"They seemed to be like cogs working in different directions": a longitudinal qualitative study on Long COVID healthcare services in the United Kingdom from a person-centred lens

BACKGROUND

The COVID-19 pandemic has presented significant challenges to the already over-stretched healthcare system in the United Kingdom (UK). These challenges are particularly pronounced for people living with the novel condition of Long COVID (LC) as they often face persistent and fluctuating symptoms, encountering prolonged uncertainty when seeking medical support. Despite a growing understanding of the healthcare challenges associated with LC, existing qualitative studies have predominantly focused on individual experiences rather than examining the structural aspects of healthcare.

METHODS

A longitudinal qualitative study with 80 participants and 12 healthcare practitioners was conducted in the UK to explore the healthcare experiences of those with LC. In total, 178 interviews (with attrition) were collected across two rounds, from November 2021 to March 2022, and from June to October 2022.

RESULTS

Embracing a person-centred framework that recognises and nurtures interconnected individual, relational, and existential needs, we investigated healthcare experiences related to LC across primary, secondary, and specialist integrated care. Using this perspective, we identified three overarching themes. Theme 1 addresses the persistent hurdle of accessing primary care as the initial point of contact for LC healthcare; Theme 2 underscores the complexity of navigating secondary care; and Theme 3 encapsulates the distinctive challenges of developing LC integrated care. These themes are interlinked, as people with LC often had to navigate or struggle between the various systems, with practitioners seeking to collaborate across the breadth of their professional responsibilities.

CONCLUSION

From a person-centred approach, we were able to identify the needs of those affected by lasting LC symptoms and comprehend how health services intricately influence these needs. The focus on healthcare systems also captures the nuanced impact that continuing healthcare struggles can have on people's identity. As such, our findings provide evidence to inform a more effective and sustainable delivery of person-centred care for people with LC across various healthcare settings and over time.

'I am just a shadow of who I used to be'-Exploring existential loss of identity among people living with chronic conditions of Long COVID

Identity loss and (re)construction forms a central debate in sociology of chronic illness. Living with chronic/persistent health conditions may raise questions about how disruptions can touch upon and further threaten the very roots of existence, by which people reflexively perceive a coherent and stable sense of 'being-in-the-world'. Whilst medical sociologists have shown interest in 'existential loss' in chronic illness, this question remains largely underexplored. Adopting a qualitative study on Long COVID (LC) as an example, this article illuminates existential identity loss as a deeply painful experience of losing body as a fundamental medium to retain continuity and consistency of one's narratively constructed identity. Interviews with 80 LC sufferers in the UK revealed that living with persistent and often uncertain symptoms and disruptions can cause the loss of biographical resources and resilience, making it difficult to reflexively understand their own being within the world. Their dynamic responses to LC also highlighted how sufferers' longing for a narratively coherent self can profoundly shape the ongoing construction of their identity in chronic health conditions. These insights into the complicated and often hard-to-express existential pain of identity loss can also nurture more holistic understandings of and support for LC and chronic illness more broadly.

'I don't know what to do or where to go'. Experiences of accessing healthcare support from the perspectives of people living with Long Covid and healthcare professionals: A qualitative study in Bradford, UK

BACKGROUND

In October 2022, it was estimated 2.3 million people in the United Kingdom have self-reported Long Covid (LC). Many people have reported not receiving adequate healthcare support. There is a lack of research which provides an in-depth exploration of the barriers faced by people with LC in accessing healthcare support. It is important to understand these barriers to provide better support, care and advice for those experiencing LC.

OBJECTIVE

To understand the barriers faced in accessing primary, secondary and specialist healthcare support for people with LC.

DESIGN AND PARTICIPATION

40 interviews were conducted with people living with LC in Bradford alongside 12 interviews with healthcare professionals (HCPs) providing LC support in Bradford healthcare settings. Interviews were analysed using reflexive thematic analysis.

RESULTS

People living with LC had a large degree of difficulty in accessing healthcare services for LC support. We categorized the healthcare access experiences of participants into five main types: (1) being unable to access primary care, (2) accessing primary care but receiving (perceived) inadequate support, (3) extreme persistence, (4) alternatives to mainstream health care and (5) positive experiences. There was a severe lack of access to specialist LC services. Ethnic minority participants faced a further barrier of mistrust and fear of services deterring them from accessing support. HCPs discussed systemic barriers to delivering services. Experiences were embedded in macrostructural issues further exacerbated by the pandemic.

