qualitative research title examples for students about covid 19

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100+ Best Research Titles About COVID-19 Examples

The covid-19 pandemic has been the most devastating thing to happen in humanity in the past decade or two. It caused global panic and changed people’s lives in multiple aspects. Therefore, it is the perfect research topic for high school, postgraduate, and undergraduate students.

Exciting Sample Research Title About Pandemic

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Academic research related to covid-19 would be perfect because of its relevance. Furthermore, it applies to any field of study thanks to the vast and immense impacts of the pandemic. For instance, business and finance students can research the effects of the covid-19 pandemic on the economy, while social science majors can discuss the various social results.

The pandemic research topics are a good path also because they are interesting. Additionally, research topic examples about covid-19 give you a great research opportunity because of the numerous materials. There are multiple topics you can consider, from the quantitative and qualitative research titles about covid 19 to the effects and reception of the vaccine, among others.

Ready for detailed quantitative and qualitative research topics ? Find a great research title about a covid-19 example from the samples below.

The impacts of the pandemic were and are still felt globally. So, this means that there are numerous creative directions you can pursue when choosing the perfect topic. Here are some research titles about the pandemic and argumentative essay topics :

• An exploration of the impacts of the pandemic on the global economy
• The covid-19 pandemic and the global recession: what is the link?
• The correlation between your country’s economy and its response to the pandemic
• The connection between kid’s immune system and their survival from the pandemic
• The impacts of the pandemic on third world countries
• A comparison of the effects of the pandemic on third and first-world countries
• A comparison of the response to the pandemic in Europe and America
• The role of the pandemic in the appreciation of the scientific research field
• An exploration of the long-term impacts of the pandemic on the education sector?
• What could global governments have done better to prevent the pandemic?

Quantitative research about the pandemic involves collecting and analyzing data. However, choosing a quantitative research topic is not easy since you must select a researchable one. An example of a quantitative research title about covid-19 may be a good start. So, let’s look at some quantitative research title examples about covid-19:

• How effective are detergents against germs during the pandemic?
• An exploration of coronavirus response and future preparedness against pandemics
• The global coronavirus pandemic: prevention and transmission of the virus
• A look into the ethical controversies during the pandemic
• A look into the effectiveness of the pandemic regulations
• The psychological effects of the pandemic’s control measures
• A link between intimate partner violence increase and the pandemic
• Impacts of the global pandemic on the sports sector
• The influences of the coronavirus pandemic on human relations
• The pandemic and its aftermath

A qualitative research title about covid-19 significantly depends on data collected from first-hand observations, interviews, recordings in natural settings, and case studies. So, qualitative social issues research topics are mostly non-numerical data. Find a qualitative research title about the pandemic from the samples below:

• How ethical are the covid-19 regulations?
• The rise of racist attacks during the coronavirus pandemic
• Racist attacks against the Asian community: what role did covid-19 pandemic play in this?
• Hoarding and selfish tendencies during the coronavirus pandemic
• The rise of the internet age during the coronavirus pandemic
• How streaming services have benefited from the covid-19 pandemic
• The role of pandemics and epidemics in promoting global change
• The rate of employee retention among local businesses during the covid-19 pandemic
• Companies that saw significant profits during the pandemic
• Controversial theories about the pandemic and the coronavirus

You can also find a quantitative research title about covid-19, specifically focusing on the pandemic and its resulting issues. In addition to a quantitative research topic during a pandemic, research topics for STEM students are also pretty interesting. Here are some research topics during the pandemic that you can write about:

• A link between the pandemic and employee retention rates in large corporations
• Global recovery from the pandemic
• The profoundly detrimental consequences of the covid-19 pandemic on the economy
• How the global economy can recover from the pandemic
• The long-term effects of the pandemic on the medical sector
• The correlation between a decrease in employees in the medical industry and the pandemic
• Mitigating the detrimental impacts of the pandemic on the education sector
• The link between the pandemic and increased mental health challenges
• The pandemic and depression: what is the link?
• An analysis of the death rates during the life cycle of the coronavirus pandemic

You can also explore various research topics related to the covid-19 vaccines. The vaccine has been a controversial topic to study from various angles. Here are some research topics about covid 19, especially about vaccines:

• The difference between the acceptance of the covid-19 vaccine in first and third-world countries
• The role of social media influencers in promoting covid-19 vaccines
• The controversies surrounding the covid-19 vaccine
• How effective is the covid-19 vaccines against the virus?
• An analysis of the covid-19 vaccination rates among conservative Americans?
• The adverse effects of the covid-19 vaccine
• An overview of the pros and cons of the covid-19 vaccines
• The rate of covid-19 vaccination in 2021 vs. 2022
• Covid-19 vaccine boosters: how many people go for the booster shots?
• What happens when you get covid-19 after the vaccination?

When choosing a research topic, always pick an interesting and relevant topic. Doing so will simplify your research, help with data collection, and make your paper enjoyable. Get a research title about covid 19 quantitative for 2020 from the list below:

• An analysis of the start of the covid-19 pandemic
• An overview of the source of the coronavirus
• Breaking down the myths about the coronavirus, its inception, and its impacts
• The link between the spike in opioid addiction and the pandemic
• The effects of the pandemic on essential social values
• Quarantine in third-world countries compared to first-world countries
• The rates of covid-19 infections and deaths in Africa
• Social barriers during and after the coronavirus pandemic
• Consumer Psychonomic during the covid-19 pandemic
• The impact of the covid-19 pandemic on a globalized economy

The covid-19 pandemic offers multiple incredible research topic ideas. Choosing the best research title about the coronavirus can be tricky. So, let’s look at some qualitative research title examples about covid-19:

• The covid-19 pandemic and what we can learn from it
• What can global governments take away from the covid-19 pandemic?
• An exploration of the impact of the coronavirus on the body
• A look at how a strong immune system fights the coronavirus
• Mental well-being during the coronavirus pandemic
• Covid-19: managerial accounting during the pandemic
• The positive impacts of the pandemic on the environment
• A compelling city planning approach during the pandemic
• Covid-19 and social values: what is the link
• American administration responses to the covid-19 pandemic

The pandemic is a great study area for a thesis. You can choose various directions for your thesis depending on your study area and interest. Whether it is a quantitative research title about the pandemic or an example of a qualitative research title about covid-19, the following research titles about covid 19 should come in handy:

• The coronavirus pandemic: changes in public spaces and hygiene
• Development Control Regulations as the perfect medium to navigate and fight the pandemic
• A revision of housing topologies after the pandemic
• The drastic effects of the pandemic on the public transformation system
• Workspace design changes after the pandemic
• The effects of the pandemic on productivity and company culture
• The concept of social distancing during the pandemic and its effectiveness
• Sanitization practices in public spaces and residential buildings during the pandemic
• Pedestrianization during the coronavirus pandemic
• Public transportation and its impacts during the covid-19 pandemic

The covid-19 pandemic affected multiple sectors. However, the business industry is arguably the most impacted area beside the medical sector. So, a research title about business during the pandemic is an excellent study focus. Find a research title for the pandemic specifically focused on business:

• The rate of business launches during the pandemic
• How online businesses benefited from the pandemic
• The pandemic and the business sector: the correlation
• An overview of successful companies launched during the pandemic
• The rate of business closures during the pandemic
• How did businesses survive the pandemic
• How Amazon took advantage of the pandemic to become a global giant
• Lessons businesses can take away from the pandemic and its impacts
• Business consumer retention and the pandemic
• Crisis preparedness: what businesses learned from the coronavirus pandemic

A research title about the pandemic can be a great idea if you want to study a relevant topic. However, the topic relevance will depend on your study area. Find a great topic for research this pandemic from the list below:

• A comprehensive reflection on the covid-19 pandemic
• Leadership and management during the coronavirus pandemic
• Economic factors and consequences of the covid-19 pandemic
• Religion and the coronavirus pandemic: what is the overview?
• The role of social media in spreading misinformation on the covid-19 pandemic
• The role of social media in promoting the covid-19 pandemic
• How streaming services and the internet helped maintain peoples’ sanity in the pandemic
• Misinformation handling during the coronavirus pandemic
• Job satisfaction levels during the pandemic in 2020 and 2021
• A controversial argument on the benefits of the pandemic

A research title about the vaccine of covid 19 can be controversial. However, it makes an excellent topic for intellectual study. Find the best title for research about the pandemic related to vaccines

• Mental health during the coronavirus pandemic and what to improve
• Conspiracy theories regarding the covid-19 pandemic
• Conservative views on the covid-19 vaccine in the Christian community
• Public health: the issue of the coronavirus pandemic between 2020 to 2022
• The changing health behaviors following the coronavirus pandemic situation
• The impacts of the pandemic on early childhood development the pandemic
• The pandemic generation: children born during the pandemic and their view of the world
• A comparison of the influenza pandemic and the covid-19 pandemic
• The effect of the pandemic on workers in the medical sector
• Stress and coping mechanisms for nurses and doctors during the covid-19 sector

You can find a thesis statement about social media or a great research title about covid 19 vaccine and other topics online. However, not every research title about covid is relevant or great for academic research. You need the best social media research topics . Find a fantastic title of research about covid from the list below:

• How social media helped mitigate the impacts of the pandemic
• The rise of TikTok during the pandemic
• Social media influence during the pandemic and the changes
• The positive changes in the view of the coronavirus pandemic on social media tendencies
• School closure during the coronavirus pandemic and the role of social media
• The role of social media in promoting mental well-being during the covid-19 pandemic
• Streaming services for the elderly during the 2020 coronavirus pandemic
• How did the pandemic lead to increased adverse effects of social media
• The American mental health population: the impacts of the covid-19 pandemic
• Business negotiation strategies during the covid-19 pandemic

Third-world countries like the Philippines are among the most impacted nations by the pandemic. So, cover the research title example quantitative or qualitative, depending on your preferred data collection and analysis techniques. Some pandemic research title examples about the Philippines are:

• The Philippines’ medical sector during the pandemic
• Mitigation measures by the Philippines government during the pandemic
• How the pandemic impacted the Philippines’ public sector
• The Philippines’ education sector after the pandemic
• Religion and the covid-19 pandemic: God’s existence in Covid-19 times
• Philippines’ public policies after the pandemic
• The Philippines food and beverage plan: the impacts of the pandemic
• Covid-19 vaccination rates in the Philippines’
• The psychological impacts of the pandemic on the Philippines society
• A survey on conditions of low-income households during the pandemic

Title research about the pandemic will earn you excellent grades because of the topic’s relevance and multiple study opportunities. However, the quality of the subject matters significantly. Find an example of a research title about covid-19 pandemic below:

• What has the world learned from the covid-19 pandemic?
• How has the pandemic influenced the public’s view of health?
• Why are there fewer medical employees after the pandemic?
• How did nurses and doctors survive overworking during the pandemic?
• Is there a link between the global recession and the pandemic?
• How did the WHO’s response to the pandemic help mitigate its impacts?
• What challenges did the WHO face while addressing the covid-19 pandemic?
• Should people continue getting covid-19 vaccinations in 2022?
• What is the correlation between the pandemic and the current state of global society?
• What is social solidarity during the pandemic?

The covid-19 pandemic front liners were among the most impacted by the pandemic. So, it would make sense to focus your study on the frontliners. Find an incredible sample of a research title during the pandemic here:

• Frontliners during the pandemic: how were they affected?
• An overview of front liner’s view of the pandemic
• A look into the covid-19 pandemic through the eyes of the pandemic
• School closures during the pandemic: the impacts on frontline families
• Effects of the pandemic on social relationships among frontliners
• Frontliners: how their families suffered from the pandemic
• Frontliner mental health and the pandemic: the correlation
• Getting back into conventional practices in the medical sector after the pandemic
• How frontline helped mitigate the risks of the pandemic
• The age of online learning before and after the pandemic

You do not have to be in college or university to focus your research on the pandemic. Even high school students can write research topics about the pandemic. Here are some sample research topics for high school students:

• Organizational risk management strategies after the pandemic
• Social solidarity and the pandemic: the link
• A link between the social response to plagues and the covid-19 pandemic
• Social changes after the covid-19 pandemic
• The covid-19 pandemic and the World History
• Healthcare management and quality during the covid-19 pandemic
• The covid-19 pandemic: The story of the 21 st -century pandemic
• Child abuse and the pandemic: a correlation
• The covid-19 pandemic: causes and solutions
• The reality of the covid-19 pandemic in the elder community

Reach Out for More Interesting Topics About the Covid-19 Pandemic

You deserve the best research titles for high school, postgraduate, and undergraduate studies. Now that you know the best research title about covid-19 to choose from, reach out to us for help with COVID-19 assignments, research papers, essays, thesis for bachelor degree and even more topic suggestions in this area.

Scientists now agree that the COVID pandemic is arguably the most annoying thing to happen in the 21 st century, making it an ideal focus area. It will go down in history as the most challenging time for the economy, environment, and human health.

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Open Access

Peer-reviewed

Research Article

The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study

Contributed equally to this work with: Dominika Maison, Diana Jaworska, Dominika Adamczyk, Daria Affeltowicz

Roles Conceptualization, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

Affiliation Faculty of Psychology, University of Warsaw, Warsaw, Poland

Roles Formal analysis, Investigation, Writing – original draft, Writing – review & editing

Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Roles Conceptualization, Formal analysis, Investigation, Methodology

• Dominika Maison, 
• Diana Jaworska, 
• Dominika Adamczyk, 
• Daria Affeltowicz

• Published: October 11, 2021
• https://doi.org/10.1371/journal.pone.0258133
• Peer Review
• Reader Comments

The conducted qualitative research was aimed at capturing the biggest challenges related to the beginning of the COVID-19 pandemic. The interviews were carried out in March-June (five stages of the research) and in October (the 6 th stage of the research). A total of 115 in-depth individual interviews were conducted online with 20 respondents, in 6 stages. The results of the analysis showed that for all respondents the greatest challenges and the source of the greatest suffering were: a) limitation of direct contact with people; b) restrictions on movement and travel; c) necessary changes in active lifestyle; d) boredom and monotony; and e) uncertainty about the future.

Citation: Maison D, Jaworska D, Adamczyk D, Affeltowicz D (2021) The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study. PLoS ONE 16(10): e0258133. https://doi.org/10.1371/journal.pone.0258133

Editor: Shah Md Atiqul Haq, Shahjalal University of Science and Technology, BANGLADESH

Received: April 6, 2021; Accepted: September 18, 2021; Published: October 11, 2021

Copyright: © 2021 Maison et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files ( S1 Dataset ).

Funding: This work was supported by the Faculty of Psychology, University of Warsaw, Poland from the funds awarded by the Ministry of Science and Higher Education in the form of a subsidy for the maintenance and development of research potential in 2020 (501-D125-01-1250000). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The coronavirus disease (COVID-19), discovered in December 2019 in China, has reached the level of a pandemic and, till June 2021, it has affected more than 171 million people worldwide and caused more than 3.5 million deaths all over the world [ 1 ]. The COVID-19 pandemic as a major health crisis has caught the attention of many researchers, which has led to the creation of a broad quantitative picture of human behavior during the coronavirus outbreak [ 2 – 4 ]. What has been established so far is, among others, the psychological symptoms that can occur as a result of lockdown [ 2 ], and the most common coping strategies [ 5 ]. However, what we still miss is an in-depth understanding of the changes in the ways of coping with challenges over different stages of the pandemic. In the following study, we used a longitudinal qualitative method to investigate the challenges during the different waves of the coronavirus pandemic as well as the coping mechanisms accompanying them.

In Poland, the first patient was diagnosed with COVID-19 on the 4 th March 2020. Since then, the number of confirmed cases has grown to more than 2.8 million and the number of deaths to more than 73,000 (June 2021) [ 1 ]. From mid-March 2020, the Polish government, similarly to many other countries, began to introduce a number of restrictions to limit the spread of the virus. These restrictions had been changing from week to week, causing diverse reactions in people [ 6 ]. It needs to be noted that the reactions to such a dynamic situation cannot be covered by a single study. Therefore, in our study we used qualitative longitudinal research in order to monitor changes in people’s emotions, attitudes, and behavior. So far, few longitudinal studies have been carried out that investigated the various issues related to the COVID-19 pandemic; however, all of them were quantitative [ 7 – 10 ]. The qualitative approach (and especially the use of enabling and projective techniques) allows for an in-depth exploration of respondents’ reactions that goes beyond respondents’ declarations and captures what they are less aware of or even unconscious of. This study consisted of six stages of interviews that were conducted at key moments for the development of the pandemic situation in Poland. The first stage of the study was carried out at the moment of the most severe lockdown and the biggest restrictions (March 2020) and was focused on exploration how did people react to the new uncertain situation. The second stage of the study was conducted at the time when restrictions were extended and the obligation to cover the mouth and nose everywhere outside the household were introduced (middle of April 2020) and was focused at the way how did people deal with the lack of family gatherings over Easter. The third stage of the study was conducted at the moment of announcing the four stages of lifting the restrictions (April 2020) and was focused on people’s reaction to an emerging vision of getting back to normalcy. The fourth stage of the study was carried out, after the introduction of the second stage of lifting the restrictions: shopping malls, hotels, and cultural institutions were gradually being opened (May 2020). The fifth stage of the study was conducted after all four stages of restriction lifting were in place (June 2020). Only the obligation to cover the mouth and nose in public spaces, an order to maintain social distance, as well as the functioning of public places under a sanitary regime were still in effect. During those 5 stages coping strategies with the changes in restrictions were explored. The sixth and last stage of the study was a return to the respondents after a longer break, at the turn of October and November 2020, when the number of coronavirus cases in Poland began to increase rapidly and the media declared “the second wave of the pandemic”. It was the moment when the restrictions were gradually being reintroduced. A full description of the changes occurring in Poland at the time of the study can be found in S1 Table .

The following study is the first qualitative longitudinal study investigating how people cope with the challenges arising from the COVID-19 pandemic at its different stages. The study, although conducted in Poland, shows the universal psychological relations between the challenges posed by the pandemic (and, even more, the restrictions resulting from the pandemic, which were very similar across different countries, not only European) and the ways of dealing with them.

Literature review

The COVID-19 pandemic has led to a global health crisis with severe economic [ 11 ], social [ 3 ], and psychological consequences [ 4 ]. Despite the fact that there were multiple crises in recent years, such as natural disasters, economic crises, and even epidemics, the coronavirus pandemic is the first in 100 years to severely affect the entire world. The economic effects of the COVID-19 pandemic concern an impending global recession caused by the lockdown of non-essential industries and the disruption of production and supply chains [ 11 ]. Social consequences may be visible in many areas, such as the rise in family violence [ 3 ], the ineffectiveness of remote education, and increased food insecurity among impoverished families due to school closures [ 12 ]. According to some experts, the psychological consequences of COVID-19 are the ones that may persist for the longest and lead to a global mental health crisis [ 13 ]. The coronavirus outbreak is generating increased depressive symptoms, stress, anxiety, insomnia, denial, fear, and anger all over the world [ 2 , 14 ]. The economic, social, and psychological problems that people are currently facing are the consequences of novel challenges that have been posed by the pandemic.

The coronavirus outbreak is a novel, uncharted situation that has shaken the world and completely changed the everyday lives of many individuals. Due to the social distancing policy, many people have switched to remote work—in Poland, almost 75% of white-collar workers were fully or partially working from home from mid-March until the end of May 2020 [ 15 ]. School closures and remote learning imposed a new obligation on parents of supervising education, especially with younger children [ 16 ]. What is more, the government order of self-isolation forced people to spend almost all their time at home and limit or completely abandon human encounters. In addition, the deteriorating economic situation was the cause of financial hardship for many people. All these difficulties and challenges arose in the aura of a new, contagious disease with unexplored, long-lasting health effects and not fully known infectivity and lethality [ 17 ]. Dealing with the situation was not facilitated by the phenomenon of global misinformation, called by some experts as the “infodemic”, which may be defined as an overabundance of information that makes it difficult for people to find trustworthy sources and reliable guidance [ 18 ]. Studies have shown that people have multiple ways of reacting to a crisis: from radical and even violent practices, towards individual solutions and depression [ 19 ]. Not only the challenges arising from the COVID-19 pandemic but also the ways of reacting to it and coping with it are issues of paramount importance that are worth investigating.

The reactions to unusual crisis situations may be dependent on dispositional factors, such as trait anxiety or perceived control [ 20 , 21 ]. A study on reactions to Hurricane Hugo has shown that people with higher trait anxiety are more likely to develop posttraumatic symptoms following a natural disaster [ 20 ]. Moreover, lack of perceived control was shown to be positively related to the level of distress during an earthquake in Turkey [ 21 ]. According to some researchers, the COVID-19 crisis and natural disasters have much in common, as the emotions and behavior they cause are based on the same primal human emotion—fear [ 22 ]. Both pandemics and natural disasters disrupt people’s everyday lives and may have severe economic, social and psychological consequences [ 23 ]. However, despite many similarities to natural disasters, COVID-19 is a unique situation—only in 2020, the current pandemic has taken more lives than the world’s combined natural disasters in any of the past twenty years [ 24 ]. It needs to be noted that natural disasters may pose different challenges than health crises and for this reason, they may provoke disparate reactions [ 25 ]. Research on the reactions to former epidemics has shown that avoidance and safety behaviors, such as avoiding going out, visiting crowded places, and visiting hospitals, are widespread at such times [ 26 ]. When it comes to the ways of dealing with the current COVID-19 pandemic, a substantial part of the quantitative research on this issue focuses on coping mechanisms. Studies have shown that the most prevalent coping strategies are highly problem-focused [ 5 ]. Most people tend to listen to expert advice and behave calmly and appropriately in the face of the coronavirus outbreak [ 5 ]. Problem-focused coping is particularly characteristic of healthcare professionals. A study on Chinese nurses has shown that the closer the problem is to the person and the more fear it evokes, the more problem-focused coping strategy is used to deal with it [ 27 ]. On the other hand, a negative coping style that entails risky or aggressive behaviors, such as drug or alcohol use, is also used to deal with the challenges arising from the COVID-19 pandemic [ 28 ]. The factors that are correlated with negative coping include coronavirus anxiety, impairment, and suicidal ideation [ 28 ]. It is worth emphasizing that social support is a very important component of dealing with crises [ 29 ].

Scientists have attempted to systematize the reactions to difficult and unusual situations. One such concept is the “3 Cs” model created by Reich [ 30 ]. It accounts for the general rules of resilience in situations of stress caused by crises, such as natural disasters. The 3 Cs stand for: control (a belief that personal resources can be accessed to achieve valued goals), coherence (the human desire to make meaning of the world), and connectedness (the need for human contact and support) [ 30 ]. Polizzi and colleagues [ 22 ] reviewed this model from the perspective of the current COVID-19 pandemic. The authors claim that natural disasters and COVID-19 pandemic have much in common and therefore, the principles of resilience in natural disaster situations can also be used in the situation of the current pandemic [ 22 ]. They propose a set of coping behaviors that could be useful in times of the coronavirus outbreak, which include control (e.g., planning activities for each day, getting adequate sleep, limiting exposure to the news, and helping others), coherence (e.g., mindfulness and developing a coherent narrative on the event), and connectedness (e.g., establishing new relationships and caring for existing social bonds) [ 22 ].

Current study

The issue of the challenges arising from the current COVID-19 pandemic and the ways of coping with them is complex and many feelings accompanying these experiences may be unconscious and difficult to verbalize. Therefore, in order to explore and understand it deeply, qualitative methodology was applied. Although there were few qualitative studies on the reaction to the pandemic [e.g., 31 – 33 ], they did not capture the perception of the challenges and their changes that arise as the pandemic develops. Since the situation with the COVID-19 pandemic is very dynamic, the reactions to the various restrictions, orders or bans are evolving. Therefore, it was decided to conduct a qualitative longitudinal study with multiple interviews with the same respondents [ 34 ].

The study investigates the challenges arising from the current pandemic and the way people deal with them. The main aim of the project was to capture people’s reactions to the unusual and unexpected situation of the COVID-19 pandemic. Therefore, the project was largely exploratory in nature. Interviews with the participants at different stages of the epidemic allowed us to see a wide spectrum of problems and ways of dealing with them. The conducted study had three main research questions:

• What are the biggest challenges connected to the COVID-19 pandemic and the resulting restrictions?
• How are people dealing with the pandemic challenges?
• What are the ways of coping with the restrictions resulting from a pandemic change as it continues and develops (perspective of first 6 months)?

The study was approved by the institutional review board of the Faculty of Psychology University of Warsaw, Poland. All participants were provided written and oral information about the study, which included that participation was voluntary, that it was possible to withdraw without any consequences at any time, and the precautions that would be taken to protect data confidentiality. Informed consent was obtained from all participants. To ensure confidentiality, quotes are presented only with gender, age, and family status.

The study was based on qualitative methodology: individual in-depth interviews, s which are the appropriate to approach a new and unknown and multithreaded topic which, at the beginning of 2020, was the COVID-19 pandemic. Due to the need to observe respondents’ reactions to the dynamically changing situation of the COVID-19 pandemic, longitudinal study was used where the moderator met on-line with the same respondent several times, at specific time intervals. A longitudinal study was used to capture the changes in opinions, emotions, and behaviors of the respondents resulting from the changes in the external circumstances (qualitative in-depth interview tracking–[ 34 ]).

The study took place from the end of March to October 2020. Due to the epidemiological situation in the country interviews took place online, using the Google Meets online video platform. The audio was recorded and then transcribed. Before taking part in the project, the respondents were informed about the purpose of the study, its course, and the fact that participation in the project is voluntary, and that they will be able to withdraw from participation at any time. The respondents were not paid for taking part in the project.

Participants.

In total, 115 interviews were conducted with 20 participants (6 interviews with the majority of respondents). Two participants (number 11 and 19, S2 Table ) dropped out of the last two interviews, and one (number 6) dropped out of the last interview. The study was based on a purposive sample and the respondents differed in gender, age, education, family status, and work situation (see S2 Table ). In addition to demographic criteria intended to ensure that the sample was as diverse as possible, an additional criterion was to have a permanent Internet connection and a computer capable of online video interviewing. Study participants were recruited using the snowball method. They were distant acquaintances of acquaintances of individuals involved in the study. None of the moderators knew their interviewees personally.

A total of 10 men and 10 women participated in the study; their age range was: 25–55; the majority had higher education (17 respondents), they were people with different professions and work status, and different family status (singles, couples without children, and families with children). Such diversity of respondents allowed us to obtain information from different life perspectives. A full description of characteristics of study participants can be found in S2 Table .

Each interview took 2 hours on average, which gives around 240 hours of interviews. Subsequent interviews with the same respondents conducted at different intervals resulted from the dynamics of the development of the pandemic and the restrictions introduced in Poland by the government.

The interviews scenario took a semi-structured form. This allowed interviewers freely modify the questions and topics depending on the dynamics of the conversation and adapt the subject matter of the interviews not only to the research purposes but also to the needs of a given respondent. The interview guides were modified from week to week, taking into account the development of the epidemiological situation, while at the same time maintaining certain constant parts that were repeated in each interview. The main parts of the interview topic guide consisted of: (a) experiences from the time of previous interviews: thoughts, feeling, fears, and hopes; (b) everyday life—organization of the day, work, free time, shopping, and eating, etc.; (c) changes—what had changed in the life of the respondent from the time of the last interview; (d) ways of coping with the situation; and (e) media—reception of information appearing in the media. Additionally, in each interview there were specific parts, such as the reactions to the beginning of the pandemic in the first interview or the reaction to the specific restrictions that were introduced.

The interviews were conducted by 5 female interviewers with experience in moderating qualitative interviews, all with a psychological background. After each series of interviews, all the members of the research teams took part in debriefing sessions, which consisted of discussing the information obtained from each respondent, exchanging general conclusions, deciding about the topics for the following interview stage, and adjusting them to the pandemic situation in the country.

Data analysis.

