3.2. Thematic Analysis through Narrative Synthesis
A total of n = 1921 thematic units were coded using 1042 unique participant references across nine broad themes (Figure 1
), producing an average of 1.80 themes coded per participant (with range of 0–6 and mode equal to 1). Of the 646 responders, n = 10 participants were unable to be coded within any theme due to ambiguity or a nonsensical response. The three most reported themes were the immediate family commitments, the broader family and social commitments, and the home/work environment. Through content analysis, a total of nine broad themes and 36 sub-themes were identified, which are described below under their broad themes.
Immediate family commitments: The immediate family unit, being spouses, children and parents who are isolated to the same household, reported a lot of challenges during the lockdown, including care responsibilities, school and childcare responsibilities, as well as concerns over the emotional wellbeing of children. Care responsibilities related primarily to elderly relatives who were unwell and required time and resources by family to support their needs, “Caring for an elderly relative who couldn’t be assessed for a care package”.
The school needs of children were a large contributor to lockdown challenges, with concerns about space, time commitments of parents to support schooling, different school requirements across different age groups, lack of support from schools, and guilt that parents weren’t doing enough to support their children’s educational needs, “Managing online school for 3 children in 3 different schools, with different schedules and expectations”; “…the burden of resolving all problems and answering questions falling to us (instead of teachers)”; “lack of supporting resources to keep the kids having meaningful time”; “Balancing work and home schooling and doing both badly (or at least inefficiently)”; “Guilt that we are doing the bare minimum with our kids and not providing them with a great education”.
Alongside school requirements for older children, childcare responsibilities needed to be managed in conjunction with large employment workloads. This was a particular concern for people with young children, who would typically rely on external childcare services to free up time for work commitments, “Trying to keep on top of housework and childcare while also trying to complete required number of work hours”; “Trying to balancing the demands of a very clingy baby, stimulate my pre-schooler, and maintaining my work productivity”; “Caring for a kid is another full time job on top of my actual job”.
This resulted in unhealthy adjustments to lifestyles, such as extended work hours or sacrifices to work productivity, “Working evenings and weekends to maximise childcare time”; “Balance of young children and work. I end up working on and off between 7 am and 10 pm depending on the children’s needs”; “Sick days for 1-yr old son. If he is unable to go to day-care, then working from home is a challenge. I try to get uninterrupted time during his nap or after bedtime”. Parents were also concerned about the impact that these attempts to prioritise work on their children when childcare needed to be balanced in the home, “Juggling working hours and childcare between me and my husband in such a way that our daughter is not just plonked in front of a TV. I work part time, he works full time. Unfortunately, there are times when we are both working, or in meetings, and she has had to be left to herself. She is only 4, so can’t really expect her to entertain herself for too long”.
Similarly, the emotional needs of children were cause for concern among parents due to disruption to routines and the removal of social interactions and both psychological and physical outlets supporting wellbeing, “Managing children’s frustration with the pandemic (especially teenagers)”; “Dealing with mental health issues involving my teenagers”; “Children missing friends”; “The kids are used to having very busy lives, and suddenly, they were left very socially isolated without much to do”. Parents were then concerned about the alternative avenues of entertainment children engaged in, with screen time activities being the dominant worry, “Too much screen time for the younger child”; “Getting the youth away from their computers”; “…too many distractions from social media and gaming”.
Financial worries were also identified by some participants, particularly related to job loss and reduced security in employment, “Spouse was furloughed then laid off”; “The loss of my husband’s job”; “Not knowing if my job was secure”.
Broader family and social: The loss of social interactions was identified as one of the biggest challenges faced by the lockdown. People missed visiting family and friends, especially when family members were grown-up children, unwell, or elderly, “Was usually visiting my old parents and siblings once a month. The most challenging problem was not to even have chance to visit them for more than four months.” It wasn’t just the social interaction that was missed, but the physical contact of others, “Lack of human touch. No hugs”; “No kisses to loved ones”; “no physical contact with elderly parents”.
Some identified the ability to support family members who were struggling with lockdown as a concern, particularly when family members were relying on these visits for their own psychological welfare, “…especially when family members were grown-up children, were unwell or elderly and relied on these visits for their own mental wellbeing”; “mental strain of concern for family members isolated”.
People also missed social experiences such as travelling and spending time in social settings and at social events. This was not just organised events, as due to COVID-19 restrictions some public spaces were also closed, “Not being able to go to church and other activities such as social events, movies etc.”; “Parks, trails and beaches being closed”, the loss of these social outlets was found to cause behavioural changes from frustrations and reduced external stimulation, particularly among children, “Cancellation of all social, preschool, and sports (gymnastics) classes and activities for the kids as well as closure of parks and libraries, so the children are confined to the house and yard all day every day. Their behaviour has been harder to manage with the loss of these outlets for activity and socialisation”.
