Exploring Barriers to Effective COVID-19 Risk Mitigation, Recovery, and Chronic Disease Self-Management: A Qualitative Multilevel Perspective

Gayenell S Magwood,1,2 Charles Ellis Jr,3 Chanita Hughes Halbert,4 Ebony Allen Toussaint,1 Jewel Scott,1 Lynne S Nemeth1,2 1Department of Biobehavioral Health and Nursing Science, University of South Carolina, Columbia, SC, USA; 2College of Nursing, Medical University of South Carolina, Charleston, SC, USA; 3Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA; 4Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USACorrespondence: Gayenell S Magwood, Professor and Myrtle Irene Brown Endowed Chair, Department of Biobehavioral Health and Nursing Science College of Nursing, University of South Carolina, Columbia, SC, 29208, USA, Email [email protected]: Many research activities have focused on SARS-CoV-2 infection and subsequent COVID-19 respiratory illness during the pandemic. However, significant racial inequities emerged months after the COVID-19 pandemic began. The similarity between racial/ ethnic disparities in COVID-19 and those for other diseases raised awareness about the context for risk exposure and healthcare access. The purpose of this study is to examine social and structural determinants of health among COVID-19 survivors, carepartners, and the perspectives of healthcare stakeholders who experienced disruption during the early pandemic.Material and methods: A purposive sample of interviews (n=9) and focus groups (n=10) were used to collect data regarding knowledge of barriers to effective COVID-19 risk mitigation, recovery, and chronic disease self-management. This included nurses, physicians, COVID-19 survivors and their carepartners, public health, and community leaders connected with the healthcare systems in rural counties of South Carolina.Results: Five major themes were identified across the subgroups. The themes: The COVID-19 Illness Trajectory Added Major Health Challenges and Stressors, Access to Care Is Lacking, Support is Needed for COVID-19 Survivors and Care Partners, Support Must be Distributed Equitably, and Racism and Structural Issues Affect Stress reflect the strengths, opportunities, and inequities perceived within these groups.Conclusion: This research is the first qualitative study focused on COVID-19 survivor-carepartner dyads that consider the intersectionality of race/ ethnicity, geography, and health that is known to occur when engaging healthcare systems. The themes illustrate the need for infectious disease prevention at all socioecological levels: structural/ systemic, community, organizational/ institutional, interpersonal, and individual.Keywords: COVID-19, health equity, rural, African American, chronic disease, dyads