Exploring barriers and facilitators to physical activity during the COVID-19 pandemic: a qualitative study

ObjectivesQuantitative data show that physical activity (PA) reduced during the COVID-19 pandemic, with differential impacts across demographic groups. Qualitative research is limited, so reasons for this have not been explored in-depth. This study aimed to understand barriers and facilitators to PA during the pandemic, focusing on groups more likely to have been affected by restrictions, and to map these onto the Capability, Opportunity, Motivation Model of Behaviour (COM-B). DesignSemi-structured qualitative interview study. MethodsOne-to-one telephone/videocall interviews were conducted with younger (aged 18-24) and older adults (aged 70+), those with long-term physical health conditions or mental health conditions, and parents of young children, probing about their experiences of PA. Barriers and facilitators were identified using reflexive thematic analysis, and themes were mapped onto COM-B dimensions. Results116 participants were included (18-93 years old, 61% female, 71% White British). Key themes were the importance of the outdoor environment, impact of COVID-19 restrictions, fear of contracting COVID-19, and level of engagement with home exercise. Caring responsibilities and conflicting priorities were a barrier. PA as a method of socialising, establishing new routines, and the importance of PA for protecting mental health were motivators. Most themes mapped onto the physical opportunity (environmental factors) and reflective motivation (evaluations and plans) COM-B domains. ConclusionsFuture interventions should increase physical opportunity and reflective motivation for PA during pandemics, to avoid further negative health outcomes following periods of lockdown. Strategies could include tailoring PA guidance depending on location and giving education on the health benefits of PA. Statement of ContributionO_ST_ABSWhat is already known on this subject?C_ST_ABSO_LIPhysical activity (PA) levels reduced during the COVID-19 pandemic. C_LIO_LIThe extent of this reduction varied across demographic groups. C_LIO_LIVery few qualitative studies have explored reasons for these changes. C_LI What does this study add?O_LINovel interview data, giving context to existing quantitative data. C_LIO_LIInsight into which themes were important for different demographic groups. C_LIO_LISuggestions for increasing PA in future pandemics, by mapping findings to a theoretical framework. C_LI

A qualitative study exploring the impact of the COVID-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK: PWID and service provider perspectives

BackgroundPeople Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID-19 transmission and related health and social complications. In response to COVID-19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in-person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer-term impact of the pandemic on the health and wellbeing of PWID in the UK, including provider and client experiences of treatment changes. MethodsInterviews were conducted with 19 PWID and 17 drug treatment providers between May - September 2021, recruited from third-sector drug services in the UK. Data were analysed using reflexive thematic analysis. ResultsMost participants expressed ongoing fears of COVID-19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. changing drug use patterns, including transitions to crack cocaine, benzodiazepine and pregabalin use) and socio-economic harms (e.g. limited opportunities for sex work engagement and income generation). Finally, whilst clients reported some favourable experiences from service adaptations prompted by COVID-19, including increased regulatory flexibility in OST guidelines, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period. ConclusionsWhilst our findings emphasize the importance of accessible harm reduction measures attending to changing indices of drug-related harm during this period, there is a need for additional structural supports to ensure pre-existing disparities and harms impacting PWID are not exacerbated further by the conditions of the pandemic. In addition, any sustained policy and service delivery adaptations prompted by COVID-19 will require further attention if they are to be acceptable to both service users and providers.

Factors affecting the mental health of pregnant women using UK maternity services during the COVID-19 pandemic: A qualitative interview study.