Home environment: There were many reported changes in the home environment, with people reporting that domestic duties increased, with more housework and the need to cook everyday, due to people being at home more and ordering ready-made food outside of the house being more difficult. For some people to work full-time, they relied on other people to help with domestic duties, which could no longer occur due to lockdown requirements, “Not having the cleaning lady and having to do home chores”; “I used to have maids and part-timers for daily chores, I now have to do all grocery shopping for a household for 4 because they are all my dependants”. For most of the responders, the balance of time and demands was the biggest problem, “Balancing everything. Ensuring the kids are happy. Keeping the house clean. Continuing to run our business”. People also reported difficulties with usual domestic duties such as shopping and getting essential items, “There was only a little difficulty in finding free slots for on-line grocery shopping”; “Go shopping food and the protocol to disinfect all”; “Unable to buy essential items”. These changes to the home environment did cause some negative consequences in the family dynamic, “The long working hours and time spent on household/pet chores sometimes took a toll on family relationship”.
Attempts to balance all the usual pre-lockdown activities while in lockdown caused people to feel inadequate as they tried to keep the normal routines in place and struggled to adapt to the new environment, “Trying not to feel guilty about not always working and instead giving my children some focused attention without trying to multi-task; feeling like my co-workers (without children or with stay-at-home partners) do not understand the struggles of balancing full-time work and childcare; struggling to complete all my work-related tasks in the limited hours I have”.
In this new home environment, people tried to adjust to constantly being in close quarters with other members of the family all the time and would try to apply boundaries on personal space, “Seeing too much of each other”; “Family coexistence in respecting individuality”; “Being together ALL THE TIME”; “Small house, all being home in it at the same time with very different hours of awake and sleep time”; “Maintaining private space in a small 3 bedroom house with two adults and four children (the eldest been 20, youngest been 12)”. This meant that time outside was missed and this was therefore identified as being a substantial challenge, “To stay in the house for a long time and not be able to go out”; “The stress of not being allowed to do things outside of the house”. As a result, people reported blurring lines between work and home, which resulted in a feeling of repetition, “My 400 sq ft living space becoming my workspace as well; there is no work-life separation anymore and feeling of living the same day over and over set in early. Depression and anxiety run high”.
Working from home environment: “Work is not work; home is not home”. Many people found time issues to be the biggest concern when trying to work from home. This included issues of trying to find time to fit everything in, the workday being spread out over longer periods, not knowing when to stop work and resume family time, and blurred lines between what would otherwise be very distinct home and work environments, “Feeling that the day is too long”; “Working too much. Not knowing when to stop”. Some participants reported that longer working hours were necessary just to balance all the relevant commitments, “Working evenings and weekends to maximise childcare time.”; “Don’t have days off. Working from Monday to Sunday, being pregnant, so I can work 60 h a week and at the same time taking care of my daughter since she is not attending to school”; “…my part-time work consumed much more time than normal… There was no way of getting time off from work”. At the same time, others struggled to find the time needed for work, especially when they have children who need care or help with schooling, “Hard to have dedicated quiet time. Kids keep calling ‘Mum’”; “To have protected and extended time for myself to do my work. I can only have snippets of time e.g., 30 min–1 h in between management of the kids, their wellbeing, and zoom classes, to do my own work. Work that require longer focus time, would need to wait until after 11 pm, after the kids slept, for me to embark on a 2–3 h of work. Sometimes sleeping only at 2.30 am. It is very taxing and certainly unsustainable everyday”.
Finding adequate workspace in the home was also a problem, especially when space is needed for adults working from home and for children doing schoolwork, “Having the whole family working/schooling from home, so finding suitable space for everybody”; “…not enough computers in the house for everyone to work efficiently all the time”; “Not being disturbed because I had to work in my dining room”. This issue sometimes caused friction and comparisons about whose work was more important to prioritise for the available space, “Challenge of negotiating whose work is more important at any given time”; “Finding the balance between my wife’s work (Fed Gov) and my work (Healthcare). The discussion determined that my work in Healthcare was more important and that I be given priority to continue the work for our community, hospitals, testing centers, etc.” It was also a problem when work required confidential discussions, “…lack of privacy and space, such as discussing sensitive issues at work over zoom, or dealing with colleague who is melting down over zoom”.
Others reported that worksite contact was still necessary. However, the need to work from home made it difficult to track who was in the office and decide when to go into the office. There was also a sense of unfairness when people from some institutions could work from home whilst others were forced to stay in the workplace, and vice versa, “Keeping track of who is at home versus who is in the clinic on any given day”; “Seeing other institutions work from home and you can’t”.
