key: cord-0695629-sx1mbl22 authors: Kumari, Archana; Ranjan, Piyush; Sharma, K. Aparna; Sahu, Anamika; Bharti, Juhi; Zangmo, Rinchen; Bhatla, Neerja title: Impact of COVID‐19 on psychosocial functioning of peripartum women: A qualitative study comprising focus group discussions and in‐depth interviews date: 2020-12-31 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13524 sha: e320c744410e51bcdd92d7a61799ebc5aeff7e3f doc_id: 695629 cord_uid: sx1mbl22 OBJECTIVE: Peripartum is a period of profound hormonal changes in the body and COVID‐19 seems to have an additional impact on these women's psychosocial functioning. This calls for a need to address the psychosocial and behavioural impact of COVID‐19 on peripartum women's lives. METHODS: Three focus group discussions and ten in‐depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive sampling. In verbatim transcription was done, followed by thematic analysis to extract key conceptual themes. RESULTS: Fourteen pregnant and eleven postpartum women were included. The mean age was 28.5 years. Two major domains were identified: 1) the psychological domain including the categories of thoughts, emotions, and behaviour, and 2) the social domain comprising categories of relationships with family members and friends, perceived loss of social support, doctor‐patient relationship, and social determinants of health. CONCLUSION: The pandemic has indeed affected the psychosocial functioning of peripartum women. The study results might prove to be helpful for clinicians and mental health specialists who can suggest and develop different coping strategies for peripartum women during this pandemic. COVID-19 has had a significant effect on all sections of society, including pregnant and peripartum women. Studies suggest a significant burden of COVID-19 among pregnant women attending the hospital for any reason. 1 Hormonal changes and several other factors predispose these women to behavioural changes and alteration in psychological functioning and social well-being. A recent survey of pregnant women conducted in Italy found severe psychological impact of COVID-19 on more than half of participants. 2 Qualitative studies like focused group discussions and in-depth interviews are essential to understand a homogeneous population group's thoughts, opinions, beliefs, and attitudes regarding any particular topic. 3 Researchers worldwide have been using these modalities to gather data/information regarding dynamic opinions on various health topics. 3 Psychosocial response to a particular condition depends upon the social and cultural makeup of society, which keeps changing over time. 4 Thus it is essential to conduct such studies in different population groups over different time frames. There is a dearth of conclusive knowledge and comprehension about Indian peripartum women's experience during this pandemic. This calls for a need to address the psychosocial and behavioural impact of COVID-19 on peripartum women's lives. Thus, this study aims to conduct qualitative research comprising focus group discussions and in-depth interviews to capture peripartum women's lived experiences during the COVID-19 pandemic. We conducted qualitative content analysis with a conventional approach to obtain themes and subthemes. Pregnant women from the 30 th week of gestation till one month postpartum who could speak either English or Hindi language were selected through purposive sampling with the principle of maximum variation. In order to provide diverse experiences, participants were selected with varying work-experiences, age, parity, employment status, type of family (joint/nuclear), socio-economic status, any known medical comorbidities. Women with confirmed COVID-19 infection, previously known psychotic illnesses, or a history of significant psychiatric comorbidity warranting hospitalization were excluded. The study was conducted in September 2020 after approval by the Institute Ethics Committee (IEC/549/6/2020). Participants were informed about the purpose of the study and invited to attend the group discussion. Written informed consent was taken. Data collection was done by the primary investigator through three focus group discussions constituting five participants in each, one via an online platform while the other two were conducted in the antenatal ward. Each session lasted for about 45-50 minutes. Apart from this, ten in-depth interviews were also carried out, each session lasting for about 20-25 minutes. Both focus group discussions and in-depth interviews were initiated by an open-ended question -"What important changes have you experienced in your lives due to COVID-19?". In adjunct to this, a semi-structured guide comprising open-ended questions (Table 1) related to daily lifestyle, preventive practices, and concerns of peripartum women was prepared and used whenever needed to direct and keep the discussion focused. At the end of the discussion, participants were encouraged to include additional information, if any. Each discussion was transcribed verbatim immediately after the interview and read through several times to understand participants' perspectives. Anonymity of the information collected and confidentiality of the recorded interviews was ensured by not mentioning their names in the transcribed verbatims. Accuracy of the transcribed text was ensured by sharing it with participants, and their feedback was recorded. Data were then analyzed using a qualitative content process to identify the codes using the inductive approach, which were then condensed into