key: cord-0820894-5o61pvrt
authors: Silva, S.; Machado, H.; de Freitas, Cláudia; Lucas, Raquel
title: Concerns and coping mechanisms during the first national COVID-19 lockdown: an online prospective study in Portugal
date: 2022-04-01
journal: Public Health
DOI: 10.1016/j.puhe.2022.03.014
sha: e16e1cedbef6122413a70714b5d32efb901d9589
doc_id: 820894
cord_uid: 5o61pvrt

Objectives The aim of this study was to explore concerns and coping mechanisms during the first national COVID-19 lockdown in Portugal. The general population provided statements via an open comment box as part of an online prospective study. Study design Internet-based open cohort study. Methods Individuals aged ≥16 years were eligible to participate in this study. Inductive content analysis was performed on completed questionnaires submitted between 23–29 March 2020 and 27 April–3 May 2020 (corresponding with the early and late phases of the first national lockdown, respectively). Results Data suggest the prominence of behavioural and emotional responses to COVID-19; namely, self-compliance with measures promoted by the government; adopting practices of self-care and supporting/protecting others; and enacting hope (both currently and for the future). Concerns were related to the perception of vulnerabilities for oneself, family and others, and to challenging situations presenting in society (e.g. physical and mental health, academic/professional careers, income, social inequality, potential discrimination and stigmatisation, inconsistent information and negative approach to the news), coupled with criticism, scepticism or doubts about government policy and performance of the healthcare system. Expressions of fear and worry, and non-compliance with mitigation measures by others (e.g. close relatives, employees, general population) emerged as additional concerns. Conclusions Continuous assessment of behavioural and emotional responses to the COVID-19 pandemic is needed to support effective communication and public health policies that are sensitive to the concerns, motivations and expectations of the population. Awareness of changing public opinions enables governments to continue to effectively mobilise the population to take recommended actions to reduce transmission of COVID-19.

The COVID-19 pandemic continues to have disruptive effects on the lives of populations throughout the world. 1 There is a growing body of knowledge about the public's concerns and coping mechanisms in regards to COVID-19 (i.e. behavioural, cognitive and emotional responses to uncertainty, and the perception of putting oneself and others at risk). 2 However, the majority of studies investigating public views on COVID-19 during the first lockdown focus on negative responses, disruptive impacts on psychological status and the fragility of existing mental health services. 3 Other studies suggest a variety of positive and negative coping mechanisms and corresponding effects on mental health. 4 Knowledge about how the general population responds to severe restrictive measures is useful for future public health actions by informing the design of focused interventions and sensitive communication. 5 While vaccination coverage is growing in Europe, with Portugal currently having the highest vaccination rate, a high level of uncertainty about the pandemic evolution and future pandemics persists. This complex situation requires more knowledge about the responses of the general population to mitigation measures. This will provide data for future strategies that increase solidarity at interpersonal, group and contractual levels, and allow governments to continue to effectively mobilise the population to take recommended actions to contain the spread of the virus. 6 This short report analyses statements from the general population in Portugal regarding different aspects of dealing with COVID-19 during the first national lockdown (18 March to 2 May 2020). Comments were received through an open comment box as part of an online prospective study. Responses with similar meanings and connotations were inductively synthesised into exhaustive and mutually exclusive categories after a priori coding. 6 As comments from an individual may include more than one concern or coping mechanism, responses could be coded into several separate categories, with each idea belonging to only one category.

Sociodemographic characteristics of the study participants are summarised in Table S1 in the supplementary material.

Participants mainly expressed negative emotions in both the early and late phases of the first lockdown (see Table 1 ). Participants reported fear of losing close relatives and of contracting/spreading the virus, as well as fear of using healthcare services or entering indoor public spaces (particularly shops), along with feelings of anxiety towards individuals with symptoms, suspected, infected or exposed to COVID-19. There was also the expression of negative feelings towards the future.

Experiencing vulnerabilities regarding oneself and others constituted an additional topic of concern. Participants mentioned the negative impact of the pandemic on their mental health and how the lack of physical contact with family members and friends was J o u r n a l P r e -p r o o f difficult. They also perceived vulnerabilities regarding their children/grandchildren, mainly related to their academic/professional careers and health (physical and mental), highlighting the need to prioritise children's well-being and to invest in children's psychological support. Some participants voiced concerns related to an increase in social inequality, discrimination and stigmatisation. In addition, a few participants referred to the loss of individual freedom and autonomy resulting from constant surveillance and sanitation and cleaning of bodies and spaces.

The economic crisis and the wide dissemination of information about COVID-19 were perceived as challenging and difficult situations for society. Worries about job loss and decreasing household incomes were prominent. Respondents frequently expressed concerns related to working remotely from home and the additional stress of having to take care of children and other dependent individuals, or feeling that productivity was hampered by adverse working conditions at home. Another issue concerning participants was the lack of consistency in the information conveyed to citizens by the government and the media, as well as the negativity in the news. Participants requested readily available information for people with health conditions who might be at increased risk during the pandemic and urged for increased collaboration among the scientific community.

Participants were also concerned about others not complying with government measures, particularly rules on physical distancing and face coverings. There were reports of noncompliance among close relatives, the general population and employers who refused to work remotely from home or waived the measures recommended in the workplace.

Comments that expressed criticism, scepticism or doubts towards government policy 

Contrasting with concerns about non-compliance by others, self-compliance with government measures emerged as the main coping mechanism. Participants reported establishing personal contacts, travelling only for justifiable reasons (e.g. professional practice, social/family support, health issues, essential goods/services) and the use of selfprotective equipment and masks. Perceiving privileges for oneself (e.g. the possibility of resorting to a second home) and trust towards institutions (e.g. healthcare, political institutions, police forces and the scientific community) were less frequently mentioned coping mechanisms.

Data suggest the prominence of behavioural and emotional responses to COVID-19; namely, self-compliance with government measures, adopting practices of self-care and supporting/protecting others, and enacting hope. These results are in line with previous J o u r n a l P r e -p r o o f evidence. 7 Concerns were related to the perception of vulnerabilities for oneself, family and others, and challenging situations for society (physical and mental health, academic/professional careers, income, social inequality, potential discrimination and stigmatisation, inconsistent information, and negative approach to the news), coupled with criticism, scepticism or doubts towards government policy and the perceived efficiency and reliability of the healthcare system, as previously observed. 8 Expressions of negative emotions, such as fear and worry, and others (e.g. close relatives, employees and the general population) not complying with government measures emerged as additional sources of anxiety. 9 Results from this study promote positive actions by governments to face future pandemics by adding a culturally sensitive perspective from Portugal to promote the strengthening of social ties, empathy and solidarity at interpersonal, group and contractual levels. 6 Although this study lacks the generalisability of a representative sample of the Portuguese population, results may indicate the general concerns and coping mechanisms of Efficiency and reliability of the healthcare system 44 13

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The authors thank all the researchers involved in the COVID-19 Task Force 

None declared.