Productivity of working from home environment: Some participants reported that employer expectations for output did not change despite the new working environment and some employers had concerns about the ability for work to be done from home, “Expectation to care and teach children while still completing full or nearly full workload. Managers are trying to be accommodating but the work doesn’t go away”; “School closed, my department not allowed me working from home and no annual leave allowed, this make me difficult because no one take care my children”; “My boss had anxiety about work from home. He was very stressed about our availability etc. He is very old school in his views on work/life balance”. The loss of professional interaction also meant that acknowledgement for work was affected, “Lack of face to face recognition for doing work”.
For some participants the expectations of employers increased, “…the expectations were that we had to be flexible for our students, meaning that in effect we had to be available 24/7 to answer emails and help with their study concerns. In practice, this translated to continuous monitoring of email/online forums and a new chat group setup by a colleague”; “pressure from employer to take leave even though workload has not dropped”; “triple workload!”. There also appeared to be a significant disparity between participants with children and those without children. “Expectation to care and teach children while still completing full or nearly full workload. Managers are trying to be accommodating but the work doesn’t go away”; “Redeployment in the hospital. Since I don’t have a family to care for, I was asked to continue my normal job while also being redeployed, resulting in working 60–70 h weeks for the past 2 months. I’m exhausted”.
The ability to concentrate on work activities in the working from home environment was reported by many participants to be a challenge. Distractions from spouses and children were the primary source of lost concentration, “My husband and I distract each other while working from home. It is harder to focus”; “Being interrupted every hour by our 9 yo [years old] needing something”; “I am supposed to help them with virtual learning as school is closed. Keep getting disturbed so cannot focus on my work. My husband also trying to work. We have no home office. When one is talking (e.g., Zoom meeting), it is difficult to other. Hated tele-meeting online”. While distractions around the home related to usual hobbies, housework, and pets, “There are definitely more distractions from home that took adjustment (i.e., cats jumping on home desk while working)”.
Participants identified that adaptations were needed to manage the workload, otherwise productivity decreased, “Combine the time of work, rest and home duties, because there is a lot of tasks and is essential optimise the organisation of it”. Unfortunately, in some cases, it was simply not productive to work from home, which had significant negative ramifications for productivity, “Seminars were cancelled by clients”; “laboratory activities were a challenge for me. I cannot pretend that my students have gained technical skills”; “All the working schedules of onsite training got affected, even though we changed to deliver the training remotely, but we can’t provide the full content to our user effectively and we can’t be sure that they can operate the machine on their own”. This was a particular issue among teachers who were required to quickly adapt to the new online mode of education delivery with limited success: “Learning to do online classes”; “Teaching issues”. However, for some, certain working activities had to stop. “No access to lab for work purposes”; “…delayed projects due stopped economy”; “Laboratory work was stopped for some time”; “Not able to access the labs and most experimental works for research are stopped”.
Communication in working from home environment: Connectivity issues were the biggest barrier to effective communication when working from home. This included issues around no internet connection or slow internet speed, getting access to the virtual private network (VPN i.e., remote access to work computer files) and needing to communicate via phone or e-mail instead of face-to-face, “Working with those not able to participate in online meetings and thus working with them via phone & email”; “Poor internet connectivity to the work environment”; “Accessing files stored on my work computer”. To address these issues, some people found that the costs of communicating were higher, “Cost of Internet usage”. Or they had to develop new ways of communicating, “…transform the traditional lectures to a lecture assisted by Internet”.
However, despite attempted workarounds, the loss of professional interaction remained an issue and hindered the ability to effectively communicate, “To speak to people via any video conferencing facilities. The message cannot be delivered effectively”; “Not having in person contact with some colleagues that led to some instances of missed information hand off”; “lag time interaction with peers”.
One participant felt that changes in communication due to social distancing have had substantial negative ramifications resulting in cultural changes, “No direct contact with colleagues and students, means that a whole category of spontaneous communication, including questions, incidentals, comments, relationship building, brainstorming, body language, etc., no longer takes place and interactions become stilted, limited and distant. This has successfully engendered fear and distrust. I find this cultural change to be oppressive and difficult to cope with”.
