Recovered but Constrained: Narratives of Ghanaian COVID-19 Survivors Experiences and Coping Pathways of Stigma, Discrimination, Social Exclusion and Their Sequels

Document Type : Original Article

Authors

1 Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana

2 Ghana Health Service, Abokobi Health Centre, Accra, Ghana

3 Faculty of Health and Allied Sciences, Catholic University College of Ghana, Sunyani, Ghana

Abstract

Background 
Research about the coronavirus disease 2019 (COVID-19), its epidemiology and socio- economic impact on populations worldwide has gained attention. However, there is dearth of empirical knowledge in low- and middleincome settings about the pandemic’s impact on survivors, particularly the tension of their everyday life arising from the experiences and consequences of stigma, discrimination and social exclusion, and how they cope with these behavioral adversities.
 

Methods 
Realist qualitative approach drawing data from people clinically diagnosed positive of COVID-19, admitted into therapy in a designated treatment facility, and subsequently recovered and discharged for or without follow-up domiciliary care. In-depth interviews were conducted by maintaining a code book for identifying and documenting thematic categories in a progression leading to thematic saturation with 45 participants. Data were transcribed and coded deductively for broad themes at the start before systematically nesting emerging themes into the broad ones with the aid of NVivo 12 software.
 

Results 
Everyday lived experiences of the participants were disrupted with acts of indirect stigmatization (against relatives and family members), direct stigmatization (labeling, prejudices and stereotyping), barriers to realizing full social life and discriminatory behaviors across socio-ecological structures (workplace, community, family, and social institutions). These behavioral adversities were associated with self-reported poor health, anxiety and psychological disorders, and frustrations among others. Consequently, supplicatory prayers, societal and organizational withdrawal, aggressive behaviors, supportive counseling, and self-assertive behaviors were adopted to cope and modify the adverse behaviors driven by misinformation and fearful perceptions of the COVID-19 and its contagious proportions.
 

Conclusion 
In the face of the analysis, social campaigns and dissemination of toolkits that can trigger behavior change and responsible behaviors toward COVID-19 survivors are proposed to be implemented by health stakeholders, policy and decision makers in partnership with social influencers, the media, and telecoms.

