1
|
Caldas B, Portela M, Stelson E, Singer S, Amaral T, Amaral C, Escosteguy C, Martins M, de Andrade CLT, Soares L, Cornish F, Rosenthal M, Aveling EL. Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil. J Clin Epidemiol 2024; 173:111423. [PMID: 38880435 DOI: 10.1016/j.jclinepi.2024.111423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.
Collapse
Affiliation(s)
- Bárbara Caldas
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Margareth Portela
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Elisabeth Stelson
- Patient-Led Research Collaborative, Calabasas, CA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sara Singer
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Thatiana Amaral
- Center for Health Sciences and Sports, Universidade Federal do Acre (UFAC), Rio Branco, Brazil
| | - Cledir Amaral
- Instituto Federal do Acre (IFAC), Rio Branco, Brazil
| | - Claudia Escosteguy
- Epidemiology Service, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Mônica Martins
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Flora Cornish
- Department of Methodology, London School of Economics and Political Science, London, UK
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Marques FRDM, Laranjeira C, Carreira L, Gallo AM, Baccon WC, Paiano M, Baldissera VDA, Salci MA. Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study. Behav Sci (Basel) 2023; 14:14. [PMID: 38247666 PMCID: PMC10813415 DOI: 10.3390/bs14010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.
Collapse
Affiliation(s)
- Francielle Renata Danielli Martins Marques
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Rua de Santo André-66-68, Campus 5, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Marcelle Paiano
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Vanessa Denardi Antoniassi Baldissera
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| |
Collapse
|
3
|
Hawkings MJ, Vaselli NM, Charalampopoulos D, Brierley L, Elliot AJ, Buchan I, Hungerford D. A Systematic Review of the Prevalence of Persistent Gastrointestinal Symptoms and Incidence of New Gastrointestinal Illness after Acute SARS-CoV-2 Infection. Viruses 2023; 15:1625. [PMID: 37631968 PMCID: PMC10459193 DOI: 10.3390/v15081625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
It is known that SARS-CoV-2 infection can result in gastrointestinal symptoms. For some, these symptoms may persist beyond acute infection, in what is known as 'post-COVID syndrome'. We conducted a systematic review to examine the prevalence of persistent gastrointestinal symptoms and the incidence of new gastrointestinal illnesses following acute SARS-CoV-2 infection. We searched the scientific literature using MedLine, SCOPUS, Europe PubMed Central and medRxiv from December 2019 to July 2023. Two reviewers independently identified 45 eligible articles, which followed participants for various gastrointestinal outcomes after acute SARS-CoV-2 infection. The study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. The weighted pooled prevalence for persistent gastrointestinal symptoms of any nature and duration was 10.8% compared with 4.9% in healthy controls. For seven studies at low risk of methodological bias, the symptom prevalence ranged from 0.2% to 24.1%, with a median follow-up time of 18 weeks. We also identified a higher risk for future illnesses such as irritable bowel syndrome, dyspepsia, hepatic and biliary disease, liver disease and autoimmune-mediated illnesses such as inflammatory bowel disease and coeliac disease in historically SARS-CoV-2-exposed individuals. Our review has shown that, from a limited pool of mostly low-quality studies, previous SARS-CoV-2 exposure may be associated with ongoing gastrointestinal symptoms and the development of functional gastrointestinal illness. Furthermore, we show the need for high-quality research to better understand the SARS-CoV-2 association with gastrointestinal illness, particularly as population exposure to enteric infections returns to pre-COVID-19-restriction levels.
Collapse
Affiliation(s)
- Michael J. Hawkings
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.M.V.)
| | - Natasha Marcella Vaselli
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.M.V.)
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK
| | - Dimitrios Charalampopoulos
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Liam Brierley
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Alex J. Elliot
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.M.V.)
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK
| | - Iain Buchan
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.M.V.)
| | - Daniel Hungerford
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.M.V.)
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK
| |
Collapse
|