Constrained candidacy: exploring different barriers to attaining healthcare access and treatment for long COVID illness by NHS workers in Scotland.

Adams, Nicholas; MacIver, Emma; Kennedy, Catriona; Douglas, Flora; Skåtun, Diane; Hernandez Santiago, Virginia; Torrance, Nicola; Grant, Aileen

Abstract

Long COVID (LC) affects 1.2 million people in the UK, including 120,000 NHS workers. LC remains poorly understood, comprising manifold symptoms ranging in severity, disrupting quality of life and work abilities. Emerging qualitative findings suggest attaining healthcare for LC is challenging. This study aims to explore the experiences of NHS workers with LC to understand their illness experiences, conceptualisations of healthcare eligibility, and barriers to attaining healthcare. We apply Candidacy theory, how persons conceptualise eligibility for healthcare, to interpret the findings. Study design was mixed methods, including an online questionnaire and in-depth qualitative interviews, and with follow-up data collection after six months. Participants (n=471) were purposefully sampled for interview following initial questionnaire completion using maximum variation sampling. All interviews were conducted remotely and transcribed verbatim, and data were analysed thematically, inductively and deductively using framework analysis in NVivo software. 50 participants were interviewed in the first phase of interviews, 44 in the second phase. LC caused devastating, long-standing disruptions to many aspects of life as indicated by questionnaires (51% reporting ability to undertake day-to-day activities had been "limited a lot") and interview data collected. Shared in interviews, NHS workers experienced manifold candidacy-driven barriers to health care access including feelings of reluctance to seek help for fears of "overburdening" the NHS, perceptions that LC was not taken seriously or understood by GPs and specialists, and little occupational and healthcare supports existed. Some accessed limited supports via services and work contacts, sought private healthcare, engaged with online support groups and utilised medical experience and knowledge to keep abreast of published LC literatures. NHS workers struggle to access healthcare for LC. Access journeys are complex and inexorably connected to notions of illness candidacy. Feelings of a lack of entitlement to healthcare, a lack of legitimisation of LC illness and participants' expectations of low success when attempting to seek help, which was often driven by past healthcare experiences, constrain access. Professional role and role-identity represented significant components in participants' conceptualising of their eligibility for access and how access was approached. Nuances between professional groups, identity and healthcare access will be discussed in the presentation. The findings of this study are important; giving a voice to those suffering from LC, and highlighting the multiple barriers that prevent and constrain NHS workers from receiving healthcare for LC illness, which ultimately impacts return to work and fulfilment of their functional - and essential - role in the struggling NHS healthcare system.

Citation

ADAMS, N.N., MACIVER, E., KENNEDY, C., DOUGLAS, F., SKÅTUN, D., HERNANDEZ SANTIAGO, V., TORRANCE, N. and GRANT, A. 2023. Constrained candidacy: exploring different barriers to attaining healthcare access and treatment for long COVID illness by NHS workers in Scotland. Presented at the 67th Society for Social Medicine and Population Health annual scientific meeting (SSM Annual Scientific Meeting 2023), 6-8 September 2023, Newcastle, UK.

• Presentation Conference Type: Lecture
• Conference Name: 67th Society for Social Medicine and Population Health annual scientific meeting (SSM Annual Scientific Meeting 2023)
• Conference Location: Newcastle, UK
• Start Date: Sep 6, 2023
• End Date: Sep 8, 2023
• Deposit Date: Sep 7, 2023
• Publicly Available Date: Sep 7, 2023
• DOI: https://doi.org/10.1136/jech-2023-SSMabstracts.32
• Keywords: Long COVID; COVID-19; NHS workers; Healthcare workers; Access to healthcare
• Public URL: https://rgu-repository.worktribe.com/output/2071742
• Additional Information: The abstract for this presentation has been published with the following citation: ADAMS, N., MACIVER, E., GRANT, A., TORRANCE, N., DOUGLAS, F., SKÅTUN, D., HERNANDEZ SANTIAGO, V. and KENNEDY, C. 2023. Constrained candidacy: exploring different barriers to attaining healthcare access and treatment for long COVID illness by NHS workers in Scotland. Journal of epidemiology and community health [online], 77(Suppl 1): proceedings of the 67th Society for Social Medicine and Population Health annual scientific meeting (SSM Annual Scientific Meeting 2023), 6-8 September 2023, Newcastle, UK, pages A16-A17, abstract OP32. Available from: https://doi.org/10.1136/jech-2023-SSMabstracts.32