Pandemics have caused significant individual, social, and economic problems. Healthcare workers, who form the backbone of the healthcare system, were at high risk due to their direct involvement in providing care during the pandemic [1]. Healthcare workers represented 14% of the cases reported to the World Health Organization [2]. The spread of the disease among healthcare workers has been worsened by insufficient awareness of infection prevention practices [3]. Healthcare workers’ fear, knowledge, and attitudes toward the pandemic affect their commitment to control measures [4]. Increasing knowledge and preventive behaviors related to the pandemic may enhance infection control practices among healthcare workers, improving patient care while also protecting the health of healthcare workers [5]. Since the effects of pandemics on healthcare workers are still not fully understood, this remains an active area of research and is crucial for shaping future intervention strategies aimed at improving the health of healthcare workers and, ultimately, patient outcomes [6].

Social isolation and public health measures, such as quarantine practices, travel restrictions, curfews, and social distancing rules implemented worldwide, along with the fear of the virus with unknown causes and treatments, have led to changes in individuals’ eating habits [7]. During the quarantine period, there were significant decreases in the consumption of rice, meat, poultry, dairy products, fresh vegetables and fruits, while the consumption of highly processed and high-energy foods, such as ready-to-eat foods, snacks, and cereals, increased. Reports indicated that individuals tended to prefer fatty, sugary, and salty foods, and increased stress from social isolation led to overeating [8]. Significant changes in adults’ diets during quarantine were found, with an increase in the consumption of sweets and canned meat products [9]. The increased workload and stress caused by the pandemic led to higher consumption of ultra-processed foods, which are low in nutrients and high in sugar and fat content [6]. This has been associated with an increased risk of serious complications, as it contributes to chronic inflammation [10]. Adequate and balanced nutrition, as well as adequate intake of micro- and macronutrients, are important factors influencing immune function across all age groups [11-12]. These dietary changes have particularly increased the risk of chronic diseases such as obesity, diabetes, cardiovascular diseases, and eating disorders, which are further exacerbated by media exposure, disruption of daily activities, social isolation, and fear of infection [13]. Examining the changing dietary habits of healthcare workers, understanding their level of knowledge about exposure to the virus, and identifying factors that influence their attitudes and practices are crucial for protecting them during and after the pandemic [4-5].

This study explores how the pandemic has influenced the nutritional habits of healthcare workers, a group highly vulnerable to both physical and psychological stress. By examining changes in the consumption of food groups such as milk and dairy products, cereals, vegetables and fruits, meats, fats, and sugary foods in relation to participants’ COVID-19-related knowledge, preventive behaviors, fear, and misconceptions, this research provides valuable insights into how these psychological and behavioral factors may have altered nutritional habits. Understanding these changes is crucial from a public health perspective, as the findings can inform targeted interventions aimed at supporting the well-being of healthcare workers.

This study aimed to assess the complex interplay between COVID-19-related knowledge, preventive behaviors, fear, misconceptions, and their impact on healthcare workers’ health behaviors, particularly nutritional habits, and included a total of 354 volunteer adult healthcare workers. In the fight against COVID-19, it is crucial to evaluate the fear, knowledge, preventive behaviors, and misconceptions of healthcare workers regarding the pandemic, as they are on the front lines and at high risk of contracting the disease [22]. The findings of this study are expected to provide valuable insights into the changing dietary habits of healthcare workers during the pandemic, as well as their fear, knowledge, preventive behaviors, and misconceptions related to the virus. This information could help guide the systematic design of policies for infection prevention, protection, and control.

