key: cord-1009563-j9cvjnwt
authors: Fisher, Harriet; Lambert, Helen; Hickman, Matthew; Yardley, Lucy; Audrey, Suzanne
title: Experiences of the coronavirus disease-19 (COVID-19) pandemic from the perspectives of young people: Rapid qualitative study
date: 2021-07-08
journal: Public Health Pract (Oxf)
DOI: 10.1016/j.puhip.2021.100162
sha: 83599e5a78fd7ad6c8120eb43f2fa81f6fd2884c
doc_id: 1009563
cord_uid: j9cvjnwt

OBJECTIVES: Young people are considered at lower risk from coronavirus disease-19 (COVID-19). However, measures to limit the population health impact of the current COVID-19 pandemic have caused significant disruptions to their lives. The objective of this study was to explore the experiences of young people predominantly living in the south-west of England during the COVID-19 pandemic. STUDY DESIGN: Rapid qualitative study. METHODS: Following advertisement on social media, a purposive sample of young people by age and gender who had expressed an interest were invited to participate. In June 2020, 21 young people (12–17 years) took part in 18 semi-structured interviews, either through a digital platform or by telephone. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVvivo Software. RESULTS: Young people felt the greatest impacts of the pandemic have been disruption to how they learned because of school closures and limited face-to-face interaction with their social networks. There was variation in terms of how satisfied young people were with self-directed learning at home, and some anxieties in relation to its effectiveness outside the school environment. Most young people reported maintaining social relationships remotely, but some young people appeared to have little social interaction outside their household. High levels of adherence to social distancing and handwashing were reported, which could lead to a sense of injustice resulting from visibility of other people breaching social distancing guidance. Young people were willing to be vaccinated against COVID-19 if a vaccine became available, with the greatest motivator being to protect others above themselves. CONCLUSIONS: Young people have experienced significant disruption to their education and social networks during the COVID-19 pandemic. During lockdown, high levels of compliance to government public health guidelines to reduce transmission of COVID-19 were reported by young people. If an effective vaccine is developed, a schools-based vaccination programme could be an efficient method to interrupt transmission to more at-risk populations and prevent further disruptions to young people's education.

Objectives: Young people are considered at lower risk from coronavirus disease-19 . However, measures to limit the population health impact of the current COVID-19 pandemic have caused significant disruptions to their lives. The objective of this study was to explore the experiences of young people predominantly living in the south-west of England during the COVID-19 pandemic. Study design: Rapid qualitative study. Methods: Following advertisement on social media, a purposive sample of young people by age and gender who had expressed an interest were invited to participate. In June 2020, 21 young people (12-17 years) took part in 18 semi-structured interviews, either through a digital platform or by telephone. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVvivo Software. Results: Young people felt the greatest impacts of the pandemic have been disruption to how they learned because of school closures and limited face-to-face interaction with their social networks. There was variation in terms of how satisfied young people were with self-directed learning at home, and some anxieties in relation to its effectiveness outside the school environment. Most young people reported maintaining social relationships remotely, but some young people appeared to have little social interaction outside their household. High levels of adherence to social distancing and handwashing were reported, which could lead to a sense of injustice resulting from visibility of other people breaching social distancing guidance. Young people were willing to be vaccinated against COVID-19 if a vaccine became available, with the greatest motivator being to protect others above themselves. Conclusions: Young people have experienced significant disruption to their education and social networks during the COVID-19 pandemic. During lockdown, high levels of compliance to government public health guidelines to reduce transmission of COVID-19 were reported by young people. If an effective vaccine is developed, a schoolsbased vaccination programme could be an efficient method to interrupt transmission to more at-risk populations and prevent further disruptions to young people's education.

Infection with the new coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2) causes novel coronavirus disease 2019 . In March 2020, the World Health Organisation declared the COVID-19 outbreak to be a pandemic [1] . By January 2021, over 100 million cases had been confirmed in addition to over 2 million fatalities [2] .