Keywords

Main Subjects


  1. Barach P, Fisher SD, Adams MJ, et al. Disruption of healthcare: will the COVID pandemic worsen non-COVID outcomes and disease outbreaks? Prog Pediatr Cardiol. 2020;59:101254. doi:10.1016/j.ppedcard.2020.101254
  2. Haider N, Osman AY, Gadzekpo A, et al. Lockdown measures in response to COVID-19 in nine sub-Saharan African countries. BMJ Glob Health. 2020;5(10):e003319. doi:10.1136/bmjgh-2020-003319
  3. Szczesniak D, Ciulkowicz M, Maciaszek J, et al. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: results from a nationwide survey. Brain Behav Immun. 2020;87:161-162. doi:10.1016/j.bbi.2020.05.027
  4. Wang C, Chudzicka-Czupała A, Grabowski D, et al. The association between physical and mental health and face mask use during the COVID-19 pandemic: a comparison of two countries with different views and practices. Front Psychiatry. 2020;11:569981. doi:10.3389/fpsyt.2020.569981
  5. Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The psychological impact of COVID-19 on the mental health in the general population. QJM. 2020;113(8):531-537. doi:10.1093/qjmed/hcaa201
  6. Ahinkorah BO, Ameyaw EK, Hagan JE Jr, Seidu AA, Schack T. Rising above misinformation or fake news in Africa: another strategy to control COVID-19 spread. Front Commun. 2020;5:45. doi:10.3389/fcomm.2020.00045
  7. Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry. 2020;63(1):e32. doi:10.1192/j.eurpsy.2020.35
  8. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med. 2020;180(6):817-818. doi:10.1001/jamainternmed.2020.1562
  9. Peprah P, Gyasi RM. Stigma and COVID-19 crisis: a wake-up call. Int J Health Plann Manage. 2021;36(1):215-218. doi:10.1002/hpm.3065
  10. Cipolletta S, Ortu MC. COVID-19: common constructions of the pandemic and their implications. J Constr Psychol. 2020:1-17. doi:10.1080/10720537.2020.1818653
  11. Veldsman DP. God’s spirit (of wisdom) has been sent into the world, not COVID-19: a contextual systematic-theological perspective. HTS Teologiese Studies/Theological Studies. 2020;76(1):a6222. doi:10.4102/hts.v76i1.6222
  12. de-Graft Aikins A. ‘Colonial virus’? creative arts and public understanding of COVID-19 in Ghana. Journal of the British Academy. 2020;8(1):401-413. doi:10.5871/jba/008.401
  13. Ransing R, Ramalho R, de Filippis R, et al. Infectious disease outbreak related stigma and discrimination during the COVID-19 pandemic: drivers, facilitators, manifestations, and outcomes across the world. Brain Behav Immun. 2020;89:555-558. doi:10.1016/j.bbi.2020.07.033
  14. Mattia JG, Vandy MJ, Chang JC, et al. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis. 2016;16(3):331-338. doi:10.1016/s1473-3099(15)00489-2
  15. Statista. Coronavirus cases in Africa as of April 22, 2021, by country. Hamburg, Germany: Statista GmbH; 2021.
  16. Govender K, Cowden RG, Nyamaruze P, Armstrong RM, Hatane L. Beyond the disease: contextualized implications of the COVID-19 pandemic for children and young people living in Eastern and Southern Africa. Front Public Health. 2020;8:504. doi:10.3389/fpubh.2020.00504
  17. Semo BW, Frissa SM. The mental health impact of the COVID-19 pandemic: implications for sub-Saharan Africa. Psychol Res Behav Manag. 2020;13:713-720. doi:10.2147/prbm.s264286
  18. Ghana Health Service. COVID-19: Ghana outbreak response management updates. 2021. https://www.ghanahealthservice.org/covid19/archive.php. Accessed February 6, 2020.
  19. 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. doi:10.1177/1525822x05279903
  20. Coetzee BJ, Kagee A. Structural barriers to adhering to health behaviours in the context of the COVID-19 crisis: considerations for low- and middle-income countries. Glob Public Health. 2020;15(8):1093-1102. doi:10.1080/17441692.2020.1779331
  21. Widayati A. Knowledge, perceptions, and awareness related to COVID-19 among the Indonesian adults during the outbreak's escalation period: a cross-sectional online survey in Yogyakarta province, Indonesia. Asia Pac J Public Health. 2021:10105395211001655. doi:10.1177/10105395211001655
  22. Nivette A, Ribeaud D, Murray A, et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: insights from a longitudinal cohort study. Soc Sci Med. 2021;268:113370. doi:10.1016/j.socscimed.2020.113370
  23. Bhattacharya P, Banerjee D, Rao TS. The "untold" side of COVID-19: social stigma and its consequences in India. Indian J Psychol Med. 2020;42(4):382-386. doi:10.1177/0253717620935578
  24. McMahon SA, Ho LS, Brown H, Miller L, Ansumana R, Kennedy CE. Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone's Ebola epidemic. Health Policy Plan. 2016;31(9):1232-1239. doi:10.1093/heapol/czw055
  25. O'Leary A, Jalloh MF, Neria Y. Fear and culture: contextualising mental health impact of the 2014-2016 Ebola epidemic in West Africa. BMJ Glob Health. 2018;3(3):e000924. doi:10.1136/bmjgh-2018-000924
  26. Keita MM, Taverne B, Sy Savané S, et al. Depressive symptoms among survivors of Ebola virus disease in Conakry (Guinea): preliminary results of the PostEboGui cohort. BMC Psychiatry. 2017;17(1):127. doi:10.1186/s12888-017-1280-8
  27. Parasher A. COVID-19: current understanding of its pathophysiology, clinical presentation and treatment. Postgrad Med J. 2021;97(1147):312-320. doi:10.1136/postgradmedj-2020-138577
  28. Dash S, Parray AA, De Freitas L, et al. Combating the COVID-19 infodemic: a three-level approach for low and middle-income countries. BMJ Glob Health. 2021;6(1):e004671. doi:10.1136/bmjgh-2020-004671
  29. Okereke M, Ukor NA, Ngaruiya LM, et al. COVID-19 misinformation and infodemic in rural Africa. Am J Trop Med Hyg. 2020;104(2):453-456. doi:10.4269/ajtmh.20-1488
  30. Hart JL, Turnbull AE, Oppenheim IM, Courtright KR. Family-centered care during the COVID-19 era. J Pain Symptom Manage. 2020;60(2):e93-e97. doi:10.1016/j.jpainsymman.2020.04.017
  31. Teixeira da Silva JA. Stigmatization, discrimination, racism, injustice, and inequalities in the COVID-19 era. Int J Health Policy Manag. 2020;9(11):484-485. doi:10.34172/ijhpm.2020.87
  32. Kniffin KM, Narayanan J, Anseel F, et al. COVID-19 and the workplace: implications, issues, and insights for future research and action. Am Psychol. 2021;76(1):63-77. doi:10.1037/amp0000716
  33. Demirović Bajrami D, Terzić A, Petrović MD, Radovanović M, Tretiakova TN, Hadoud A. Will we have the same employees in hospitality after all? the impact of COVID-19 on employees’ work attitudes and turnover intentions. Int J Hosp Manag. 2021;94:102754. doi:10.1016/j.ijhm.2020.102754
  34. Singh R, Subedi M. COVID-19 and stigma: social discrimination towards frontline healthcare providers and COVID-19 recovered patients in Nepal. Asian J Psychiatr. 2020;53:102222. doi:10.1016/j.ajp.2020.102222
  35. Ironson G, Kremer H, Lucette A. Relationship between spiritual coping and survival in patients with HIV. J Gen Intern Med. 2016;31(9):1068-1076. doi:10.1007/s11606-016-3668-4
  36. Rzeszutek M. Health-related quality of life and coping strategies among people living with HIV: the moderating role of gender. Arch Womens Ment Health. 2018;21(3):247-257. doi:10.1007/s00737-017-0801-2

Articles in Press, Corrected Proof
Available Online from 09 August 2021
  • Receive Date: 07 March 2021
  • Revise Date: 14 June 2021
  • Accept Date: 06 July 2021