BackgroundPeople using maternity services in the United Kingdom (UK) have faced significant changes brought on by the COVID-19 pandemic and social distancing regulations. We focused on the experiences of pregnant women using UK maternity services during the pandemic and the impact of social distancing rules on their mental health and wellbeing. MethodsWe conducted 23 qualitative semi-structured interviews from June 2020 to August 2021, with women from across the UK who experienced a pregnancy during the pandemic. Nineteen women in the study carried their pregnancy to term and four women experienced a miscarriage during the pandemic. Interviews took place remotely over video or telephone call, discussing topics such as mental health during pregnancy and use of UK maternity services. We used reflexive thematic analysis to analyse interview transcripts. ResultsWe generated six higher order themes: (1) Some pregnancy discomforts alleviated by social distancing measures, (2) The importance of relationships that support coping and adjustment, (3) Missed pregnancy and parenthood experiences, (4) The mental health consequences of birth partner and visitor restrictions, (5) Maternity services under pressure, and (6) Lack of connection with staff. Many participants felt a sense of loss over a pregnancy experience that differed so remarkably to what they had expected because of the pandemic. Supportive relationships were important to help cope with pregnancy and pandemic-related changes; but feelings of isolation were compounded for some participants because opportunities to build social connections through face-to-face parent groups were unavailable. Participants also described feeling alone due to restrictions on partners being present when accessing UK maternity services. ConclusionsOur findings highlight some of the changes that may have affected pregnant womens mental health during the COVID-19 pandemic. Reduced social support and being unable to have a partner or support person present during maternity service use were the greatest concerns reported by women in this study, as this absence removed a protective buffer in times of uncertainty and distress. This suggests that the availability of a birth partner or support person must be prioritised wherever possible to protect the mental health of women experiencing pregnancy and miscarriage in times of pandemics.

"I had no life. I was only existing". Factors shaping the mental health and wellbeing of people experiencing long Covid: a qualitative study.

BackgroundAround one in 10 people who have COVID-19 report persistent symptoms or long Covid. Impaired mental health and wellbeing is commonly reported including anxiety, depression and reduced quality of life. There is however, limited in-depth research exploring why mental health and wellbeing have been impacted among people experiencing long Covid. AimsTo explore factors impacting mental health and wellbeing, from the perspective of people with long Covid. MethodSemi-structured qualitative interviews that were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. 21 people with long Covid participated in the study. Participants were eligible to take part if they self-reported a positive swab test/antibody test, or one or more commonly reported COVID-19 symptoms at illness onset and experiences of one or more long Covid symptom three or more weeks following illness onset. ResultsFive themes were identified across participant accounts regarding factors impacting mental health and wellbeing including i) experiences of care and understanding from others; ii) lack of service and treatment options; iii) severe disruption to daily life iv) uncertainty of illness trajectories and v) changes to identity. ConclusionsPeople with long Covid experience a range of factors that negatively impact their mental health and wellbeing. Providing patient centred health services that integrate the rapidly evolving research in this area is important, as are peer support groups and supported approaches to self-management.

Impact of the COVID-19 pandemic on the mental health and wellbeing of parents with young children: a qualitative interview study

BackgroundParents have faced unique challenges during the coronavirus disease 2019 (COVID-19) pandemic, including mobility constraints, isolation measures, working from home, and the closure of schools and childcare facilities. There is presently a lack of in-depth qualitative research exploring how these changes have affected parents mental health and wellbeing. MethodsSemi-structured qualitative interviews with 29 parents of young children. Interviews were analysed using reflexive thematic analysis. ResultsWe identified five superordinate themes affecting participant mental health and wellbeing: 1) navigation of multiple responsibilities and change inside the home; 2) disruption to home life; 3) changes to usual support networks; 4) changes in personal relationships; and 5) use of coping strategies. Participants described stress and exhaustion from navigating multiple pressures and conflicting responsibilities with home, schooling, and work, without their usual support networks and in the context of disrupted routines. Family roles and relationships were sometimes tested, however, many parents identified coping strategies that protected their wellbeing including access to outdoor space, spending time away from family, and avoiding conflict and pandemic-related media coverage. ConclusionsEmployers must be cognisant of the challenges that the pandemic has placed on parents, particularly women and lone parents. Flexible working arrangements and support might therefore relieve stress and increase productivity. Coping strategies identified by parents in this study could be harnessed and encouraged by employers and policymakers to promote positive wellbeing during times of stress throughout the pandemic and beyond.