All the interviews were transcribed in Polish by the moderators and then double-checked (each moderator transcribed the interviews of another moderator, and then the interviewer checked the accuracy of the transcription). The whole process of analysis was conducted on the material in Polish (the native language of the authors of the study and respondents). The final page count of the transcript is approximately 1800 pages of text. The results presented below are only a portion of the total data collected during the interviews. While there are about 250 pages of the transcription directly related to the topic of the article, due to the fact that the interview was partly free-form, some themes merge with others and it is not possible to determine the exact number of pages devoted exclusively to analysis related to the topic of the article. Full dataset can be found in S1 Dataset .

Data was then processed into thematic analysis, which is defined as a method of developing qualitative data consisting of the identification, analysis, and description of the thematic areas [ 35 ]. In this type of analysis, a thematic unit is treated as an element related to the research problem that includes an important aspect of data. An important advantage of thematic analysis is its flexibility, which allows for the adoption of the most appropriate research strategy to the phenomenon under analysis. An inductive approach was used to avoid conceptual tunnel vision. Extracting themes from the raw data using an inductive approach precludes the researcher from imposing a predetermined outcome.

As a first step, each moderator reviewed the transcripts of the interviews they had conducted. Each transcript was thematically coded individually from this point during the second and the third reading. In the next step, one of the researchers reviewed the codes extracted by the other members of the research team. Then she made initial interpretations by generating themes that captured the essence of the previously identified codes. The researcher created a list of common themes present in all of the interviews. In the next step, the extracted themes were discussed again with all the moderators conducting the coding in order to achieve consistency. This collaborative process was repeated several times during the analysis. Here, further superordinate (challenges of COVID-19 pandemic) and subordinate (ways of dealing with challenges) themes were created, often by collapsing others together, and each theme listed under a superordinate and subordinate category was checked to ensure they were accurately represented. Through this process of repeated analysis and discussion of emerging themes, it was possible to agree on the final themes that are described below.

Main challenges of the COVID-19 pandemic.

Challenge 1 –limitation of direct contact with people . The first major challenge of the pandemic was that direct contact with other people was significantly reduced. The lockdown forced many people to work from home and limit contact not only with friends but also with close family (parents, children, and siblings). Limiting contact with other people was a big challenge for most of our respondents, especially those who were living alone and for those who previously led an active social life. Depending on their earlier lifestyle profile, for some, the bigger problem was the limitation of contact with the family, for others with friends, and for still others with co-workers.

I think that because I can’t meet up with anyone and that I’m not in a relationship , I miss having sex , and I think it will become even more difficult because it will be increasingly hard to meet anyone . (5 . 3_ M_39_single) . The number In the brackets at the end of the quotes marks the respondent’s number (according to Table 1 ) and the stage of the interview (after the dash), further is information about gender (F/M), age of the respondent and family status. Linguistic errors in the quotes reflect the spoken language of the respondents.

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https://doi.org/10.1371/journal.pone.0258133.t001

Changes over time . Over the course of the 6 months of the study, an evolution in the attitudes to the restriction of face-to-face contact could be seen: from full acceptance, to later questioning its rationale. Initially (March and April), almost all the respondents understood the reasons for the isolation and were compliant. At the beginning, people were afraid of the unknown COVID-19. They were concerned that the tragic situation from Italy, which was intensively covered in the media, could repeat itself in Poland (stage 1–2 of the study). However, with time, the isolation started to bother them more and more, and they started to look for solutions to bypass the isolation guidelines (stage 3–4), both real (simply meeting each other) and mental (treating isolation only as a guideline and not as an order, perceiving the family as being less threatening than acquaintances or strangers in a store). The turning point was the long May weekend that, due to two public holidays (1 st and 3 rd May), has for many years been used as an opportunity to go away with family or friends. Many people broke their voluntary isolation during that time encouraged by information about the coming loosening of restrictions.

During the summer (stage 5 of the survey), practically no one was fully compliant with the isolation recommendations anymore. At that time, a growing familiarity could be observed with COVID-19 and an increasing tendency to talk about it as “one of many diseases”, and to convince oneself that one is not at risk and that COVID-19 is no more threatening than other viruses. Only a small group of people consciously failed to comply with the restrictions of contact with others from the very beginning of the pandemic. This behavior was mostly observed among people who were generally less anxious and less afraid of COVID-19.

I’ve had enough. I’ve had it with sitting at home. Okay, there’s some kind of virus, it’s as though it’s out there somewhere; it’s like I know 2 people who were infected but they’re still alive, nothing bad has happened to anyone. It’s just a tiny portion of people who are dying. And is it really such a tragedy that we have to be locked up at home? Surely there’s an alternative agenda there? (17.4_F_35_Adult and child)

Ways of dealing . In the initial phase, when almost everyone accepted this restriction and submitted to it, the use of communication platforms for social meetings increased (see Ways of dealing with challenges in Table 1 ) . Meetings on communication platforms were seen as an equivalent of the previous face-to-face contact and were often even accompanied by eating or drinking alcohol together. However, over time (at around stage 4–5 of the study) people began to feel that such contact was an insufficient substitute for face-to-face meetings and interest in online meetings began to wane. During this time, however, an interesting phenomenon could be seen, namely, that for many people the family was seen as a safer environment than friends, and definitely safer than strangers. The belief was that family members would be honest about being sick, while strangers not necessarily, and—on an unconscious level—the feeling was that the “family is safe”, and the “family can’t hurt them”.

When it became clear that online communication is an insufficient substitute for face-to-face contacts, people started to meet up in real life. However, a change in many behaviors associated with meeting people is clearly visible, e.g.: refraining from shaking hands, refraining from cheek kissing to greet one another, and keeping a distance during a conversation.

I can’t really say that I could ‘feel’ Good Friday or Holy Saturday. On Sunday, we had breakfast together with my husband’s family and his sister. We were in three different places but we connected over Skype. Later, at noon, we had some coffee with my parents, also over Skype. It’s obvious though that this doesn’t replace face-to-face contact but it’s always some form of conversation. (9.3_F_25_Couple, no children)

Challenge 2 –restrictions on movement and travel . In contrast to the restrictions on contact with other people, the restrictions on movement and the closing of borders were perceived more negatively and posed bigger challenges for some people (especially those who used to do a lot of travelling). In this case, it was less clear why these regulations were introduced (especially travel restrictions within the country). Moreover, travel restrictions, particularly in the case of international travels, were associated with a limitation of civil liberties. The limitation (or complete ban) on travelling abroad in the Polish situation evoked additional connotations with the communist times, that is, with the fact that there was no freedom of movement for Polish citizens (associations with totalitarianism and dictatorship). Interestingly, the lack of acceptance of this restriction was also manifested by people who did not travel much. Thus, it was not just a question of restricting travelling abroad but more of restricting the potential opportunity (“even if I’m not planning on going anywhere, I know I still can”).

Limitations on travelling around the country were particularly negatively felt by families with children, where parents believe that regular exercise and outings are necessary for the proper development of their children. For parents, it was problematic to accept the prohibition of leaving the house and going to the playground (which remained closed until mid-May). Being outdoors was perceived as important for maintaining immunity (exercise as part of a healthy lifestyle), therefore, people could not understand the reason underlying this restriction and, as a consequence, often did not accept it.

I was really bothered by the very awareness that I can’t just jump in my car or get on a plane whenever I want and go wherever I want. It’s not something that I have to do on a daily basis but freedom of movement and travelling are very important for me. (14.2_M_55_Two adults and children)

Changes over time . The travel and movement limitations, although objectively less severe for most people, aroused much greater anger than the restrictions on social contact. This was probably due to a greater sense of misunderstanding as to why these rules were being introduced in the first place. Moreover, they were often communicated inconsistently and chaotically (e.g., a ban on entering forests was introduced while, at the same time, shopping malls remained open and masses were allowed to attend church services). This anger grew over time—from interview to interview, the respondents’ irritation and lack of acceptance of this was evident (culminating in the 3 rd -4 th stage of the study). The limitation of mobility was also often associated with negative consequences for both health and the economy. Many people are convinced that being in the open air (especially accompanied by physical activity) strengthens immunity, therefore, limiting such activity may have negative health consequences. Some respondents pointed out that restricting travelling, the use of hotels and restaurants, especially during the holiday season, will have serious consequences for the existence of the tourism industry.

I can’t say I completely agree with these limitations because it’s treating everything selectively. It’s like the shopping mall is closed, I can’t buy any shoes but I can go to a home improvement store and buy some wallpaper for myself. So I don’t see the difference between encountering people in a home improvement store and a shopping mall. (18.2_F_48_Two adults and children)

Ways of dealing . Since the restriction of movement and travel was more often associated with pleasure-related behaviors than with activities necessary for living, the compensations for these restrictions were usually also from the area of hedonistic behaviors. In the statements of our respondents, terms such as “indulging” or “rewarding oneself” appeared, and behaviors such as throwing small parties at home, buying better alcohol, sweets, and new clothes were observed. There were also increased shopping behaviors related to hobbies (sometimes hobbies that could not be pursued at the given time)–a kind of “post-pandemic” shopping spree (e.g., a new bike or new skis).

Again, the reaction to this restriction also depended on the level of fear of the COVID-19 disease. People who were more afraid of being infected accepted these restrictions more easily as it gave them the feeling that they were doing something constructive to protect themselves from the infection. Conversely, people with less fears and concerns were more likely to rebel and break these bans and guidelines.

Another way of dealing with this challenge was making plans for interesting travel destinations for the post-pandemic period. This was especially salient in respondents with an active lifestyle in the past and especially visible during the 5 th stage of the study.

Today was the first day when I went to the store (due to being in quarantine after returning from abroad). I spent loads of money but I normally would have never spent so much on myself. I bought sweets and confectionery for Easter time, some Easter chocolates, too. I thought I’d do some more baking so I also bought some ingredients to do this. (1.2_ F_25_single)

Challenge 3 –necessary change in active lifestyle . Many of the limitations related to COVID-19 were a challenge for people with an active lifestyle who would regularly go to the cinema, theater, and gym, use restaurants, and do a lot of travelling. For those people, the time of the COVID constraints has brought about huge changes in their lifestyle. Most of their activities were drastically restricted overnight and they suddenly became domesticated by force, especially when it was additionally accompanied by a transition to remote work.

Compulsory spending time at home also had serious consequences for people with school-aged children who had to confront themselves with the distance learning situation of their children. The second challenge for families with children was also finding (or helping find) activities for their children to do in their free time without leaving the house.

I would love to go to a restaurant somewhere. We order food from the restaurant at least once a week, but I’d love to go to the restaurant. Spending time there is a different way of functioning. It is enjoyable and that is what I miss. I would also go to the cinema, to the theater. (13.3_M_46_Two adults and child.)

Changes over time . The nuisance of restrictions connected to an active lifestyle depended on the level of restrictions in place at a given time and the extent to which a given activity could be replaced by an alternative. Moreover, the response to these restrictions depended more on the individual differences in lifestyle rather than on the stage of the interview (except for the very beginning, when the changes in lifestyle and everyday activities were very sudden).

I miss that these restaurants are not open . And it’s not even that I would like to eat something specific . It is in all of this that I miss such freedom the most . It bothers me that I have no freedom . And I am able to get used to it , I can cook at home , I can order from home . But I just wish I had a choice . (2 . 6_F_27_single ).

Ways of dealing . In the initial phase of the pandemic (March-April—stage 1–3 of the study), when most people were afraid of the coronavirus, the acceptance of the restrictions was high. At the same time, efforts were made to find activities that could replace existing ones. Going to the gym was replaced by online exercise, and going to the cinema or theater by intensive use of streaming platforms. In the subsequent stages of the study, however, the respondents’ fatigue with these “substitutes” was noticeable. It was then that more irritation and greater non-acceptance of certain restrictions began to appear. On the other hand, the changes or restrictions introduced during the later stages of the pandemic were less sudden than the initial ones, so they were often easier to get used to.

I bought a small bike and even before that we ordered some resistance bands to work out at home, which replace certain gym equipment and devices. […] I’m considering learning a language. From the other online things, my girlfriend is having yoga classes, for instance. (7.2_M_28_Couple, no children)

Challenge 4 –boredom , monotony . As has already been shown, for many people, the beginning of the pandemic was a huge change in lifestyle, an absence of activities, and a resulting slowdown. It was sometimes associated with a feeling of weariness, monotony, and even of boredom, especially for people who worked remotely, whose days began to be similar to each other and whose working time merged with free time, weekdays with the weekends, and free time could not be filled with previous activities.

In some way, boredom. I can’t concentrate on what I’m reading. I’m trying to motivate myself to do such things as learning a language because I have so much time on my hands, or to do exercises. I don’t have this balance that I’m actually doing something for myself, like reading, working out, but also that I’m meeting up with friends. This balance has gone, so I’ve started to get bored with many things. Yesterday I felt that I was bored and something should start happening. (…) After some time, this lack of events and meetings leads to such immense boredom. (1.5_F_25_single)

Changes over time . The feeling of monotony and boredom was especially visible in stage 1 and 2 of the study when the lockdown was most restrictive and people were knocked out of their daily routines. As the pandemic continued, boredom was often replaced by irritation in some, and by stagnation in others (visible in stages 3 and 4 of the study) while, at the same time, enthusiasm for taking up new activities was waning. As most people were realizing that the pandemic was not going to end any time soon, a gradual adaptation to the new lifestyle (slower and less active) and the special pandemic demands (especially seen in stage 5 and 6 of the study) could be observed.

But I see that people around me , in fact , both family and friends , are slowly beginning to prepare themselves for more frequent stays at home . So actually more remote work , maybe everything will not be closed and we will not be locked in four walls , but this tendency towards isolation or self-isolation , such a deliberate one , appears . I guess we are used to the fact that it has to be this way . (15 . 6_M_43_Two adults and child) .

Ways of dealing . The answer to the monotony of everyday life and to finding different ways of separating work from free time was to stick to certain rituals, such as “getting dressed for work”, even when work was only by a computer at home or, if possible, setting a fixed meal time when the whole family would gather together. For some, the time of the beginning of the pandemic was treated as an extra vacation. This was especially true of people who could not carry out their work during the time of the most severe restrictions (e.g., hairdressers and doctors). For them, provided that they believed that everything would return to normal and that they would soon go back to work, a “vacation mode” was activated wherein they would sleep longer, watch a lot of movies, read books, and generally do pleasant things for which they previously had no time and which they could now enjoy without feeling guilty. Another way of dealing with the monotony and transition to a slower lifestyle was taking up various activities for which there was no time before, such as baking bread at home and cooking fancy dishes.

I generally do have a set schedule. I begin work at eight. Well, and what’s changed is that I can get up last minute, switch the computer on and be practically making my breakfast and coffee during this time. I do some work and then print out some materials for my younger daughter. You know, I have work till four, I keep on going up to the computer and checking my emails. (19.1_F_39_Two adults and children)

Challenge 5 –uncertainty about the future . Despite the difficulties arising from the circumstances and limitations described above, it seems that psychologically, the greatest challenge during a pandemic is the uncertainty of what will happen next. There was a lot of contradictory information in the media that caused a sense of confusion and heightened the feeling of anxiety.

I’m less bothered about the changes that were put in place and more about this concern about what will happen in the future. Right now, it’s like there’s these mood swings. […] Based on what’s going on, this will somehow affect every one of us. And that’s what I’m afraid of. The fact that someone will not survive and I have no way of knowing who this could be—whether it will be me or anyone else, or my dad, if somehow the coronavirus will sneak its way into our home. I simply don’t know. I’m simply afraid of this. (10.1_F_55_Couple, no children)

Changes over time . In the first phase of the pandemic (interviews 1–3), most people felt a strong sense of not being in control of the situation and of their own lives. Not only did the consequences of the pandemic include a change in lifestyle but also, very often, the suspension of plans altogether. In addition, many people felt a strong fear of the future, about what would happen, and even a sense of threat to their own or their loved ones’ lives. Gradually (interview 4), alongside anxiety, anger began to emerge about not knowing what would happen next. At the beginning of the summer (stage 5 of the study), most people had a hope of the pandemic soon ending. It was a period of easing restrictions and of opening up the economy. Life was starting to look more and more like it did before the pandemic, fleetingly giving an illusion that the end of the pandemic was “in sight” and the vision of a return to normal life. Unfortunately, autumn showed that more waves of the pandemic were approaching. In the interviews of the 6 th stage of the study, we could see more and more confusion and uncertainty, a loss of hope, and often a manifestation of disagreement with the restrictions that were introduced.

This is making me sad and angry. More angry, in fact. […] I don’t know what I should do. Up until now, there was nothing like this. Up until now, I was pretty certain of what I was doing in all the decisions I was making. (14.4_M_55_Two adults and children)

Ways of dealing . People reacted differently to the described feeling of insecurity. In order to reduce the emerging fears, some people searched (sometimes even compulsively) for any information that could help them “take control” of the situation. These people searched various sources, for example, information on the number of infected persons and the number of deaths. This knowledge gave them the illusion of control and helped them to somewhat reduce the anxiety evoked by the pandemic. The behavior of this group was often accompanied by very strict adherence to all guidelines and restrictions (e.g., frequent hand sanitization, wearing a face mask, and avoiding contact with others). This behavior increased the sense of control over the situation in these people.

A completely opposite strategy to reducing the feeling of uncertainty which we also observed in some respondents was cutting off information in the media about the scale of the disease and the resulting restrictions. These people, unable to keep up with the changing information and often inconsistent messages, in order to maintain cognitive coherence tried to cut off the media as much as possible, assuming that even if something really significant had happened, they would still find out.

I want to keep up to date with the current affairs. Even if it is an hour a day. How is the pandemic situation developing—is it increasing or decreasing. There’s a bit of propaganda there because I know that when they’re saying that they have the situation under control, they can’t control it anyway. Anyhow, it still has a somewhat calming effect that it’s dying down over here and that things aren’t that bad. And, apart from this, I listen to the news concerning restrictions, what we can and can’t do. (3.1_F_54_single)

Discussion and conclusions

The results of our study showed that the five greatest challenges resulting from the COVID-19 pandemic are: limitations of direct contact with people, restrictions on movement and travel, change in active lifestyle, boredom and monotony, and finally uncertainty about the future. As we can see the spectrum of problems resulting from the pandemic is very wide and some of them have an impact on everyday functioning and lifestyle, some other influence psychological functioning and well-being. Moreover, different people deal with these problems differently and different changes in everyday life are challenging for them. The first challenge of the pandemic COVID-19 problem is the consequence of the limitation of direct contact with others. This regulation has very strong psychological consequences in the sense of loneliness and lack of closeness. Initially, people tried to deal with this limitation through the use of internet communicators. It turned out, however, that this form of contact for the majority of people was definitely insufficient and feelings of deprivation quickly increased. As much data from psychological literature shows, contact with others can have great psychological healing properties [e.g., 29 ]. The need for closeness is a natural need in times of crisis and catastrophes [ 30 ]. Unfortunately, during the COVID-19 pandemic, the ability to meet this need was severely limited by regulations. This led to many people having serious problems with maintaining a good psychological condition.

Another troubling limitation found in our study were the restrictions on movement and travel, and the associated restrictions of most activities, which caused a huge change in lifestyle for many people. As shown in previous studies, travel and diverse leisure activities are important predictors of greater well-being [ 36 ]. Moreover, COVID-19 pandemic movement restrictions may be perceived by some people as a threat to human rights [ 37 ], which can contribute to people’s reluctance to accept lockdown rules.

The problem with accepting these restrictions was also related to the lack of understanding of the reasons behind them. Just as the limitation in contact with other people seemed understandable, the limitations related to physical activity and mobility were less so. Because of these limitations many people lost a sense of understanding of the rules and restrictions being imposed. Inconsistent communication in the media—called by some researchers the ‘infodemic’ [ 18 ], as well as discordant recommendations in different countries, causing an increasing sense of confusion in people.

Another huge challenge posed by the current pandemic is the feeling of uncertainty about the future. This feeling is caused by constant changes in the rules concerning daily functioning during the pandemic and what is prohibited and what is allowed. People lose their sense of being in control of the situation. From the psychological point of view, a long-lasting experience of lack of control can cause so-called learned helplessness, a permanent feeling of having no influence over the situation and no possibility of changing it [ 38 ], which can even result in depression and lower mental and physical wellbeing [ 39 ]. Control over live and the feeling that people have an influence on what happens in their lives is one of the basic rules of crisis situation resilience [ 30 ]. Unfortunately, also in this area, people have huge deficits caused by the pandemic. The obtained results are coherent with previous studies regarding the strategies harnessed to cope with the pandemic [e.g., 5 , 10 , 28 , 33 ]. For example, some studies showed that seeking social support is one of the most common strategies used to deal with the coronavirus pandemic [ 33 , 40 ]. Other ways to deal with this situation include distraction, active coping, and a positive appraisal of the situation [ 41 ]. Furthermore, research has shown that simple coping behaviors such as a healthy diet, not reading too much COVID-19 news, following a daily routine, and spending time outdoors may be protective factors against anxiety and depressive symptoms in times of the coronavirus pandemic [ 41 ].

This study showed that the acceptance of various limitations, and especially the feeling of discomfort associated with them, depended on the person’s earlier lifestyle. The more active and socializing a person was, the more restrictions were burdensome for him/her. The second factor, more of a psychological nature, was the fear of developing COVID-19. In this case, people who were more afraid of getting sick were more likely to submit to the imposed restrictions that, paradoxically, did not reduce their anxiety, and sometimes even heightened it.

Limitations of the study.

While the study shows interesting results, it also has some limitations. The purpose of the study was primarily to capture the first response to problems resulting from a pandemic, and as such its design is not ideal. First, the study participants are not diverse as much as would be desirable. They are mostly college-educated and relatively well off, which may influence how they perceive the pandemic situation. Furthermore, the recruitment was done by searching among the further acquaintances of the people involved in the study, so there is a risk that all the people interviewed come from a similar background. It would be necessary to conduct a study that also describes the reaction of people who are already in a more difficult life situation before the pandemic starts.

Moreover, it would also be worthwhile to pay attention to the interviewers themselves. All of the moderators were female, and although gender effects on the quality of the interviews and differences between the establishment of relationships between women and men were not observed during the debriefing process, the topic of gender effects on the results of qualitative research is frequently addressed in the literature [ 42 , 43 ]. Although the researchers approached the process with reflexivity and self-criticism at all stages, it would have seemed important to involve male moderators in the study to capture any differences in relationship dynamics.

Practical implications.

The study presented has many practical implications. Decision-makers in the state can analyze the COVID-19 pandemic crisis in a way that avoids a critical situation involving other infectious diseases in the future. The results of our study showing the most disruptive effects of the pandemic on people can serve as a basis for developing strategies to deal with the effects of the crisis so that it does not translate into a deterioration of the public’s mental health in the future.

The results of our study can also provide guidance on how to communicate information about restrictions in the future so that they are accepted and respected (for example by giving rational explanations of the reasons for introducing particular restrictions). In addition, the results of our study can also be a source of guidance on how to deal with the limitations that may arise in a recurrent COVID-19 pandemic, as well as other emergencies that could come.

The analysis of the results showed that the COVID-19 pandemic, and especially the lockdown periods, are a particular challenge for many people due to reduced social contact. On the other hand, it is social contacts that are at the same time a way of a smoother transition of crises. This knowledge should prompt decision-makers to devise ways to ensure pandemic safety without drastically limiting social contacts and to create solutions that give people a sense of control (instead of depriving it of). Providing such solutions can reduce the psychological problems associated with a pandemic and help people to cope better with it.

Conclusions

As more and more is said about the fact that the COVID-19 pandemic may not end soon and that we are likely to face more waves of this disease and related lockdowns, it is very important to understand how the different restrictions are perceived, what difficulties they cause and what are the biggest challenges resulting from them. For example, an important element of accepting the restrictions is understanding their sources, i.e., what they result from, what they are supposed to prevent, and what consequences they have for the fight against the pandemic. Moreover, we observed that the more incomprehensible the order was, the more it provoked to break it. This means that not only medical treatment is extremely important in an effective fight against a pandemic, but also appropriate communication.

The results of our study showed also that certain restrictions cause emotional deficits (e.g., loneliness, loss of sense of control) and, consequently, may cause serious problems with psychological functioning. From this perspective, it seems extremely important to understand which restrictions are causing emotional problems and how they can be dealt with in order to reduce the psychological discomfort associated with them.

Supporting information

S1 table. a full description of the changes occurring in poland at the time of the study..

https://doi.org/10.1371/journal.pone.0258133.s001

S2 Table. Characteristics of study participants.

https://doi.org/10.1371/journal.pone.0258133.s002

S1 Dataset. Transcriptions from the interviews.

https://doi.org/10.1371/journal.pone.0258133.s003

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• Volume 10, Issue 12
• Impact of the COVID-19 pandemic on mental health and well-being of communities: an exploratory qualitative study protocol
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• http://orcid.org/0000-0003-0180-0213 Anam Shahil Feroz 1 , 2 ,
• Naureen Akber Ali 3 ,
• Noshaba Akber Ali 1 ,
• Ridah Feroz 4 ,
• Salima Nazim Meghani 1 ,
• Sarah Saleem 1
• 1 Community Health Sciences , Aga Khan University , Karachi , Pakistan
• 2 Institute of Health Policy, Management and Evaluation , University of Toronto , Toronto , Ontario , Canada
• 3 School of Nursing and Midwifery , Aga Khan University , Karachi , Pakistan
• 4 Aga Khan University Institute for Educational Development , Karachi , Pakistan
• Correspondence to Ms Anam Shahil Feroz; anam.sahyl{at}gmail.com

Introduction The COVID-19 pandemic has certainly resulted in an increased level of anxiety and fear in communities in terms of disease management and infection spread. Due to fear and social stigma linked with COVID-19, many individuals in the community hide their disease and do not access healthcare facilities in a timely manner. In addition, with the widespread use of social media, rumours, myths and inaccurate information about the virus are spreading rapidly, leading to intensified irritability, fearfulness, insomnia, oppositional behaviours and somatic complaints. Considering the relevance of all these factors, we aim to explore the perceptions and attitudes of community members towards COVID-19 and its impact on their daily lives and mental well-being.

Methods and analysis This formative research will employ an exploratory qualitative research design using semistructured interviews and a purposive sampling approach. The data collection methods for this formative research will include indepth interviews with community members. The study will be conducted in the Karimabad Federal B Area and in the Garden (East and West) community settings in Karachi, Pakistan. The community members of these areas have been selected purposively for the interview. Study data will be analysed thematically using NVivo V.12 Plus software.

Ethics and dissemination Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-4825-10599). The results of the study will be disseminated to the scientific community and to the research subjects participating in the study. The findings will help us explore the perceptions and attitudes of different community members towards the COVID-19 pandemic and its impact on their daily lives and mental well-being.

• mental health
• public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2020-041641

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Strengths and limitations of this study

The mental health impact of the COVID-19 pandemic is likely to last much longer than the physical health impact, and this study is positioned well to explore the perceptions and attitudes of community members towards the pandemic and its impact on their daily lives and mental well-being.

This study will guide the development of context-specific innovative mental health programmes to support communities in the future.

One limitation is that to minimise the risk of infection all study respondents will be interviewed online over Zoom and hence the authors will not have the opportunity to build rapport with the respondents or obtain non-verbal cues during interviews.

