Critical Appraisal of the Quality and Relevance of Published Evidence

            The Corona Virus Disease of 2019, well known as COVID-19, hit the entire world by surprise, impacting all aspects of human life. The COVID-19 pandemic affected the world’s economy, physical health, mental health, learning activities, business operations, and numerous other essential fields. The most significant impact of the COVID-19 pandemic was on human health, which resulted in the loss of approximately 5.7 million people globally. According to the World Health Organization COVID-19 Dashboard (2022), “as of February 11th, 2022, there have been 5,783,776 deaths reported to the World Health Organization. Furthermore, this virus has significantly affected persons with pre-existing physical health conditions such as diabetes, HIV/AIDS, cancer, heart diseases, hypertension, kidney disease, and respiratory diseases such as chronic obstructive pulmonary disease and asthma.

Abigail Fisher, Anna Roberts, Alison R. McKinlay, Daisy Fancourt, and Alexandra Burton conducted a qualitative study in 2021 investigating the effects of the COVID-19 pandemic on the well-being and mental/ psychological health of persons living with long-term physical health conditions. This article was published by BMC Public Health journal, an open-access peer-reviewed journal that comprises articles on disease epidemiology and the understanding/ knowledge of all public health aspects. This qualitative research aimed to examine how living with a long-term physical health issue throughout the COVID-19 epidemic impacted individuals’ well-being and psychological welfare. This public health issue under consideration is crucial because the COVID-19 pandemic has been discussed on our news channels, social media platforms, and schools for the past twenty-four months. Additionally, public health is faced with other life-threatening illnesses such as diabetes, cancer, kidney diseases, and cardiovascular diseases. Moreover, people with these long-term physical health conditions face an increased risk of severe sickness due to COVID-19. In most cases, such people are subject to the severest pandemic guidance; thus, they might be disproportionally affected (Fisher et al., 2021). Therefore, it is significant to explore how the virus impacted people with these other diseases and ascertain how these impacts can be mitigated in the future.
Validity is the degree to which a study investigates/ explores what it claims to research. Any given study should be valid for its results or findings to be interpreted and applied accurately. Additionally, validity is essential because it ascertains the research questions to be used in a particular study and assists in ensuring that researchers utilize questions that genuinely investigate the issue under investigation (Mohajan, 2017). The study by Fisher et al. (2021) is valid because the results are consistent with the study’s aim or research question. The study addressed a research question/ purpose: to investigate the effects of the COVID-19 pandemic on the well-being and mental/ psychological health of persons living with long-term physical health conditions. This research purpose is valid because it is true that COVID-19 has impacted the well-being and mental welfare of people living with long-term physical health issues, and Fisher et al. (2021) set out to explore these impacts qualitatively.
Fisher et al. (2021) used qualitative research methods to carry out this study. The methods used were interviews and questionnaires. In the present study, authors/ researchers conducted one-to-one semi-structured qualitative interviews via telephone or video calls to examine the effect of living with a long-term physical health condition during the pandemic on the selected participants (Fisher et al., 2021). The researchers administered pre-interview demographic questionnaires to the participants requiring them to report their ages, ethnicities, education levels, genders, details of their long-term physical health conditions, and marital statuses.
The interviews adhered to a topic guide that the researchers had formulated for this study utilizing current theories on behavior change, social networks and health, and stress. The topic guide involved several aspects such as understanding and adherence to COVID-19 guidelines, COVID-19’s impact on the long-term condition, description of social life before and during the COVID-19 pandemic, COVID-19’s impact on mental health, and future prospection of life now that the virus appears to be here for a long time. The research methods that Fisher et al. (2021) used for this study were appropriate because, during this period, most countries were restricting all social gatherings. Therefore, video or telephone calls were the only efficient and cost-effective options for conducting interviews. According to Adhabi & Anozie (2017), interviews are very operative in qualitative studies because they assist researchers in explaining, better understanding, and exploring research participants’/subjects’ behavior, phenomenon, opinions, and experiences. Additionally, interviews allow researchers to collect in-depth information from the participants by asking open-ended questions about a given topic.
This study comprised thirty-three participants who had long-term physical health conditions, which was the primary requirement to participate in this study. These participants’ long-term health issues included cancer, diabetes, autoimmune diseases, respiratory illnesses, musculoskeletal problems, cardiovascular diseases, inflammatory bowel disease, organ transplant complications, and comorbid mental health conditions. The results revealed four all-embracing themes specific to living with a long-term physical health condition. These overarching themes included: high anxiety and fear levels attributed to the supposed implications of contracting COVID-19, effects of isolation on well-being and mental health, healthcare experience during the COVID-19 pandemic, and anxiety resulting from uncertainty about the future (Fisher et al., 2021). Additionally, Fisher et al. (2021) identified fourteen subthemes, including the significance of social support systems and concerns about obtaining crucial supplies.