subcategories and categorized by the process of induction. Finally, the theme was derived through data analysis. External supervisors with experience in qualitative research were approached for conformability of findings and coding agreement. Of the 25 peripartum women who participated in our study, 14 were currently pregnant and 11 were postpartum. The average age of the participants was 28.5 ± 4.6 (mean ± SD) years. Occupations were as follows: homemakers (n = 10), healthcare professionals (n = 8), miscellaneous (n = 7): teachers (3), engineers (2), banker (1), lawyer (1) . The characteristics of the participants are shown in Table 2 . What important changes have you experienced in your lives due to COVID 19? How has your social life (meeting friends, family members, attending social gatherings, religious ceremonies, etc.) got affected due to COVID-19? Describe your relationship you share with your family members staying with you during COVID-19. (Relationship with a spouse, children, and other family members) What precautions are you taking to prevent yourself from getting infected by COVID-19? Highlight any changes that you have experienced in your lifestyle related to diet, physical activity, and sleep. Put some light on the role and usage of social media. What has been your experience regarding the availability of healthcare services? What difficulties are you facing due to COVID-19? How do you spend your day these days? How has your employment got affected due to COVID-19? (Job, business, working hours, workload) What are your concerns about your own health? What are your concerns for your baby? The transcribed verbatims has been shown in Table 3 . Two major themes were derived as shown in Table 4 : (1) When asked about the various effects of the coronavirus pandemic on their lives, most participants reported a sense of fear and/or anxiety. They felt puzzled about what exactly they were supposed to do in the changing world. The fear of getting infected with the coronavirus and unborn baby were shared by all participants. Various codes such as social boycott, inability to meet friends, inability to attend social gatherings, religious ceremonies, and inability to visit doctors/people depicted the household confinement aspect expressed by the participants. However, three participants reported enjoying this home confinement with their family members. Moreover, many participants also reported that this pandemic had upended their daily routine such as not being able to maintain a healthy diet and regular physical activity. Participants claimed that they were following preventive measures during the COVID-19 pandemic, which included frequent hand washing/ sanitizing, maintenance of social distancing, usage of masks, etc. Some participants also reported that they always shopped in bulk for grocery items every time they stepped out, kept them outside the home for at least 48 hours, and then sanitized thoroughly before finally using them. Moreover, they discontinued any household help. On being questioned about how they were trying to overcome their COVID-19-associated agitation and fear, the participants reported that they were spending time with their families, watching television, binge-watching their favourite shows, indulging in their hobbies, staying active on various social media programs, etc. Many surveys assessing the psychosocial impact of COVID-19 on peripartum women have been conducted. 10, 12, 13 Our study is one of the first attempts worldwide and in India to assess COVID-19 impact on peripartum women's psychosocial functioning through focus group discussions and in-depth interviews to not only focus on 'what' but also on 'how' and 'why'. However, this hospital study has a few limitations. Participants were recruited via purposive sampling through contacts and networks of investigators. Moreover, the sample may be unrepresentative as it only included women visiting a tertiary care centre and were mostly educated. The COVID-19 pandemic has affected the psychosocial functioning of peripartum women. The study results can help clinicians and mental health specialists who can suggest and develop different coping strategies for peripartum women based on the lived experience shared in the study. This study will make way for further studies with a larger sample size looking into questionnaire development and community based surveys. It is imperative to do future research to address the magnitude of the problem among this vulnerable population and assess the degree of severity of each psychosocial component. The study has been supported by AIIMS New Delhi under "Fast track intramural research grant theme: research on SARS-COV-2 AND COVID-19". The authors have no conflicts of interest. NB, AK and PR conceived the idea. AK, KAS, RZ and JB planned and conducted focused group discussion and in-depth interviews with chief guidance of NB. AK, AS and NB wrote the manuscript and other authors have given their inputs. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis Psychological impact of coronavirus disease 2019 in pregnant women Carrying out rapid qualitative research during a pandemic: emerging lessons from COVID-19 Social and Cultural Dynamics: A Study of Change in Major Systems of Art, Truth, Ethics, Law and Social Relationships Maternal stress in pregnancy: considerations for fetal development Impact of maternal stress, depression & anxiety on fetal neurobehavioral development Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. 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