You're just there, alone in your room with your thoughts: A qualitative study about the impact of lockdown among young people during the COVID-19 pandemic

BackgroundAdolescents and young adults have been greatly affected by quarantine measures during the coronavirus-19 pandemic. Quantitative evidence suggests that many young people have struggled with their mental health throughout "lockdown", but little is understood about the qualitative impact of social distancing restrictions on mental health, wellbeing and social life. We therefore sought to elicit the views and experiences of adolescents and young adults living in the UK during the pandemic. MethodsSemi-structured qualitative interviews were undertaken with 37 participants aged 13-24. ResultsWe identified 4 superordinate themes most commonly described by participants about their experiences during the pandemic, including: a) missing social contact during lockdown, b) disruption to education, c) changes to social relationships, and d) improved wellbeing during lockdown. Although we identified some positive experiences during the pandemic, including an increased awareness of mental health and stronger relationship ties, many said they struggled with loneliness, a decline in mental health, and anxiety about socialising after the pandemic. ConclusionsFindings suggest that some young people may have felt less stigma talking about their mental health now compared to before the COVID-19 pandemic. However, many are worried about how the pandemic has affected their education and social connections and may require additional psychological, practical and social support. Our findings highlight the important role that education providers play in providing a source of information and support to adolescents and young adults during times of uncertainty.

Public Opinion about the UK Government during COVID-19 and Implications for Public Health: A Topic Modelling Analysis of Open-Ended Survey Response Data

Confidence in the central UK Government has declined since the beginning of the COVID-19 pandemic, and while this may be linked to specific government actions to curb the spread of the virus, understanding is still incomplete. Examining public opinion is important, as research suggests that low confidence in government increases the extent of non-compliance with infection-dampening rules (for instance, social distancing); however, the detailed reasons for this association are still unclear. To understand public opinion on the central UK government during COVID-19, we used structural topic modelling, a text mining technique, to extract themes from over 4000 free-text survey responses, collected between 14 October and 26 November 2020. We identified eleven topics, among which were topics related to perceived government corruption and cronyism, complaints about inconsistency in rules and messaging, lack of clear planning, and lack of openness and transparency. Participants reported that elements of the governments approach had made it difficult to comply with guidelines (e.g., changing rules) or were having impacts on mental wellbeing (e.g., inability to plan for the future). Results suggested that consistent, transparent communication and messaging from the government is critical to improving compliance with measures to contain the virus, as well as protecting mental health during health emergencies.

It makes you realise your own mortality: A qualitative study on mental health of older adults in the UK during COVID-19

BackgroundOlder adults have been disproportionately affected by COVID-19, with high fatalities and health complications reported. Adults over the age of 70 in the UK were advised to self-isolate for 3 months early during the pandemic and it is unclear which factors influenced their experiences during this time. ObjectiveThe aim of this qualitative study was to explore factors that threatened and protected the wellbeing of older adults living in the UK during the COVID-19 pandemic. MethodsWe undertook semi-structured interviews with 20 adults aged over 70. Purposive sampling methods were used to increase diversity within the group. Transcripts were analysed using thematic analysis. ResultsParticipants were aged 72-93, 9 women and 11 men, 80% were White British, 40% lived alone. We identified 2 superordinate themes, including (1) Threats to wellbeing: mortality concerns, grief and loss of normal life, restricted health service access, COVID-19 concerns, and restricted access to activities that protect wellbeing. (2) Factors protective of wellbeing: slower pace of life, maintaining routine, socialising, and use of past coping skills. Many participants drew on their resilience and life experience to self-manage fear and uncertainty associated with the pandemic, using their time during lockdown to reflect or organise end-of-life affairs. ConclusionsThis study provides evidence that while older adults experienced challenges, many were resilient against COVID-19 restrictions despite early concerns of mental health consequences. Our findings highlight the importance of maintaining access to essentials to promote feelings of normality and social support to help reduce uncertainty in times of pandemics.