In England, public health control measures to reduce transmission were introduced. In late March 2020, schools were closed nationally, and 'lockdown' measures were put in place where the public were allowed to leave their homes only for exercise and for grocery shopping. From mid-May, the general public were allowed outside for unlimited exercise and to meet one other person at a minimum distance of two metres. From mid-June, primary and secondary schools were partially opened for priority year groups, and up to six people were allowed to meet outside.

In England, there is strong accumulating evidence that people aged over 70 years are disproportionately affected by COVID-19 [3] . Young people (defined in the study according to the World Health Organisation criteria as aged between 10 and 24 years [4] ) are much less likely to be adversely affected by COVID-19 in relation to their physical health. However, they have had to adjust to dramatic changes in their daily routines, homelife, and education as a result of COVID-19 public health measures.

Concerns have been raised that young people's social and emotional well-being has been negatively affected by these changes. A survey showed a deterioration in symptoms and increased feelings of loneliness and isolation among young people with existing mental health issues [5] . Similarly, a survey undertaken in the north of England reported young people have increased anxiety and worries [6] . Concurrently, young people have recently become subject to increased negative scrutiny by local media outlets [7, 8] following reports that they are disproportionately represented in new cases of COVID-19 across Europe [9] .

The overall aim of this rapid qualitative study is to examine the experiences of the COVID-19 pandemic from the perspectives of young people. The specific objectives are to:

(i) explore the social impact of the COVID-19 pandemic on young people; (ii) examine the extent to which young people are implementing COVID-19 public health guidance, and; (iii) consider the acceptability of vaccination against COVID-19 among young people.

A rapid qualitative study.

Recruitment and data collection took place in June 2020. The study was initially promoted by an email and social media accounts associated with University of Bristol research and advisory groups. These posts were then more widely disseminated through recipients' own social network and social media accounts. Overall, 121 expressions of interest were received from young people or their parents. The age and gender of the potential participants were ascertained. Ethnicity and sociodemographic data were not collected.

To ensure the study sample was balanced by gender and age category, a purposive sample of young people were selected to participate.

The characteristics of the sample by age and gender are provided (Table 1 ). Most participants lived in Bristol or the immediate surrounding areas, with three participants based in London and two in South Wales.

Topic guides were developed to explore young people's experiences during the COVID-19 pandemic. Prior to the interviews taking place, verbal or written parental consent was recorded for participants aged 15 years or below. Verbal or written assent was also obtained from all participants, which included permission to digitally record the interview. Semi-structured interviews took place remotely either by a digital platform or telephone. Depending on their preference, young people were interviewed individually, or with a nominated peer or family member.

Interview recordings were transcribed, anonymised, and double checked for accuracy. Thematic analysis [10] was undertaken assisted by NVivo 12 software. Familiarisation with the dataset began by reading and re-reading the transcripts. Sections of text were coded, with multiple codes being allocated where appropriate. Coding was simultaneously inductive (emerging from the data in the transcripts) and deductive (based on the research questions). Similar codes were grouped together to create a thematic framework comprising a hierarchy of themes and sub-themes, within which similarities and differences were explored. Interpretation of the data was discussed at a consensus meeting (HF, SA) as analysis progressed.

Twenty-one young people participated in 18 interviews (depending on their preference to be interviewed alone or with a peer or family member).

The findings are reported by the following themes and sub-themes related to the objectives of the study: (i) social impact of COVID-19 pandemic on young people ('schooling and education', 'disruption to social networks', and 'hobbies and extracurricular activities'); (ii) implementation of COVID-19 government guidelines ('social distancing', 'handwashing and hygiene', 'self-isolation', and 'enforcement of rules'), and: (iii) acceptability of vaccination against COVID-19. Illustrative quotations were chosen, because they were expressed concisely and typify responses relating to the themes (Tables 2-4).

None of the participants believed that anyone in their household had experienced COVID-19, although some young people were aware of cases affecting more distant members within their social networks. Therefore, the impact of the COVID-19 pandemic was usually felt through disruption to their schooling education, their social networks, and hobbies and extracurricular activities.