The COVID-19 pandemic has affected almost 180 countries since it was first detected in Wuhan, China in December 2019. 1 2 The COVID-19 outbreak has been declared a public health emergency of international concern by the WHO. 3 The WHO estimates the global mortality to be about 3.4% 4 ; however, death rates vary between countries and across age groups. 5 In Pakistan, a total of 10 880 cases and 228 deaths due to COVID-19 infection have been reported to date. 6

The worldwide COVID-19 pandemic has not only incurred massive challenges to the global supply chains and healthcare systems but also has a detrimental effect on the overall health of individuals. 7 The pandemic has led to lockdowns and has created destructive impact on the societies at large. Most company employees, including daily wage workers, have been prohibited from going to their workplaces or have been asked to work from home, which has caused job-related insecurities and financial crises in the communities. 8 Educational institutions and training centres have also been closed, which resulted in children losing their routine of going to schools, studying and socialising with their peers. Delay in examinations is likewise a huge stressor for students. 8 Alongside this, parents have been struggling with creating a structured milieu for their children. 9 COVID-19 has hindered the normal routine life of every individual, be it children, teenagers, adults or the elderly. The crisis is engendering burden throughout populations and communities, particularly in developing countries such as Pakistan which face major challenges due to fragile healthcare systems and poor economic structures. 10

The COVID-19 pandemic has certainly resulted in an increased level of anxiety and fear in communities in terms of disease management and infection spread. 8 Further, the highly contagious nature of COVID-19 has also escalated confusion, fear and panic among community residents. Moreover, social distancing is often an unpleasant experience for community members and for patients as it adds to mental suffering, particularly in the local setting where get-togethers with friends and families are a major source of entertainment. 9 Recent studies also showed that individuals who are following social distancing rules experience loneliness, causing a substantial level of distress in the form of anxiety, stress, anger, misperception and post-traumatic stress symptoms. 8 11 Separation from family members, loss of autonomy, insecurity over disease status, inadequate supplies, inadequate information, financial loss, frustration, stigma and boredom are all major stressors that can create drastic impact on an individual’s life. 11 Due to fear and social stigma linked with COVID-19, many individuals in the community hide their disease and do not access healthcare facilities in a timely manner. 12 With the widespread use of social media, 13 rumours, myths and inaccurate information about COVID-19 are also spreading rapidly, not only among adults but are also carried on to children, leading to intensified irritability, fearfulness, insomnia, oppositional behaviours and somatic complaints. 9 The psychological symptoms associated with COVID-19 at the community level are also manifested as anxiety-driven panic buying, resulting in exhaustion of resources from the market. 14 Some level of panic also dwells in the community due to the unavailability of essential protective equipment, particularly masks and sanitisers. 15 Similarly, mental health issues, including depression, anxiety, panic attacks, psychotic symptoms and even suicide, were reported during the early severe acute respiratory syndrome outbreak. 16 17 COVID-19 is likely posing a similar risk throughout the world. 12

The fear of transmitting the disease or a family member falling ill is a probable mental function of human nature, but at some point the psychological fear of the disease generates more anxiety than the disease itself. Therefore, mental health problems are likely to increase among community residents during an epidemic situation. Considering the relevance of all these factors, we aim to explore the perceptions and attitudes towards COVID-19 among community residents and the impact of these perceptions and attitude on their daily lives and mental well-being.

Methods and analysis

Study design.

This study will employ an exploratory qualitative research design using semistructured interviews and a purposive sampling approach. The data collection methods for this formative research will include indepth interviews (IDIs) with community members. The IDIs aim to explore perceptions of community members towards COVID-19 and its impact on their mental well-being.

Study setting and study participants

The study will be conducted in two communities in Karachi City: Karimabad Federal B Area Block 3 Gulberg Town, and Garden East and Garden West. Karimabad is a neighbourhood in the Karachi Central District of Karachi, Pakistan, situated in the south of Gulberg Town bordering Liaquatabad, Gharibabad and Federal B Area. The population of this neighbourhood is predominantly Ismailis. People living here belong mostly to the middle class to the lower middle class. It is also known for its wholesale market of sports goods and stationery. Garden is an upmarket neighbourhood in the Karachi South District of Karachi, Pakistan, subdivided into two neighbourhoods: Garden East and Garden West. It is the residential area around the Karachi Zoological Gardens; hence, it is popularly known as the ‘Garden’ area. The population of Garden used to be primarily Ismailis and Goan Catholics but has seen an increasing number of Memons, Pashtuns and Baloch. These areas have been selected purposively because the few members of these communities are already known to one of the coinvestigators. The coinvestigator will serve as a gatekeeper for providing entrance to the community for the purpose of this study. Adult community members of different ages and both genders will be interviewed from both sites, as mentioned in table 1 . Interview participants will be selected following the eligibility criteria.

• View inline

Study participants for indepth interviews

IDIs with community members

We will conduct IDIs with community members to explore the perceptions and attitudes of community members towards COVID-19 and its effects on their daily lives and mental well-being. IDI participants will be identified via the community WhatsApp group, and will be invited for an interview via a WhatsApp message or email. Consent will be taken over email or WhatsApp before the interview begins, where they will agree that the interview can be audio-recorded and that written notes can be taken. The interviews will be conducted either in Urdu or in English language, and each interview will last around 40–50 min. Study participants will be assured that their information will remain confidential and that no identifying features will be mentioned on the transcript. The major themes will include a general discussion about participants’ knowledge and perceptions about the COVID-19 pandemic, perceptions on safety measures, and perceived challenges in the current situation and its impact on their mental well-being. We anticipate that 24–30 interviews will be conducted, but we will cease interviews once data saturation has been achieved. Data saturation is the point when no new themes emerge from the additional interviews. Data collection will occur concurrently with data analysis to determine data saturation point. The audio recordings will be transcribed by a transcriptionist within 24 hours of the interviews.

An interview guide for IDIs is shown in online supplemental annex 1 .

Supplemental material

Eligibility criteria.

The following are the criteria for inclusion and exclusion of study participants:

Inclusion criteria

Residents of Garden (East and West) and Karimabad Federal B Area of Karachi who have not contracted the disease.

Exclusion criteria

Those who refuse to participate in the study.

Those who have experienced COVID-19 and are undergoing treatment.

Those who are suspected for COVID-19 and have been isolated/quarantined.

Family members of COVID-19-positive cases.

Data collection procedure

A semistructured interview guide has been developed for community members. The initial questions on the guide will help to explore participants’ perceptions and attitudes towards COVID-19. Additional questions on the guide will assess the impact of these perceptions and attitude on the daily lives and mental health and well-being of community residents. All semistructured interviews will be conducted online via Zoom or WhatsApp. Interviews will be scheduled at the participant’s convenient day and time. Interviews are anticipated to begin on 1 December 2020.

Patient and public involvement

No patients were involved.

Data analysis

We will transcribe and translate collected data into English language by listening to the audio recordings in order to conduct a thematic analysis. NVivo V.12 Plus software will be used to import, organise and explore data for analysis. Two independent researchers will read the transcripts at various times to develop familiarity and clarification with the data. We will employ an iterative process which will help us to label data and generate new categories to identify emergent themes. The recorded text will be divided into shortened units and labelled as a ‘code’ without losing the main essence of the research study. Subsequently, codes will be analysed and merged into comparable categories. Lastly, the same categories will be grouped into subthemes and final themes. To ensure inter-rater reliability, two independent investigators will perform the coding, category creation and thematic analyses. Discrepancies between the two investigators will be resolved through consensus meetings to reduce researcher bias.

Ethics and dissemination

Study participants will be asked to provide informed, written consent prior to participation in the study. The informed consent form can be submitted by the participant via WhatsApp or email. Participants who are unable to write their names will be asked to provide a thumbprint to symbolise their consent to participate. Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-4825-10599). The study results will be disseminated to the scientific community and to the research subjects participating in the study. The findings will help us explore the perceptions and attitudes of different community members towards the COVID-19 pandemic and its impact on their daily lives and mental well-being.

The findings of this study will help us to explore the perceptions and attitudes towards the COVID-19 pandemic and its impact on the daily lives and mental well-being of individuals in the community. Besides, an indepth understanding of the needs of the community will be identified, which will help us develop context-specific innovative mental health programmes to support communities in the future. The study will provide insights into how communities are managing their lives under such a difficult situation.

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• Harding LE , et al
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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

ASF and NAA are joint first authors.

Contributors ASF and NAA conceived the study. ASF, NAA, RF, NA, SNM and SS contributed to the development of the study design and final protocols for sample selection and interviews. ASF and NAA contributed to writing the manuscript. All authors reviewed and approved the final version of the paper.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Research article
• Open access
• Published: 07 April 2021

Learning about COVID-19: a qualitative interview study of Australians’ use of information sources

• Deborah Lupton 1 &
• Sophie Lewis 2  

BMC Public Health volume  21 , Article number:  662 ( 2021 ) Cite this article

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A multitude of information sources are available to publics when novel infectious diseases first emerge. In this paper, we adopt a qualitative approach to investigate how Australians learnt about the novel coronavirus and COVID-19 and what sources of information they had found most useful and valuable during the early months of the pandemic.

In-depth semi-structured telephone interviews were conducted with a diverse group of 40 Australian adults in mid-2020 about their experiences of the COVID-19 crisis. Participants were recruited through Facebook advertising. Detailed case studies were created for each participant, providing the basis of a thematic analysis which focused on the participants’ responses to the questions about COVID-19-related information sources.

Diverse sources of COVID-19-related information, including traditional media, online media and in-person interactions, were actively accessed, appraised and engaged with by participants. There was a high level of interest in COVID-19 information as people grappled with uncertainty, anxiety and feeling overwhelmed. Certain key events or experiences made people become aware that the outbreak was threatening Australia and potentially themselves. Most people demonstrated keen awareness that misinformation was rife in news outlets and social media sites and that they were taking steps to determine the accuracy of information. High trust was placed in health experts, scientists and government sources to provide reliable information. Also important to participants were informal discussions with friends and family members who were experts or working in relevant fields, as well as engaging in-person in interactions and hearing from friends and family who lived overseas about what COVID-19 conditions were like there.

A constantly changing news environment raises challenges for effective communication of risk and containment advice. People can become confused, distressed and overwhelmed by the plethora of information sources and fast-changing news environment. On the other hand, seeking out information can provide reassurance and comfort in response to anxiety and uncertainty. Clarity and consistency in risk messaging is important, as is responding quickly to changes in information and misinformation. Further research should seek to identify any changes in use of and trust in information sources as time goes by.

Peer Review reports

News and social media can play an important role in providing information to publics in cases of new or emerging diseases. It is vital to reach people quickly and share details in a situation in which medical and public health authorities are grappling with how the disease spreads and can best be controlled [ 1 , 2 , 3 , 4 , 5 ]. Major infectious disease outbreaks are highly newsworthy, typically attracting dramatic statements concerning risk [ 6 , 7 , 8 ]. News media coverage is often a starting point at which people start to reflect on the seriousness of pandemic risk and its implications for their own lives [ 2 , 9 ]. However, news reports can also become hyperbolic or convey misinformation, leading to scepticism and lack of trust in official sources, unfounded complacency or alternatively, generating heightened feelings of fear, uncertainty, depression and anxiety [ 2 , 10 , 11 ].

The COVID-19 outbreak began to receive public attention in early January 2020, following reports by Wuhan health officials of a cluster of viral pneumonia cases of unknown cause affecting people in that large Chinese city in Hubei province [ 12 ]. The news and public health communication environment responding to the COVID-19 crisis has been fraught, frequently characterised by conflicting or rapidly changing information as health authorities and governments struggled to make sense of this new outbreak and identify the best way to control its spread [ 13 , 14 , 15 ]. COVID-19 news reporters and creators and sharers of social media content have been subjected to continual criticism for disseminating misleading or false information. The term ‘infodemic’ has been used in some popular media outlets and academic analyses to describe the wealth of ‘fake news’ and conspiracy theories circulating, particularly in online news sites and social media platforms [ 16 , 17 , 18 , 19 , 20 ].

Analyses of how news reporting and social media content have framed COVID-19 issues across different countries have identified marked variances. Ageism in social media content has been identified, with older people positioned as both more vulnerable and more expendable than other age groups [ 21 ]. Racism has also featured in some countries’ news reporting, particularly against Chinese people, who have been frequently positioned as to blame for the emergence of the novel coronavirus in Wuhan [ 22 ]. Politicisation and polarisation of opinion has characterised COVID-19 news in US television networks and newspapers [ 23 ], whereas strong support for government measures was evident in South Korean newspaper reporting [ 24 ]. A focus on prevention and control measures, medical treatment and research, and global or local socioeconomic influences was identified in an analysis of Chinese news articles [ 25 ].

Information provided in news coverage of COVID-19 in Australia has included reporting of the first cases and deaths and the subsequent rapid spread of the novel coronavirus around the world, accounts of statements, decisions and press conferences held by political leaders and health authorities, strategies to avoid infection, medical controversies and debates and progress towards treatments for COVID-19 and vaccines [ 5 , 26 , 27 ]. In Australia, very early news reporting (January 2020) focused on the ‘mystery Chinese virus’ and made continual comparisons to SARS [ 26 ]. A study of two major Australian newspapers’ COVID-19 coverage found that they were quite slow to begin covering the emerging outbreak, suggesting an initial lack of awareness that it might pose a threat to Australians. Subsequent news reporting largely focused on the social and economic impacts of the crisis. There was little blame or judgement directed at any social or national groups, although panic buyers did receive some criticism [ 27 ].

Quantitative surveys to determine how publics were responding to coverage of the COVID-19 crisis in news and social media have identified an association between COVID-19-related news and social media consumption and heightened anxiety and distress in Russia [ 28 ], China [ 29 , 30 ] and USA [ 31 ]. Malaysian research found that respondents mainly used television and internet news portals to access COVID-19 information. Those who preferred government sources of information were more confident about the control of COVID-19 and believed their government was handling the crisis well [ 32 ]. Research in the UK found that people’s news consumption surged in the early months of the crisis but gradually returned to pre-crisis levels, with evidence of a growing avoidance of news. A decline in respondents’ trust in key sources of COVID-19-related news and information was also noted: particularly in relation to social media sites and government sources [ 33 ].

A comparative international online survey included nationally representative samples from Australia, New Zealand, UK, USA, Italy and South Korea [ 34 ]. For respondents in most of these countries, government and friends and family were the most trusted sources of COVID-19 information, ranked above the news media and social media. Together with New Zealanders (89%), Australians evidenced the highest levels of trust in their government (78%) to give clear and accurate advice on COVID-19. While 58% of Australians said they trusted the news media in general for COVID-19 advice, only 30% trusted information found or shared on social media more specifically.

Another online survey conducted early in the Australian nation-wide lockdown (April 2020) [ 35 ] found that Australians were consuming news media more than usual due to their interest in and concern about the pandemic. More than two-thirds said that they had been accessing news more than once a day since the outbreak. Half of the respondents were using television reporting as their main COVD news source, while 22% were accessing online news coverage and 18% news on social media. The respondents reported high levels of satisfaction with news coverage of COVID-19 (73%), but it was contributing to people’s feelings of anxiety, particularly for women and younger people. Most respondents said that they trusted health experts and scientists (85%) and to a lesser degree, government (66%) to provide information about COVID-19. Just over half said that they trusted news organisations but less than a quarter of respondents reported that they had encountered high levels of misinformation in the news or social media about COVID-19. Australians agreed that the federal government had done a good job of informing them about the pandemic (75%) and how they should respond (81%).

The surveys reviewed above are valuable in identifying trends across large populations in attitudes and practices related to COVID-19 information sources. To complement and extend such findings, qualitative social research methods provide a way of investigating people’s engagements with personal sources of information about emerging health risks such as family members and healthcare providers as well as with government sources and news and social media reporting in greater depth. This approach provides for explorations of lived experiences in sociocultural contexts [ 1 , 2 , 11 , 36 ]. Thus far, few qualitative analyses of Australians’ responses to news and social media coverage of COVID-19 have been published. Among other issues, the ‘Australians’ Experiences of COVID-19′ study investigated people’s use and appraisal of information about COVID-19. We wanted to surface the full range of information sources upon which participants relied and those they most trusted: including but beyond media or government sources.

The study took place during the first 6 months of the COVID-19 crisis in Australia, following the identification of the first Australian COVID-19 cases on 25 January 2020 and the implementation of a nation-wide lockdown from mid-March 2020 [ 37 ]. Forty indepth, semi-structured interviews with adults living in Australia were conducted by the second author between late May and late July 2020. In addition to the closing of international borders and some national state borders, the national lockdown included directives for people to work at home where possible, limits on household visitors, bans on public gatherings, the closing of non-essential services and schools, and physical distancing rules. The spread of COVID-19 began to be slowed by April 2020. Restrictions were progressively eased from mid-May 2020 onwards but fluctuated in response to the incidence of COVID-19 community case numbers. Restrictions were re-introduced in the state of Victoria from July until November 2020, following a significant second wave of infection in that state [ 37 ].

Due to physical distancing restrictions, the interviews for this study were conducted by telephone. This method also ensured that people living across the nation, including in regional and remote areas, had the opportunity to participate in the study. Interested potential participants responded to an advertisement about the study on Facebook. Participants were offered a gift card to compensate them for their time. Sub-quotas were set and achieved in recruitment to ensure a heterogeneous interviewee group with a spread of participants across gender, age group, and place of residence (metropolitan, regional and rural/remote areas). Facebook was chosen to advertise for recruitment because of its popularity among Australian adults. At the time this study was carried out, figures on Australian Facebook use show that 60% of all Australians (of any age) were regular Facebook users, with 50% of the Australian population logging on at least once a day [ 38 ]. Using this method of recruitment therefore proved to be fast and effective, and we easily met our sub-quotas. Table  1 shows the sociodemographic characteristics of the participants.

The study adopted a qualitative approach that was focused on a wide-ranging interview about the participants’ experiences of the novel coronavirus/COVID-19 during the 6 month period following identification of the first Australian cases. All interviews were audio-recorded and professionally transcribed in full. A narrative case study approach was adopted in compiling and analysing the interview materials. This approach sees the indepth interview as a form of shared storytelling, in which participants recount narratives in response to interview questions and researchers formulate their accounts into narratives [ 39 , 40 ]. The second author wrote fieldnotes for each participant soon after she conducted each interview. These fieldnotes were presented in narrative form, drawing on the author’s impressions and recollections of how the participants responded to the questions. Once each interview was transcribed by a professional service and returned to the authors, both authors then used the transcripts to augment these notes, inserting illustrative direct quotations from them to configure a detailed narrative case study for each interviewee. These case studies, together with the full transcripts, comprise our research materials for analysis.

Some of our findings are reported thematically across the case studies, while in other analyses we present case studies to provide a detailed biographical narrative. For the purposes of the present paper, the set of detailed case studies formed the basis of a topical thematic analysis which focused on the participants’ responses to the questions about sources of information about COVID-19. These themes were derived as an iterative analytical process involving both authors working with the research materials of case studies we had developed together with the interview transcripts. This approach to social inquiry is directed at identifying ‘making the mundane, taken-for-granted, everyday world visible’ through interpretative and narrative practices ( [ 41 ] , p. 723). As Denzin ( [ 41 ] , p. 722) puts it, human experience (and by extension, social inquiry) ‘is a process. It is messy, open-ended, inconclusive, tangled up’. Hence our focus on interpretation and narrative as modes of analysis: the interviewees interpreted our questions in formulating their responses, and we in turn interpreted their responses in configuring the case studies, identifying themes across the cases and presenting our findings.

The first question in the interview prompted participants to think back to how and when they had first heard about COVID-19 and to provide narratives of how they felt about it at that time. This question was followed up by asking participants ‘Since that first time of hearing about the coronavirus/COVID-19, what has been the most helpful or useful sources of information for you to learn about the virus?’ and ‘What has made these sources so helpful or useful for you?’. It is on their responses to these three opening questions that we focus in this article.

Initial reactions to COVID-19-related information

Given that initial news reports in Australian outlets focused on China and SARS [ 26 ], it is not surprising that most participants had first heard about the new infectious disease outbreak through news media sources reporting on the ‘mystery SARS-like’ cluster of cases in China. The location of the outbreak in first news reports and the comparison with SARS in this early news coverage led people to think that it was a faraway problem that would not directly affect them. Several people drew on their memories of previous outbreaks of novel infectious diseases such as SARS, MERS and Ebola in their responses. For example, Michael (aged 56) initially heard about the virus in Wuhan through television news reporting. He recalls hearing about coronavirus as it was being compared with SARS. He remembered that the SARS epidemic had not affected Australia, so did not think COVID-19 would either.

SARS seemed to affect other countries around the world but not Australia. So, I didn’t think that it would be as severe as what it ended up, so widespread across the world. So no, I didn’t really worry at the time.

Greg (aged 69) was even less concerned about the threat of COVID-19 at first, as his initial exposure to news about the coronavirus was via jokes that circulated on Facebook. He remembered that Facebook friends at first tended to make light of the threat of the outbreak: ‘I wasn’t too sure what to make of it, and enjoyed a couple of jokes when people said “I’m having a corona attack!” and put a photo of a [Corona brand] beer up on Facebook’. It was when Greg heard projections of the number of people that might be hospitalised with the virus in Australia on television news reporting in early March that he began to realise that it was a serious problem. The initial joking on Facebook was countered by the dramatic television news reports of the growing threat posed by COVID-19 to Australians.

I had listened to all the news broadcasts: listened with some trepidation to the forecasts of 'the hospitals are going to need thousands of beds', and concerned about that … By early March, I started to pay attention.

The initial sheer volume of news reporting and other public messaging about the spread of the coronavirus and measures needed to contain it could be overwhelming for some people. Because of the novel nature of the COVID-19 pandemic and the fast-changing news about it and its potential impacts on Australia, it was common for the participants to observe that they found themselves not being able to look away from news reporting about the crisis once the serious nature and rapid spread of the pandemic worldwide began to be reported in Australian news outlets. Participants commented on the importance of judicious consumption of news and information about the virus to avoid becoming overly obsessed and anxious after realising the risks to Australians of COVID-19. Several participants commented that they began to feel that there was saturation of ‘bad news’ and fear-inducing announcements from government officials in press conferences and health communication campaigns.

Some participants noted the tendency for sensationalism in news reporting and social media activity and the deleterious effects on their feelings of wellbeing. They often talked about ‘switching off’ from or limiting their exposure to news about the virus as time went on as a way of managing their distress and supporting their mental wellbeing. As Joe (aged 41) commented:

when I have looked at the international news and looking at what’s happening in America and that sort of stuff, it gets me really worked up and I get very upset about it. I find that quite challenging, and at the same time, I find it very difficult not to look. So, I found it really hard, particularly in the early days, in terms of just not constantly having the news on and constantly hearing about what was going on. It’s only probably been in the last two weeks that I’ve managed to sort of cut that down to maybe two or three times a week, whereas it was two or three times a day. It was just, I had to know what was going on all the time.

Several others reported difficulty in keeping up with all the new information being issued from these sources: some of which could be contradictory. For example, Emma (aged 29) described the government-provided information in press conferences or public health campaigns concerning restrictions as often ‘confusing’. She noted that some of the restrictions imposed by the government were ‘arbitrary’ or hard to make sense of. Emma gave the example of the number of people allowed at a wedding or a funeral, a rule which she remembered was constantly changed during the early months of the pandemic: ‘It’s, like, bizarre and kind of hard to understand’.

Blame, misinformation and conspiracy theories

Many participants were highly aware of the potential for news reporting or social media content to be misleading or inaccurate: problems which themselves have received attention from the news media itself as well as public health authorities in Australia [ 5 , 15 ]. Some people expressed feelings such as frustration, distress or anger around the kinds of information (conspiracies, misinformation, concerns about bias or fake news) circulating social media platforms. One example is Sarah (aged 54), whose husband is an essential worker in health services. She was concerned that the misinformation about COVID-19 in the news media and social media could reinforce or sanction careless or negligent behaviours that would place her husband and other frontline healthcare workers at increased risk of infection. She knew from her husband’s first-hand experience that the threat of COVID-19 was not exaggerated.

My husband was dealing with those patients who are highly contagious, and he was told not to wear full protection and that was frightening. So when people were saying ‘It’s a hoax, don’t worry about it,’ I’m like, ‘Well, you’re putting my husband’s life in danger’. So it was really distressing.

Other participants demonstrated a high level of scepticism towards the accuracy of information they encountered in the news media. They said that they were careful to try to evaluate the level of risk as it was reported in news outlets, given the news media’s tendency towards hyperbole to attract viewers. As James (aged 26) commented:

[The media] are going to catastrophise everything and anything, all the information. So, whatever I’m reading, I’ve got to make sure that I don’t just believe it straight away and look into it a bit more and ask some more questions, rather than just saying, yep, okay, I believe that.

For Greg (aged 69), the main source of information to learn about the novel coronavirus and COVID-19 has been television news reporting. He talked about the importance of ‘reading between the lines’ and being mindful of the polarisation and ‘bias of the media’ in reporting about the coronavirus. Greg was also concerned about some of the conspiracy theories that were circulating initially, and that the outbreak was not being taken seriously by a section of the community. He was even more vigilant in appraising the validity of news and commentary on Facebook: his second main source of information.

I must admit I’ve become quite careful about reading conspiracy-type theories on Facebook. Yeah, it’s a platform for everyone to have their say, but I’ve discovered that in my own opinion, some theories are quite farfetched. People can be sincerely wrong.

Joe (aged 41) said he is surprised by how many people he knows have ‘bought into’ the conspiracy theories, including his own elderly mother. He perceives these theories as expressed by people who need someone to blame. Joe said that he does his best to counter these claims where he has seen them expressed: which includes in face-to-face interactions or telephone conversations with close family members as well as in social media outlets such as Facebook.

There has been some discussion that I’ve had with family that has been just ridiculous. My mother, who’s a bit older and just, I don’t know, a bit susceptible to bad information, says all sorts of conspiracy-type things to me, which I’ve just told her is ridiculous. At one point, I think she was saying that China’s done this deliberately, and this was to break the world economy. I mean, the worst one I’ve seen and heard of, which was from an associate on Facebook, was the 5G theory, which – I just think – I don’t know … it seems to – a lot of people were buying into that, which surprised me. I think they were desperate to have a cause of something they could point at.

Most trustworthy information sources

Given their caution about news reporting and social media content, many participants talked about being judicious around what sources of information they used to learn about the COVID-19 crisis. They placed an emphasis on trusted, unbiased, reliable sources of information that they assumed were founded on expert medical and scientific advice and research, or on personal experience of the pandemic.

Natalia (aged 67) was born overseas and keeps in close contact with friends and family there: including viewing content about COVID-19 they have shared on Facebook. She said that she is careful to check that any news items she sees her friends or family members sharing comes from ‘a well-known news source’ such as the ABC (Australian Broadcasting Corporation) or the Washington Post (USA) news outlet or quoting a scientific study: ‘I try to do that, because well, I know how fake news creates fear or hopes for nothing’. Ruth (aged 70) also referred to the ABC as well as the BBC (British Broadcasting Corporation) as trustworthy, noting that she uses her smartphone to access their news reporting.

I just keep reading on my phone and some articles I discount because I think they’re crap, and other articles I think, well, yeah, this seems to make sense … I take the ABC and the BBC as being okay.

For most participants, government sources such as the federal government health minister and state premiers and health authorities such as Chief Medical Officers were also viewed as credible. Greg (aged 69) said that he finds information from these sources to be the most helpful, mainly because he believes that ultimately, they have the country’s and its citizens’ best interests at heart. He positioned himself and other Australians as responsible for following government advice for the collective good of the community and as a way of demonstrating good citizenship.

Well that was pretty much the bottom line for me. That, okay, if the government says you’ve got to socially isolate, well that’s what I’ll do. I’ll take precautions, I’ll wear a mask, I’ll wear gloves when I go shopping. I did all of that in the early stages.

Max (aged 52) spoke about the value he placed on the federal government response communicated in regular news conferences that were closely covered by the news media. He liked keeping up to date with reporting of these news conferences because he thought that they provided the most current and local information about the pandemic and the current restrictions in a situation in which these details could change from day to day. Max found it reassuring and informative that these news conferences and announcements were predictable and appreciated being able to readily access these details using digital news outlets.

Even though those news conferences became a bit tedious and repetitive, it was good to know that they were regular conferences … and that you knew that a couple of times a day we were being updated as to what’s going on.

High value and trust were also placed on the information provided by people known personally to the participants who were considered to have expert knowledge or personal experience of the pandemic. Such sources included friends or family members who work in healthcare, government or science domains. They were viewed as unbiased and therefore more credible than some of the news media reporting. For example, Ruth (age 70) said that she trusts both her doctor and her brother, who is a scientist, to give her authoritative and fact-based advice about COVID-19.

I actually discussed it with my doctor, probably three or four weeks ago, because I see him frequently … He said in our particular district there hasn’t been any coronavirus cases for three or four weeks and he thought it was quite safe. So, I talked to him about it … I talk to my brother about it – he’s a scientist. I think it’s factual information and people with scientific backgrounds that provide the information.

