Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries

Abstract

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic.

Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels.

Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised.

Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Figure 1

Overall weighted mean of COVID-19’s impact. The ratings of -2, -1, 0, 1, and 2 represent substantially reduced, a bit reduced, no change, a bit increased, and substantially increased, respectively.

Figure 2

Biplots of multidimensional preference analysis visualizing countries’ preferences also by: Panel A. Country level impact. Panel B. World Health Organization (WHO) region level impact. Panel C. Economic development level impact. Panel D. COVID-19 severity level impact. The numbers in Panels A, B, C and D refer to those variables listed in Table 2 that share the same corresponding number. Arrows in Panels A, B, C and D correspond to a country, a WHO region, an economic development level, and a COVID-19 severity level, respectively, and they point toward increased change. For each area, the projected length on the arrow corresponding to a particular country reflects the magnitude of the impact on that area relative to others in the country. AFR – African Region, AMR – Region of Americas, EMR – Eastern Mediterranean Region, EUR – European Region, SEAR – South-East Asian Region, WPR – Western Pacific Region, HICs – high income countries, UMICs – upper middle income countries, LMICs – lower middle income countries, LICs – low income countries

Figure 3

Overall weighted mean of the perceived importance for possible preparations. The ratings of 1, 2, 3, 4, and 5 indicate not important, somewhat important, important, very important, and extremely important, respectively.

Figure 4

Biplots of multidimensional preference analysis visualizing countries’ preferences also by: Panel A. Country level impact. Panel B. World Health Organization (WHO) region level. Panel C. Economic developmental level. Panel D. COVID-19 severity level. The numbers in panels A, B, C and D refer to those variables listed in Table 3 that share the same corresponding number. Arrows in panels A, B, C and D correspond to a country, a WHO region, an economic development level, and a COVID-19 severity level, respectively, and they point toward increased preference. For each area, the projected length on the arrow corresponding to a particular country reflects the magnitude of the impact on that area relative to others in the country. AFR – African Region, AMR – Region of Americas, EMR – Eastern Mediterranean Region, EUR – European Region, SEAR – South-East Asian Region, WPR – Western Pacific Region, HICs – high income countries, UMICs – upper middle income countries, LMICs – lower middle income countries, LICs – low income countries