The impact of the COVID-19 pandemic on mental health and well-being of people living with a long-term physical health condition: a qualitative study

BackgroundThe COVID-19 pandemic and associated restrictions caused major global disruption. Individuals with long-term physical health conditions (LTCs) are at higher risk of severe illness and often subject to the strictest pandemic guidance, so may be disproportionally affected. The aim of this study was to qualitatively explore how living with a LTC during the COVID-19 pandemic affected peoples mental health and wellbeing. Sample and methods32 participants, mean age 57 (SD 13) years, 66% female and 72% white British, who reported having LTCS (most commonly cancer, respiratory conditions or cardiovascular diseases), participated in telephone/video call interviews based on a semi-structured topic guide. Key themes and subthemes were determined using deductive and inductive thematic analysis. ResultsThere were four overarching themes specific to living with a LTC. These were 1) high levels of fear and anxiety related to perceived consequences of catching COVID-19, 2) impact of shielding/isolation on mental health and wellbeing, 3) experience of healthcare during the pandemic and 4) anxiety created by uncertainty about the future. Fourteen subthemes were identified, including concerns about accessing essential supplies and the importance of social support. Individuals who lived alone and were advised to shield could be profoundly negatively affected. ConclusionsThis study found that there were a number of aspects of living with a LTC during the pandemic that had a significant impact on mental health and well-being. There should be focus on how best to provide practical and social support to people with LTCs during a pandemic, particularly if they have to shield or isolate.

Impact of the Covid-19 pandemic on the mental health and wellbeing of adults with mental health conditions in the UK: A qualitative interview study

BackgroundPeople with mental health conditions have been identified as particularly vulnerable to poor mental health during the coronavirus disease 2019 (COVID-19) pandemic. However, why this population have faced these adverse effects, how they have experienced them and how they have coped remains under-explored. AimsTo explore how the COVID-19 pandemic affected the mental health of people with existing mental health conditions, and to identify coping strategies for positive mental health. MethodsSemi-structured qualitative interviews with 22 people with mental health conditions. Participants were purposively recruited via social media, study newsletters and third sector mental health organisations. Data were analysed using reflexive thematic analysis. ResultsParticipants were aged 23-70 (mean age 43), predominantly female (59.1%) and of white ethnicity (68.2%). Fifty percent were unable to work due to illness and the most frequently reported mental health condition was depression. Five pandemic related factors contributed to deteriorating mental health: i) feeling safe but isolated at home ii) disruption to mental health services, iii) cancelled plans and changed routines iv) uncertainty and lack of control, v) rolling media coverage. Five coping strategies were identified for maintaining mental health: i) previous experience of adversity ii) social comparison and accountability iii) engaging in hobbies and activities, iv) staying connected with others, v) perceived social support. ConclusionsChallenges were identified as a direct result of the pandemic and people with severe mental illnesses were particularly negatively affected. However, some found this period a time of respite, drew upon reserves of resilience and adapted their coping strategies to maintain positive wellbeing.

The psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study.

ObjectivesTo explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic. DesignThis was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding. ParticipantsThis study involved 25 participants from a range of frontline professions in health and social care. SettingInterviews were conducted over the phone or video call, depending on participant preference. ResultsFrom the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth, and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life. ConclusionsThis study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions. Strengths and limitations of this studyO_LIThis is the first study in the UK to interview both health and social care professionals working in a range of settings on their experiences working through COVID-19. C_LIO_LIThis study used a strong theoretical approach to inform the topic guide, and one-to-one interviews allowed in-depth analysis of the psychosocial experiences of health and social care professionals, complementing the wider availability of quantitative evidence. C_LIO_LIWe interviewed a wide range of professions, which provided breadth of experience but might limit the specificity of findings. C_LIO_LIGiven the fluctuating nature of the pandemic, attitudes of health and social care professionals may change over time. This can be challenging to capture during a single interview, however we did ask questions on how their experience had progressed longitudinally. C_LIO_LIOur sample may have been biased towards people who had more free time to participate and so were coping better than others. However, our sample still described a number of stressful experiences during the pandemic, and it is also possible that workers who were frustrated or stressed wished to express their views. C_LI