During the pandemic, healthcare workers have been the most psychologically, socially, and mentally affected group due to the additional responsibilities placed on their duties. Studies have reported that a significant portion of healthcare workers are at high risk for developing poor mental health during this period [23]. Quarantine measures and restrictions have contributed to mood disorders, depression, anxiety, fear, and stress in individuals [24]. Additionally, there has been an increase in the number of people seeking treatment for anxiety and depressive disorders [25]. Changing quarantine protocols, restrictions, lack of information, long working hours, and insufficient personal protective equipment have physically and emotionally exhausted healthcare workers, heightening their fears of contracting the disease and even leading to resignations [26-28]. A study conducted by Labrague et al. (2021) reported a mean score of 19.92±6.15 on the COVID-19 fear scale [29]. In this study, the COVID-19 fear scale score was 17.49±5.73 (Table 1). Compared to studies on fear levels in the general population, the mean score in this study is like some studies but higher than that in others [30,31]. Among healthcare workers, anxiety and fear can negatively impact their health, well-being, and job performance during a pandemic crisis [15]. To effectively contribute during the pandemic, healthcare workers must prioritize and maintain their psychological and mental health [32].

A study conducted in Bangladesh found that COVID-19 fear is strongly associated with women in both the general population and healthcare workers [33]. In this study, not only were the mean scores for COVID-19 fear and misconceptions high, but women also have higher scores for both fear and misconceptions compared to their male counterparts (Table 2). Similarly, a study by Feleke et al. also found that misconceptions were more prevalent among women than men [34]. Although men face a higher risk of morbidity and mortality from the pandemic, women report higher levels of fear [35]. Another study indicated that women experience higher levels of fatigue, anxiety, and depression compared to men [28]. This has been attributed to women bearing a heavier burden than men during the pandemic, including household chores, childcare, and family responsibilities, in addition to their professional duties [36]. However, the finding that female medical students report higher levels of fear than their male counterparts suggests that, beyond work-related pressures, other gender-related factors may also contribute to fear [37]. It has been suggested that women, due to a more sensitive hypothalamic-pituitary axis compared to men, are more prone to fear. This highlights the need for greater focus on women’s mental health and the development of targeted strategies [28]. Among healthcare workers, the most significant factors associated with COVID-19 fear are, in order: the fear of infecting family members, becoming infected themselves, being quarantined, not receiving medical treatment, and death [26]. Indeed, this study found that married individuals exhibited significantly higher preventive behaviors (Table 2), suggesting that the concern about infecting family members may trigger more preventive actions among married individuals.

During the COVID-19 pandemic, psychological distress including anxiety, depression, stress, and fear – among Jordanian healthcare workers was significantly associated with being over 40 years old and having more clinical experience [38]. In this study, COVID-19 fear was also found to be associated with increasing age. An increase of 1 unit in age resulted in a 0.060 increase in the fear scale score (Table 3). Similarly, in the study by Kabasakal et al., the COVID-19 fear score for healthcare workers aged 45 and over was found to be 4.041 times higher compared to individuals in the 18-24 age group. In healthcare workers, the increase in age can be considered to parallel work experience, knowledge, fear, and coping abilities [35].

To reduce the spread of the virus, the level of knowledge among healthcare workers is directly associated with strict preventive behaviors. Several studies have investigated the level of COVID-19 knowledge among healthcare workers and found it to be high [4,39]. Ebrahimi et al. (2023) found that most healthcare workers (73.6%) had high levels of knowledge and preventive behavior [40]. In this study, most healthcare workers found to have high levels of COVID-19 knowledge (95.8%) and engaged in preventive behaviors to ensure protection (91.8%) (Table 1). This suggests that professional training received by individuals may have contributed to these results. In contrast, most healthcare workers in Pakistan who reported high levels of fear (88.1%) indicated that health education on topics such as infection control measures in COVID-19 centers and maintaining good hygiene practices is necessary to prevent the spread of infection [26]. Healthcare workers who are in direct contact with patients must protect their own health while providing care. A lack of information about the pandemic can significantly contribute to the increase in case numbers and hinder healthcare workers from protecting their own health. It is well-established that the level of knowledge directly influences susceptibility to the disease and the adoption of preventive behaviors [27]. Although the literature suggests that gender is a factor associated with knowledge, this study found no significant difference in COVID-19 knowledge levels between genders among healthcare workers (Table 2) [41]. The educational level is a significant factor associated with knowledge levels. Several studies have shown that as the educational level increases, knowledge about COVID-19 also significantly improves [41,42]. However, Taghrir et al. [43] did not find a significant difference between educational level and COVID-19 knowledge. Similarly, in this study, although COVID-19 knowledge increases with higher educational levels, the difference is not statistically significant (Table 2).

