time frame of covering events in “last three months” instead of the last one year.

Confirmatory factor analysis showed that the modified JTES including four additional indicators is a valid instrument to measure potential work-related traumatic events of Pakistani journalists. Factor loadings of both scales, Journalist Traumatic Exposure Scale- Frequency, and Event Occurrence indicate that all items are a valid indicator of the construct. Although, some studies reported low internal consistency because JTES covers multifarious events of stress, however, in the present study, Cronbach alpha of both subscales and total evidenced that the scale has good internal consistency. These results are consistent with many others reporting good internal consistency for adopted versions of JTES [29,31].

Journalists faced considerably more personal threats from unknown or known state elements. News editors are coerced to censor undesirable information or are enforced to give stories a specific slant. Media houses are jeopardized with financial damage in case they refuse to toe the line. Further, 84% of media professionals endorsed exposure to personal victimization including physical aggression, being verbally threatened, and receiving electronic threats. Likewise, numerous studies indicate that journalists may experience trauma directly through intimidation, violence (physical or verbal threats faced by journalists because of their profession), and harassment (aggressive physical or verbal actions directed towards someone) [15-19].

Journalist exposure to trauma has been studied in several countries and across a range of media houses. The results highlighted key trends in research relating to journalist work-related and personal exposure to trauma. The present study is aimed to provide preliminary statistics about work-related trauma exposure of Pakistani journalists. Similar to the findings of Pyevich et al. [1] and S. E. Drevo, [15] on work-related trauma exposure, the results of the present study indicate that events involving war activities, blasphemy, and train/airplane crash were among the least commonly reported events by Pakistani journalists. However, journalists indicated that they frequently experienced events related to a dead child, physical assault within and outside the family, and events involving physical injury or murder. Similar findings have been reported by numerous studies suggesting that the most common events covered by journalists include assignments related to dead/injured children [5,15,29], violent assault [6,24], and physical injury or murder [32].

The results further showed that journalists’ endorsement regarding a report of events that occurred mostly in the last three months included street crimes, murder, and lifethreatening illness. These results are in confirmation of enormous studies documenting that commonly reported events include murder and life-threatening illness [1,11,25]. The present study also indicates findings similar to the research conducted by Pyevich et al. [1] which documented that 78.8% of the journalists reported covering potential traumatic events onsite and 94% of the participants indicated that they have experienced multiple traumatic events within the same week. Approximately half of the sample also reported witnessing gruesome events while covering an assignment [1].

Apart from the fact that intimidation has been reported as the most common problem faced by media professionals, it has not been systematically studied among journalists. The statistics regarding intimidation (kidnapping, detention, murder, etc.) are routinely collected and reported by independent news organizations (International News Safety Institute, etc.) but the data is less visible and in more discrete forms. Journalists report deadly, violent, and sometimes extreme, personal attacks while fulfilling their job responsibilities.

Findings of the present study indicate that most commonly journalists experienced intimidation (physical or verbal threats), harassment (Physical and verbal aggression), and violence. A study conducted by Barton and Storm documented that two out of three of their participants endorsed “yes” to question involving experiencing abuse, threats, or intimidation about their work? Further, the study concluded that the most frequent act was abuse of authority or power, followed by written, verbal, or physical intimidation which includes threats to harm you and threats to damage honour and reputation. A study finding revealed that media professionals are easy targets of violence, which may represent more severe and deteriorated forms of intimidation. The majority of the participants (88%) endorsed that the security and safety of media workers and journalists are more challenging nowadays than it was 10 years ago. The report showed that86% of the media persons expressed that they are easy targets of violence and intimidation [33]. Victimization of journalists in any form may directly or indirectly contribute to the traumatic exposure. It was hypothesized that journalists facing intimidation and aggression are more vulnerable to traumatic exposure and the results confirmed the hypothesis by showing that journalists experiencing intimidation or aggression scored high on both components of JTES (Frequency, and Event Occurrence). Although the frequency of the traumatic experience is important, however, all types of victimization of journalists differentiated scores on the event occurrence component of trauma exposure.

Conclusion

■ Implications

The adapted instrument is culturally reflective of the variation in journalists’ exposure to traumatic events. The external validity of JTES is improved with the incorporation of culturally important indicators. The use of the adapted instrument in future studies on Pakistani journalists will reflect a more realistic picture of the phenomena and its correlates.

■ Limitations

The study included a sample from all major cities of the country having a nationwide representation, however, it lacks the representation from rural areas particularly war-zone areas (tribal areas). The representation of female media professionals is also low in comparison to male media professionals. Additionally, the study presents very primitive statics and that too using only self-report measures.

■ Recommendations

Based on the findings of the study, cultural adaptation is recommended for use of JTES in any other culture and geographic locality. Further, the adapted JTES for Pakistani journalists shall be used in combination with other related measures to investigate the effect of consistent exposure to trauma on media professionals. It is also recommended that future studies shall also include a qualitative approach with substantial representation in a sample from far-flung areas and female media professionals.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Human rights

All procedures performed in studies involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. These procedures were approved by the Senior Author’s University IRB before any data collection took place.

Informed consent

Informed consent was obtained from all individual participants included in the study.

The welfare of animals

This article does not contain any studies with animals performed by any of the authors.

Funding source

The study is supported by grant no. 10795/ Federal/NRPU/R&D/HEC/2017 from Higher Education Commission, Pakistan.

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