Constitution of Long COVID illness, patienthood and recovery: a critical synthesis of qualitative studies.

OBJECTIVES: To investigate the lived experiences of Long COVID. DESIGN: Critical interpretive synthesis of qualitative research. DATA SOURCES: PubMed and Web of Science databases were searched on 14 September 2023. ELIGIBILITY CRITERIA: Original peer-reviewed qualitative studies describing the experiences of Long COVID were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: We used established qualitative synthesis methods to search, screen and manually code the included studies. Critical interpretation methods were used to analyse the data and develop synthetic constructs. RESULTS: 68 articles were identified in the first phase of sampling, with 16 studies and 879 participants included in the final synthesis. The analysis of these studies was organised into three thematic constructions of Long COVID: (1) the illness, (2) the patient and (3) recovery. Long COVID was diversely characterised across study approaches, designs and findings but was underpinned by shared diagnostic logics, which shaped the identification and measurement of symptoms. The boundaries between different constitutions of Long COVID in qualitative accounts of illness experience were often imprecise. Slippages between different definitions of Long COVID had implications for patient experiences in relation to diagnosis, help-seeking and care, and expectations of recovery. CONCLUSIONS: Long COVID is a site of multiple and diverse qualitative interpretation. Accounts of lived experience emphasise the constitutions of illness, patienthood and recovery as situated and emergent. The ongoing context-based negotiation of Long COVID is a defining qualitative feature of the condition. Approaches to researching, diagnosing and developing health interventions must be as adaptive as the varieties of Long COVID lived experience.

"COVID is a huge jigsaw puzzle that I am trying to make sense of myself": Exploring the perceptions towards the COVID-19 vaccine communication strategy in Australia amongst unvaccinated Australian adults.

The COVID-19 pandemic and the associated introduction of a novel vaccine has provided researchers with the opportunity to investigate how to support vaccine acceptance and reduce hesitancy using novel approaches. This study aimed to understand the perceptions of COVID-19 unvaccinated Australian adults towards the COVID-19 vaccines and the factors influencing their vaccine decision-making. We also explored their attitudes towards vaccine communication strategies and the availability and quality of resources to support decision-making and preferences during future public health emergencies. In-depth interviews were undertaken with 35 members of the Australian community who self-identified as being unvaccinated against COVID-19 from September to December 2021 and did not intend to vaccinate. Key themes that emerged focused on past experiences of vaccination, feelings of being coerced or pushed into vaccination, concerns about transparency around the development processes used for the COVID-19 vaccines, the value of getting vaccinated and issues regarding the mandates being used. Participants acknowledged that they would be open to talking to peers but held some reservations about the process. Requirements for vaccination have now been lifted in many countries. While governments should continue to strive to promote COVID-19 primary and booster vaccines going forward, this research suggests that there will be a small proportion of the community who continue to actively decline the vaccine. Further work is needed to understand the strategies that can support decision-making during pandemics amongst people who remain uncertain about the need for the vaccines or are concerned about vaccine safety. This includes innovatively exploring the role of peer-to-peer communication and the influence it may have on correcting misunderstandings and supporting confidence.

An audit of the maternal medicine clinic: Cancer and pregnancy.

AIMS: To explore the incidence and complexity of women presenting for maternity care who require concurrent cancer care, and to report the birth outcomes of these women. MATERIALS AND METHODS: A retrospective audit of women attending a 'high risk' maternal medicine clinic at an Australian tertiary maternity hospital between 1 October 2021 and 30 April 2023 was conducted. The inclusion criteria were a diagnosis of cancer and a concurrent pregnancy, or a diagnosis of cancer prior to the current pregnancy. Clinic lists and coding data were screened via the electronic medical record to identify potential subjects. Data were collected from the individual maternity and neonatal records. RESULTS: Forty of 705 (5.7%) women attending the maternal medicine clinic met the inclusion criteria, of which ten had a new diagnosis of cancer in pregnancy and 30 presented for maternity care after a previous diagnosis of cancer. Cancer therapy during pregnancy included surgery and chemotherapy. Most pregnancies (92.5%) resulted in term deliveries (≥37 weeks gestation). Four neonates were preterm, and one was small-for-gestational-age. Caesarean section delivery and post-partum haemorrhage were more common than expected, but the rate of other adverse pregnancy outcomes was consistent with the background population. Over half of neonates required neonatal intensive care unit / special care nursery admission but the indications for admission were common, self-limiting conditions, and the length of stay was short (mean <5.0 days). CONCLUSIONS: Approximately 6% of women attending the maternal medicine clinic had a current or previous diagnosis of cancer. Most pregnancies resulted in term deliveries and neonatal outcomes were excellent.

The fluid hospital: On the making of care environments in COVID-19.