Healthcare workers’ direct involvement in patient care increases their risk of contracting COVID-19 compared to the general population [44]. In this study, a statistically significant correlation was found between COVID-19 fear and knowledge, preventive behaviors, and misconceptions (Table 3). It can be inferred that elevated levels of COVID-19 fear trigger increased knowledge and misconceptions, as well as the adoption of preventive measures. Misconceptions are likely to be fueled by misinformation, disinformation, myths, low literacy, and limited access to reliable sources, such as healthcare services and professionals [45]. During the pandemic, the presence of various information sources about the outbreak, coupled with the uncertainty regarding disease treatment, may contribute to misconceptions, which in turn could heighten fear among individuals [46]. A statistically significant difference was found between the fear of contracting the disease and COVID-19 knowledge levels in medical students. Those with a low level of knowledge reported higher levels of fear of infection, while those with a high level of knowledge expressed a lower level of fear [43,47]. Indeed, in this study, individuals with higher levels of COVID-19 fear were found to have greater knowledge levels, more preventive behaviors, and increased misconceptions (Table 3).

While some studies reported an increase in body weight due to the intense work pace of healthcare workers during the pandemic period, along with social restrictions and quarantine measures introduced to reduce the spread of the disease, other studies found no change in body weight [48-50]. In a study conducted with healthcare workers in Türkiye, it was reported that 51.4% of participants experienced weight gain, 17.8% had weight loss, and 30.9% reported no change in body weight [7]. In this study, during the pandemic period, 40.4% of healthcare workers reported weight gain, 25.1% reported weight loss, and 33.3% reported no change in weight (Table 1). While changes in body weight serve as an indicator of nutritional status, body fat percentage and its distribution are crucial for maintaining health and preventing the risk of chronic diseases. Although this study did not assess body composition, it is important to note that muscle loss can occur even in individuals who experience no change in body weight. A study conducted with healthcare workers in Brazil found that, during the post-pandemic period, there was a significant increase in body weight, waist circumference, and body fat percentage, while lean mass decreased by an average of 1.4 kg [51].

The pandemic disrupted healthcare workers’ professional activities and daily routines [52]. Gomes et al. [52] observed an increase in body weight among physicians due to reduced physical activity levels caused by social distancing measures. Factors such as stress related to social distancing, fear of contamination, and reduced income can lead to changes in dietary and physical activity habits [53,54]. Oliver et al. [55] reported that a reduction in physical activity was a contributing factor to the increase in body weight during the COVID-19 pandemic. However, some studies suggest that negative changes in dietary habits, rather than physical inactivity, have had a more significant impact [56,57]. The COVID-19 pandemic was a period of increased incidence of eating behavior disorders in individuals [58]. A study conducted during the pandemic found a positive association between night eating syndrome and body mass index [59].

It is known that eating habits are influenced by psychological symptoms such as fear, depression, anxiety, and stress, and it has been observed that these conditions, which developed during the pandemic, affected eating habits and diet quality [60,61]. COVID-19 fear, increased workload, stress levels, restrictions, long shifts, and emotional eating have been reported to lead to an increase in fast food and processed food consumption, resulting in higher dietary intake of energy, fat, and simple sugars [7,51]. A study conducted in Türkiye during the pandemic found that healthcare workers had higher levels of emotional eating compared to the general population [62]. Increased fear and stress during the pandemic may lead to changes in eating habits. Additionally, losing a relative to COVID-19 has been identified as an independent risk factor influencing changes in dietary habits among healthcare workers [7].