Since school closures, all of the young people interviewed were provided with home learning from their school. This usually involved being set work by the teachers which was uploaded by the young person via an online portal when completed. The learning undertaken at home was largely self-guided by the young people, with little or no additional input from teachers, even if requested. There was variation in relation to the acceptability of home learning, with the majority of young people reporting both advantages and disadvantages over face-to-face teaching in a classroom. There was no obvious difference in experience by age of the participant. Some young people preferred being able to independently self-direct their learning. However, disadvantages reported by young people included that they felt the home environment was less conducive to learning than the classroom environment ( Table 2) . Some young people experienced difficulties in sustaining motivation and were more distracted at home, which led to worries about falling behind in their work. The young people not enrolled to sit national exams in summer 2020 reported little impact from not having to sit routine end of year tests. Mixed feelings were evident among those young people who were scheduled to sit national exams. Frustration over wasted effort towards their schooling and revision was evident, but this was counter-balanced by a reduction in stress from not having to prepare for and sit exams. There was also recognition that assessment based on teachers' predicted grades could unfairly disadvantage young people who perform better in exams or do not have a good relationship with their teacher (Table 2) .

At the time of data collection, most young people were unaware of plans to return to school, although some were attending school for short periods before the Summer Term ended. There was recognition that when schools fully re-opened there may be changes to how the school day would operate to adhere to social distancing guidance. Young people trusted the school to make changes to keep them safe and were not overly concerned about being at greater risk of contracting COVID-19 when they returned. The majority of young people were looking forward to their return to school and being able to spend time with their school friends. However, for some young people, school closures appeared to be more beneficial ( Table 2) .

Many young people reported limited face-to-face interaction with people outside their household in recent months. Most young people reported keeping in contact with friends through different digital platforms. A few of the participants appeared more isolated, reporting few interactions with people outside their household. As the guidelines around meeting up with members external to one's household relaxed in June 2020, older participants reported enjoying being able to spend time with friends. This was less frequently reported by younger participants who may have less independence than older participants and be more heavily reliant on parents to organise social events ( Table 2) .

During lockdown, participants of this study often reported they had more time to pursue existing or new hobbies and extracurricular activities. Although some activities were unable to take place, some providers had switched to an online model of delivery to continue engaging with young people. Young people reported being more physically active than they would have been usually, going out for walks or runs with members of their household. There was improved confidence among some young people to cycle on roads when there was less traffic (Table 2) .

All study participants were aware of COVID-19 related government guidelines in relation to social distancing and increased handwashing and hygiene. Most young people also mentioned the requirement to stay at home and self-isolate in the event of being diagnosed with COVID-19. Reflecting the governmental guidance at the time, wearing face coverings was rarely considered by young people.

Social distancing was most widely discussed among young people, reporting very high levels of household adherence to guidelines. Most young people reported very strict adherence to guidelines by not making physical contact, maintaining a two metre distance, and meeting friends or family members outside rather than inside. A few young people admitted they were not always strictly compliant, but these were usually minor infractions (Table 3) .

Almost all young people perceived that others, mostly those of a similar age to themselves, may not adhere as strictly to socially distancing rules. At the time of interviews, in response to the death of an African American citizen in police custody, Black Lives Matter protests were taking place globally. Around half of the participants spontaneously discussed this in relation to whether social distancing could be maintained and the likely impact this could have on the ongoing pandemic. Young people had mixed feelings about whether people should have congregated at Black Lives Matter events (Table 3) .

Family norms around hygiene measures appear to have changed, with young people reporting increased frequency and adherence to handwashing. Some young people reported having dry, cracked hands as a result of this change. Older family members may remind younger family members about adherence. Some young people recognised wider societal implications of increased handwashing and hygiene practices in relation to other infectious diseases (Table 3) .

