Patients' Perspectives on Life and Recovery 1 Year After COVID-19 Hospitalization

Abstract

Background: Many patients hospitalized for COVID-19 experience prolonged symptoms months after discharge. Little is known abou t patients' personal experiences recovering from COVID-19 in the United States (US), where medically underserved populations are at particular risk of adverse outcomes.

Objective: To explore patients' perspectives on the impact of COVID-19 hospitalization and barriers to and facilitators of recovery 1 year after hospital discharge in a predominantly Black American study population with high neighborhood-level socioeconomic disadvantage.

Design: Qualitative study utilizing individual, semi-structured interviews.

Participants: Adult patients hospitalized for COVID-19 approximately 1 year after discharge home who were engaged in a COVID-19 longitudinal cohort study.

Approach: The interview guide was developed and piloted by a multidisciplinary team. Interviews were audio-recorded and transcribed. Data were coded and organized into discrete themes using qualitative content analysis with constant comparison techniques.

Key results: Of 24 participants, 17 (71%) self-identified as Black, and 13 (54%) resided in neighborhoods with the most severe neighborhood-level socioeconomic disadvantage. One year after discharge, participants described persistent deficits in physical, cognitive, or psychological health that impacted their current lives. Repercussions included financial suffering and a loss of identity. Participants reported that clinicians often focused on physical health over cognitive and psychological health, an emphasis that posed a barrier to recovering holistically. Facilitators of recovery included robust financial or social support systems and personal agency in health maintenance. Spirituality and gratitude were common coping mechanisms.

Conclusions: Persistent health deficits after COVID-19 resulted in downstream consequences in participants' lives. Though participants received adequate care to address physical needs, many described persistent unmet cognitive and psychological needs. A more comprehensive understanding of barriers and facilitators for COVID-19 recovery, contextualized by specific healthcare and socioeconomic needs related to socioeconomic disadvantage, is needed to better inform intervention delivery to patients that experience long-term sequelae of COVID-19 hospitalization.

Keywords: COVID-19; health disparities; outcomes; qualitative research; recovery.

Fig. 1

Recruitment of study participants. While the MESSI-COVID study continued to enroll and engage participants in follow-up, recruitment for this qualitative study was stopped at the time of confirming data saturation. Recruitment flow includes only those participants eligible at the conclusion of this qualitative study. *Exclusion criteria for the MESSI-COVID parent cohort included no proxy or necessary interpreter available at time of recruitment (n = 39), desire for exclusively palliative care (n = 38), active enrollment in a clinical trial (n = 14), age under 18 (n = 2), pregnancy (n = 2), severe anemia (n = 2). **Reasons for declining qualitative study participation: “not interested” (n = 1), “insufficient time” (n = 1), “not ready to tell my story” (n = 1).