According to Fisher et al. (2021), under the first theme, participants reported anxiety and fear resulting from the sentience of the prospective implications of contracting COVID-19. Some described an increased sense of risk combined with understanding the significance of protecting themselves from the virus. Other subjects described the particular risks that the virus could cause, including long-lasting health complications, risk of dying, being hospitalized, ventilation, and admitted the damaging/ adverse impact of these risks on mental health. Under the second theme, the COVID-19 restrictions imposed on the subjects’ lives resulted in several negative mental health consequences (Fisher et al., 2021). Since most of the participants were in tremendously vulnerable groups, they were advised to go on isolation or had decided to isolate themselves from the general public. Isolation led to specific concerns, such as concerns about obtaining vital supplies, where participants experiencing difficulty in accessing these supplies reported fear and anxiety. Additionally, even though social support systems were critical, participants who went into isolation reported the need to depend on their close friends and relatives and the loss of independence as challenging (Fisher et al., 2021).
Under the third theme, participants reported both positive and negative effects of the encounters of healthcare and treatment during the COVID-19 pandemic. Numerous participants reported how their medical care consultations had shifted to video/ telephone appointments throughout the pandemic, and most participants regarded this shift as a more suitable and appropriate alternative. Additionally, subjects undertaking cancer treatment described the anxiety and stress resulting from the threat of interruption to treatment. Under the fourth theme, while several participants acknowledged that their experience of living with long-term physical health conditions may have somehow prepared them to deal with uncertainty, they still reported some concerns specific to the COVID-19 epidemic troubling mental wellness. For some subjects, the epidemic worsened their fears about upcoming treatments, progression of the long-term health conditions, and the capability to access medical services in the future if their health worsened (Fisher et al., 2021). Although several subjects reported they would discretionarily remain isolated after COVID-19 restrictions/ lockdowns were lifted, other participants asserted that the uncertainty surrounding how long the epidemic would be around was challenging. Furthermore, other participants reported a sense of grief/ loss in not knowing if or when social lives would resume normalcy.
The results are helpful because they illustrate an accurate picture of what people living with long-term physical health conditions during the COVID-19 pandemic experienced and how this situation impacted their health and mental wellness. These findings are helpful because relevant healthcare authorities can use them to mitigate the negative impacts encountered. The generalizability of the findings is that the COVID-19 pandemic imparted adverse mental health and physical health challenges on most people living with underlying physical health conditions. Furthermore, the findings were consistent with other related studies. For instance, in the present study, subjects required to isolate or live alone reported the mental health challenges they experienced when living alone. According to Fisher et al. (2021), two participants reported having attempted suicide or experienced suicidal thoughts due to living in isolation without receiving social support, in coupling with other issues like worrying about managing their long-term health conditions during the epidemic and loss of jobs. This finding is broadly consistent with a quantitative survey by Elbogen et al. (2021). This study by Elbogen et al. (2021), which involved 6607 United States adults, revealed that COVID-19 related social isolation, financial difficulty, and stress were attributed to self-harm and suicidal thoughts, even though this research did not focus on participants with long-term physical health conditions.
Additionally, the finding that most participants recorded that anxiety about the supposed implications of contracting the virus impacted their mental health negatively was consistent with several studies by Philip et al. (2020), Singh et al. (2020), and Pal et al. (2020). Pal et al. (2020) conducted a qualitative study that revealed that young adults living with type 1 diabetes experienced worsening glycemic control during the COVID-19 restrictions/ lockdowns. Singh et al. (2020) conducted a quantitative study that explored patients’ lived encounters, challenges/ problems experienced by persons with chronic diseases, their coping mechanisms, and the economic and social effects of the COVID-19 pandemic. According to Singh et al. (2020), most of the participants in their study reported experiencing adverse financial impacts due to the COVID-19 pandemic, which resulted in augmented stress and anxiety levels. On the other hand, Philip et al. (2020) conducted a qualitative study to determine the concerns of persons living with long-term respiratory complications in the United Kingdom regarding the COVID-19 pandemic’s impact and how these concerns impacted them. Philip et al. discovered that the pandemic adversely affected the psychological wellness of people living with respiratory complications.
