Patient experiences and perceptions of chronic disease care during the COVID-19 pandemic in India: a qualitative study

• Type of Material: Article
• Authors: Kavita Singh, Public Health Foundation of India; Aprajita Kaushik, Public Health Foundation of India; Leslie Johnson, Emory University; Suganthi Jaganathan, Centers for Disease Control and Prevention; Prashant Jarhyan, Public Health Foundation of India; Mohan Deepa, Madras Diabetes Research Foundation; Sandra Kong, Stanford University; Nikhil Srinivasapura Venkateshmurthy, Public Health Foundation of India; Dimple Kondal, Public Health Foundation of India; Sailesh Mohan, Public Health Foundation of India; Ranjit Mohan Anjana, Madras Diabetes Research Foundation; Mohammed Ali, Emory University; Nikhil Tandon, All India Institute of Medical Sciences; Kabayam Venkat Narayan, Emory University; Viswanathan Mohan, Madras Diabetes Research Foundation; Karen Eggleston, Stanford University; Dorairaj Prabhakaran, Emory University
• Language: English
• Date: 2021-01-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2021
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjopen-2021-048926
• Title of Journal or Parent Work: BMJ OPEN
• Volume: 11
• Issue: 6
• Start Page: e048926
• End Page: e048926
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: public health; quality in health care; IMPACT; qualitative research; Medicine, General & Internal; General & Internal Medicine; COVID-19; Life Sciences & Biomedicine; Science & Technology; health policy
• Research Categories: Biology, Virology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Objective People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients' lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic. Design, setting and participants We conducted a qualitative study using a syndemic framework to understand the patients' experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being. Results Participant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures. Conclusion People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients' lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and 'distanced' physical clinic visits.