Health inequalities and the COVID-19 pandemic: A qualitative study of Chinese people returning to China and diagnosed with COVID-19
Main Article Content
Abstract
Purpose: We aimed to describe the experiences of Chinese citizens who returned home during the COVID-19 pandemic and the COVID-19 infection experiences they had in China. A further aim was to explore health inequalities in healthcare and access to services as a consequence of the COVID-19 pandemic.
Design: This qualitative study used in-depth interviews with 20 participants with confirmed COVID-19 upon returning to China.
Methods: Purposively sampled participants were recruited from a COVID-19 designated facility in Shanghai, China, from June to July 2020. Semi-structured, in-depth interviews were conducted and a thematic analysis approach was used to analyze the data.
Findings: Three main themes emerged from the interview study: access to services, COVID-19-related health care, and COVID-19-related stigma and discrimination. Regarding access to services, participants shared their experience of school closures and community shutdowns, and the difficulties encountered during their journey home to China. Regarding their experience with COVID-19-related health care, participants shared their experiences in foreign environments and access to COVID-19 care in China. In addition to experiencing discrimination overseas, similar discrimination from their networks in China was encountered by the study participants.
Conclusions: Participants experienced health inequalities in accessing healthcare services and nursing during the COVID-19 pandemic and experienced stigma and discrimination related to COVID-19. Future studies should focus on developing culturally sensitive interventions to decrease public discrimination and provide suggestions to government policy makers on how to mount a public policy response during epidemics that does not increase health inequalities.
Keywords:
COVID-19, Health inequality, Overseas, China, Qualitative study
Article Details
How to Cite
SUN, Wenxiu et al.
Health inequalities and the COVID-19 pandemic: A qualitative study of Chinese people returning to China and diagnosed with COVID-19.
Medical Research Archives, [S.l.], v. 12, n. 7, july 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5501>. Date accessed: 05 aug. 2024.
doi: https://doi.org/10.18103/mra.v12i7.5501.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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7. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020;33(2):e100213. doi:10.1136/ gpsych-2020-100213
8. Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. 2020;74(11):964-968. doi: 10.1136/jech-2020-214401.
9. Sydenstricker E. The incidence of influenza among persons of different economic status during the epidemic of 1918. 1931. Public Health Rep. 2006;121 Suppl 1:191-190.
10. Rutter PD, Mytton OT, Mak M, Donaldson LJ. Socio-economic disparities in mortality due to pandemic influenza in England. Int J Public Health. 2012;57(4):745-750. doi: 10.1007/s00038-012-0337-1.
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12. Johnson-Agbakwu CE, Ali NS, Oxford CM, Wingo S, Manin E, Coonrod DV. Racism, COVID-19, and health inequity in the USA: a call to action. J Racial Ethn Health Disparities. 2022;9(1):52-58. doi: 10.1007/s40615-020-00928-y.
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doi: 10.1136/jech.55.10.693.
14. McCartney G, Popham F, McMaster R, Cumbers A. Defining health and health inequalities. Public Health. 2019;172:22-30. doi: 10.1016/j.puhe.2019.03.023.
15. Bielecki M, Patel D, Hinkelbein J, et al. Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: a narrative review. Travel Med Infect Dis. 2021;39:101915.
doi: 10.1016/j.tmaid.2020.101915.
16. Bielecki M, Patel D, Hinkelbein J, et al. Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: A narrative review. Travel Med Infect Dis. 2021;39:101915.
doi:10.1016/j.tmaid.2020.101915.
17. Lei H, Tang JW, Li Y. Transmission routes of influenza A(H1N1)pdm09: analyses of inflight outbreaks. Epidemiol Infect. 2018;146(13):1731-1739. doi: 10.1017/S0950268818001772.
18. Marienau KJ, Cramer EH, Coleman MS, Marano N, Cetron MS. Flight related tuberculosis contact investigations in the United States: comparative risk and economic analysis of alternate protocols. Travel Med Infect Dis. 2014;12(1):54-62. doi: 10.1016/j.tmaid.2013.09.007.
19. Olsen SJ, Chang HL, Cheung TY, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med. 2003;349 (25):2416-2422. doi: 10.1056/NEJMoa031349.
20. Grout A, Howard N, Coker R, Speakman EM. Guidelines, law, and governance: disconnects in the global control of airline-associated infectious diseases. Lancet Infect Dis. 2017;17(4):e118-e122. doi: 10.1016/S1473-3099(16)30476-5.
21. Hoehl S, Karaca O, Kohmer N, et al. Assessment of SARS-CoV-2 transmission on an international flight and among a tourist group [published correction appears in JAMA Netw Open. 2020 Sep 1;3(9):e2022333]. JAMA Netw Open. 2020;3(8):e2018044. doi: 10.1001/jamanetworkopen.2020.18044.
22. Speake H, Phillips A, Chong T, et al. Flight-associated transmission of severe acute respiratory syndrome coronavirus 2 corroborated by whole-genome sequencing. Emerg Infect Dis. 2020;26 (12):2872-2880. doi: 10.3201/eid2612.203910.
23. Worsnop CZ. Domestic politics and the WHO's international health regulations: explaining the use of trade and travel barriers during disease outbreaks. Rev Int Organ. 2017;12(3):365-395. doi: 10.1007/s11558-016-9260-1.