The need for self-isolation to contain COVID-19 was discussed by most young people during the interviews. None of the participants had to do this themselves, but appeared willing to if required. With the rules around social distancing becoming more permissive, some young people recognised greater difficulties in adherence to self-isolation if this resulted in missing out on social opportunities (Table 3) .

Perceptions of non-compliance by other people invoked differing levels of social judgement by the study participants. This was mostly discussed in relation to social distancing, which was visible both in public settings and through social media. Many young people, both in the older and younger age groups, felt negatively towards people who were perceived to be 'rule breaking', explaining their actions were unjust, risky and selfish towards others. These young people felt largely powerless, or not confident enough, to communicate this directly to the perpetrators. Other young people were less affected by the actions of others, or felt it was not their place to enforce compliance. This may also be difficult among their peer groups. Where young people reported experiences of civic enforcement of 'rule breakers', these appeared to be viewed negatively (Table 3) .

All young people interviewed were willing to be vaccinated against COVID-19 if a vaccine became available. Most were motivated by an altruistic desire to protect others at greater risk from COVID-19 than themselves. Others cited the importance of reducing the impact of the infectious disease among the population. Some young people recognised that the availability of the vaccine could help a return 'back to normal' (Table 4) .

Others suggested they may not agree to be vaccinated if there was a potential for harm, for example through serious side-effects, or weak evidence for effectiveness. Some young people felt that the vaccine should be prioritised for population groups at greater risk. The young people interviewed were all pro-vaccine, but felt people with negative views about vaccines in general were unlikely to change their mind towards being vaccinated against COVID-19 (Table 4 ).

The greatest impacts of the COVID-19 pandemic on young people have been through the indirect consequences of public health measures including school closures and social distancing guidelines, rather than from the disease itself. Young people reported adherence to public health guidelines which could be coupled with a sense of social injustice invoked where others were perceived to be non-compliant. There did not appear to be marked differences in levels of compliance by the age of participants. However, greater levels of freedom to meet and socialise with groups outside of their household were apparent among the older participants, which could contribute to perceptions of lower levels of adherence. This has the potential to influence ongoing adherence to public health guidance by young people, as has been shown in a recent study with an adult population [11] .

To reduce the spread of COVID-19, school closures have been implemented in the majority of countries with significant implications for young people's education [12] . In general, young people in this study had continued their school work at home and appeared confident in their abilities to self-direct some of their learning. However, some anxieties were evident in relation to their perceptions of the effectiveness of home learning especially in preparation for external examinations. Data collection for this study largely took place using digital platforms, where young people used personal electronic equipment in their own bedroom or in a shared communal space without being interrupted by other members of their household. Reflective of their reported experiences, their home environment appeared to be conducive to home learning. The experiences reported in this study may not therefore be representative of the experiences of young people in other households throughout England or other households more widely where access to digital equipment, internet, or personal space is compromised.

In January 2021, schools in England were closed which is causing young people significant disruption to their education. The Chief Medical Officer has recently stated that young people are more likely to be harmed by the school closures, than from physical health problems resulting from COVID-19 [13] . Increased symptoms of mental distress have also been reported [5, 6] , in addition to increased loneliness and isolation, a lack of safe space, challenging family relationships and increased social media pressure [14] .

In contrast, a recent survey undertaken in the south-west of England showed some young people have had reduced levels of anxiety during school closures. The authors attributed this to the removal of stress factors such as pressure of academic work and challenging peer relationships [15] . The qualitative findings of this study undertaken with young people who appeared to be from relatively affluent backgrounds lend support to there being perceived benefits from lockdown. Many participants of this study had additional time to pursue hobbies and extracurricular activities. In some cases, young people perceived their learning to be enhanced at home. For other young people who did not enjoy school, not having to attend school at designated times, or at all, could be of clear benefit. The reference to not having 'to get up in the morning' may also be relevant as research suggests teenagers have a natural tendency to fall asleep later and wake up later [16] .