Sarah (aged 54) noted that with her husband working in a hospital, their family had received a proliferation of COVID-19-related information from his workplace even before the national lockdown took place. She knew from her husband’s work experiences that hospitals were engaged in rushed preparations for a predicted surge of patients needing care for COVID-19: ‘Yeah that was the word of mouth we were getting. So that was, yeah, it was good in some respects and terrifying in others’.

Participants who had family members or friends living overseas also often nominated these people as important sources of details about what life was like in countries such as the USA, UK, Spain and Italy where the COVID-19 crisis was much further advanced than in Australia. Riley (aged 29), who was born in the USA and still has family and friends living there, observed that: ‘certainly once it hit New York, then I was getting inundated with messages from my parents, because it was affecting them very directly obviously’.

A small number of participants mentioned faith-based communities or teachings as contributing to their sense-making around COVID-19. For Greg (aged 69), it was his fundamentalist Christian teachings that contributed to his growing awareness that the COVID-19 outbreak in China could be serious globally, resulting in the ‘end times’ he believes is forecast in the Bible. For Riley (aged 29), the personal risk of infection was really brought home by new measures introduced into the synagogue that Riley regularly attends.

I was involved in a lot of stuff in the synagogue and about early to mid-March, early March, they were starting to say we can’t shake hands anymore and we can’t come close to each other anymore. When they started talking about that in the synagogue, I was starting to really pay attention, I was like ‘They’re telling me this for a reason!’. I started to take it a bit more seriously, so I’m glad that the people in my religious community were taking it seriously before I started to.

Bringing sources together

As is evident from the participants’ accounts outlined above, many used a range of information sources about COVID-19. The relative influence of these sources in some cases changed as the pandemic gathered momentum or as key details about COVID-19 changed over the first 6 months when medical and public health experts were still learning about the ways the novel coronavirus spread, the effects of COVID-19 and how best to contain the pandemic and governments and health officials were struggling to find the most effective and least harmful policy settings.

Several people explained the complex processes by which they appraised and made sense of COVID-19 information through a range of sources. For example, Georgia (aged 24) commented that she likes the immediacy of sources of information like Twitter and television news reports but considers them not always trustworthy or reliable. Typically, she will supplement this information through her own online research using government websites and through word of mouth from friends who live overseas and have been more seriously affected or exposed to the COVID-19 crisis. Georgia explained that the government-sourced information is the most helpful for her because it is ‘verifiable’. She knows that the government draws on health expertise in formulating its COVID-19 advice and policy. In particular, she finds localised information most useful: for instance when and where it is safe to go outside in her local area, and what actions she should be taking to reduce her own risk of COVID-19 as well as risks to others. It is less important for her to learn about the ‘bigger picture’ of the pandemic. These practices also help Georgia deal with the plethora of information available about COVID-19: ‘Anything where the information is bite sized and verifiable, I appreciate, so I guess in that sense, Twitter is good as long as I then go fact check’.

Emma (aged 29) also receives a lot of news through Twitter, preferring to read a range of different sources on that platform so that she is then able to formulate her own views about the issue. She also recounted hearing in the news and social media about people’s real-life experiences of becoming ill with COVID-19 and how that was particularly powerful for her. Emma described herself as already living with anxiety pre-COVID-19. She noted that accessing more information and gaining knowledge about COVID-19 made her feel less worried: in part, because it gave her the knowledge to take precautions to avoid contracting the novel coronavirus. Emma was also keen to be aware of what the government was doing to handle the crisis, including how she as an individual could help the collective response.

Personally, I find it really helpful to have as much information as possible on things. I think that helps me relax a bit more. I know certain people, it’s the opposite, where the more you know about something, reading about something a lot, will make you more agitated. But it was the opposite for me – where I was like, I would like to know as much as possible about this so I can avoid it and knowing what the governments are doing and knowing what you can do personally to help and so on and so forth.

Another example of bringing different information sources together is provided by Darren (aged 64). He said that he has relied on government-related information in finding out and learning more about the coronavirus and COVID-19. He accesses this information via online government health websites. Darren commented that he finds this kind of information more truthful than the news media ‘spin’ that is imposed on government-based information.

I saw the media reports where health ministers and health advisors were giving information out, but to be quite honest I didn’t pay too much attention to it, because attached to all that was the media spin afterwards. So I left it alone to a great extent and just relied on the government website and blogs that were from medical personnel.

Darren noted that he is cautious about the circulation of ‘false information’ and ‘fake news’ on social media. However, he is willing to use social media to access websites and ‘serious’ bloggers which he accesses as more truthful and trustworthy: ‘They are either scientific or they are reliable blogs, if you know what I mean. They are ones that I have read for many, many years’.

The description of his evaluation of COVID-19 information sources provided by Mark (aged 48) highlights the importance of the advice offered both by international bodies that can provide general advice and local sources of information, as well as demonstrating that social media sites can be vital platforms for disseminating these details. Mark said that he has ‘never trusted the media for reporting anything’. He preferred the World Health Organization’s (WHO) regular media briefings hosted on social media outlets as his chief source of information about the novel coronavirus and COVID-19. Mark said that he used Australian government sources of information as a secondary source to the WHO, to provide more localised information and advice: for instance about guidelines and directives for daily living and how to prevent against contracting or spreading the coronavirus.

Similar to previous qualitative research on publics’ responses to information sources about new disease outbreaks [ 1 , 2 , 11 , 36 ], our findings show that participants were active users of information sources rather than passively accepting news accounts, government spokespeople or social media content as authoritative. The participants demonstrated awareness that misinformation was rife in news outlets – and especially social media sites – and that they were taking steps to determine the accuracy of information. Their accounts also highlight the interactions of different forms of information sources, and the sophistication with which participants engage with these different kinds of information. Diverse sources of COVID-19-related information, both international and local, were actively accessed, appraised and engaged with by participants.

As was found in survey findings in Australia [ 35 ] and other countries [ 32 ], traditional media (television and radio news reports) were important sources for participants, as were government sources such as press conferences, health campaigns and websites [ 34 , 35 ] and friends and family [ 34 ]. Despite contentions that Australian publics have lost confidence in the advice of public health authorities and governments due to conflicting and rapidly changing information provided [ 13 ], our participants demonstrated willingness to trust these sources for information and advice about how to respond to the crisis. Indeed, other research conducted around the same time as our study showed that Australians’ trust in government had increased dramatically since the outbreak of COVID-19: largely because they assess government interventions to manage COVID-19 as appropriate and effective [ 42 ]. Regular press conferences with government and health officials were important in gaining people’s trust and reassuring them that the federal and state governments were working hard to control the crisis. People wanted both very localised information that was directly relevant to them and general information from trusted global health organisations such as the WHO.

Healthcare professionals personally known to people, such as their regular general practitioner, were also trusted sources of information. Illustrative of the importance placed on experiential knowledge, the participants referred to the value of having informal discussions with friends and family members who were experts or working in relevant fields, such as healthcare or science, as well as engaging in-person in interactions with groups such as faith-based communities and simply hearing from friends and family who lived overseas about what COVID-19 conditions were like there.

Our findings support and extend other research that has highlighted the affective dimensions of engaging with information sources in relation to major health crisis such as outbreaks of new infectious diseases [ 2 , 9 , 10 , 11 ]. Similar to survey-based research in Australia [ 35 ] and internationally [ 28 , 29 , 30 , 31 , 33 ], our study’s participants reported a high interest in COVID-19 news reports in the initial stages of the pandemic. Some people described feelings of anxiety or distress in response to the plethora of information continually published in news reports and on social media. Others were angry and frustrated about the extent of misinformation that was circulating in the community and online and the potential for it to contribute to the spread of the coronavirus and pose a risk to others. However for many people, keeping up to date with changes in information and news in the rapidly changing environment of the COVID-19 crisis was a form of reassurance and helpful in ensuring they were conforming to best-practice risk avoidance and management.

The findings also show how certain key events or experiences made people become aware that the outbreak was threatening Australia and potentially themselves. For some people, this was hearing in the news media about the growing number of cases in their region, drastic government interventions imposed to contain the spread or the identification of infected people in their immediate locale. For others, it was face-to-face encounters or telephone conversations with trusted people or viewing content from friends and family members overseas on social media about how they were experiencing the pandemic in their countries that really brought home the dire threats posed by COVID-19 and what could happen to Australia if the outbreak were not contained.

A limitation of our study is that it did not involve a representative sample of Australian adults and therefore the findings are not generalisable to the population as a whole. However, a diverse group of participants was included, and the findings support and provide further detail about the trends identified in large-scale surveys of Australians’ news consumption and trust in information sources during the initial months of the COVID-19 crisis [ 34 , 35 ].

Conclusions

Our findings provide further contextual insights into the complexities and social contexts of these practices and sense-making responses, including how people bring together information from different sources in understanding the threat of COVID-19 and the interactions of digital with non-digital sources. A constantly changing news environment, as was the case during the first 6 months of the COVID-19 crisis, raises challenges for effective communication of risk and containment advice. People can become confused, distressed and overwhelmed by the plethora of information sources and fast-changing news environment. On the other hand, seeking out information can provide reassurance and comfort in response to anxiety and uncertainty. Clarity and consistency in risk messaging is important, as is responding quickly to changes in information and misinformation.

Our interview study took place at a certain point in the Australian experience of the COVID-19 crisis (towards the end of the national lockdown). Given the rapidly changing nature of the spread of COVID-19 in Australia since then, including a major outbreak in the state of Victoria and an extended second lockdown in that state, continuing and follow-up research is recommended to better understand how Australians have made sense of and protected themselves against the COVID-19 crisis and which sources have been most helpful for them in doing so.

Availability of data and materials

No data or materials are publicly available as the participants did not consent to open sharing of their interview transcripts or other personal information. Anonymised interview transcripts may be made available from the corresponding author on reasonable request.

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Acknowledgements

We thank the participants for giving their time to be interviewed for this study.

The study was funded by personal research support awarded to DL by UNSW Sydney as part of her SHARP Professorship.

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DL conceived the project, conducted the literature review, contributed to the analysis, interpretation and discussion of the research materials and wrote the manuscript. SL conducted the interviews, wrote the case studies, contributed to the analysis, interpretation and discussion of the materials and reviewed and commented on the manuscript draft. Both authors read and approved the final manuscript.

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Lupton, D., Lewis, S. Learning about COVID-19: a qualitative interview study of Australians’ use of information sources. BMC Public Health 21 , 662 (2021). https://doi.org/10.1186/s12889-021-10743-7

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A mixed-method study on adolescents’ well-being during the COVID-19 syndemic emergency

• Alessandro Pepe 1 , 2 &
• Eleonora Farina 1 , 2  

Scientific Reports volume  13 , Article number:  871 ( 2023 ) Cite this article

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In this study, we set out to investigate adolescents’ levels of perceived well-being and to map how they went about caring for their well-being during the COVID-19 syndemic. Participants were 229 Italian adolescent high school students (48.9% males, mean age = 16.64). The research design was based on an exploratory, parallel, mixed-method approach. A multi-method, student-centered, computer-assisted, semi-structured online interview was used as the data gathering tool, including both a standardized quantitative questionnaire on perceived well-being and an open-ended question about how adolescents were taking charge of their well-being during the COVID-19 health emergency. Main findings reveal general low levels of perceived well-being during the syndemic, especially in girls and in older adolescents. Higher levels of well-being are associated with more affiliative strategies (we-ness/togetherness) whereas low levels of well-being are linked with more individualistic strategies (I-ness/separatedness) in facing the health emergency. These findings identify access to social support as a strategy for coping with situational stress and raise reflection on the importance of balancing the need for physical distancing to protect from infection, and the need for social closeness to maintain good mental health.

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Introduction.

Officially declared a pandemic on 11 March 2020, the COVID-19 outbreak has resulted so far in over 550million cases and 6.3million deaths worldwide 1 . Although it appeared at the start of the pandemic that all populations around the world would be affected to the same extent, we now know that this is not the case. Indeed, while multiple sources initially claimed that "we were all in the same boat," two years after the onset of the pandemic, we are now in a position to state that "We are all on the same sea, but the boats from which we are dealing with the effects of COVID-19 are very different." Not only have the more strictly medical aspects differentially affected different populations (with the outcome of exacerbating inequalities), but the measures implemented by various governments for reducing the spread of the disease (e.g., lockdowns, restrictions on movement, school closures, and the adoption of distance education) have differentially affected different segments of the population in each country 2 .

Covid-19 from a syndemic perspective

Variability in the evidence reported in the literature regarding the effects of the COVID-19 pandemic on different populations of interest and in different contexts may be explained by drawing on the concept of syndemic 3 . A syndemic is a situation in which two or more health conditions co-occur in environments of aggravated adversity and interact synergistically to yield worse health outcomes than each affliction would likely generate on its own 4 . Limiting the harms caused by COVID-19 will require paying far greater attention to so-called noncommunicable diseases (NCDs) and socioeconomic inequality than has been done up to now. Although NCDs have conventionally been analyzed in relation to the risk factors for cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes, scholars have recently emphasized 5 that cardiovascular diseases, diabetes, cancer, and respiratory diseases frequently co-occur with both common mental disorders (such as depression and anxiety) and severe mental illnesses (such as schizophrenia and bipolar disorder). A syndemic is more than the outcome of a pandemic in terms of comorbidities; rather, it is an intertwining of biological and social conditions that increases an individual's susceptibility to harm or worsens their health outcomes. The most important implication of viewing the COVID-19 outbreak as a syndemic is that this helps to focus on its social origins. The vulnerability of younger and older citizens, ethnic minority communities, and key workers, who are frequently underpaid and enjoy less social welfare protection, points to an unacknowledged truth: no matter how effective a treatment or protective a vaccine, any exclusively biomedical solution for COVID-19 will fail.

Impact of syndemic on adolescents’ well-being and mental health

The international scientific literature presents extensive research on the effects of the syndemic on individual well-being in different age groups and based on different methods of inquiry 6 . Adolescents, although at lower risk of death or severe illness due to COVID-19 than the adult population, are still having to cope at different levels with the negative impact of the public health emergency on their mental health 7 . Among other manifestations, the literature highlights anxiety-related, depressive, psychosomatic symptoms, as well as high levels of post-traumatic stress; these symptoms are more marked in girls, older adolescents, and adolescents with pre-existing vulnerabilities 8 . A recent review of 156 studies on changes in adolescents’ mental health during the COVID-19 emergency showed that outcomes had significantly worsened in several areas 9 . Among studies of depression, some 79% of studies found that participants’ symptoms had worsened, while 76% of studies of anxiety identified a worsening of symptoms, especially in girls and young women. Similarly, 70% of the research on stress and distress observed a clear increase in these phenomena with respect to the pre-pandemic period. Also considered in the review were studies—both longitudinal and cross-sectional—that found changes in subjective well-being, quality of life, and life satisfaction: the vast majority of authors identified a worsening of these dimensions. On the other hand, contrary to fears that adolescents would engage in greater substance abuse during the COVID-19 health emergency, findings regarding the use of substances have been mixed. A recent report by the U.S. National Institutes of Health identified a sharp decline in adolescent substance use in 2021 10 . The syndemic’s impact on substance use has likely been moderated by a number of factors, including changes in the social settings in which young people normally have the opportunity to use substances. In-person social interaction was drastically reduced in many contexts, thus reducing opportunities to drink alcohol 11 . In contrast, other studies showed that young people who remained more isolated during stay-at-home regimes used more cannabis than those who continued to socialize in person 12 .

However, in relation to mental health problems, contrasting results have been found both within and between categories. The overall decline in mental health is likely related to multiple factors implicated in the COVID-19 emergency internationally, including the specifics of different socioeconomic backgrounds 13 as the concept of syndemic also reflects. Although most longitudinal studies on depression, anxiety and stress have documented an increase in symptoms over the period of the COVID-19 emergency, others have found no change or even a decrease in the incidence of these symptoms. Increases in suicide ideation and suicide attempts have been reported in several countries, but in one of the few studies conducted with a subgroup of marginalized youth, a significant reduction in episodes of self-harm was reported during the pandemic, potentially attributable to good service response 14 . Furthermore, different aspects of the syndemic setting likely generated different mental health problems. For example, a survey of U.S. students found that school-related concerns (e.g., lower quality online courses) were associated with increased depressive symptoms, while concerns related to home confinement per se (e.g., “cabin fever”) were associated with increased generalized anxiety symptoms 15 . It is also worth reporting the various studies during these syndemic years that also noted people's ability to detect positive aspects related to the emergency situation. For example, one line of research focused on the development of a form of wisdom derived from the ability to detect positive opportunities (such as spending more time with family members, developing forms of solidarity with other people) to develop new attitudes, behaviors, and values 16 . Other studies have pointed out that the emotional impact of syndemia, although predominantly characterized by emotions such as anxiety, sadness, and fear, over time also brings out positive emotions such as hope, trust, and tranquility 17 .

Maintaining personal well-being during the syndemic

Studies that did not find significant changes in levels of well-being among youth have identified an association with the use of positive coping strategies in many cases 18 , 19 . Young people report that they used different ways to sustain resilience: in most cases, these strategies involved trying to maintain relational connections with significant others who were physically out of reach (friends and relatives), combined with more individual approaches to maintaining physical and mental well-being (exercising, spending time outdoors, meditating…).

Among the different factors that can reduce the risk of non-communicable disease during a syndemic, the literature recognizes coping strategies, along with perceived social support, as protective against the development of acute symptoms following exposure to particularly stressful events. Coping is the deployment of behavioral and cognitive strategies to modify negative aspects of one’s environment, and to minimize or escape internal threats induced by stress or trauma. Such strategies are diverse and can be more or less adaptive 20 , 21 . A more active coping style includes problem-oriented strategies, for example target the context as a means of solving difficulties, create an action plan, referring to someone, and be free to express and share feelings. Avoidance strategies include denial, substance use, and behavioral and mental detachment: trying to suppress emotions, withdrawing from people and enacting risky behaviors can be examples of avoidant coping style. Social support can be sought with a view to acquiring understanding or information or as an emotional outlet, which is a crucial resource to cope with stressful events and develop a positive attitude of acceptance, containment, and positive reinterpretation of events. In literature emerged that the use of avoidant coping strategies among adolescents was associated with overall higher levels of anxiety and depression and with other factors related to living conditions, such as having three or more siblings, having separated parents with low educational level 22 .

The restrictions imposed in the context of the COVID-19 health emergency have drastically reduced and disrupted access to many forms of social support, meaning that one coping strategy is less available or completely unavailable. However, studies show that family life during the initial severe lockdown of 2020, although it severely constrained adolescents’ drive for autonomy—hindering the fulfillment of a fundamental developmental task—acted as a key protective factor in their mental well-being 23 , 24 .

In light of the strong association between adolescents’ interactions with peers, friends, and family and their psychological well-being, it is of crucial importance to examine the factors that could further hinder or damage interpersonal interactions during this vulnerable stage of life.

The present study

In this study, we set out to investigate adolescents’ levels of perceived well-being and to map how they went about caring for their well-being during the COVID-19 syndemic. In keeping with the literature reviewed above, we hypothesized that they would have drawn on both individual and social resources to feel good and safe, as well as making novel use—and possibilities to use—of indoor and outdoor spaces. We expected that different strategies would be associated with differential levels of well-being. More specifically, we hypothesized that a strategy of seeking to maintain satisfying and supportive relationships with family and peers would foster the deployment of more proactive coping attitudes and consequently higher levels of perceived well-being. In contrast, we predicted that more individualistic and inward-looking coping strategies would be associated with a tendency toward passivity, a diminished perception of being in control of the situation, and consequent lower levels of well-being.

Participants were 229 Italian adolescent high school students. The sample was balanced in terms of gender, comprising 48.9% males (n = 112) and 48% females (n = 110); seven participants (3.1%) did not specify their gender. Participants’ ages ranged from 14 to 19 years ( M  = 16.64, SD  = 1.46). The inclusion criteria were: (1) attending high school, (2) being aged between 14 and 19 years, (3) accepting the terms of participation in the research. We did not apply any exclusion criteria. We recruited a convenience sample via a non-probability sampling technique whereby participants are selected from the population only because they agree to participate 25 . We collected the data during the period from April 2021 to June 2021.

Procedure and materials

This exploratory study was underpinned by a parallel mixed-method research design 26 and its primary source of data was a multi-method, student-centered, computer-assisted web interview (CAWI) 27 , 28 . The research protocol comprised three main sections: (1) demographic background, (2) closed items about well-being, (3) two open-ended question about being an adolescent during the COVID-19 public health emergency (“At this time, what are the times, situations, or events that help you feel good?” and “If you were to describe, using a phrase, image, or metaphor, what it is like to be a girl/boy of your age these days, what would you write?”). With regards to demographic data, the research plan included age and gender as variable of interest since the study was exploratory and used a convenience sample. Data were collected anonymously, and all participants were briefed about the research aims and procedure. Participation in the study was on a voluntary basis, meaning that participants received no monetary or financial rewards. The study was approved by the Ethics Board at Milano-Bicocca University (prot. N. 0059806/21) and was conducted in keeping with the ethical principles laid down in the Declaration of Helsinki 29 and the American Psychological Association code of conduct 30 . Informed consent was obtained from all participants and from parents for underage participants. During data collection (i.e., April to June 2021, a zoning policy was still in effect, based on the rate of contagion, while secondary school students were attending in-person classes 50% to 100% of the time, depending on the zone and the internal organization of schools.

World Health Organization Well-Being Index (WHO-5) The five-item World Health Organization Well-Being Index (WHO-5) is a short rating scale measuring global subjective well-being 31 . The instrument has been used in many different settings to assess positive well-being and as a proxy for mental health 32 . The questionnaire items are: (1) ‘I have felt cheerful and in good spirits’, (2) ‘I have felt calm and relaxed’, (3) ‘I have felt active and vigorous’, (4) ‘I woke up feeling fresh and rested’ and (5) ‘My daily life has been filled with things that interest me’. Respondents rate each item on a Likert scale ranging from 5 (all of the time) to 0 (none of the time). The raw WHO-5 scores are computed by summing the scores for the individual items, yielding global scores ranging from 0 (no well-being) to 25 (maximal well-being) which are then conventionally converted to a scale of 0–100. A generally accepted threshold for poor well-being and the risk of developing depressive symptoms is less than 50 33 . In this study, Cronbach’s alpha reliability coefficient (α) 34 was 0.817.

Qualitative material In line with our research aims, we analyzed the open-ended question “At this time, what are the times, situations, or events that help you feel good?” with a view to gathering direct information about how adolescents tried to taking care of their well-being during the COVID-19 health emergency. A total of 223 responses were collected, totaling 1915 words, with an average response length of 8.6 words. In terms of missing values, 6 participants did not respond or responded "I don't know," resulting in a missing value rate of around 2.5%.

Data analysis strategy

We analyzed the data from our mixed-method questionnaire using quantitative textual analysis (QTA) 35 . QTA is a form of qualitative content analysis and assumes that (1) words that tend to appear together (i.e. close proximity) in a given context may be interpreted as related to a common lexical theme or concept within the discourse under study 36 and (2) traditional statistical techniques may be used to analyze narrative data 37 . Hence, we analyzed the adolescents’ replies to the question “If you were to describe, using a phrase, image, or metaphor, what it is like to be a girl/boy of your age these days, what would you write?” via co-word analysis of correspondence based on our research interests (CA) 38 . The advantage of using CA to analyze this kind of material is that this method allows the researcher to examine the structure of a dataset by rescaling a set of proximity measures into visual distances representing specific locations in a spatial (Cartesian coordinate system) configuration 39 . The analysis yields word-maps which allow the researcher to identify recurring themes, their degree of salience, and how they relate to one another. We assessed similarities via the chi-square and Salton’s cosine indexes 40 along with their statistical significance (set at p < 0.05). Salton’s cosine allows us to organize the relations geometrically so that they can be visualized as structural patterns of relations 41 .

To make the results of the co-word analysis more understandable, word-based concept mapping tools based on multivariate QTA methodologies may be used to identify dominant themes, their relative weight, and how they relate to one another within a given set of textual data 42 . Many studies in the field of health psychology and health promotion 43 , 44 have suggested that common cluster analysis of textual data may be an interesting solution when researchers wish to gain meaningful insight into participants' words by bringing a positivist approach to bear on qualitative data 45 . In the present study, we used the k-means cluster analysis algorithm 46 . The k-means algorithm first groups objects into an arbitrary number of clusters, then computes cluster centroids and assigns each object in such a way that the squared error between it and the empirical mean of a cluster is minimized (i.e., Euclidean distance is used). K-means, like other techniques, seeks to minimize variability within clusters while maximizing variability between clusters 47 . A second critical issue in performing k-means cluster analysis in exploratory QTA is determining the optimal cluster configuration, where optimal refers to the outcome among all possible grouping combinations that presents the full set of the most meaningful associations 48 . Determining what distribution of clusters provides a better understanding of data requires the selection of an objective 'measure of optimal partitioning' (or clustering validity criteria). We chose Calinski- Harabasz index, which is also known as the Variance Ratio Criterion (VRC) 49 from among the available measures because it evaluates the quality of data partitions according to a standard formula. Specifically, the greater the value of the between variance-within variance ratio normalized with respect to the number of clusters, the superior the data partition. To find the best configuration, we ran cluster analysis on the word co-occurrence matrix with varying numbers of clusters (from three to nine), choosing the solution with the best local VRC peak. For all analyses, the alpha level was set at 0.05. In the context of the present study, we expected that the output of the CU would allow us to analyze adolescents’ chosen metaphors by grouping “naturally” occurring emerging themes as a function of lexical similarity and in relation to well-being scores. All analyses were conducted using TLAB 5.0 and SPSS 21.0.

Data cleaning and general descriptive statistics for the lexical corpus

As with other data exploration techniques, QTA required a pre-processing stage to prepare data for analysis. As recommended in the literature, we conducted normalization (removing all general function words such as articles, connection forms, and prepositions); lemmatization (reducing all inflected words to their root form as found in the dictionary) and synonimization (reducing words that may be considered equivalent from the semantic point of view—e.g., illness and sickness—ì to the same root form) with a view to preserving the accuracy of the textual data and preparing the database for running algorithms designed to generate both occurrence and co-occurrence matrices (for details about the process, see 50 , 51 , 52 ).

The resulting qualitative database comprised 1616 occurrences, 652 raw forms, and 439 hapaxes (i.e., words that occurred only once in the text). By adopting a threshold of at least four occurrences (text coverage 83%), root type/token ratio (an index of text richness 53 ) was 16.21, suggesting that the data were suitable for multiple correspondence analysis.

The results are divided into two sections. In the first section, we present quantitative data (i.e., descriptive statistics and zero-order correlations) concerning the levels of general well-being recorded in the adolescent sample using the World Health Organization threshold. In the second section, we summarize the results of the co-word correspondence analysis and subsequent clustering procedure.

The quantitative data outcomes are reported in Table 1 .

The zero-order correlations suggest that the adolescents’ levels of well-being were negatively associated with age and gender, with younger participants reporting greater well-being and girls (WHO-5 mean score = 47.6) reporting less happiness than boys (WHO-5 mean score = 57.9). In this regard, analysis of variance revealed that the difference in levels of well-being between gender-based groups was statistically significant [t(1,220) = 3.54, p 0.001]. In addition, 36.6% of boys and 54.5% of girls obtained scores of less than 50, indicating that they were at risk of developing depressive symptoms. Furthermore, 12.5% of boys and 20.9% of girls scored less than 28, suggesting that they were at risk of clinical depression. Before moving on to the qualitative analyses, in Fig.  1 we show the percentages of boys and girls classified according to the World Health Organization’s well-being spectra. This figure illustrates the differences in well-being scores between boys and girls, particularly in the group at risk of developing clinical symptoms of depression and the group reporting high well-being.

Adolescents grouped according WHO5 scores. Participants with scores of under 28 were at risk of clinical depression, while those with scores of over 75 displayed high levels of well-being.