The present study’s findings bolster large-scale quantitative studies but build on these by offering valuable context, depth, and elements that could mitigate some of the adverse impacts. The advantage of a qualitative study is that it can provide substantial insights into persons’ lived encounters, which is not achievable via quantitative research methods. However, conducting interviews through video or telephone calls had some limitations. The researchers might have missed several nonverbal gestures and the capability to establish trust and rapport between participant and respondent offered by physical interviews (Fisher et al., 2021). Nonetheless, even though the pandemic lockdowns and restrictions prohibited face-to-face interviewing, the content and length of interviews indicate that subjects could still engage in authentic discussions. Additionally, some people find it easy to open up and share more over the phone than during face-to-face interviews (Fisher et al., 2021). However, since the interviews were carried out when isolating was recommended, views might vary as guidelines and restrictions change.
The findings of this study will assist in shaping the response to and understanding of pandemics that might occur in the future; therefore, these findings serve as the evidence base. Generally, the present study adds to the literature suggesting that persons with long-term physical health conditions can be affected adversely by pandemics. The findings from this research bolster the suggestions to prevent the unwanted and dangerous pandemic impacts of individuals living with long-term health issues defined by Hartman-Boyce and Mahtani (2020). These recommendations describe the significance of collaboration, such as creating community partnerships, communication, such as offering information, support, and emergency/ central contact points for persons with lasting health issues, and pandemic continuity preparation for providers to guarantee access to vital supplies (Hartman-Boyce and Mahtani, 2020).
Furthermore, the strengths of the current study provide a blueprint for future studies about the impacts of pandemics on specific groups of people because they will follow what this study followed to be effective and successful. Moreover, the present study outlines the limitations and challenges it experienced to help future research avoid such encounters to be effective. Additionally, the present research offers several recommendations for future public health studies. Foremost, upcoming studies should examine how persons with lasting health conditions can be supported and encouraged that it is safer and more secure to seek medical advice than postpone presenting symptoms (Fisher et al., 2021). Secondly, future research should explore the associations between COVID-19 related financial difficulty, stress, and social isolation with self-harm and suicidal ideation in persons with long-term health conditions, specifically those who are tremendously clinically vulnerable and advised to isolate. Lastly, future research should focus on how relevant healthcare organizations and institutions balance the loss of independence by isolated persons with long-term health issues while ensuring such people receive the necessary support when in isolation.
To sum up, this qualitative research aimed to examine how living with a long-term physical health issue throughout the COVID-19 epidemic impacted individuals’ well-being and psychological welfare. The study by Fisher et al. (2021) is valid because the results are consistent with the study’s aim or research question. Additionally, researchers conducted one-to-one semi-structured qualitative interviews via telephone or video calls to collect the research data. The generalizability of the study findings is that the COVID-19 pandemic imposed adverse mental health and physical health challenges on most people living with underlying physical health conditions. Furthermore, the findings were consistent with other related studies. Lastly, the present research offers several recommendations for future public health studies.

Adhabi, E. and Anozie, C.B., 2017. Literature review for the type of interview in qualitative research. International Journal of Education, 9(3), pp.86-97. DOI:
Elbogen, E.B., Lanier, M., Blakey, S.M., Wagner, H.R. and Tsai, J., 2021. Suicidal ideation and thoughts of self‐harm during the COVID‐19 pandemic: The role of COVID‐19‐related stress, social isolation, and financial strain. Depression and Anxiety, 38(7), pp.739-748. DOI:
Fisher, A., Roberts, A., McKinlay, A.R., Fancourt, D. and Burton, A., 2021. The impact of the COVID-19 pandemic on mental health and well-being of people living with a long-term physical health condition: a qualitative study. BMC Public Health, 21(1), pp.1-12. DOI:
Hartmann-Boyce, J., and Mahtani, K. R., 2020, March 20th. Supporting people with long-term conditions (LTCs) during national emergencies. Centre for Evidence Based Medicine Review. Available at: [Accessed February 12th, 2022].
Mohajan, H.K., 2017. Two criteria for good measurements in research: Validity and reliability. Annals of Spiru Haret University. Economic Series, 17(4), pp.59-82. DOI:
Pal, R., Yadav, U., Verma, A. and Bhadada, S.K., 2021. Awareness regarding COVID-19 and problems being faced by young adults with type 1 diabetes mellitus amid nationwide lockdown in India: A qualitative interview study. Primary Care Diabetes, 15(1), pp.10-15. DOI:

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