All participants of this study were favourable towards being vaccinated against COVID-19, primarily to protect higher-risk groups. A previous study examining young people's motivations to receive the HPV vaccine focussed on the benefits of protecting themselves from developing cancer [17] . It may be that greater attention should be given to young peoples' potential for altruism in a range of public health initiatives. Based on assumptions from influenza outbreaks, delivery of a COVID-19 vaccination programme to children and young people has the potential to be an effective strategy to interrupt transmission to older people [18] and reduce the requirement for additional school closures.

Controlling outbreaks in education settings is currently highly relevant to policy makers given the rising prevalence of COVID-19 infections among younger age groups. Schools-based models for delivery of adolescent vaccination programmes are widely acceptable among professionals, young people and their families [19] and can achieve high levels of uptake [20] [21] [22] . Future research could establish how best to develop a communication strategy for a future COVID-19 vaccine which aligns with the high levels of altruism reported by these young people.

This study offers valuable insights into young people's views and experiences of the restrictions imposed upon them as a result of the COVID-19 pandemic. The sample was balanced by gender and included younger and older adolescents, but information relating to the socioeconomic status or ethnicity of the participants were not taken. Therefore, the findings from this study may not be representative of young people belonging to BAME groups or more deprived communities. The study used a rapid qualitative design in order to enable findings to be delivered in a timely way so they can be used to inform decision-making processes and policy. Presentation of findings took a broad approach, rather than focussing in-depth on a key issue.

Young people have experienced significant disruption to their education and social networks. High levels of compliance to government public health guidelines were reported suggested that young people are willing to play their part in reducing transmission of COVID-19. High levels of acceptability to be vaccinated were apparent.

This work was supported by the Elizabeth Blackwell Institute, University of Bristol, the Wellcome Trust ISSF3 grant 204813/Z/16/Z and QR SPF (Quality-Related Strategic Priorities Fund), UKRI Research England.

There are no conflicts of interest declared.

Supplementary data to this article can be found online at https://doi. org/10.1016/j.puhip.2021.100162.

World Health Organisation, WHO Director-General's Opening Remarks at the Mission Briefing on COVID-19

World Health Organisation, WHO Coronavirus Disease (COVID-19) Dashboard

COVID-19: Review of Disparities in Risks and Outcomes

World Health Organisation, Health for the World's Adolescents: A Second Chance in the Second Decade

Coronavirus: Impact on Young People with Mental Health Needs

Initial Research Findings on the Impact of COVID-19 on the Well-Being of Young People Aged 13 to 24 in the UK

Saints or Sinners: Young People and Covid-19, in the Telegraph

Do You Really Need to Party?' WHO Urges Young People to Help Control the Spread of Coronavirus as Global Death Toll Tops 700,000, in Daily Mail

World Health Organisation, WHO Director-General's Opening Remarks at the Media Briefing on COVID-19

Using thematic analysis in psychology

Factors associated with adherence to self-isolation and lockdown measures in the UK: a cross-sectional survey

Education: from Disruption to Recovery

Coronavirus: Missing School Is Worse than Virus for Children -Whitty

The Impact of COVID-19 on Young People & the Youth Sector

Young People's Mental Health during the COVID-19 Pandemic: Initial Findings from a Secondary School Survey Study in South West England

Sleep Needs, Patterns, and Difficulties of Adolescents: Summary of a Workshop

Barriers and facilitators to uptake of the school-based HPV vaccination programme in an ethnically diverse group of young women

The relationship between school holidays and transmission of influenza in England and wales

Literature review of HPV vaccine delivery strategies: considerations for school-and non-school based immunization program

Examining inequalities in the uptake of the school-based HPV vaccination programme in England: a retrospective cohort study

Vaccine Coverage Estimates for the School Based Meningococcal ACWY (MenACWY) Adolescent Vaccination Programme in England

Vaccine Coverage Estimates for the School Based Tetanus, Diphtheria and Polio (Td/IPV, 'school Leaver Booster') Adolescent Vaccination Programme in England