The first result of the QTA concerned the words most frequently used by the cohort of adolescents to describe the moments, situations, or events that help them feel good during the COVID-19 syndemic. Given that frequently occurring words reflect recurring themes in a textual corpus and serve as the foundation for more complex coding categories, this is a preliminary form of analysis. The most frequently occurring words in the data set (with the number of occurrences reported in brackets) were: friends (137), family (51), to hang out (38), sport (18), music (18), boyfriend (16), to play (15), time (15), to meet (10), to chat (9), to watch (8), to listen (8), home (7), to help (7), people (6), on-line (5), to sleep (5) and alcohol (4). Even this initial look at the data provides some insight into the contents of adolescents’ strategies for coping with difficulties related to the syndemic; however, this level of interpretation is still quite biased (e.g., word frequency count is not weighted in relation to the length of responses), and it does not reveal the underlying structures in the data or the associations between words. When cluster analysis is used, it provides a more detailed picture. Because the evidence reviewed in the literature does not provide a theoretical framework for the structure of coping strategies, we began our exploratory analysis by determining the most appropriate cluster configuration for our qualitative data. Table 2 displays the values obtained for this purpose via the Calinski-Harabasz index.

The VRC values revealed that, based on the defined word co-occurrence matrix, the optimal configuration was a solution with four distinct clusters. Peak VRC was found to explain 66.2% of total variance, with low within-variance values: cluster_1 (CL1, ssw = 0.162), cluster_2 (CL2, ssw = 0.131), cluster_3 (CL3, ssw = 0.081) and cluster_4 (CL4, ssw = 0.073). In terms of cluster density, the partition of words across the clusters was relatively even and satisfactory, with CL1 including 35.1% of replies and CL2, CL3 and CL4 including 22.8%, 31.9% and 10.1%, respectively. We then investigated the main contents of the coping strategies adopted by adolescents by calculating the association between the replies grouped in each cluster and the cluster itself (in terms of distance from the centroids). In addition, we evaluated the associations between variables (e.g. age, gender and levels of well-being) and clusters by calculating χ 2 and its statistical significance. Finally, we plotted the cluster coordinates in two-dimensional factorial space to bring to light the meaning of the individual factors. Figure  2 offers a graphical representation of the four-cluster solution.

Graphical representation of clusters and occurrences in a Cartesian Space.

Cluster 1: In general, this cluster was associated with boys (χ 2  = 6.35, p = 0.012) aged 16 years (χ 2  = 5.85, p = 0.016) who reported a high level of well-being (χ 2  = 6.31, p = 0.012). Quotes from this first cluster include: “ hanging out with friends, family, music ” (Boy, 16 y.o, WHO5 = 64), “ the rare evenings when I get together with my group of friends to quietly play some board games ” (Boy, 17 y.o., WHO5 = 72), “ being with my friends, going out, and talking to people close to me .” (Girl, 16 y.o., WHO5 = 64) and “ being with my friends ” (Girl, 16 y.o., WHO5 = 72).

Cluster 2: This cluster grouped 18-year-old adolescents of (χ 2  = 11.85, p = 0.001) with low levels of well-being (χ 2  = 9.42, p = 0.002). Representative quotes included in the cluster were: “ Being with my family or boyfriend, or practicing sports ” (Girl, 18 y.o., WHO5 = 44), “ being with myself ” (Boy, 18 y.o., WHO5 = 38), “ Resting, going out, shopping ” (Male, 16 y.o., WHO5 = 24), “ I listen to music very often, in the evening I sometimes spend time on video calls with "friends" I met online who are from different countries ” (Male, 16.y.o, WHO5 = 36).

Cluster 3: this cluster was associated with 17-year-old adolescents (χ 2  = 4.60, p = 0.032) with a medium–low level of well-being (χ 2  = 4.11, p = 0.042). Quotes include: “ Nighttime, when all is silent and the thoughts screaming in the head fly away ” (Male, 19 y.o., WHO5 = 44), “ sport, alcohol, family ” (Male, 18 y.o., WHO5 = 40), “ Making music, being with my family, and going out for leisurely walks ” (Girl, 17 y.o., WHO5 = 54) and “ I do well in class, in the afternoon I never go out except sometimes with only one friend, so being in class with my classmates makes me feel good because there is no need for me to arrange to be with them ” (Male, 15 y.o., WHO5 = 48).

Cluster 4: The final cluster, which was the least dense accounting for approximately 10% of responses, was exclusively associated with “older” participants aged 19 years (χ 2  = 16.18, p = 0.032). In this case, representative quotes included: “ Seeing my mother happy, feeling right with myself ” (Male, 19 y.o., WHO5 = 44), “ Dancing ” (Girl, 16 y.o., WHO5 = 60), “ Playing online games, watching anime, and talking with friends ” (Male, 17 y.o., WHO5 = 76) and “ taking advantage of my free time ” (Male, 18 y.o., WHO5 = 56).

Before proceeding with the last step in the data analysis, we deemed it of interest to list all the coping strategies deployed by the adolescents with a WHO-5 well-being score of under 28: “ leisure time”, “my family”, “no one”, “Being with friends”, “listening to music and playing with the Xbox”, “seeing my friends outside of school”, “seeing friends and sleeping”, “Seeing my friends and playing football with my team”, “being with friends”, “spending time with my friends”, “there is no time”, “going to school”, “I have no idea”, “sleeping and eating” and “resting, going out, shopping ”. With a view to comparison, we similarly listed all the coping strategies drawn on by the adolescents with a WHO-5 well-being score of over 75: “ My friends, soccer, and my girlfriend's love”, “My family and my girlfriend”, “Family and friends”, “Being with friends”, “Being with family during the holidays”, “My parents' affection and my friends' trust”, “When I am with friends, when I am with my family at home or outside”, ”hanging out with friends”, “being with the people who make me happy, friends and family”, “hanging out with friends and family”, “family, hanging out with friends and playing soccer”, “soccer”, “sports, hanging out with friends and playing” and “Being with people who love me”. It should be noted here that there are substantial differences in the well-being strategies described by these two groups of adolescents (high vs. low well-being). In the descriptions of the high well-being group, for example, both the actions taken to feel better and the different social actors (friends, family members, boyfriends) involved, as well as the positive emotions and feelings felt (love, affection, happiness), were also present. This component (positive emotion and feelings) was lacking in the descriptions of the group with low well-being.

The final step in our data analysis was to label the two axes of Cartesian space with a view to defining a framework of meaning within which to organize the clusters. The principal axis is the straight line that runs closest to the profile point and passes through the zero point, hence meaning is identified first along the y -axis and then along the x -axis (Fig.  2 ). Conventionally, this type of graph in QTA cluster analysis is interpreted in terms of the geometric figures that can be drawn between the representation’s outermost points (see 35 ): in this case, the “triangle” drawn between CL1 (center-right), CL4 (top-left and bottom-center), CL3 (bottom-left). Looking at the first axis (X), we can see that this dimension has two poles: the negative extreme to the left is constituted by CL4 and CL3, whereas the positive extreme to the right is CL1 (the terms positive and negative are only artifacts of the calculus process, and they could easily be inverted within this framework). CL1 was associated with high levels of well-being, while CL4 and CL3, at the opposite pole, grouped adolescents reporting low or medium–low levels of well-being. Consequently, the x dimension may be labeled level of well-being. Similarly, the second axis ( y ) divides CL4 at the positive extreme from CL3 at the negative extreme, with CL2 and CL1 remaining in the middle. CL4 (and CL2, whose projection on the Cartesian axis is very close to that of CL4) included coping strategies that may be conducted alone or with a limited number of people, such as: dancing, playing online games, shopping, and making music. On the other side, CL3 (and CL1, whose projection on the Cartesian axis resembles that of CL2) seemed to group coping strategies that were more social and collective in nature, such as: spending time with family and friends. Hence, the y -axis may be labeled as a second dimension of coping strategies that reflects a notion of I-ness as opposed to a sense of We-ness 54 .

To summarize our findings from this QTA of qualitative data collected from adolescents during the COVID-19 syndemic and integrate them into the existing framework of coping strategies for well-being, the cluster analysis results implies the existence of two 'macro-dimensions' that allow us to organize otherwise apparently “atomized” elements of subjective experience during a time of health emergencies and existential uncertainty. A first factor termed level of well-being and a second termed i-ness/we-ness. In this sense, coping strategies of adolescent during COVID-19 syndemic seem not only to range from individuation (I-ness) to affiliation (we-ness)—or, to draw on the words of Wiekens and Stapel, from a sense of togetherness (We-ness) to a sense of separateness (I-ness); rather, they also seem to be strongly associated with different levels of well-being.

The aim of the present study was to advance our understanding of adolescents’ perceived personal well-being during the COVID-19 public health emergency. Besides assessing participants’ levels of well-being by means of a validated and standardized instrument such as the WHO-5, we were interested in exploring the way adolescents were taking care of their mental health during the syndemic period. Our results were generally in line with the hypotheses that we had formulated, offering insights into how best to support adolescents’ mental health trajectories, informing a complex interpretation of the concept of wellbeing, and calling for further, more in-depth investigation.

The role of age and gender in adolescents’ wellbeing

Looking at the results for gender and age differences in relation to perceived well-being, our data support the findings already reported in the literature: girls perceive significantly lower levels of well-being than their male peers 55 , 56 . In addition, older ages are correlated with lower levels of well-being with a general decline in mental well-being with increasing age, whereby older adolescents experience lower levels of life satisfaction, are less likely to report excellent health, and suffer more frequent mental health problems 57 . Furthermore, the same study showed that, by age 15, girls report poorer mental well-being than boys. The COVID-19 syndemic has confirmed and in some cases accentuated these differences, with older female adolescents suffering more from anxiety and depressive symptoms 58 . This situation is part of a broader picture whereby adolescent mental health has been undergoing a general decline in recent years 59 : for example, a study 60 identified, from 2018 to 2020, a decrease in mean perceived well-being, as measured by the WHO-5, from 43.7 to 35.8 (albeit that both of these scores invite reflection on the state of mental health in adolescence more generally). Thus, it seems that the COVID-19 emergency has accelerated a process that had already been underway for some years, and which requires policy makers to urgently examine the adequacy of current mental health promotion services and practices.

Self-care practices

The results of the QTA offer us a more in-depth and nuanced understanding of the conditions that influence adolescents’ well-being, including the role of gender and age. If we examine cluster 1, we find mainly younger male adolescents, who, when asked the open-ended question about how they take care of their personal well-being, answer by naming strategies chiefly aimed at maintaining peer relationships and teams sports-playing. This cluster is associated with high levels of well-being. On the other hand, in clusters where levels of well-being are lower, adolescents refer to the use of more individualistic and intimate, but also more "passive" strategies (music, shopping…). When looking at the coping strategies reported by those with "extreme" scores on the well-being curve (under 28 and over 75), key differences emerge. Adolescents with scores of < 28 (who are thus potentially at risk of depression) report seeking support from relationships, yet positive affective states rarely feature in their responses, and they make greater use of "static" verbs ("I'm with," "I see…"). Furthermore, in the responses of the group of adolescents with very low levels of well-being, food or alcohol intake (about 5%) also appeared as—dysfunctional—coping strategies, along with higher levels of apathy ("sleep longer"…). In contrast, adolescents with high levels of perceived well-being reported actively seeking out social support and positive relationships, within their families and among their friends, and these efforts were more frequently and explicitly associated with affective and emotional states. This finding corroborates studies in the literature which suggest that adolescents’ growing desire for autonomy and independence from parents and to belonging to a peer group 61 , 62 takes shape in parallel with the maintenance of close and positive relationships with family as a key requirement for psychological well-being and adjustment 63 . In particular, adolescents who have poorer and dysfunctional family interactions and relationships experience greater psychological maladjustment. In the context of the public health emergency, everyday living conditions, especially the fact of sharing the same spaces with family for a prolonged length of time, likely amplified the impact of positive vs dysfunctional family relationships on levels of well-being. We might speculate that the participants in the present study who most frequently mentioned their family as a positive resource are those who were already embedded in more protective and functional systems. Nevertheless, examining the levels of well-being of clusters 1 and 2 (medium–high) versus cluster 3 (medium–low), it seems that it is the combination of family-friends (as in cluster 1 and 2) as sources of support, as opposed to "just" family (as in cluster 3), that makes the difference with respect to levels of perceived well-being.

When the dimensions of well-being and coping strategies are jointly represented along Cartesian axes, a continuum emerges from high levels of well-being associated with more affiliative strategies (we-ness/togetherness) to low levels of well-being associated with more individualistic strategies (I-ness/separatedness). Again, the collective dimension emerges as a resource. However, this result prompts reflection about access to social support as a strategy for coping with situational stress. Thinking "we are all on the same sea" is a view that may help, but it is also true that "everyone has a different boat": those who experience positive and satisfying family and extra-familial relationships may be more likely to identify and seek out the collective dimension as a potential source of protection against stress, while those who had already been experiencing conditions of marginality or dysfunctional family relationships or vulnerability prior to the advent of COVID-19 may find it more difficult and/or unhelpful to turn to more "social" coping strategies. We might reflect on how much this syndemic has widened such gaps, which are not only economic but also social and political, among people in general and among adolescents in particular. Studies have proven that in fragile adolescents (suffering from anxiety and depression), the impact of the public health emergency has further exacerbated their situation and increased the distance between these youths and peers with good levels of mental health who are well integrated at the socio-relational level: indeed, the literature shows that adolescents who experience greater symptoms of anxiety and depression experience a deterioration in social well-being over time, and receive less social support and greater victimization from peers 64 . Other similar studies have shown how the COVID-19 outbreak and the related risk-reduction strategies have changed the social contexts of adolescents in low- and middle-income countries, with profound implications for their well-being, especially in the case of vulnerable adolescents, including those affected by poverty and armed conflict. In such contexts, pre-existing conditions of disadvantage have had a negative impact on the mental health of adolescents, especially that of girls 65 .

Thus, in the current syndemic setting, the issue of "non-communicable disease" emerges strongly, coupled with, and exacerbating the impact of the virus on the physical health of self and significant others. In this scenario, it is not difficult to discern whether the increase in mental health symptoms is the result of the disease itself (directly or indirectly experienced, or as a source of concern for one’s own safety) or the related restrictive measures (e.g., separation from friends, disruption of school, etc.). In any case, it is crucial to carefully weigh the potential benefits of reduced COVID-19 transmission against the detrimental effects on mental health of social isolation, especially in adolescents. From this perspective, insistent calls for social distancing from the authorities seem unfair and counterproductive: while physical distancing may offer protection from a physical health perspective, we need social closeness to maintain good mental health.

Limitations

This study, like others of its kind, features several limitations that should be noted. First, the study is cross-sectional, which means that the teenagers were questioned at a point in time when the COVID-19 epidemic was still ongoing. While this was congruent with the research aims, the research design offers no information about the dynamic evolution of the phenomena under observation, either in terms of well-being or in terms of self-care strategies. A second limitation concerns the fact that the interviews were administered online. Although this approach facilitated data collection at a time when mobility constraints and public health measures made it difficult to gather data directly in the field, it raises concerns regarding the sample's effective representativeness. The most susceptible groups of teenagers or those with educational and economic difficulties may have had restricted access to the Internet and computer technologies, affecting their ability to respond the survey. This means that caution is required in generalizing our findings to all Italian teenagers. Another limitation is that the research plan only considered demographic variables such as age and gender. Instead, studies are needed to detect the effects of other contextual variables that may be associated with adolescent well-being in order to better assess the dynamics of syndemics. In the future, follow-up studies within this line of inquiry should be conducted with larger samples and longitudinal designs, in order to gain a clearer picture of the variables studied, in terms of both the stability of the identified associations and the scope for change, especially given the fact that adolescence in general is a period of transition and rapid transformation.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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The experiences of patients with COVID-19 and their relatives from receiving professional home care nursing: a qualitative content analysis

• Mina Shayestefar 1 ,
• Nayyereh Raiesdana 2 , 3 &
• Monir Nobahar 2 , 3 , 4  

BMC Nursing volume  23 , Article number:  352 ( 2024 ) Cite this article

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To overcome of patients with COVID-19 over the capacity of hospitals and mild to moderate severity of the disease in most cases, the World Health Organization and the Centers for Disease Control and Prevention in the United States, recommend home care for these patients. Receiving care at home will face challenges that can be context-based, especially in crises like the Coronavirus pandemic. The present study aimed to describe the experiences of patients with COVID-19 and their relatives from receiving professional home care nursing.

This study was conducted using a qualitative content analysis method. Nine participants with COVID-19 who were receiving home care nursing in Semnan participated in this study. The purposive sampling method was used. Sampling continued until no new categories appeared, meaning the category’s theoretical saturation. Deep and semi-structured interviews were used to collect data based on the research question. Data was analyzed using the conventional content analysis method using Graneheim and Lundman’s approach.

After analyzing the interviews and comparing codes based on similarities and differences, three main themes, 11 categories, and 30 subcategories were identified. The main themes included “The value of home care” (personalization of care, being economical, providing intellectual security, and reducing the concern of family), “Comprehensive care” (professional commitment, empathy, mastery in care, and patronage), and “Care challenges” (cultural barriers, inadequate services, and lack of information about costs and conditions).

The patients with COVID-19 who received professional nursing care at home mentioned some challenges, such as the caregiver not being of the same sex as the patient, delay in receiving the service, the inadequacy of the centers, the limitation of the right to choose the care provider, and insufficient information about the cost of services received before receiving each care.

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COVID-19 as a pandemic crisis put unprecedented pressure on healthcare services [ 1 ]. The experience of caring for patients with some infectious diseases such as SARS shows that the evaluation and care of these patients are costly and require a lot of facilities and human resources. In addition, providing care increases the risk of transmitting the disease to other patients, nurses, and medical staff [ 2 ]. Approximately 81% of COVID-19 patients show mild symptoms and can be recovered at home; therefore, quarantine and home care are some of the common treatments for this disease [ 3 ]. In early 2020, the World Health Organization and the United States Centers for Disease Control and Prevention recommended that people with COVID-19 receive care at home, emphasizing that most cases are mild or moderate [ 4 ].

Today, the increasing number of people needing home care services, especially the elderly and chronic disease patients, have taken nursing care from hospitals and nursing centers to home care [ 5 ]. Providing care at home allows patients to choose the care provider and the amount of nursing services according to their willingness and choice [ 6 ]. During the COVID-19 home quarantines, home care services may act as an essential auxiliary component of health care services, which reduces the burden on the formal health care system [ 7 , 8 ].

Home care nursing services are essential to community-based integrated care systems to support people needing care in the community [ 9 ]. Nursing services at home have been significantly developed in the last twenty years to meet the population’s needs and adapt to the health system’s limitations [ 10 ]. Home care can maintain safe care during the pandemic due to COVID-19, with a low incidence of COVID-19, low hospitalization rate, and low mortality [ 11 ].

Preliminary regulations of home care services have been approved since 1999 in Iran and then revised in 2014 [ 12 ]. Although the movement toward professionalization in-home care has begun in Iran, there is still a long way to go [ 13 ].

Home care nurses provide a wide range of professional and supportive health services such as patient education, wound care and treatment [ 14 ], rehabilitation treatment, social work, and diet [ 15 ]. They are often the first to recognize and report the deterioration of the patient’s condition or the manifestation of dangerous symptoms [ 14 ].

Jacob et al. (2021) and De Mestral et al. (2019) have stated that nursing at home may help reduce emergency visits and re-hospitalization [ 16 ]. As Heyn et al. (2021) noted in their study, most of the concerns during the visits are related to primary nursing care and/or medication administration and the type of home visit (including providing basic needs, medication administration, and nursing procedures altogether or separately) may affect the expressed concerns of the elderly. However, it seems that the complexity of the health condition of the elderly has little effect on the expressed concerns [ 17 ].

The research findings related to home care nursing can provide primary data for the use and policy-making of home care nursing [ 15 , 18 ]. COVID-19 has made a wide range of changes in all aspects of healthcare systems. Also, it reveals the gaps in providing healthcare, which should be reflected and may help improve home care services and cope with other situations. One of the best quality assessment methods in healthcare can be the receiver care’s viewpoints and experiences. Therefore, the present study was conducted to describe patients’ experiences with COVID-19 and their relatives from receiving professional home care nursing with a qualitative approach in Semnan, Iran.

Materials and methods

Qualitative approach.

This study was conducted using conventional content analysis, according to the objective of this study.

Research population

The research population consisted of all the patients with COVID-19 and their relatives in Semnan, Iran, who received nursing care at home and were willing to participate in this research.

Participant selection

Inclusion criteria were: participants’ age of 18 years and above, the experience of receiving home care nursing at least once due to COVID-19 in 2022, absence of COVID-19 disease at the time of sampling, willingness to participate in the current study, ability to share their experience, and cognitive disorders. Also, exclusion criteria were sudden changes in the participant’s physical or mental status leading to the inability to communicate and the participant withdrawing from continuing cooperation for any reason. As stated in the research title, the participants were patients or their family members. Due to speech impairments and the death of some eligible participants, researchers had to interview the closest family member who was in connection with the home care center instead of the patients to gather important information in these situations.

The purposive sampling method was used in the present study. After seven interviews, new data did not emerge, and the following two interviews were conducted to ensure that no new data emerged. Data gathering was done from June 2022 to December 2022.

Data collection

The data collection tool was in-depth and semi-structured interviews based on the research question. Also, during the interviews, field notes were taken. A total of ten interviews with nine participants were conducted (Table  1 ).

After approving the research project and obtaining the ethics code (IR.SEMUMS.REC.1401.039), the first author (M.Sh.) went to all of the nursing centers that provide home care in Semnan City and received the list of patients with COVID-19. Then, an appointment was made with the eligible informants during a phone call, and the research objectives were explained.

The location of the interviews was coordinated by the suggestion of the participants and in a place with the least disturbing factors. Participants completed the informed consent form during the meeting.

All interviews were conducted by a first author (female faculty member, Ph.D. candidate in nursing). With the participants’ permission, all the interviews were recorded by the MP3 player without mentioning any names during the interview. They were informed that their information is confidential and anonymous and will be used in the research process by assigning a number. The audio file was transcribed verbatim immediately after each interview, and the meaning units were extracted by the interviewer (first author, Ph.D. candidate in nursing) and verified by the research team. The average duration of the interviews was 28.77 ± 11.48 (min 16, max 48) minutes.

Initially, a general question was asked based on the research aim: “ Please describe your experience of receiving nursing care at home during the COVID-19 ”. In addition, during the interview, some guiding questions were added, including “ Please describe your feelings about receiving nursing care at home during the COVID-19 ” and “ How would you describe receiving nursing care at home during this disease ?” so that the participants explained their experiences more about receiving home care nursing. Also, based on the participant’s answers and the interview progress, probing questions such as “ What do you mean ?”, “ If you can explain more? ” were asked. The path of the following interviews was determined through data collection, simultaneous analysis, and the formation of categories. After several interviews, other questions were added based on the research progress. The participants’ non-verbal messages, such as tone of voice, silence, emphasis, and sighing, also were recorded.

Data analysis

For data analysis, the first author (M.Sh.) listened to each interview and read the transcription several times better to understand the feelings and experiences of the participants. The approach used for data analysis was Graneheim and Lundman’s (2004) conventional content analysis. According to this approach, the text of the interviews was transcribed verbatim and divided into meaning units (by M.Sh.). Then, meaning units were coded by two researchers separately (M.Sh. and N.R.). According to the participants’ experiences, evident and hidden concepts were determined from sentences, paragraphs, or words, and then coding and summarization were done. Based on the continuous comparison of similarities, differences, and appropriateness, the codes that indicate a single subject were placed in one subcategory, and the subcategories were merged to form the categories. Ambiguous points that need attention, in addition to being reviewed by the participants, were also explored in subsequent interviews (the first participant interviews). In such a way, the ambiguities were resolved, and the location of the codes in each category was fully specified. At the interpretation level, the central concept of each category was determined, and the primary and abstract concepts or themes were extracted [ 19 ].

Data analysis was done in the same way and simultaneously with data collection. Four criteria developed by Lincoln and Guba- credibility, transferability, dependability, and confirmability- were used to define the quality criteria of qualitative studies.

In the present study, prolonged engagement with the data and spending enough time to collect and analyze the data, data triangulation, member check, and peer check were used to verify the credibility of the data.

For transferability, the conditions of using the results in other contexts were provided for the readers by carrying out deep, analytical, and rich descriptions of the context and characteristics of the participants, describing the study context and precise description of limitations.

For dependability, data and documents were carefully reviewed by an external reviewer. The dependability of data is in similar time and conditions and is equivalent to reliability in quantitative research. In this study, the dependability of the data was determined in such a way that the data obtained in the interview also emerged in field notes. In this study, to achieve the standard of confirmability, all the stages of conducting the research, especially the stages of data analysis, were recorded in a detailed and comprehensive manner so that if another researcher who wants to continue research in this field, follows the work process based on the documents quickly. In addition, all interviews were reviewed after transcription in face-to-face meetings with all research team members, and their corrective comments were applied.

After analyzing the interviews and comparing codes based on similarities and differences, three main themes, 11 categories, and 30 subcategories were identified (Table  2 ).

The value of home care

The theme “value of home care” refers to the preference of home care from the patient’s point of view. In this theme, an implicit comparison was often made between receiving care at home and in the hospital. This theme includes four categories: “Personalization of care,” “Being economical,” “Providing intellectual security,” and “Reducing the concern of family.”

Personalization of care

This category refers to the sense of ownership over one’s surroundings and the feeling of belonging and confidence that comes with it. This category includes three subcategories: “Being in the personal environment,” “Availability of personal belongings,” and “Being with familiar persons.”

Being in a personal environment

This subcategory refers to the patients’ interest and desire to receive care in a familiar climate; indeed, it means the patient’s home, which leads to a sense of security in the patient.

“It’s that feeling of security that comes from knowing you can care for yourself in your environment. For example, your home is a place you have control over 24 hours (making a circle with both hands). You can do whatever you want there, but it’s not like that in a hospital” (P8).

Availability of personal belonging

This subcategory refers to the feeling of independence over personal belongings and access to personal amenities such as the patient’s favorite food; also, the accessibility to personalized sanitary equipment was an important factor for them.

“But I was at home because I was alone, and it was just me, and I was comfortable with myself. I took care of myself in terms of food and everything” (P1).

Being with familiar persons

This subcategory refers to the patient’s preference for receiving care from a familiar and consistent nursing provider. This can provide care with more focus and exclusivity, allowing for more family involvement and presence.

“Taking care at home is great. It’s better inside the house because one person’s focus, attention, and care are higher. They say they do their job better than being in the hospital with 10 or 20 patients or even a single room. Well, it’s different. They rush things in the hospital, but at home, they provide better care, focus, and attention to detail, and they do their job better… But having a doctor or nurse come to your home to care for you is even better since their focus is higher, and they do your job with greater accuracy and better care, which is much better” (P9). “My father is also stressed, and it would be better if we were not around him in a crowded space, especially my sister, who gets extremely stressed. Plus, the COVID-19 section was there, which added to his stress. We returned home and told him we would care for him and see what happened next. We were sure he was stressed there, and being around someone stressed was not good for us. Being there for him emotionally makes a big difference” (P7).

Being economical

This category refers to the patients’ mental consideration of cost-effectiveness when receiving care, which includes three subcategories: “Reducing costs,” “Saving time,” and “Coordination with medical centers in necessity.”

Reducing costs

The subcategory of “reducing costs” does not necessarily mean less spending on home care but rather refers to the value of the cost spent versus the care received.

“To be honest, I wasn’t focused on the cost and how it was or what it was. I didn’t pay too much attention to it. But I feel like it was worth it. Let me put it this way” (P5).

Saving time

This subcategory refers to reducing the time commitment for the patient and family (such as waiting time for appointments) in receiving care compared to care received outside the home.

“When you go to a clinic, you have to wait in line and deal with the crowd, but it’s not like that at home. It’s much better” (P5).

Coordination with medical centers in necessity

The following subcategory indicates providing telephone consultation for home care nursing in various fields with relevant individuals, which can accelerate the treatment process.

“In terms of food, Dr. … said that she is a professor of traditional medicine at the university, and they gave me her phone number. She provided consultation over the phone on what to eat and what to do” (P1).

Providing intellectual security

Ensuring mental security refers to peace of mind and a sense of safety for the patient, which includes two subcategories: “Reducing the fear of hospitalization” and “Reducing the mental load of disease worsening.”