On the other hand, some studies have reported that healthcare workers adopted healthier eating habits as a coping mechanism to maintain their health during the pandemic. Increased awareness of health and immunity led healthcare workers to consume more fruits and vegetables [7]. Additionally, for some healthcare workers, the transition to remote work provided more opportunities to prepare or eat meals at home. A study conducted with healthcare workers in Qatar found that, compared to before the pandemic, 55.6% of participants ate out at restaurants less frequently, while 19.4% either did not eat out at all or exclusively consumed home-cooked meals. Furthermore, during the pandemic, the consumption of foods such as fish, red meat, jam, sugary drinks, sugar, ice cream, and pickles increased, while the consumption of sugar-free beverages, sweets, cakes, chocolates, and nuts decreased [63]. In this study, a significant relationship was found between high COVID-19 misconception scores and a decrease in the consumption of pastries, chocolate, wafers, and biscuits during the pandemic (Table 4).

Yaman and Hocaoğlu (2023) reported that during the pandemic, 43.2% of healthcare workers in Türkiye increased their consumption of fresh vegetables, fruits, ginger, turmeric, onions, and garlic, believing these foods helped protect them from illnesses [7]. Specific nutrients, including omega-3 fatty acids, vitamins C and D and other antioxidant compounds found in the Mediterranean diet foods, such as fish, olive oil, nuts, fruits and vegetables, can support the optimal function of the immune system [64]. Doğan et al. [65] reported that during the pandemic, Turkish healthcare workers increased their consumption of frozen foods, canned foods, fresh fruits, dried fruits, nuts, tea/coffee, red meat, and honey products. The study by Molina-Montes et al. [66]) emphasizes that quarantine measures led to an improvement in dietary habits, increasing adherence to the Mediterranean diet across 16 European countries. About 10-15% of participants reported an increase in their consumption of olive oil, legumes and fish during the lockdown, while approximately 20-25% reported consuming more fruits and vegetables. In contrast, their consumption of red meat, soft drinks and pastries generally decreased. In this study, healthcare workers with higher average COVID-19 knowledge scores were found to have increased their consumption of milk, green leafy vegetables, and yellow-orange vegetables, while reducing their intake of bread, chocolate, wafers, and biscuits (Table 4). Similarly, among healthcare workers on the front lines of patient care, healthy eating behaviors have been identified as an independent determinant of COVID-19 fear. Additionally, it has been shown that healthcare workers with higher healthy eating behavior scores e lower levels of COVID-19 fear [67]. Among healthcare workers in Vietnam, a state of well-being has been linked to healthy eating habits, regular exercise, and adherence to COVID-19 preventive measures [68]. This study found a significant relationship between COVID-19 preventive behaviors and an increase in only cheese consumption (Table 4). Similarly, this study found that, although no changes were observed across all food groups, healthcare workers who made positive changes in their eating habits due to the COVID-19 pandemic had higher scores in knowledge, preventive behaviors, fear, and misconceptions. The results underscore the need for additional interventions to promote health and well-being among healthcare workers during the pandemic. Further research is needed to expand the investigation beyond healthcare settings to other working environments affected by the pandemic. Comparing the unique challenges faced by healthcare workers with findings from remote workers, as highlighted by several studies, could provide a more comprehensive understanding of how COVID-19 influenced dietary habits, stress, lifestyle behaviors, and other factors. Such comparisons could inform targeted interventions for various occupational groups during future health crises [69-73].

During the pandemic, healthcare workers have shouldered significant responsibilities. The findings indicate that, although not statistically significant, healthcare workers, especially women, possess good knowledge and positive preventive behaviors towards COVID-19. The results suggest that interventions should pay closer attention to men and older healthcare workers. Unhealthy eating behaviors may contribute to more severe issues of overweight and obesity, potentially leading to a greater burden of chronic diseases in later life. This study focuses on the impact of the pandemic, providing valuable lessons for designing interventions aimed at improving the well-being of healthcare workers and supporting the sustainability of health systems. Understanding the current state of dietary patterns will be valuable for numerous stakeholders, including healthcare professionals and policymakers, as it allows for consideration of potential outcomes when making future decisions. The results of this study provide valuable insights for public health, informing both clinical practice and policy-making during the unprecedented pandemic period. Further research is needed to enable policymakers to develop strategies, and intervention plans for healthcare workers, with particular attention to high-risk groups.