CONCLUSION

To better support people with LC, the barriers faced in accessing healthcare support must be addressed. Of significance, improvements to general practitioner access are required; especially as GPs are the first line of support for people living with LC.

PATIENT AND PUBLIC INVOLVEMENT

A patient and public involvement group is engaged at regular intervals in the project.

Narrating future selves: perspectives on ageing from a Scottish cohort born in 1936

In this paper we investigate the perspectives individuals take on their future at a particular chronological age, the late 70s.  We seek to provide insights into the diverse ways that older people incorporate narratives about possible future selves into their decision making and planning for the future, and how this supports wellbeing. This paper is based on detailed analysis of qualitative biographical interviews conducted with 33 men and women who were all born in Scotland in 1936.These individuals were chosen because they formed part of a longitudinal cohort study called the ‘6-day sample study’ that was initiated in Scotland in 1947. The material we draw on enables us to examine individuals’ biographical narratives as recounted in a research interview alongside insights into individual capacities and wellbeing derived from more structured quantitative questionnaires. We are interested in the presentation of the ageing self in an ethnographic interview, and how these presentations may complement or conflict with insights from the structured quantitative data collected in the study.

Approaching Retirement After a Working Life in Poverty

This paper uses a life course perspective to explore and understand how an individual’s experiences over their lifetime contribute to the formation of a growing consciousness about their impending retirement. The fieldwork took place in 2016 and was part of a wider mixed methods study about retirement in the UK, which used data from the 1958 birth cohort study (also known as the National Child Development Study). The paper focuses on the qualitative dimension of the study and uses in-depth case studies of four people approaching 60 to consider, in particular, the effects of health, financial resources and employment history on their views on retiring, including the anticipated timing of their exit from the labour market. All four were purposively chosen because they had experienced low pay or poverty during their lifetime and were employed in relatively low paid jobs. State Pension Ages (SPAs) are on the rise in many countries, including the UK, and the authors maintain that it is important to study the working poor, who, even though are more likely to continue working until SPA, are more prone to suffer from poor health, and less likely to be able to put savings aside for their retirement.

Do children's expectations about future physical activity predict their physical activity in adulthood?

Background

Much of the population fails to meet recommended physical activity (PA) levels, but there remains considerable individual variation. By understanding drivers of different trajectories, interventions can be better targeted and more effective. One such driver may be a person’s physical activity identity (PAI)—the extent to which a person perceives PA as central to who they are.

Methods

Using survey information and a unique body of essays written at age 11 from the National Child Development Study (N = 10 500), essays mentioning PA were automatically identified using the machine learning technique support vector classification and PA trajectories were estimated using latent class analysis. Analyses tested the extent to which childhood PAI correlated with activity levels from age 23 through 55 and with trajectories across adulthood.

Results

42.2% of males and 33.5% of females mentioned PA in their essays, describing active and/or passive engagement. Active PAI in childhood was correlated with higher levels of activity for men but not women, and was correlated with consistently active PA trajectories for both genders. Passive PAI was not related to PA for either gender.

Conclusions

This study offers a novel approach for analysing large qualitative datasets to assess identity and behaviours. Findings suggest that at as young as 11 years old, the way a young person conceptualizes activity as part of their identity has a lasting association with behaviour. Still, an active identity may require a supportive sociocultural context to manifest in subsequent behaviour.

Adapting to Aging: Older People Talk About Their Use of Selection, Optimization, and Compensation to Maximize Well-being in the Context of Physical Decline

Objectives:

Selection, Optimization, and Compensation (SOC) may contribute to successful aging by helping older people maximize well-being in the context of physical decline. To explore this hypothesis, and to investigate the potential for narrative analysis to improve understanding of SOC, we analyze interviews conducted with 15 members of the 6-Day Sample, a cohort of Scots born in 1936.

Method:

Interviewees were chosen based on their physical function and well-being scores. Interviews were analyzed to investigate “SOC talk,” that is, older people’s talk about SOC behaviors in everyday life. Types and amounts of SOC talk were quantified, and talk was narratively analyzed. We hypothesized that older people who engaged in more SOC talk would have higher well-being.

Results:

Older people who engaged in high levels of SOC talk had high well-being despite low physical function. Those who engaged in little SOC talk had low well-being despite higher physical function.

Discussion:

The concept of successful aging is valuable in part because of its narrative quality: One must strive to keep one’s life story developing despite physical decline and other losses. We provide evidence, from the perspectives of older people themselves, of the ways in which SOC may play a role in that process.