Reducing the fear of hospitalization

This subcategory refers to reducing the fear of illness, which involves the fear of hospitalization in medical centers, and home care can create a sense of comfort and security for the patient.

“From the perspective of how much worse pollution is in a hospital environment, people are scared because COVID patients come and back… This fear is on the one hand, and the other hand, your home environment feels safer for this reason” (P8).

Reducing the mental load of disease worsening

This subcategory has been developed based on reducing the mental pressure caused by hospitalization with COVID-19. However, when it becomes possible to provide care for the patient at home, their mental perception of the severity of the illness decreases.

“When they say that taking care at home helps the patient breathe a sigh of relief, for example, they say, ‘Well, it’s not that severe that they have to hospitalize me.’ Because it always comes to their mind that whenever a doctor says to be hospitalized, people start saying, ‘Oh, what’s happening?’ and so on… and they convince themselves that there is nothing wrong, and they might get better in, say, five days a week” (P8).

Reducing the concern of family

The culture of excessive communication in Iranian families often leads to the involvement of family members in problems or even the illness of one of them. Home care, based on its features, can reduce the excessive participation and concern of the patient’s relatives. This category consists of three subcategories: “No need to move the patient,” “Easiness of availability to the required drugs,” and “Removing pressure care from family members.”

No need to move the patient

This subcategory refers to patients not needing to be transferred to healthcare centers for treatment and care. This situation is particularly more noticeable in elderly patients and those with a significant reduction in mobility.

“Taking care at home is very effective, and my father was more comfortable. Every day, despite his old age, he didn’t have to struggle to get in and out of the car and travel. Not only was he a patient, but also without being sick, it is hard for him at his age” (P2).

Easiness of availability to the required drugs

This subcategory refers to the purchase of medications from pharmacies which were near the patients’ homes, as well as the access to the medicines by home care nurses who have more information about different routes of drug purchase, especially in times of drugs shortages during the COVID-19 crisis in Iran.

“As the saying goes, that person who comes buys and brings all these medicines, and the patient inside the house does nothing ………. There were some foreign vitamins. Mr. … himself didn’t take them, my sister went to one or two pharmacies and couldn’t get them, I don’t know where Mr. … got them from now” (P9).

Removing pressure care from family members

Another subcategory of the essential patient experiences regarding reducing family concern is “relieving the caregiving pressure on family members”. This means that family members are less anxious and worried about caring for the patient by facilitating the caregiving process.

“During the coronavirus, I got sick and was hospitalized. My two sons were very involved in caring for me because I needed a lot of help. Then the doctor called my sons and said you annoyed a lot in this way; take your father home and take care of him there. It’s perfect, especially now that the sons are too busy in their own lives.” (P4).

Comprehensive care

Comprehensive care refers to professional nursing care based on ethical principles. This theme includes four categories: “Professional commitment,” “Empathy,” “Mastery in care,” and “Patronage.”

Professional commitment

The “Professional commitment” category refers to some professional nursing principles that are more prominent in caring for COVID-19 patients at home. It includes four subcategories: “Punctuality,” “Availability,” “Responsibility,” and “Compliance with health principles.”

Punctuality

Many participants mentioned time management is an essential professional commitment principle, as it leads to gaining the patient’s trust and accelerating the treatment process.

“He used to come regularly on time” (P1).

Availability

Patients who receive care at home must feel confident that the nurse can answer any questions or address any problems.

“Most of the time, if something happens, I call him, and if I can’t go to his office because of my job, I tell him my problem over the phone, and then he tells me what medication to take and what to do. If I need an injection or something, I take it and go to his office. I am delighted with him for the treatment” (P9).

Responsibility

Feeling responsible for providing nursing care was another expectation that patients had from their nurses.

“Even Mr. …. himself wouldn’t come; he would call and ask about our condition for a while. He would check how I was doing, my situation, and whether I had improved or improved. This is very important” (P9).

Compliance with health principles

During the COVID-19 pandemic, observing health principles was crucial for recipients of health care services. These health principles included wearing a mask, maintaining social distancing, washing hands, and using sanitizers.

“They were wearing special COVID clothes, masks, gloves, and hats when they came in” (P1).

Empathy is the ability to understand the patient’s feelings and experiences and for the nurse to look at the situation that COVID-19 has created for the patient from the patient’s perspective. In this study, empathy refers to “Understanding the patient’s condition,” “Being good-humored,” and “Effective communication.”

Understanding the patient’s condition

The most fundamental concept of empathy is “Understanding the patient’s condition.” The patient feels they have received care for their physical and emotional well-being.

“Then, when he came, it was like he was doing this with all of his heart and soul ” (P4). “He used to work very lovingly when he came to our house.” (P1).

Being good-humored

Another important subcategory of empathy is “Being good-humored.” Cheerfulness in home care nursing can lead to the continuity of care.

“If I want to recommend home care to others, it all comes from the behavior and ethics of that nurse” (P9). He used to come on time, was very gentlemanly, and had obvious eyes. (P3)

Effective communication

The expectation that patients have from nurses is to have close and appropriate communication. Effective communication makes the patient feel safe and calm.

“But on the other hand, he would ask about my well-being nicely. He would say, ‘How are you feeling now? What’s your condition like? Are you stable? Is your blood pressure okay? Do you feel nauseous? Do you have a fever?’ Everyone has their personality, so it all depends on the nurse who comes to take care of you” (P9).

Mastery in care

Mastery of clinical nursing skills brings patients trust and peace of mind, which can be based on professional nursing knowledge and practice. Mastery in care in the present study consists of “Clinical skill in meeting care needs” and “Knowledge in providing care.”

Clinical skill in meeting care needs

A patient’s expectation in the first stage of a nurse is to meet their care needs and master their profession.

“I knew they were proficient in their work, and when they are proficient, I also feel calm.” (P4).

Knowledge in providing care means having the necessary understanding, skills, and expertise to provide effective and efficient care to individuals who require it. This knowledge can come from various sources, including formal education, training, and experience in healthcare or social services.

“Their high level of knowledge helped me greatly with my treatment since I became ill” (P9).

During the COVID-19 pandemic, due to the unique conditions created (such as the need for home quarantine, controlling anxiety caused by family illness, unfamiliarity with the dimensions of the disease, etc.), the supporter and advisor role of home care nurses is highlighted. Support includes three subcategories: “Providing necessary guidance,” “Answering the patient’s questions,” and “Strengthening the morale.”

Providing the necessary guidance

Patients expect their nurses to be able to guide them in various aspects of their illness and demonstrate their expertise in different areas of the disease. In some cases, home care nurses would also seek guidance from qualified individuals if necessary.

“They would order us to wear masks, wash our hands thoroughly, and clean our clothes when we arrived. Regarding eating food in the same place, they would recommend these things to us and emphasize the health care precautions in this regard” (P2).

Answering the patient’s questions

The role of nursing counseling, feeling responsible for patients’ questions, and answering them were also among patients’ expectations.

“He would answer the questions I asked him” (P4).

Strengthening morale

Another subcategory of “Patronage” was obtained. Nurses can improve patients’ morale through their knowledge and experience so that they feel better emotionally. As mentioned below:

“In my opinion, these centers that provide services could be much more effective if they could work with them on their mental well-being and provide counseling. Unfortunately, because my father was alone and had no one else, he was very effective in his morale and had an impact on his recovery when he talked to him” (P2).

Care challenges

The challenges of caring for COVID-19 patients include mentioning the problems patients face in receiving care at home, which has much to do with the community’s behavior and the patient’s individual and informational literacy. Three subcategories include “Cultural barriers,” “Inadequate services,” and “Lack of information about costs and conditions”.

Cultural barriers

Due to the religious and cultural norms of society, the presence of a nurse of the opposite gender in the patient’s home is one of the challenges for patients. “Opposite sex of patient and caregiver” and “Accepting a stranger at home” are subcategories of cultural barriers.

Opposite sex of patient and caregiver

There is a sense of comfort in receiving care from a same-gender caregiver in the culture of many Iranian society members.

“Since my mother was older, she was a bit uncomfortable. Because of her age, she was more restricted and did not allow herself to be seen. But anyway, she was sick, and we had no choice but to accept that injections had to be done… I saw that she was in a lot of pain during the injections, so I called Mr.… and asked if it would be possible that your wife, who is a home care nurse too, do my mother the injection” (P5).

Accepting a stranger at home

The presence of confidence in receiving the entry of nurses into the house and the lack of organizational introduction strategies for them are among the challenges mentioned in patients’ experiences.

“Because the number is low and you can’t be sure to find good ones, and there is also the issue of trust; they will come to our house” (P2).

Inadequate services

Unmet societal expectations and the mismatch between nursing centers and their evolving needs lead to the emergence of service delivery challenges at home, which participants have repeatedly mentioned. Inadequate service delivery includes three subcategories: “Inability to receive long-term care,” “Delay in receiving care,” and “Limited number of service delivery centers.”

Inability to receive long-term care

According to the participants, the lack of approved health system care centers that provide long-term care is felt.

“If someone wants a caregiver to come to their house and care for them 24/7, they won’t find such a person at all” (P7).

Delay in receiving care

Another challenge identified by the participants was that sometimes there seemed to be an excessive delay in receiving further care, which exceeded the patient’s or their family’s expectations.

“You need an expert in treatment factors, for example, to take care of you 24/7 and check on you, but you don’t have this at home, and maybe it only happens once. For example, they come once, do what needs to be done, and then they may be unable to return” (P8).

Limited number of service delivery centers

The subcategory “Limited number of service delivery centers” clearly indicates the lack of structural and human resources in the home care field that align with the community’s needs.

“There are families who give a good amount of money despite financial difficulties, but there are also families who don’t care about the money aspect, but would not hire someone they don’t trust” (P2).

Lack of information about costs and conditions

Many participants expressed concerns about the lack of transparency regarding the types of nursing services covered by primary and complementary insurance and their costs. The category of “Lack of initial awareness of costs and conditions” also refers to “Inadequate information on pays fees” and “Lack of information about covered services.”

Inadequate information on pay fees

According to the participants’ experiences, ambiguity in the process and amount of payment is due to the lack of patient awareness by nursing centers before starting care services and insufficient knowledge of service tariffs at the community level.

“However, it would be great if there was a tariff or something on a website for this system that people could look at. They say they will deposit it now; of course, the amount is not much, but having tariffs is not bad” (P7).

Lack of information about covered services

Another subcategory of “Lack of information about costs and conditions” was “Lack of information about covered services.” Due to the unknown aspects of some dimensions of home care nursing in Iran, insurance companies have not provided good transparency, which was felt in patients’ experiences.

“I didn’t understand what happened with its costs and supplements. They didn’t give me any supplementary insurance” (P5).

The findings include three main themes, 11 categories, and 30 subcategories were identified. The main themes included “The value of home care” (personalization of care, being economical, providing intellectual security, and reducing the concern of family), “Comprehensive care” (professional commitment, empathy, mastery in care, and patronage), and “Care challenges” (cultural barriers, inadequate services, and lack of information about costs and conditions). The present study is unique because it explains the home care receiver’s experiences during COVID-19, a critical situation.

One of the subcategories obtained in the present study was “Knowledge in providing care,” which led to a sense of confidence among the participants. Given the importance of the knowledge foundation of a profession, this value can also be extracted from the participants’ statements. Aune and Struksnes also concluded from their study, based on the experiences of home care nurses, that nurses work with complex challenges in home care. Still, the criteria for success depend on the knowledge of patients and nurses, organizational aspects, and collaboration [ 20 ].

“Responsibility” is an essential aspect of “Comprehensive care,” based on the experiences of participants, which reflects the “Professional commitment” of home care nurses. In the study by Fatemi et al., attention was paid to the fundamental values of the main categories obtained from their understanding of home care nurses’ professionalism, which included the subcategory of adherence to laws and responsibility [ 21 ]. In both studies, responsibility is an essential part of the nursing profession.

In the present study, one of the subcategories of “Comprehensive care” was “Empathy,” which consisted of three subcategories: “Understanding the patient’s condition,” “Being good-humored,” and “Effective communication.” One of the skills of a nurse, especially in-home care, is to establish appropriate communication by ethical and professional principles. As Hemberg and Bergdahl have also pointed out in their study on palliative care at home, nurses can balance their actions in the moment and change their nursing actions according to the patient’s wishes through sensitivity and ethical perception, and by creating participation in their approach [ 22 ].

“Mastery in care” includes two subcategories: “Clinical skill in meeting care needs” and “Knowledge in providing care,” which were emphasized by most participants. Along with the new conditions created by COVID-19 in providing care, nurses also had to adapt to knowledge and clinical performance. In a qualitative study, Jia and colleagues extracted specialized nursing skills as a primary data category. They stated that to cope with the ethical challenges arising from nursing COVID-19 patients, nurses must gain knowledge and nursing skills related to COVID-19, which can improve their clinical performance in infectious cases [ 23 ].

Another important subcategory extracted from this study was “Strengthening morale,” obtained from the main category of “Comprehensive care.” This subcategory indicates the nurse’s role as a counselor, especially in crises such as COVID-19. Galehdar and colleagues have reported similar findings in the study. In their study, the category of the need for psychological counseling for patients indicates that COVID-19 patients even require psychological counseling before the need for nursing care. The study of Galehdar et al. has the same question through the nurses’ experiences. The finding revealed three main categories: care erosion, nursing professional growth, and necessities. They emphasized the emotional challenges of home care nurses during the COVID-19 including bad feelings of inefficiency, stress, excessive physical fatigue, the dilemma between care delivery, falling apart from their families, and the fear of infecting them upon returning home, which can affect the quality of patient care [ 24 ].

The subcategory of “Inadequate services” with subcategories of “Inability to receive long-term care,” “Delay in receiving care,” and “A limited number of service delivery centers” can stem from inadequate planning and support at higher levels of management and policy-making in nursing, which can pose challenges in care. As Joo and Liu pointed out in their systematic review study on barriers to nursing care for COVID-19 patients, insufficient support for nurses from hospitals and the healthcare system can contribute to this subcategory [ 25 ]. Also, Akbarbegloo et al.’s study about psychological care experiences of COVID-19 patients in the home revealed that these patients experienced the non-response of the treatment team and concerns about the persistent condition of the disease [ 26 ].

In the present study, two subcategories of “Cultural barriers” and “Inadequate services” were obtained from the main category of “Nursing challenges,” indicating the significant role of cultural and religious issues on various dimensions of Iranian society, as well as some managerial deficiencies and the need for updating service delivery structures from the participants’ experiences. Similarly, Heydari et al. identified cultural dimensions and insufficient infrastructure as two main categories obtained from the experiences of participants in their study on barriers to home care services in Iran [ 27 ]. One of the nursing challenges during COVID-19 was the cultural aspects of Iranian society are so related to the Islamic religion, which creates limitations to taking home care by an opposite-sex nurse. So, localization based on these differences needs the top manager facilitator role for adequate home care services. Using the evidence-based method, the present study describes these people’s experiences and reveals the need to expand these services in Iran.

One of the findings of the present study was the “Inability to receive long-term care” and “Delay in receiving care,” both of which are related to “Inadequate services” in this area of the nursing profession in Iran. Human resource issues are among the subcategories obtained in Lotfi Fatemi et al.’s study on home care in Iran. They stated that home care managers believe home care is not permanent in Iran for various reasons, and retaining nurses’ interests in this field is complicated. Therefore, recruiting and retaining nurses for the long term is a significant challenge [ 21 ].

Considering the advances in designing systems and medical information record systems, the use of technology in identifying and recording patient information and home care nurses should be approved and qualified. It should replace paper-based records and traditional methods. Plans have also been proposed to add home care nurse information to the EHR [ 28 ].

The findings of this research can help to understand the opinions and expectations of the beneficiaries of nursing care at home in the religious and Iranian cultural context. Also, these findings can help develop the infrastructure and solve the challenges of home care by presenting the participants’ experiences.

Study limitations

This is the first study on the experiences of COVID-19 patients receiving home care in Semnan, Iran. Some other aspects of these patients’ experiences with different contexts are unexplored and need further studies. To increase the credibility of the data, efforts were made to interview participants who received care from other nurses and had different economic, cultural, and social backgrounds. Additionally, some patients were elderly and unable to speak or were deceased at the time of the study, and as a result, interviews were conducted with their closest relatives. Since some of the recipients of nursing care at home were not able to express their experiences accurately due to reasons such as speech impairments or old age, or some of them had died, one of their close family members was involved in the research to express their experiences.

This study revealed that patients with COVID-19 who received professional nursing care at home had emphasized positive aspects and the comprehensiveness of nursing care provided at home. But also, they mentioned some challenges, such as the caregiver not being of the same sex as the patient, delay in receiving the service, the inadequacy of the centers, the limitation of the right to choose the care provider, and insufficient information about the cost of services received before receiving each care.

Data availability

The data that support the findings of this study are available from the corresponding upon reasonable request.

Abbreviations

Corona Virus Disease

Electronic Health Record

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Acknowledgements

The authors are thankful to the Vice Chancellor for Research of Semnan University of Medical Sciences, the managers of nursing home care centers of Semnan and the participants who shared their valuable experiences.

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Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran

Nayyereh Raiesdana & Monir Nobahar

Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran

Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

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Contributions

M.Sh. and N.R. contributed to the first conception and design of this research; M.Sh. contributed to collect data; M.Sh., NR and M.N. contributed to the data analysis; M.Sh., N.R. and M.N. wrote the manuscript. All authors reviewed the manuscript meticulously and approved it. All names of the authors were listed in the title page.Correspondence to Nayyereh Raiesdana.

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Correspondence to Nayyereh Raiesdana .

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This article is the result of research approved by the Ethics Committee of Semnan University of Medical Sciences with the ethics code of IR.SEMUMS.REC.1401.039. The authors confirmed that all methods were performed according to the relevant guidelines and regulations. All participants accepted the participation in the present study. The researchers introduced themselves to the research units, explained the research purpose, and then all participants signed the written informed consent. The research units were assured that the collected information was anonymous. The participant was informed that participating in the study was completely voluntary so that they could safely withdraw from the study at any time and that the results would be available upon their request.

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Shayestefar, M., Raiesdana, N. & Nobahar, M. The experiences of patients with COVID-19 and their relatives from receiving professional home care nursing: a qualitative content analysis. BMC Nurs 23 , 352 (2024). https://doi.org/10.1186/s12912-024-02021-9

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University teachers’ perspectives on student attendance: a challenge to the identity of university teachers before, during and after Covid-19

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• Mateus Detoni 1 ,
• Arlene Allan 2 ,
• Sean Connelly 3 ,
• Tina Summerfield 4 ,
• Sheena Townsend 5 &
• Kerry Shephard   ORCID: orcid.org/0000-0002-4139-5112 6  

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This article addresses university teachers’ perspectives, gathered via interviews, on issues involved in their students’ decreasing attendance in formal taught-events, before and during the pandemic, and the implications of this for university teaching in the future. The research was part of a broad enquiry into learning and teaching during the Covid-19 pandemic, conducted in one research-led university in New Zealand by a research team of 19 university academics from multiple departments in this institution. We undertook 11 semi-structured interviews with eight professors, one lecturer and two teaching fellows, anonymous to all but the interviewer. A sub-group (authors of this article) used a general inductive approach to seek an underlying structure of experiences evident in participants’ interviews, in the form of emergent and reoccurring themes in the data. Self-determination theory was used as a theoretical framework for analysis. Themes suggest that university teachers may be stressed about attendance, increasingly uncertain about the links between how they teach and what and how students learn, and feel personally rather than collectively responsible as they address matters that they perceive to be only partially under their control. Researchers concluded that interviewed teachers may be collectively experiencing some form of crisis of confidence relating to their roles, responsibilities and identity as university teachers. Although perceptions of limited autonomy, relatedness and competence all suggest solutions at the institutional level, their combination and link to generic academic identity suggests that Covid-19 may have exposed broader limitations in university teaching as a collegiate, rather than professional, activity.

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1 Introduction

Lack of student attendance in formal higher-education activities, such as lectures, has increasingly been identified as problematic in many parts of the world. Substantial international research has been conducted on the issues involved and multiple explanations and solutions have been proposed (Bukoye & Shegunshi, 2016 ; Sloane et al., 2020 ). The bulk of this international research focuses on students’ motivation, reasons for non-attendance, and proposals for teachers to change their teaching practices to motivate, encourage or require attendance. Relatively little international research has addressed university teachers’ perspectives on student attendance. In New Zealand, traditionally attendance at university lectures has not been compulsory, other than in some professional programmes. Naturally attendance at formal education events, on its own, is hardly satisfactory for those university teachers who design participation and engagement into their teaching activities, but without attendance, these educationally important contributions to learning are not possible in this particular physical and temporal space.

Covid-19 brought the issue into focus. Face-to face teaching was substantially replaced in 2020 by teaching online (or for many, emergency remote teaching, Hodges et al., 2020 ). Perhaps those teachers who have traditionally taught asynchronously at a distance fared well but for many, for whom distance teaching has not been a priority, the pandemic created challenges. Many university teachers had to take their conventional courses designed for face-to-face teaching and rapidly transfer them to an online environment. Lectures, tutorials and practical classes occurred via videoconference systems, field trips became virtual, and the experiences for teachers and students dramatically changed. Internationally, many university teachers experienced precipitous declines in both attendance and engagement, especially on Zoom and for large groups (see for example, Doran, 2021 ). Empty seats in lecture theatres were replaced by student absences on Zoom, and the black screens that result from cameras being turned off were hardly encouraging for university teachers who hoped for synchronous interactions with their students. Recent research on the impacts of Covid-19 on university teaching and learning has been reviewed by Pokhrel and Chhetri ( 2021 ) and many individual studies have researched impacts in particular institutions or in particular disciplinary contexts (see as examples, Pather et al., 2020 ; Crawford et al., 2020 ). New Zealand's response to Covid-19 was particularly fractured, as the country experienced periods of Covid-19-caused disruption that resulted in shifting back and forth between in-person and online teaching, as the country attempted to eliminate each wave of the virus. Although a great deal of educational research is currently underway internationally related to the aftermath of Covid-19, there is a danger that Covid-19 will be seen as a bounded event, rather than as something that highlights an issue that was there before and may remain after.

In New Zealand, university teachers often identify themselves as 'lecturers'. It seems intuitive that lecturing to students who are not there, or there in greatly reduced numbers, will impact on how university teachers conceptualise their identity, and perhaps have an impact on the confidence that they have in their identity as 'lecturers'. Although research has explored student motivation to attend and the interventions academics can make to address attendance issues, less research has explored how shifting classroom dynamics affect academic identity. There is a strong interplay between professional roles and professional identity, and a developing discourse in the educational literature on this theme (Archer, 2008 ; Fitzmaurice, 2013 ; van Lankveld et al., 2017 ; Watson, 2006 ) suggesting that who we think we are influences what we do, and that people also become what they are because of what they do and what they experience whilst doing it. " The relationship is thus complex, reciprocal, unfixed and open to change.” (Watson, 510). McCune, exploring how university teachers sustain identities that encompass deep care for teaching in research-led universities, suggested that " maintaining engagement with teaching in contemporary higher education is likely to involve identity struggles requiring considerable cognitive and emotional energy on the part of academics … " (McCune, 2021 ). McCune's study identified considerable tensions as academics endeavoured to undertake their diverse academic roles. Participants in that research " often described considerable stress and talked about putting a lot of thought and effort into understanding and working with these tensions (29)". McCune went on to suggest institutional policies and reflexive processes that would be required to address these identity struggles, but notably that study did not address attendance issues.

Self-determination theory (SDT, Ryan & Deci, 2000 ) is, in essence, a theory about motivation. It developed in 1970s and 80 s as an alternative to existing dominant theories of motivation that focused on rewarding appropriate behaviours. SDT suggests that individuals in a range of contexts require three basic psychological needs to cope with stress, and to maintain resilience, individual empowerment and well-being. Individuals need to feel competent to undertake the tasks before them; they need to feel in control and have some autonomy in deciding how to undertake the task; and they benefit from being socially included with others undertaking similar tasks. SDT has been applied effectively in a wide range of employment-related and educational settings over several decades, in particular in situations that prioritise intrinsic motivation. SDT has proved particularly helpful in understanding factors that contribute to well-being (Hobson & Maxwell, 2017 ) and how individuals cope with stressful work-related situations (Weinstein & Ryan, 2011 ). Strong links between intrinsic motivation, coping and feelings of well-being have supported the applicability of SDT in a range of contexts. It is widely appreciated, for example, that support for employees’ basic psychological needs for autonomy, competence, and relatedness leads to higher levels of individual empowerment and well-being (Rigby & Ryan, 2018 ). Metanalysis of research also suggests that supporting leaders to address the autonomy of employees also contributes to work motivation (Slemp et al., 2018 ). SDT has been used in higher educational settings. SDT has been used, for example, to analyse students’ motivation to learn (Fabriz et al., 2021 ). The core components of self-determination (autonomy, competence and relatedness) were found to be statistically related with university teachers’ identification with all three professional roles (researcher, teacher and practitioner) as well as with overall professional identity (Kovalcikiene et al., 2019 ). SDT has great potential for developing understanding of the identity struggles of university teachers and provides the analytical framework used in this article.

The events of 2020 and 2021 have raised the prospect that what we did before the pandemic, while perhaps better than what we were doing during the pandemic, is not necessarily a guide for what we should seek to achieve in the future. The research described in this article, in this forward-looking context, was part of a broad enquiry into learning and teaching in the context of the Covid-19 pandemic, conducted in one research-led university in New Zealand, by a research team of university academics from multiple divisions and departments. This particular article addresses university teachers’ perspectives, gathered via interviews, on the issues involved in their students’ decreasing attendance in formal taught-events, and the consequences of this change on their roles and identity as teachers. SDT was used to interpret our findings and relate them to broader enquiries about academic identity and declining attendance at lectures.

Our research team included 18 university teachers (faculty), representing 15 different academic departments in the same research-led university, and one research assistant, working together as a professional learning community (PLC). The research team obtained institutional ethical approval for this research which emphasised the anonymity of interviewees to all but the interviewer, and the voluntary nature of participation. The research team considered that the issues being addressed were highly sensitive to university teachers so emphasised the importance of communicating and preserving the anonymity of participants as far as practicable in the research design. Interviewees were recruited by a purposeful sampling approach (Palinkas et al., 2015 ). Members of the research team identified individuals in their own departments who they thought would have diverse but insightful views on student attendance and on students’ motivation to learn, and passed their name onto the PI who invited them to contact our research assistant if they wished to be involved. It is important to note the highly subjective nature of individual team member’s conception of diverse and insightful, but every attempt was made to include those who regularly talked about their teaching in departmental settings and those who did not, and those recognised for using novel teaching approaches and those not recognised in this way. Some interviewees suggested the names of other faculty who might be interested in participating. The PI invited them to contact the research assistant if they wished to be involved. In line with our anonymity obligations, only the research assistant knew the identity of interviewees (each of whom was allocated a number that appears after quotations in the text below).

A sub-group of the research team developed a draft set of semi-structured questions about teachers' perspectives on their students’ attendance, on their students’ motivation to learn, and on their students’ learning success in the context of their own teaching experience, and these questions were discussed, edited and confirmed at research-team meetings and via email within the research team. Interviews were designed to open lines of enquiry and made use of prompting or contextualising questions where appropriate, but always allowed the interviewer to follow directions preferred by the interviewee. Interviews were audio-recorded. Interviewees were assured that they could withdraw from the process at any time, ask for a copy of the interview notes, audio recording or interview report, and ask for their contribution to be modified if it was not what they intended. The interview always started with two very open questions (What do you consider to be a good student? What do you consider to be a good lecturer/teacher?).