This paper explores the boundary-making practices enacted by the hospital. Taking a hospital in Sydney, Australia, as our case, we investigate how the hospital holds together as a care environment through the coordinating movements of many materials, spaces, bodies, technologies, and affects. Drawing on interviews with hospital healthcare workers involved in care, research, and management related to COVID-19, we examine the multiplying effects of these movements to trace the ways in which the hospital is (re)made in relation with pandemic assemblages. We accentuate the material affordances of care environments and how care is adapted through the reshaping of the spaces and flows of the hospital. Through this, we highlight how care providers can work with the fluidity of the hospital, including through reorganizing routines and spaces of care, engaging with communication technologies to enact care at many scales, and remaking mundane materials as medical objects in the evolving care environment.

'Getting the vaccine makes me a champion of it': Exploring perceptions towards peer-to-peer communication about the COVID-19 vaccines amongst Australian adults.

OBJECTIVES: Peer-to-peer communication approaches have been previously described as the 'power of personal referral'. Rather than relying on official channels of information, peer-to-peer communication may have a role in supporting changes in understanding and possibly behaviours. However, in emergency or pandemic situations, there is currently limited understanding of whether community members feel comfortable speaking about their vaccine experiences or advocating to others. This study explored the perceptions of COVID-19 vaccinated and unvaccinated Australian adults regarding their preferences and opinions about peer-peer communication and other vaccine communication strategies. STUDY DESIGN: Qualitative interview research. METHODS: In-depth interviews were conducted in September 2021 with 41 members of the Australian community. Thirty-three participants self-identified as being vaccinated against COVID-19, while the remainder were not vaccinated at the time or did not intend on receiving a COVID vaccine. RESULTS: Amongst those who were vaccinated, participants spoke about being willing to promote the vaccine and correct misinformation and felt empowered following their vaccination. They highlighted the importance of peer-to-peer communication and community messaging, expressing the need for both strategies in an immunisation promotional campaign, with a slight emphasis on the persuasive power of communication between family and friends. However, those who were unvaccinated tended to dismiss the role of community messaging, commenting on a desire not to be like one of the many who listened to the advice of others. CONCLUSION: During emergency situations, governments and other relevant community organisations should consider harnessing peer-to-peer communication amongst motivated individuals as a health communication intervention. However further work is needed to understand the support that this constituent-involving strategy requires. PATIENT OR PUBLIC CONTRIBUTION: Participants were invited to participate through a series of online promotional pathways including emails and social media posts. Those who completed the expression of interest and met the study criteria were contacted and sent the full study participant information documentation. A time for a 30 min semi-structured interview was set and provided with a $50 gift voucher at the conclusion.

How do care environments shape healthcare? A synthesis of qualitative studies among healthcare workers during the COVID-19 pandemic.

OBJECTIVE: To investigate how care is shaped through the material practices and spaces of healthcare environments during the COVID-19 pandemic. DESIGN: Critical interpretive synthesis (CIS) of qualitative research. PARTICIPANTS: Studies included qualitative research investigating the experiences of healthcare workers involved in the care of individuals during the COVID-19 pandemic. RESULTS: 134 articles were identified in the initial sampling frame with 38 studies involving 2507 participants included in the final synthesis. Three themes were identified in the analysis: (1) the hospital transformed, (2) virtual care spaces and (3) objects of care. Through the generation of these themes, a synthesising argument was developed to demonstrate how material spaces and practices of healthcare shape care delivery and to provide insights to support healthcare providers in creating enabling and resilient care environments. CONCLUSIONS: The findings of this study demonstrate how healthcare environments enable and constrain modes of care. Practices of care are shaped through the materiality of spaces and objects, including how these change in the face of pandemic disruption. The implication is that the healthcare environment needs to be viewed as a critical adaptive element in the optimisation of care. The study also develops a versatile and coherent approach to CIS methods that can be taken up in future research.

"A matter of time": Evidence-making temporalities of vaccine development in the COVID-19 media landscape.

This article investigates how evidence of the safety and efficacy of COVID-19 vaccines is enacted in news media via a focus on the temporality of vaccine development. We argue that time constitutes a crucial object of and mechanism for knowledge production in such media and investigate how time comes to matter in vaccine evidence-making communication practices. In science communication on vaccine development, the vaccine object (along with the practices through which it is produced) undergoes a material-discursive shift from an imagined "rushed" product to being many years in the making and uninhibited by unnecessarily lengthy processes. In both these enactments of vaccine development, time itself is constituted as evidence of vaccine efficacy and safety. This article traces how time (performed as both calendar time and as a series of relational events) is materialized as an affective and epistemic object of evidence within public science communication by analyzing the material-discursive techniques through which temporality is enacted within news media focused on the timeline of COVID-19 vaccine development. We contend that time (as evidence) is remade through these techniques as an ontopolitical concern within the COVID-19 vaccine assemblage. We furthermore argue that science communication itself is an important actor in the hinterland of public health practices with performative effects and vital evidence-making capacities.