Wellbeing: Mental health was another area of concern reported by a large proportion of participants. This included worsening symptoms of anxiety and depression, exhaustion and burnout, increased concerns about isolated family members, and not having the usual outlets for stress, “Mental strain of concern for family members isolated”; “The anxiety and depression. I already had symptoms of anxiety before the quarantine started and I had medical tests scheduled, but I had to cancel everything”. Participants also identified that a large proportion of concerns related to mental health were due to social isolation, loneliness and cabin fever, “…the anxiety and stress of confinement”; “Isolation, having to do it all by ourselves”; “Living in the same small place”. However, for others, the lack of a support network during difficult times and the ability to grieve with family and friends caused the most distress, “My son was stillborn and we had no family in the state and therefore no physical support for me or my wife from family”.
For some, it was difficult to mentally switch off because of the blurred lines between the home and work environment, meaning that recovery time was impacted, “The rest/sleep I did manage to get was interrupted because I couldn’t switch off and get to sleep or would fall asleep only to wake up in the early hours and start thinking about work. There was just no respite, my mind was racing for weeks on end, plus the worry of COVID itself and constant bad news—it was tough”.
Physical health was also impacted. People were concerned about trying to stay healthy, especially if they already had underlying health issues, “…diabetic care for ownself”. However, new physical health issues were identified due to new working from home environments and due to stress, “I have developed wrist pain from my less ergonomic home office setup”; “…staying at home many times has gave me some sickness like: lack of oxygen in my system and mostly in my cardiac functions... Not going to jogging regularly that produce a lot of stress I am still suffering Now. I am now diagnose with stomach pain since this pandemic started and my doctor diagnose the cause or it coming from stress”. Linked to physical health were limitations on exercise, which was particularly concerning for people who had routines heavily focused on physical activity, “Not being able to go to the gym. My entire family spends time at the gym almost daily”; “Lack of space for physical exercises”.
COVID-19: Many people were concerned about protection from COVID-19, particularly when they themselves or family members were at higher risk of infection due to underlying health concerns, or they were at higher risk of exposure due to their working environment, “I have an immunocompromised family member. My going into the office on non-remote weeks gives everyone anxiety”; “Managing my own exposure risks during my commute and time spent at work”; “The additional stress of worrying about my immune compromised husband”; “…being sure nor to bring COVID from hospital to home”.
People were also very mindful of public policies that differed substantially across countries, from no lockdowns in some countries to concerns that civil liberties were being taken away too easily. There were also concerns that they were being expected to adhere to unnecessary restrictions, and similarly, that current restrictions were not tight enough, “Unreasonable, panic driven decisions and rules. Wrecking the world economy. Watching how easily we are willing to give up freedoms and civil liberties.”; “Watching the country fail miserably at handling the pandemic; seeing other countries put more restrictive measures in place (and then see those measures pay off). Knowing that even if we follow the measures put in place in the UK exactly it is still not enough”; “Never being in lockdown, being unable to relate to everyone else in the world because nothing in my work or life changed, no lockdown, no restrictions”.
The uncertainty of COVID-19 was explicitly mentioned by quite a few participants. This included uncertainty about the future, concerns about getting infected and what this would mean for them and their family, and uncertainty about whether to believe health officials and believing what is said by purported experts through the media, “Dealing with the uncertainty including while waiting for test results for COVID-19”; “Planning for the uncertainty of the future has been the hardest part”; “…trying to understand the profound changes that the pandemic will bring to our lives”; “Believing what the WHO and others experts say”; “To stay quiet and see so many fake news and bad news on all aspects of life (economic, heath, politics…)”; “Politically motivated news”.
A few responders reported wearing personal protective equipment such as masks as challenges, while others reported that they or a member of their family had become ill with COVID-19. For example, “To dress properly with all protective equipment, and wear it all day”; “Partner ill with covid19”; “…my grandfather died for Covid and we couldn’t say goodbye”.
No challenges/improvements: A substantial number of participants reported no increased challenges and some even identified improvements as a consequence of the lockdown. People without young children or school commitments found productivity increased due to less socialisation and less time spent getting ready for work in the morning and commuting. Some people also identified that confinement to close quarters resulted in building stronger relationships with family and spending more quality time together, “I’m actually more productive during the lockdown and get to spend more quality time with my household members. I limit my social media and news time to less than an hour a day to avoid becoming anxious about the pandemic. I do not check my e-mail outside of work hours to help establish a boundary between work and home life since I am working from home. I only screen my e-mails for ones from my boss who very rarely e-mails me outside of normal working hours.”; “I have been enjoying working from home and hope to keep it going after the pandemic. It has improved my life allowing me to be more efficient. Less time spent on getting ready [and] traffic”; “I love how much more I’ve gotten to see my kids”; “I thoroughly enjoy working from home, and find myself to be more productive than working in the clinic (fewer distractions and interruptions)”. Some participants were even able to see the brighter side of enforced social distancing rules, “It was a rehearsal for my impending retirement.”