Guided by Thomas’ general inductive approach (Thomas, 2006 ), researchers sought to develop a summary of qualitative data to establish possible links to our research objectives and to enable the creation of a model or theory about the underlying structure of experiences evident in participants’ interviews, in the form of emergent and reoccurring themes in the data. To maintain the anonymity of the interviewees as far as practicable, the research assistant did not simply produce a transcript from the interview audio-recordings to be passed onto the other members of the research subgroup, but produced a written report of each interview, removing identifying features (such as department, discipline, and details of novel teaching approaches) and informally coded the key responses to lines of questioning to broad topics that developed in each interview (such as interviewees’ experiences of variations in attendance patterns, motivation to learn, and students success; and interviewees’ personal perceptions about cause and effect relationships in the broad contexts of teaching and learning). A sub-group of the research team (authors of this article; the PI, four other researchers and the research assistant) worked with these reports, initially as individuals and then in two extended meetings, to identify, discuss, agree and describe emergent and reoccurring themes, and to progressively reduce these to a number of themes with which all agreed. In the second extended meeting, the research subgroup agreed that SDT provided a suitable analytical framework within which emergent and reoccurring themes could be articulated. There followed an iterative process where the research assistant returned to the recordings to source quotations to illustrate these themes, and the themes themselves were redefined collaboratively by the research subgroup to match the precision provided by quotations.

It is to be emphasised that ours is qualitative research with limited aspirations for generalisability across institutions or nations. Our research design sought only inciteful observations within this field of enquiry that make a helpful contribution to this discourse. Within these limits is important to address the robustness, or trustworthiness, of our findings. With reference to Thomas’s theme of assessing the trustworthiness of analysis, and to Lincoln and Guba’s ( 1985 ) four general types of trustworthiness in qualitative research, it is hoped that the credibility, transferability, dependability and confirmability of this analysis would be reasonable, given the anonymous and voluntary nature of participation and the emphasis on ‘self’ in the interviews. Notably, and in common with other qualitative research, the researchers inevitably were influenced by their own experiences and personal views on attendance, motivation and learning during this analysis. In addition, purposeful sampling and the voluntary mature of participation, has likely limited the range of interviewees to those with a strong interest in teaching and respect for research into teaching. Similarly, although researchers recognised the sensitivity of the matters being considered here to the interviewees, and the importance of anonymity, researchers accept that the extent to which interviewees were indeed anonymous is limited. They were not anonymous to the research assistant, and as all had been invited to participate by the PI, one member of the team knew who they might be. Approximately 10 per cent of those invited chose to participate. Nevertheless, and in line with Thomas’s advice, the credibility and transferability of the dominant themes to arise from the analysis were explored using ‘peer-debriefing’ which involved ongoing discussions within our research sub-group, in two wider-team meetings, and more widely within the university during two open meetings involving approximately 50 university teachers altogether. Dependability of the analysis was explored, to a degree, by comparison with international literature within this article. Confirmability, in particular, has not been explored in detail but may come later, as others work with, and within, similar groups of university teachers.

We interviewed eleven academics from multiple academic divisions at a New Zealand University. Eight were professors, one was a lecturer, and two were teaching fellows. Individual reports from these interviews provided a rich source of data. Although each report included its own unique stance on our questions of interest, we considered the collection to be sufficiently congruent to be analysed together. Many themes within these reports were evident to the research sub-group. The research sub-group interactively and progressively re-interpreted and amalgamated these themes into emergent and reoccurring themes that together represented novel reinterpretations of our questions of interest and of all eleven interview reports. Our analysis yielded one overriding contextual theme and three emergent and reoccurring themes, that together suggested to the research sub-group that the interviewed teachers were collectively experiencing some form of crisis of confidence relating to their roles, responsibilities and identity as university teachers. Our themes are described below and illustrated with quotations from our anonymised reports. Some words or phrases have been replaced by #### to preserve anonymity.

4 A collective angst about attendance

Superimposed on all of our data was a strong sense that, for a range of different reasons and as described by interviewees in a variety of ways, student attendance in taught sessions was important to university teachers, that attendance was declining, and that lack of attendance contributed to a collective angst for participants in this research. The following quotations focus on this combination of lack of attendance and concern;

“Undergraduate [attendance]… it used to be about seventy percent, now it’s highly variable. … It varies, but undergraduates… far lower than I have ever seen before in forty years of lecturing … I feel that I have failed in my job, if the students aren’t learning or motivated in any way." (6) “ … I got concerned years ago about this inexplicable absence of students from the class, and I couldn’t work out why. And I asked them “Why didn’t you come?” [8]

The extent of angst, focused on the circumstances within which low attendance manifested and impacted, is also evident in many of the quotations used below to illustrate emergent and reoccurring themes.

5 Three emergent and reoccurring themes

Integrated within this general feeling of concern, three broad emergent themes were reoccurring in our data: teachers questioning links between inputs into higher education and outcomes or outputs from higher education; teachers feeling personally responsible for responding to attendance-related changes in higher education but inadequately supported by collective responsibility to do so; and teachers expressing concern about what they can and cannot control as they teach.

5.1 University teachers questioning the links between higher education inputs and outcomes

Interviewees expressed strong interest in their own perceptions of their competence as teachers. Some interviewees emphasised that despite uncertainly about their own competence to be a university teacher, they nevertheless had developed personal commitment to support learning and particular pedagogical approaches to encourage attendance;

“I feel responsible to help students who want to learn. But, for whatever reason they are here, for whatever reason they are motivated to take this course, whatever biases they have, I am not skilled enough to change that. So I will help where needed ... But I won’t coerce them, force them, because that is not how it is going to work. … What I tend to do is: in one paper, I give them a problem to solve in their assessment, and each lecture, or each lab, has something in it that can help them solve that problem. Now, they may not pick it up that instantly, but somebody in their close group may. You set a little encouragement, a little bit of scaffolding, a little bit [of] pushing …, attendance and assessment tend to go very closely in hand, because we’re talking some recent advanced features and I find it very hard for them to think that they can self-teach.” (2)

Some expressed strong viewpoints about using ‘incentives’ to encourage attendance, with particular views on the professionalism of some behaviours (the practice of providing edible rewards, such as chocolate fish, to encourage student participation is encountered in this institution and may even be widespread) and on indicators of teaching quality. Participant 11 and 7 both express concern about some teachers' use of incentives. Participant 11 questions the use of attendance figures as indicator of teaching quality. Participant 7 expresses concerns about differences between those who do attend, and those who do not;

“I know other people try incentives, which would be having lollies, and I just… it’s a University, and I’m not into that kind of thing. And I am not being mean to people who do those sorts of things. And I know there [are] other people that really vow that attendance was a mark of their success. I’ve never really felt that. As I said, when anyone came to my lectures, my concern was about them and their ####. I wasn’t really bothered about how that reflected on me. But I know that other people have tried ploys, but that’s not me, sorry.” (11) “You can do things that the students go, ‘Wow, that is a great lecture!’, but the problem is that you are preaching to the converted, to the students that are there, right? … You can say things, sort of bribe them… but I mean, all of that seems kind of cheap to me. I kind of think these are grown-ups, right?” (7)

Others emphasised that what might have been reasonable to incentivise attendance in the past, may no longer be reasonable in their particular circumstances, emphasising that perceptions of being competent to teach may be changing;

“It seems a bit ‘gamesy’, but … it was only worth ten percent, but it was a ten minute test when they came in, and anyway what was happening is that students went waddling in about ten minutes after class [started], and all the [students] were trying to do the exam … and so I made a rule, and I was very clear, it was advertised widely. And I said: ‘You need to be in before the class [starts] at two o’ clock. The doors will be locked between two and ten past two, and we will do the test. At ten past two, the teaching session will start. If you are not in the class by two o’clock, then you don’t get to do the test.’ And I only needed to do that once, and I remember the guy looking over the window when he came in five past [two]. And all the other students thanked me, because they were actually sick of having people rock in at five minutes after the test, and nobody did anything. And I know that sounds ridiculous, and I couldn’t do it now.” (11)

Others stressed the complexity of their role and uncertainty about how their approaches to encourage attendance reflect competence in teaching, or something else (in the case of participant 8, authority to make successful outcomes contingent on attendance);

“I thought “What could I do? [to solve declining attendance issues]”, and checked with my other colleagues; ... I asked all of the lecturers to devise a key lecture point that was the thing that they were talking about that related back to the aim of the course, and I ask them would they please ask the students that [how does the key point relate to the course’s aim], while they are in class, and then give them a mark for answering it. I suppose I kind of gamed it, in a sense that I am marking for attendance, but I am actually trying to do some useful things, I think … get everybody to get in the same storyline, at least one coherent thread to why they [the key lecture points] are all appearing one after the other… for the students, I thought it was really helpful for them to learn something in real time, instead of just sitting here without thinking.”(8)

At least one participant described the use of a particular tool to understand links between teachers’ competence to teach and the learning success of their students;

“They [the University] used to produce these graphs on how your students did in your paper versus every other paper they took in the University ... You could see within any particular student whether they did well in any other papers, but did badly in your paper, for example ... So, when I first came here … from overseas, from an institution that very much did not give any guidance to students, and I carried on my practice in my first year here, and I got one of these reports … that demonstrated that my students did relatively poorly in my course ... And basically, the message that I received from that was not that my course was harder; the message that I received from that, I wasn’t enabling them to be successful. So I think that that was good, and it was good that it came out so soon in my role here …. It made me see that, actually, what you do as their teacher has a huge impact on whether the students achieve success. And that it is really important to be aware of the things that are enabling success or inhibiting success in your class … .”(3)

Participant 3 was reflecting on how the institutional Grades Comparison Report, previously available in this institution but no longer so, supported teacher competence which was more limited without it.

Implicit within these interview records was a broadly-based suggestion that much within their teaching roles was poorly or insufficiently theorised, to the extent that it was simply impossible to assume causative links between: how teachers teach, and how student learn; between student attendance and student performance; between the grades that students earn and their likelihood of getting degree-related employment, and even at the level of the operation of higher education and the needs of society. Importantly, there was an overall sense that these links were somehow clearer in the past than they are at present, and that the challenges that university teachers face in understanding the pedagogical circumstances that they find themselves confronting nowadays are greater than in the past. Analysis of this theme can be greatly assisted by the application of SDT, in that much of the concern expressed relates to participant’s perception of their own competence, or sense of efficacy, to teach in the circumstances available to them.

5.2 Feelings of personal responsibility, inadequately supported by collective responsibility

Although ostensibly part of wider academic communities in their own department, the institution or the profession of higher-education teaching, interviewees described, to various degrees, the challenges involved in making a personal response to low attendance, lack of departmental or institutional commitment to the changes that they were personally making and the weight of personal responsibility in the context of teaching. This theme relates strongly to broad perceptions of social inclusion and relatedness and therefore to a core element of SDT.

At one end of the range of perceptions of individual responsibility were teachers who expressed a sincere personal commitment to supporting student learning with particular responses to student needs, in the context of attendance;

"There was a whole variety of reasons [why students did not attend] … , so it’s definitely a complicated thing, that behaviour … So then I thought, well, “Do I want them to come?”. And I thought “I do”, because I really like to engage with other people in the class, I go through a lot of effort to making it accessible.” (8)

Some extended this analysis to identify a sense of personal responsibility to, for example, motivate students to be interested in what they were teaching, even in the most challenging of circumstances (in the case of participant 6, acknowledgment that students nowadays are working to earn money at the same time as being enrolled in full-time study);

“I am increasingly aware, I have come aware over the many, many years, students have a much harder time now. They have many, many distractions, they have many personal and family commitments that can interact, and I cannot do anything about that … And they need to make money. Students are absolutely working. So of course, they come in and they are tired, they do all these things… so yeah, I feel responsible … To motivate them to be interested in what it is that I am doing. The learning, a lot of it is self-directed. But if you get the interest, then the motivation to learning comes with it.” (6)

While for some this sense of responsibility had escalated into disappointment in their own ability to address students’ needs;

"... I guess I'm disappointed if the students that I've been mentoring sort of one-on-one [don’t] achieve as well as I think they should, or if they come see you all the semester, and they come to you [to] ask questions at the end of the semester and that's really basic knowledge. 'We've worked on this before, I thought you've understood this'. Like, that does disappoint me - not the student disappointing me, but somehow that we haven't made that connection, and they haven't quite grasped that concept. So ... yeah, it does disappoint me, I guess. Not so much the student, just that we quite didn't make that connection, there is some sort of gap that I haven't been able to communicate effectively to that student. So I am sort of more disappointed at myself more than the student, I guess."(4)

At the centre of these personal analyses of the circumstances in which interviewees understood their responsibility was a sense in which their personal commitment to teaching was not matched by a supportive institutional commitment;

"I think the University... although it does talk a bit about how teaching is important, it's still doesn't really, I think, it still has not really recognized teaching as valuable within the constructs of the University. It tends to focus on research more. … I think that teaching is sort of under-recognized."(8)

Participant 9 compared perceptions of current support with those experienced elsewhere and in the past, emphasising how easy it is for teachers to "fall through the cracks";

“You know, I went to a liberal arts college in America, there’s a lot of hands-on stuff. We’d meet with an advisor, every couple of weeks, or once a month. There’s none of that here. It’s just – you could fall through the cracks, so easily. So adding a little bit more of that, I think it could with attendance, it could help with mental health – with the performance of our students, all of it, you know. (9)

Perhaps ironically, Participant 1 emphasised how important a sense of belonging is to students;

And a sense of belonging. I mean, there’s more to University life and to student academic [life]. I think that sitting there amongst other people, maybe you might land up talking to somebody and meeting somebody else and get a sense that you are not the only one struggling with that content, or might help at least form some relationships when you go to the tutorials, you are not feeling out of sync.” (1)

Overall, this theme emphasises profound limits to the extent to which interviewees felt socially included in a community of university teachers. A sense of isolation was palpable in many of these interviews.

5.3 Concerns about what they can and cannot control and about who does have control

Interviewees expressed strong viewpoints about distinguishing between those areas of their work over which they have autonomy and those areas they do not.

Some interviewees in some circumstances clearly did feel in control, and used this to support student learning as they thought best;

“… I enjoy it when I hear back from them [the students] as I am teaching and then I change what I am doing so it’s more accessible to them. Some years the course goes one way because the audience’s students' interest in that direction for the year; and another version of the course goes another way, even though the core content is the same, but that is because they were interested in this thing.” (8)

Some accepted that aspects of their teaching could not be in their control, but that this was inevitable and simply part of the job;

“I think it gets harder as you get older, because I think the students are much further removed from your age, and are less likely to feel that they can talk to you. And even having a title like ‘Professor’ is extremely off-putting, I think. But making sure, nevertheless, that you try … and that you are available … and if they [the students] have any query about anything that is going in class …or if what I am saying lacks clarity to them, they should feel free to come to me with those kind of things so that I can tailor them accordingly to the situation.” (3)

But others commented on the size of their class, or the circumstances in which their teaching reached their students. Participant 7 taught to groups of students too large to fit in one room, so many attended in one or more additional rooms to watch and listen to a live transmission of the lecture. Participant 6 does not teach students for a complete semester, so doesn’t manage to build relationships with students. These features are not controlled by the teachers themselves.

“For one of the papers … the lecture is piped through to other lecture theatres, and I have no idea how many people are there.”(7) “Undergraduate [attendance] is much, much harder, because often it is modular. I come in for three, four weeks at a time, I don’t get to know the class. It’s harder to do the group work, and the interactive [elements of teaching]. And I’ve angsted about this for many years, because you keep being told to do it.” (6)

Or on the high diversity of learners with resulting uncertainly about how well-prepared all of the students could be for their teaching, in the context of attendance and student motivation to learn;

“ So our students; some have got degrees, some have got [to university] just straight from school, some [have] got English language shortfalls… so they are basically scaling up before they hit first year. And so, there is a lot of different motivations. My approach is, if you can’t attend our small classes, if you haven’t got the motivation, that is probably a good idea to have a ‘plan B’ ... I have split motivations: yes to chase them up, two, I am not their mother.” (2)

Or on the way that the institution evaluates the quality of teachers’ work, and the impacts that this has on teachers’ behaviour. Participant 3 expresses doubts about the way that the institution judges their teaching quality and comments on the extent to which such processes constrain their attempts to be autonomous as they develop their teaching.

“I don’t even do student evaluations based on the standard … [institutional] evaluation form anymore ... I think it is based on teacher performance rather than student learning outcomes, and I don’t agree with it at all … It is not about my performance. Because if I am achieving my student learning outcomes, the performance is kind of irrelevant … In that way, the University does constrain lecturers. And I do remember being told, when I first arrived here, ‘Don’t do an evaluation on your first couple of years, because they’ll be rubbish and you don’t want that on your record.’ And then it was ‘Don’t do anything interesting in lectures, or try anything novel, or at all challenging for students in years that you are trying for promotion, because you will get bad evaluations in the … [institutional] evaluation form’. So that’s constraining, right? And I have that been told to me by senior colleagues, as a junior colleague, that is constraining, right? You don’t want to try anything new.” (3)

The autonomy of university teachers to teach in the way that they might like to is clearly a significant theme in this research. In some cases, individual autonomy appears to be severely constrained. Accordingly, analysis of participants’ contributions to this theme can be significantly supported by the application of SDT.

6 Peer debriefing

Peer-debriefing in discussions within our research sub-group, in two team meetings, and more widely within the university, produced a strong endorsement from university teachers that the themes to emerge from this research were highly representative of widely held perspectives amongst university teachers, within our own institution and within our own international networks. One member of the wider research team remarked “This provides a framework for me to understand how I feel but had not been able to put into words”. Not all those consulted identified with all of the emergent themes as described. For example, one team member did not doubt their understanding of the nature of teaching at present but had substantial doubts about their ability to cope in the future, mindful that the circumstances identified by the interviewees in this research, and discussed by the wider research team, appear to all to be escalating.

7 Discussion

Collectively our overarching university teachers’ theme of angst and our three emergent and recurring themes of unsupported personal responsibility, lack of personal control and concerns about uncertain links between their own inputs and student outcomes, paint a picture of a group of university teachers experiencing a crisis of confidence about their identity as university teachers. That is not to say that all participants in our research are personally exhibiting symptoms of crisis. Indeed, some have clearly developed strategies that have enabled them to maintain levels of student attendance that they consider reasonable, or personal rationalisations for why high levels of attendance are not important to them. And notably, some feel obliged to adapt their teaching to what the situation requires and not necessarily in line with what they think good teachers ought to do. But our analysis does suggest an underlying structure of experience is evident in the data suggesting that this group of academic colleagues are stressed, concerned about the extent to which they personally understand the nature of university teaching nowadays, and feeling personally responsible as they address matters that they perceive to be only partially under their control, all in the context of concern about declining attendance at formal teaching events such as lectures.

It is clear that Covid-19 is not to blame for all of this, although it has brought these things to a head. The issues raised within this research have been with us for a long time. For many years universities around the world have been reporting declining attendance by students at lectures (Doran, 2021 ; Massingham & Herrington, 2006 ). A wide range of causes have been proposed including changing student lifestyles (Massingham & Herrington, 2006 , as students increasingly work to pay tuition fees and living costs, and as nations increasingly identify university learning as a personal, rather than societal-gain), and failure of institutions to address students’ expectations of technologically-enhanced teaching processes and alternative availability of ‘content’, in conjunction with a perception by students that lectures focus on ‘delivering content’(Billings‐Gagliardi & Mazor, 2007 ). That university teachers somehow control access to the knowledge required to pass examinations, other than via curriculum design, should have been discounted by the wide acceptance of outcome-oriented education, including pre-identified intended learning outcomes, constructive alignment and student-centredness (Biggs, 1999 ; O’Neill & McMahon, 2005 ). Increasingly students have alternatives to attending lectures to gather ‘content’ and to learn more broadly, including lecture recordings, and increasingly students are using these (Luttenberger et al., 2018 ). Whether or not university teachers, in general, have actually adapted to these changes is an important corollary to these long-term interests.

And then Covid-19 arrived. Within a matter of days in early 2020, lectures, internationally, went from largely face-to-face social activities to become essentially solitary and online. Students initially attended via Zoom but as the weeks progressed their participation, internationally, generally decreased, either literally, or by virtue of having their cameras turned off (García-Morales et al., 2021 ; Skulmowski & Rey, 2020 ). Our PLC conversations and peer-debriefing confirmed that university teachers’ concerns about personal competence, personal responsibility and lack of control over the circumstances of their teaching roles generally escalated in this period, bringing concerns about student attendance and engagement into sharp focus.

The changing nature of university teaching has also been debated, or even contested, for many years. Whether university teaching is itself a profession or a professional element of the broader profession of academic scholarship has not yet been categorically determined. Boyer, for example, identified four scholarships for university academics to address (Boyer, 1990 ; discovery, engagement, integration as well as the scholarship of teaching and learning), but emphasised that not all academics would necessarily include all four in their own professional portfolio. And professional recognition (for example, via Advance HE’s Professional Standards Framework https://www.advance-he.ac.uk/guidance/teaching-and-learning/ukpsf ) for teaching remains optional for many university teachers. With contestation about the professionalism of university teaching comes debate about the knowledge, skills and values inherent to university teaching and about the need for university teachers to update themselves on advances in university teaching, as they likely would within their own research areas.

While some elements of our understanding of the relationship between how we teach and how students learn have been established for many years (see for example, Trigwell et al., 1999 on being teacher-centred, student-centred and anticipation of deep or surface approaches to learning; and Stegers‐Jager et al. ( 2012 ), np, on the importance of addressing students’ “awareness and critical analysis of their own thought processes and cognitive ability”, or metacognition; see also Young & Fry ( 2008 ), others have been unfolding in recent years and are highly relevant to the challenging nature of university teaching in the 2020s. Much with relevance to attendance relates to our increasing understanding of student behaviour in relation to the practices of university teachers. Sloan et al., ( 2020 ), for example, researched how course-design and assessment-structures play a part in determining student engagement in formal teaching sessions. They made suggestions about how teaching approaches could fit student learning-expectations. Other researchers have used expectancy-value theory to suggest that, in effect, students balance costs (in terms of hours and effort) with anticipated gains to make sound cost/benefit analyses of whether to attend lectures or not (see for example, Dietrich et al., 2019 ) and whether to complete study programmes (Perez et al., 2019 ). Sun and Richardson ( 2016 ) developed a general theoretical model linking students’ demographic characteristics, perceptions, and study behaviour with measures of outcome, to explore causal relationship between students’ perceptions and their study behaviour. Clearly the academic field of learning and teaching in higher education, or the scholarship of teaching and learning (SoTL), is making progress in developing an integrated knowledge base about how higher education teaching works. Research has also been instrumental in determining what we do not know about relationships between how we teach and how students learn, and in identifying areas that perhaps we thought we understood, but probably do not. Links between attendance and performance remain highly contested, for example. One study, in relatively-controlled circumstances, suggest that an increase in 1% in attendance results in an increase of only 0.05–0.13% in grades (Rodgers, 2001 ). The relationship was significant and positive, but the low effect size and challenges in controlling the circumstances draw into doubt the scale of the relationship. Causal links are far from clear.

Given such a complex and contested field of expertise as university teaching, it is hardly surprising that university academics wonder about their own contribution to the links that we assume exist between higher education inputs and higher education outcomes, and about their identity as academics, university teachers or 'lecturers'. It would be irrational not to question personal competencies in such fluid circumstances. That university teachers feel a weight of personal responsibility as they teach should not be surprising either. Research-led institutions internationally are often characterised as prioritising research over teaching but the relationship between each is far from simple and has significant impact on academic identity (McCune, 2021 ; Nixon, 2020 ; van Lankveld et al., 2017 ). Teaching in research-led institutions nowadays requires academics to be highly competent both at research and teaching. New Zealand’s peak body for its university sector, for example, emphasises the need for even competent researchers to be trained and supported to become good teachers; “ …universities do not believe that being a good researcher will automatically make an academic a good teacher. Universities know that teaching is a skill that requires development and that, even with training and support, not every researcher can become a competent teacher. However, universities also believe that an academic cannot be a good teacher of higher-level degrees unless they are also a competent researcher.” (Universities NZ – Te Pōkai Tara, 2017 , np). And most university teachers lecture alone, even if many collaborate in delivering papers and programmes. Perhaps academic groups used to be collegiate communities, but even basic facilities to support conversations, such as tea rooms, have declined in recent decades (Wright & Ville, 2018 ). Where it is present, collegial support for teaching can be important for developing teaching identities (van Lankveld et al., 2017 ) but academic groups are not always supportive of individuals within them in the context of teaching (McCune, 2021 ). There are well-established links between lack of collegiality in academic groups and individual stress (Hatfield, 2006 ). Stress is also a product of lack of autonomy or sense of personal control in many situations (Muraven, Rosman & Gagné, 2007 ). While many factors can contribute to institutional judgments about the quality of teaching (Smith, 2008 ) increasingly in many countries student feedback is paramount in determining tenure and promotion with respect to teaching (Goos & Salomons, 2017 ). University teachers can have a range of emotional responses to student feedback, but often these are significant and stressful (Lutovac et al., 2017 ) and remedies to poor feedback are only partly under the teacher’s own control. Students’ prior learning and preparedness for particular studies is important, but problematic for many university teachers (Bettinger & Terry-Long, 2008 ). Class size is likely to be an important factor in meeting student expectations for some university teachers, particularly those involved in teaching large groups (Ake-Little, von der Embse & Dawson, 2020 ). The circumstances in which teaching occurs is also significantly related to quality perceptions of both teachers and students. For example, synchronous hybrid teaching (with simultaneous face-to face and distance students via videoconferencing), while new and exciting for some, can be stressful for all involved and not entirely satisfactory for anyone (see for example, Raes et al., 2020 ).

We are not aware of SDT being used to explore the circumstances in which university teachers are attempting to address the changing study habits and expectations of university students, but it appears to have great utility in analysing the underlying structure of experience evident in the data collected in this research. Our underlying structure of experience highlighted a range of coping strategies but also tensions similar to those described by McCune ( 2021 ) as " identity struggles requiring considerable cognitive and emotional energy on the part of academics (30)” and a range of constructs that should help us better understand these tensions, and to research them in the future. Using SDT to support the analysis of the findings in this research also links to discourses on how to improve intrinsic motivation and wellbeing, as often research informed by SDT has these objectives in mind.

University teachers may lack confidence that their knowledge about teaching, and skills to teach, are sufficient to address long-term declines in student attendance in their lectures. In educational contexts there are strong links between teachers' perceptions of efficacy as teachers and their students' perception of efficacy as learners that have implications for student learning and for student motivation to learn (Chiu et al., 2021 ). A range of approaches have been researched, including a model of pedagogical design thinking for professional development programmes for teachers. University teachers may experience limited autonomy in an educational system where designation of quality is primarily the prerogative of students, rather than teachers, and where the design of teaching situations is decided for them. The extensive literature on SDT emphasises balance between intrinsic and extrinsic motivation and highlights lack of autonomy as a key limitation to intrinsic motivation (Ryan & Deci, 2000 ). Educational research also points to links between teachers' perceptions of their own autonomy and competence, and their perceptions of the competence of their line managers and of those whose job it is to support them (Hobson & Maxwell, 2017 ). Lack of intrinsic motivation is clearly related to perceptions of lack of autonomy but may also be linked to inept management or the unavailability of necessary support. University teachers feel the weight of personal responsibility in institutional contexts that fail to connect them within social networks including those with similar responsibilities. Research utilising SDT identifies relatedness as a reciprocal function, involving both giving and receiving, and conceptually as something that also exists at the group level, so that groups of individuals may in some cases identify as isolated (reviewed by Vansteenkiste et al., 2020 ). Wennerberg and McGrath ( 2022 ) comment on the advantages of providing professional development support for communities, rather than for individuals.

Self-determination theory, and the extensive discourses that relate to it, therefore, provide insights into how universities may be able to adapt and into basic limitations of the existing identity of university teaching. University teachers' perceptions of their competence to teach could be addressed with professional development opportunities, noting that teachers' current perceptions of limited relatedness suggest that this could beneficially be provided to groups, or communities of teachers, rather than to individuals. Perceptions of lack of autonomy could be addressed by providing teachers more autonomy in deciding how to teach, noting of course inevitable links between how teachers teach, management structures and conflicting priorities of institutions. Perhaps more realistically, this analysis points to the need for deeper and more systematic change in the identity of university teachers. SDT may help identify a path forward not only for individual institutions, but perhaps also for the institution of higher education itself as it grapples with the challenges wrought by our latest global pandemic and the longer-term declines in student attendance at lectures. Teaching in higher education is clearly a complex task, and one for which competence is unlikely to be found in a list of skills. It may require participation in a community, or a profession, to address feelings of unsupported personal responsibility, concerns about the best way to teach when those being taught are also changing, and to recapture, or discover, a sense of professionalism in how to teach, and in how to evaluate the quality of teaching. School teaching has long been recognised as a profession, whereas university teaching has not been. Although perceptions of limited autonomy, relatedness and competence all suggest solutions at the institutional level, their combination and link to generic academic identity suggests that Covid-19 may have exposed broader limitations in university teaching as something other than a fully professional role.