24. GOV.UK. Travel advice: Coronavirus (COVID-19). June 22, 2021. Updated April 5, 2023. Accessed April 18, 2021. https://www.gov.uk/guidance/travel-advice-novel-coronavirus
25. Van Nguyen Q, Cao DA, Nghiem SH. Spread of COVID-19 and policy responses in Vietnam: an overview. Int J Infect Dis. 2021;103:157-161. Doi: 10.1016/j.ijid.2020.11.154.
26. Civil Aviation Administration of China (CAAC). Preventing spread of coronavirus disease 2019 (COVID-19): Guideline for airports (4th Edition). 2020. Accessed April 8, 2021.
https://www.icao.int/Security/COVID-19/StateActions/Preventing%20Spread%20of%20Coronavirus%20Disease%202019%20(COVID-19)%20Guideline%20for%20Airports%204th.pdf
27. National Health Commission of the People’s Republic of China (NHC). Protocol on prevention and control of novel coronavirus pneumonia. 2020. Accessed April 6, 2021.
http://www.nhc.gov.cn/jkj/s3577/202001/c67cfe29ecf1470e8c7fc47d3b751e88.shtml
28. Lai AY, Lee L, Wang MP, et al. Mental health impacts of the COVID-19 pandemic on international university students, related stressors, and coping strategies. Front Psychiatry. 2020;11:584240. doi: 10.3389/fpsyt.2020.584240.
29. Zhai Y, Du X. Mental health care for international Chinese students affected by the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e22. doi: 10.1016/S2215-0366(20)30089-4.
30. Pan SW, Shen GC, Liu C, Hsi JH. Coronavirus stigmatization and psychological distress among Asians in the United States. Ethn Health. 2021;26 (1):110-125. doi:10.1080/13557858.2020.1849570.
31. Hardinges, N. British-Chinese people tell of ‘discrimination’ and hate as fears rise over coronavirus. LBC. February 6, 2020. Accessed April 6, 2021. https://www.lbc.co.uk/news/british-chinese-people-discrimination-coronavirus/
32. Civil Aviation Administration of China. Notice on Further Reducing International Passenger Flights during the Epidemic Prevention and Control Period. 2020. Accessed April 8, 2021. http://www.caac.gov.cn/XXGK/XXGK/TZTG/202003/P020200326766958017420.pdf
33. Wang Q, Leng S. Mixed feelings toward overseas Chinese returning to escape COVID-19. Global Times. March 18, 2020. Accessed April 6, 2021. https://www.globaltimes.cn/content/1183025.shtml
34. World Health Organization. COVID-19 weekly epidemiological update. Edition 158. September 19, 2023. Accessed April 6, 2021.
https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---1-september-2023
35. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251. doi: 10.1097/ACM.0000000000000388.
36. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82. https://doi.org/10.1177/1525822X05279903
37. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
38. Polit D, Beck C. Nursing research: Generating and assessing evidence for nursing practice. 9th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
39. The Lancet Infectious Diseases. Air travel in the time of COVID-19. Lancet Infect Dis. 2020; 20(9):993. doi: 10.1016/S1473-3099(20)30647-2.
40. Shadmi E, Chen Y, Dourado I, et al. Health equity and COVID-19: global perspectives. Int J Equity Health. 2020;19(1):104. doi: 10.1186/s12939-020-01218-z.
41. Zheng Y, Goh E, Wen J. The effects of misleading media reports about COVID-19 on Chinese tourists’ mental health: a perspective article. Anatolia. 2020; 31(2):337-340. https://doi.org/10.1080/13032917.2020.1747208
42. He J, He L, Zhou W, Nie X, He M. Discrimination and social exclusion in the outbreak of COVID-19. Int J Environ Res Public Health. 2020;17(8):2933. doi: 10.3390/ijerph17082933.
43. Civil Aviation Administration of China (CAAC). Notice on further reducing international passenger flights during the epidemic prevention and control period. March 26, 2020. Accessed April 6, 2021.
http://www.caac.gov.cn/XXGK/XXGK/TZTG/202003/t20200326_201746.html
44. Embassy of the People's Republic of China in the Jamaica (EPRC). Notice on airline boarding requirements for certificates of negative nucleic acid and anti-body blood tests results. 2020. Accessed April 6, 2021.
http://jm.china-embassy.gov.cn/eng/news/202209/t20220902_10761503.htm
45. Williams J, Gonzalez-Medina D. Infectious diseases and social stigma. Applied Innovations and Technologies.2011; 4(1):58-70. doi: 10.15208/ati.2011.7
46. Gao Z, Xu Y, Guo Y, et al. A systematic review of re-detectable positive virus nucleic acid among COVID-19 patients in recovery phase. Infect Genet Evol. 2020;85:104494. doi: 10.1016/j.meegid.2020.104494.
47. González-Padilla DA, Tortolero-Blanco L. Social media influence in the COVID-19 Pandemic. Int Braz J Urol. 2020;46(suppl.1):120-124. doi: 10.1590/S1677-5538.IBJU.2020.S121.
48. Su Z, McDonnell D, Wen J, et al. Mental health consequences of COVID-19 media coverage: the need for effective crisis communication practices. Global Health. 2021;17(1):4. doi: 10.1186/s12992-020-00654-4.