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Acknowledgements

Authors would like to acknowledge: the support of the wider research group who participated in planning, administration and discussions contributory to the research described in this article, but not to the degree required to be co-authors of this article (Rebecca Bird, Una Byrne, Natasha Flack, Tim McLennan, Merilyn Hibma, Hoa Luong, Craig Marshall, Miranda Mirosa, David Orlivich, Gisela Sole, Anthony Robins, Sarah Stein, Tiffany Trotman, Stephanie Woodley); our anonymous interviewees; and support from the University of Otago’s Committee for the Advancement of Learning and Teaching, for its Grant in Aid.

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All authors contributed to the study conception and design. To maintain the anonymity of interviewees, MD conducted all of the interviews, the initial analysis resulting in reports for each interview, and all interactions with the audio recordings of interviews. All authors undertook the analysis yielding reoccurring and emergent themes. KS acted as PI for the project and prepared the first draft of the manuscript. All authors commented on versions of the manuscript. All authors read and approved the submitted manuscript.

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Detoni, M., Allan, A., Connelly, S. et al. University teachers’ perspectives on student attendance: a challenge to the identity of university teachers before, during and after Covid-19. Educ Res Policy Prac (2024). https://doi.org/10.1007/s10671-024-09375-6

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With COVID-19 affecting all types of research, the authors of this article contribute to the discussions on how COVID-19 affects the world of qualitative nursing research in irrefutable ways. Underrepresented and vulnerable populations are faced with higher rates and severity of COVID-19, heightening the need to better address their health needs, which require their voices to be heard. Moreover, nurses' perspectives on practicing during COVID-19 are needed. These nurses are vulnerable and their voices must be heard. Qualitative research methodology is advantageous to bringing attention to the lived experience of others as they unfold. Thus, we offer suggestions to aid in the collection and interpretation of qualitative data among vulnerable populations. We also provide practical tips for qualitative researchers, including an exemplar of conducting qualitative research among vulnerable nurses in light of COVID-19.

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Information challenges of COVID-19: A qualitative research

Golrokh atighechian.

Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Fatemeh Rezaei

Nahid tavakoli.

1 Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Mitra Abarghoian

2 Vice-Chancellery for Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran

BACKGROUND:

At the beginning of the COVID-19 pandemic, the Iranian Ministry of Health and Medical Education set up a 24-h call center, i.e., Center 4030, to mitigate people's worries and anxieties, create composure, increase people's trust, and answer their questions. This qualitative study aimed to identify the challenges of COVID-19-related-information among people in point of experts' views.

MATERIALS AND METHODS:

This qualitative study was conducted to collect the opinions of experts on the identification of the Information challenges of COVID-19 during March–June 2020. The research population included all health professionals and experts. The sampling method was initially purposive and continued to saturate the data as snowball technique. In this study, 19 participants were interviewed. The data were collected using a semi-structured interview. After collecting the data, the audio files of the interviews were written down to extract their external and internal elements. MAXQDA version 12 software was used to organize qualitative analysis and coding data.

The results of this study involved eight themes, i.e., lack of planning, lack of social trust in government, lack of COVID-19-integrated scientific authority in the country, conflicts of interest, lack of integrated information sources, distracting public attention, infodemic, and poor information quality, classified into 16 categories.

CONCLUSIONS:

The main information challenges that people in Iran faced included the lack of a scientific reference source to access accurate information, the existence of a large volume of information in virtual networks, and a huge volume of statistics from various information channels that caused confusion among people.

Introduction

In general, any outbreak will be accompanied by a tsunami of information, which, unfortunately, most often includes misinformation and rumors as well. Moreover, this is significantly intensified in the current century due to the availability and ubiquity of social media. Obviously, getting the right information from a reliable source is a key issue in this type of pandemics.[ 1 ] “Access to the right information can save lives,” argues Zaimova, quoting the head of the World Health Organization (WHO).[ 2 ] In the recent COVID-19 pandemic, besides the challenges exerted upon the health system, the rapid dissemination of information, including false and misleading information about the disease, has had a major impact on the behavioral patterns of people in various communities. Therefore, community leaders and governments must take appropriate measures to ensure that people have access to reliable and relevant information about COVID-19. The head of the Atlantic Consulate, Wedelmann, acknowledges that scientists and other experts are the most reliable source of information, and governments and employers should call on them to obtain the most reliable information.[ 3 ] Evidence suggests that people unintentionally share false information about COVID-19, without thinking about its authenticity, based on various motives such as entertainment and attracting attention and approval on social media. Lack of transparency also leads to rumors, speculation, and misinformation.[ 4 ] Hua and Shaw stated that 44% of people were actively looking for reliable information, following the news, and putting their interests first, while 33% only passively digested information about COVID-19.[ 1 ] In this regard, the dangers of misinformation during the management of COVID-19 outbreak have been introduced with the term “infodemic.” Some experts believe that infodemic, i.e., too much information including right as well as wrong information, is spreading around the world. The worst-case scenario involves the fact that incorrect information is potentially released faster than the virus itself, causing people to make uninformed or misinformed decisions.[ 5 ] Therefore, there is the challenge of how people search for or avoid information. On the other hand, the unprecedented distribution of information on social media has provided people with access to a large amount of information. This has caused the spread of rumors and the dissemination of questionable information. As a result, this information conflict has led to the development of misinformation among people, as well as a negative impact on their behavior.[ 3 ] In addition, the psychological effects of misinformation on social media are significant. Therefore, if people cannot verify the accuracy of a large portion of information in cyberspace and the media, they will be anxious and worried. Therefore, it is necessary to draw their attention to the information that is published by official institutions and government agencies.[ 6 ] The WHO has said that misinformation has hampered the efforts of organizations and governments to control the spread of COVID-19. This makes it difficult to hear the voices of health-care organizations. Therefore, major attention and resources have been allocated to dealing with misinformation. Because the spread of this pandemic has been accompanied by a wide range of useless informational content, it has created new challenges.[ 7 ] While expressing his concern about the publication of false information about COVID-19, the head of the WHO admits that we are not fighting the coronavirus; rather, we are fighting the infodemic. Since false news and misinformation during this time will lead to misguided medical advice worldwide, the question is how to deal with such a serious problem.[ 8 ] In this regard, it is important for traditional and modern social media to help people have a better understanding of what they are looking for information about because these media are sometimes ahead of the evidence.[ 9 ] With the increasing use of social media and communication technologies, the infodemic challenge is growing,[ 10 ] and the sheer volume of online information is increasing people's anxiety. Therefore, it is imperative for the digital media platforms to be environmentally friendly and to create trust and calmness among people, especially when sharing information related to health and life threats.[ 11 ] On the other hand, many reliable sources, such as the WHO, are on social media, which can reduce people's anxiety by giving them access to the correct information while controlling the virus at the same time. Of course, the impact of the response to the infodemic varies depending on people's trust in the authorities and officials from one country to the other.[ 7 ] As the demand for access to reliable and timely information about COVID-19 increases in the community, policymakers need to be aware of the best practices for reducing the risk of the infodemic and turning to knowledge and expertise available in academic settings.[ 12 ] The wrong information is one of the great human challenges in the new COVID-19 crisis. Some people spend a lot of time reading-related information in print and virtual media. However, they are unable to distinguish quality information from false and low-quality information. This information reinforces the challenges, and people need to be equipped with the knowledge and skills of health literacy and media health literacy.[ 13 ] Academics and scientists need to pay attention to two basic aspects to share scientific information. These include filters that have the ability to increase the validity of data and the individual responsibility for creating and distributing information among people.[ 14 ] Information from all sources should be transferred to a dedicated COVID-19 center to discover, diagnose, treat, and most importantly, inform policymakers, investors, resource providers, affected populations, and social media. Reproduction and enhancement of misinformation must be prevented. In all scenarios, information must be at the level of understanding of the relevant community.[ 15 ] Over the past 2 months in Iran, people have faced many challenges due to concerns about the spread of COVID-19 because of the spread of large amounts of scattered and disorganized information on social media from domestic and foreign sources. This has exacerbated their concerns and confusion about conscious decisions on this disease's prevention and care. On the other hand, the repeated recommendations of the media and the retelling of the decisions and actions of the officials, which were sometimes inconsistent and contradictory, led to the intensification of mental fatigue and confusion of the families.[ 16 ] At the beginning of this pandemic, the Iranian Ministry of Health and Medical Education set up a 24-h call center, i.e., Center 4030, to mitigate people's worries and anxieties, create composure, increase people's trust, and answer their questions. The main objective of this call center has been to answer ambiguities and prevent rumors.

However, despite the implementation of this important step, people are still resorting to various sources to obtain information in the face of numerous information challenges related to the coronavirus, and this qualitative study has been designed to identify them.

Materials and Methods

Study Design and Setting: In this study, a qualitative study was conducted to collect the opinions of experts on the identification of the information characteristics and challenges of COVID-19 during March–June 2020.

Study participants and sampling: The research population included all health professionals and experts, including university faculty members, policymakers, university administrators and experts and physicians, nurses working in the infectious diseases unit. The sampling method was initially purposive and continued to saturate the data as snowball technique. First, five participants were selected who had experience or knowledge about the main phenomenon or basic concepts explored. In this regard, to access different opinions about the central phenomenon and the explored concepts, the sampling with maximum diversity was performed, and people with different views were selected. Sampling continued until data saturation. In this study, 19 participants were interviewed. Inclusion criteria consisted of all professionals, policymakers, managers, and experts with at least 5 years of experience. Furthermore, individuals who refused to be interviewed were excluded.

Data Collection Tool and Technique: The data were collected using a semi-structured interview. To verify the validity of the interview guide, the interview questions among the research team were first discussed with the participation of one external expert and revised accordingly. The interview guide was subsequently tested on three nonparticipants to check the number and order of the questions in the study. It is achieved by analyzing and comparing the contents of the interview until no new or appropriate details concerning a theme appear to emerge.

The time and place of the interview were prearranged with the participants, preceded by obtaining their permission through an informed consent form. The interviews were recorded through a voice recorder. Due to the prevalence of corona, some interviews were conducted by phone. After collecting the data, the audio files of the interviews were written down to extract their external and internal elements.

MAXQDA Plus version 12 software (Release 12.3.0, VERBI GmbH Berlin) was used to organize qualitative analysis and coding data. For the evaluation of the reliability of the study data, four criteria were used in Lincoln and Goba, namely, credibility, conformability, dependability, and transferability (Lincoln YS and Guba EG, 1985).

Ethical consideration: This study received the required ethics approval from Isfahan University of Medical Sciences Research Ethics Committee, Isfahan, Iran, with ethics code No. IR.MUI.MED.REC.1398.653.

More than half of the participants were male (63.1%), and the majority had a PhD (42.1%). Furthermore, more than half of the participants (52.6%) had more than 20 years of experience [ Table 1 ].

Basic characteristics of participants

The results of this study involved eight themes, i.e., lack of planning, lack of social trust in government, lack of COVID-19-integrated scientific authority in the country, conflicts of interest, lack of integrated information sources, distracting public attention, infodemic, and poor information quality Table 2 , classified into 16 categories.

Information challenges regarding COVID-19

Lack of planning

Lack of planning involves invalid information and a lack of consistency in informing the public.

Participants believed that invalid information and instability in information-related decisions were indicative of the authorities' lack of planning in the COVID-19 outbreak. The confusion of health policymakers in the decision-making process, the government's different decisions to declare closures for different jobs, and the variable decisions of managers were among the issues that the participants referred to.

The Ministry of Health and Medical Education and the health authorities do not have specific credible channels and entries, so weaknesses and conflicts are transferred to the community, then their authority is destroyed, and people lose confidence in official sources (Interviewee 5).

The reasons for the officials' lack of planning in this pandemic involved managers' changing decisions, people's confusion about whether COVID-19 was getting serious or not, lack of foresight and preparedness of the government to guide people, failure to implement preventive measures to mitigate the confusion of people, and politically ignoring the support and experience of other countries.

Due to the fact that the news and information about the Coronavirus unfortunately reached the people very late, the members of the community partially underestimated the epidemic, and no training was provided (Interviewee 1).

Lack of social trust in government

This involved lack of transparency from the officials in informing people, and a lack of trust on the part of people due to authorities downplaying the seriousness of the crisis. The government's secrecy in providing information about the number of deaths and infections led to people shifting their attention and trust to unofficial channels, which was a sign of their lack of social trust.

People's attention and trust in unofficial channels was expressed as one of the signs of social distrust. People always think that the government is hiding the facts from the foreign channels or from other media, that is, we have a kind of unhealthy atmosphere (Interviewee 1).

Participants cited a lack of transparent information in the early days of the epidemic and lack of timely information as some of the reasons for people's distrust.

The more realistic and transparent we talk to people, the more we can gain people's trust. People traditionally trust centers that have long been among their safe havens. Well, naturally, medical centers are one of these centers (Interviewee 10).

The lack of transparency in the statistics was another reason for people's distrust.

For example, even in the case of statistics, it is not yet clear whether the statistics are real or not. Even if they weren't real, it would definitely be a good reason behind it that I don't want to talk about. There is probably a reason, and I have to admit, they don't want to announce the actual statistics (Interviewee 2).

Lack of COVID-19-integrated scientific authority in the country

This theme includes a lack of consistency of published information and various media and informational sources. The lack of an integrated scientific reference led to parallel work, lack of consensus among experts on some scientific topics, and information confusion when comparing multiple information sources.

Recently, The Islamic Republic of Iran Medical Council has been working for itself, which is, in my opinion, wrong. All of this must be centralized, and in fact we must have a position of information management under the supervision of the Ministry of Health and Medical Education. All material produced must first be approved by the Ministry of Health and Medical Education, and then reach the public (Interviewee 17).

Conflicts of interest

This included disagreement between officials and disregard for different specialties. Lack of consensus among authorities and ignoring the different specialized opinion of experts led to conflicts of interest.

Every organization considers its own interests and does not value us (the Ministry of Health and Medical Education). They do not follow government orders, even if it is to their detriment. Therefore, providing information under these conditions will not be effective (Interviewee 1).

The multiplicity of nontechnical spokespersons in the national media and noncompliance with professional privacy were some of the issues raised by the participants.

Well, I don't know what's behind the scene. But when we hear and compare their official statements, there are all kinds of conflicts in the policies and words of health policymakers (Interviewee 5).

Lack of integrated information sources

This category included parallel information provision streams from the media and a lack of valid information provision channels. The existence of multiple telephone lines multiple websites created by different individuals indicated a lack of an integrated information source in the country.

One organization said we would give people a phone number, another said we would create a website. However, everyone wants to have an information channel (Interviewee 2).

Lack of knowledge about where to go for information and parallel work in informing indicated the lack of an integrated information source in the country.

People don't know where to get information and which information source to trust. Well, the existence of social networks makes information available to the public, but the important thing is to trust our own mass media or a foreign media (Interviewee 11).

Distracting public attention

This category included provoking people through cyberspace, speculations caused by following the cyberspace information sources, easy access to unreliable sources and virtual networks, misuse of virtual networks by profiteers, each person having a tribune in the cyberspace, and increasing public concern by foreign channels.

I spend almost 90% of my time dealing with and denying false news. Sir, this is not true, sir, this is not true, sir, this is not true, and then the one I can say is right is what the Ministry said. So it is better, at least for ourselves, to have the unity of voice as always (Interviewee 3).

The gap between the data reported by the government and that reported by foreign media on the disease has raised concerns.

If people are given regular statistics, their fears will be reduced (Interviewee 3).

This category included a wide dissemination of information and diffusion of false information. From the participants' point of view, the high volume of available information and the anarchy of information in COVID-19 caused anxiety and confusion among people.

The most important problem, in my opinion, is that people are confused about information, that is, they have become so bombarded with information that they can't really decide what to do (Interviewee 10).

The availability of multiple sources of information, the dissemination of false news on virtual networks, and lack of information refining have prevented people from distinguishing between right and wrong information.

Valid and reliable information must be given to people. People receive general information about COVID-19 from various media outlets, but they do not have the same information about necessary actions, such as disinfecting surfaces. One source says make Javelle water and bleaching solution with a ratio of 1:4. Another source says make it with a ratio of 1:49, another says make it with the ratio of 1:100. Individuals and/or organizations give different instructions (Interviewee 17).

Poor information quality

This category included disinformation, contradictory information, limited access to information, and misinformation. Lack of access to accurate and comprehensive information about the disease and the lack of accurate statistics on the number of infected individuals have caused concern.

We do not have accurate statistics. We don't know how many patients we have, how many samples have been sent, how many have been positive and how many have been negative. This causes fear and panic among people (Interviewee 14).

Participants acknowledged that the spread of rumors and false news by virtual networks has accelerated the dissemination of low-quality and misleading information.

At present, the media and social networks in the country have spread false information among people by spreading rumors in the community. Of course, there are reasons why we may have caused this (Interviewee 7).

Appropriate behavioral patterns among authorities and the public in epidemics regarding the production and distribution of information in various media are very helpful in promoting public awareness and knowledge for the prevention of epidemics.[ 17 ] In the present study, participants believed that provided medical information should be organized, simple, and fluent and in a language that is easy to understand by ordinary people to reduce concerns and anxieties of people. As many behavioral fears and reactions naturally arise from a lack of knowledge, rumors, and misinformation, providing clear, concise, and accurate information about COVID-19, and user-friendly ways to access such information reduce the public's focus on rumors.[ 18 ] According to the participants' views, multiple instructions from different universities, the presence of multiple articles and longwinded instructions, and the presence of multiple sources of information that must be compared have led to confusion. Moreover, they emphasized that people must refer to reliable information sources such as the website of the Ministry of Health and Medical Education, doctors' inquiries, the National Broadcasting Media, and trustworthy online news, to reduce their worries about the virus and to prevent being infected with misinformation. The WHO states that insufficient information about the coronavirus increases the likelihood of mistrust in government and authorities. In addition, this organization recommends searching for information from reliable sources, such as radio and television, and national newspapers, once or twice a day instead of once every hour, helping people manage and reduce their stress.[ 19 ] As worst-case scenarios are usually accelerated when there is no information, leaders should provide the most up-to-date information about COVID-19 for health workers to know how to protect themselves and what to do if they encounter it. In addition, the leaders should anticipate what questions might arise and prepare their answers well. In this way, they are empowered with reliable information so that they can help themselves and control their stress.[ 20 ] In their study, Stirling et al . found that 66.4% and 55.3% of medical students depended on the internet, and television and radio for getting coronavirus information, respectively.[ 21 ] Participants in the present study acknowledged that a lack of clear information and normalizing the prevalence and risk of the disease by the radio and television channels at the beginning of the epidemic, lack of transparency in the statistics provided to the public, provision of politically biased information, government secrecy and untruths, rumors, and dissemination of various pieces of false news in virtual media led to people's concern and confusion in obtaining accurate and reliable information. The findings of the present study were consistent with Baines study, showing that a lack of transparency and delay in public urgency led to fears among the health authorities and delays in disclosing information about COVID-19, spreading misinformation and rumors among the public, incorrect public forecasting, ultimately causing the unexpected dissemination of the virus.[ 22 ] Moreover, the findings of the present study were in line with those of Dong's study, showing that downplaying the severity of the epidemic of COVID-19 by the Chinese government in the early days caused people's distrust in the transparency and the decision-making capability of the government.[ 23 ] In the present study, according to the participants' views, the infodemic phenomenon led to people's confusion. In this regard, the presence of numerous information sources, the high volume of available information, people's anxiety caused by information anarchy, information redundancy, lack of information refining and cleaning instruments, and the misrepresentation of news in virtual networks were mentioned as examples. Lu's study showed that infodemic, including incorrect information about COVID-19 on social media and elsewhere, caused a major risk to people's mental health during this crisis.[ 23 ] In his study, Bains emphasized that, in order to fight infodemic, it was necessary to analyze all types of information, to have an integrated scientific approach, to have a clear and scientific definition of all types of information, and to avoid using wrong words.[ 22 ] The findings of the current study showed that provoking people through virtual networks, speculation due to following cyberspace channels, easy access to unreliable sources in virtual networks, and the misuse of virtual networks by profiteers were significant challenges people encountered. Allah Verdi believes that there is a difference between producing and disseminating COVID-19 health messages and disseminated unprofessional messages on social media. Hence, in order to break the chain of disease transmission, it is necessary for the health system to take measures to prevent the spread of misinformation.[ 24 ] Kouzy et al . analyzed 673 tweets and showed that the least amount of unconfirmed information was related to public health accounts and accounts of health-care services, while the most misleading information was related to personal and group accounts. Another noteworthy point in her study was the lower incidence of misinformation when searching the literature using COVID-19 instead of 2019_ncov and corona. She believes that incorrect medical information and a lot of unconfirmed content about COVID-19 are being widely published on social media, and it is necessary to intervene in this process to protect public safety.[ 25 ] The other challenges mentioned in the present study involved promoting people's awareness in an unfair environment structured around mistrust, higher levels of trust on the part of people in social media than mass media, people's distrust of official information sources, failure to take the virus seriously, failure to inform people by the national media, lack of managers' ability to attract public cooperation and trust, failure to provide timely information, and secrecy in reporting the number of COVID-19 deaths and patients. In her study, Sharma emphasized that the health-care organizations and other authorities should develop practical strategies for identifying credible and reliable information sources and disseminating valid information about COVID-19. In addition, she argues that, using scientific methods, such as data mining, for identifying and removing those messages in virtual networks which have no scientific evidence behind them is one of the legal measures that can be taken.[ 26 , 27 ] In the current study, provision of contradicting content from different sources; obtaining information from invalid sources, which creates anxiety; lack of a reputable reference source to answer all relevant questions; contradiction between official media news and social networks; availability of information from multiple and contradictory channels; and lack of knowledge on where to go for reliable information were among other challenges noted by the participants. Hua described the reasons of China's success in controlling COVID-19 as a strong government, implementing restrictions, and people's immediate participation. In the early stages, the highest judicial authority's guidelines on false news constituted an important step toward reducing confusion and panic among people.[ 12 ] In Medford's study, about half of the tweets scared people and about 30% were surprising them, among which the political and economic impacts of COVID-19 were the most important discussion topics.[ 28 ]

Shankar pointed out that one of the challenges for medical staff in dealing with cancer patients, who wanted to find accurate information to adapt to the conditions of COVI-19, was the existence of a large volume of information on virtual networks.[ 29 ] Health ministries and health education specialists in various countries should design an interactive dashboard to deal with the release of huge amounts of inaccurate information and misinformation, provide real-time information, and eliminate rumors related to COVID-19 around the world.[ 24 ] In his study, Bastani emphasized that health department's managers should have practical perspectives on managing public information in the community.[ 30 ]

Conclusions

With the COVID-19 pandemic, information seeking, especially on social media, emerged as one of the major challenges facing the affected communities. In this regard, the large volume of information and the lack of a reliable source to obtain accurate information, especially in the early days, caused concern and anxiety among people. In this study, the main information challenges that people in Iran faced included the lack of a scientific reference source to access accurate information, the existence of a large volume of information in virtual networks, and a huge volume of statistics and detailed news from various information channels that caused confusion among people. Therefore, considering the fact that epidemiological predictions show the high likelihood for the continuation or re-spread of this virus, it is recommended that health leaders identify and/or introduce a scientific authority for information related to COVID-19 in the country; introduce reliable information sources; provide simple, legible, and transparent information; and encourage people to improve their knowledge so that they can correctly interpret the right information, and keep themselves and their families safe from the virus.

Financial support and sponsorship

This study was funded by Isfahan University of Medical Sciences, Isfahan, Iran, with research code No. 198222.

There are no conflicts of interest.

Acknowledgments

We would like to thank all interviewees for their kind contribution. Moreover, the authors cordially appreciate Dr. Hasan Ashrafi-Rizi for his kind help and guidance.

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UMaine study examines intersections between campus hazing, white supremacy

College campuses across the country are working to put an end to hazing, a form of interpersonal and community violence that is often normalized and minimized through tradition. At the same time, postsecondary institutions are grappling with legacies of racism and white supremacy rooted in similar norms and practices.

A new study led by University of Maine researchers explores how these two issues are related and how hazing often reflects and is used to reinscribe white supremacy.

“Tradition is almost always framed as something good,” said Elizabeth Allan, a UMaine professor of higher education and the nation’s foremost expert on hazing and hazing prevention on college campuses.

“What we have found through research is that tradition is often used as a sort of euphemism for hazing, so students who undergo or perpetuate hazing practices will point to tradition as a reason for doing it,” Allan said. “At the same time, there are parallel and intersecting traditions of whiteness on college campuses because of the histories of these institutions, and the people who founded them and who attended them. So we wanted to study those connections to get a better idea of how people working in higher education today can address both problems.”

For the study, Allan worked with UMaine Assistant Professor of Higher Education Kathleen Gillon, as well as Cameron Beatty, an associate professor of educational leadership and policy studies at Florida State University; Cristobal Salinas Jr., an associate professor of educational leadership and research methodology at Florida Atlantic University; and David Kerschner, a 2021 graduate of UMaine’s doctoral program in higher education and a postdoctoral fellow for research and evaluation at StopHazing . Gillon, Beatty and Salinas co-edited an edition of New Directions for Student Services in 2019 that focused on issues of race, ethnicity and culture in fraternity and sorority life.

“It’s easy to identify hazing when it results in physical harm or death. Those are very tangible, very visible outcomes,” Gillon said. “We wanted to highlight some of the potentially invisible harms of hazing for people who are subjected to or feel like they have to take part in activities that have nothing to do with their culture or their identity in order to belong to a group or even set foot on campus.”

The researchers examined interviews, largely from focus groups, with 345 higher education staff members, students and alumni across 12 institutions who shared their perceptions of campus culture and hazing climate. The majority of the interviewees were from campuses that have participated in the Hazing Prevention Consortium, a group of colleges and universities convened by Allan’s StopHazing organization to build capacity for planning, developing and evaluating data-informed strategies for ending hazing practices.

An analysis of the interviews revealed three overlapping themes related to ways white supremacy is propagated through hazing: the influence and involvement of alumni, pride in the institution and the way space is used to other non-white individuals.

“In terms of alumni, in certain organizations such as fraternities and sororities, athletic teams and honor societies, the alums who are very involved or who come back as advisors tend to reflect a particular demographic,” Allan said. “It gets reinforced: ‘This is what we did and this is what it means to be a member of this group.’ So an expectation gets handed down or passed along to current students.”

Although many of the examples cited in the interviews reflected less visible or hidden practices that reinforce white supremacy, there were some overt cases of racism too. Gillon points to one interviewee who discussed a scavenger hunt where members of a campus group were supposed to find and have their picture taken with Asian American students.

“This was a historically white student organization. So the idea of running around campus to find people who look different from you normalizes the unequal power dynamics there and puts on display how communities of color are demonized or exoticized,” Gillon said.

Allan and Gillon said they hope the research will be helpful to individuals and institutions working to combat hazing and address historical inequities in higher education. They plan to present their findings at a Hazing Prevention Consortium Summit that will be attended by representatives from nearly 20 different colleges at UMaine June 4-5. They presented the paper in March at the annual conference of the American College Personnel Association , one of the leading professional organizations for student affairs professionals.

“You can’t really change something you don’t see,” Allan said. “So it’s just helpful to name the problem and show some of the dynamics and complexities of these larger systems of power, so that you can begin to interrupt them.”

The study, “Unsettling Tradition: Exploring Intersections of Campus Hazing and White Supremacy,” was published in the International Journal of Qualitative Studies in Education. It is available online.

Contact: Casey Kelly, [email protected]

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