Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies

Abstract

(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic.

Why Do We Not Follow Lifesaving Rules? Factors Affecting Nonadherence to COVID-19 Prevention Guidelines in Indonesia: Healthcare Professionals’ Perspectives

“…These included notions that COVID-19 was a manufactured phenomenon to manipulate the insurance reimbursement system for additional profits from testing and treatment, and that COVID-19 tests are not trustworthy and misdiagnose and amplify case numbers without (symptomatic) evidence. This aligns with other studies in Indonesia and elsewhere which demonstrated that communities with low access to COVID-19 information, or expressing beliefs of disease causation which do not align with the dominant biomedical explanations often have low levels of trust and poor adherence to pandemic restrictions [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].…”

“…As per HCP narratives, the community was suspicious of the dominant biomedical explanation for the phenomenon, evidenced by the fact that many community members have no empirical experience with sick patients despite nonadherence to preventive protocols. This suspicion and mistrust of health authorities have been reported elsewhere in the scholarly literature [40][41][42][43][44][45]. HCPs reported hearing rumours and second-hand information from the community expressing incorrect and conspiratorial beliefs about the origin and nature of COVID-19.…”

Financial Disruption and Psychological Underpinning During COVID-19: A Review and Research Agenda

“…Child care is another important segment affected by the financial distress by COVID-19 ( Vance et al, 2021 ). The findings from Poland hint that the financial insecurity during COVID-19 and related psychological problems has resulted in the postponement of childbearing intentions ( Kaye et al, 2021 ; Malicka et al, 2021 ; Raymond and Ward, 2021 ).…”

“…Child care is another important segment affected by the financial distress by COVID-19 (Vance et al, 2021). The findings from Poland hint that the financial insecurity during COVID-19 and related psychological problems has resulted in the postponement of childbearing intentions (Kaye et al, 2021;Malicka et al, 2021;Raymond and Ward, 2021). The financial struggle among healthcare workers, especially the nursing staff has the opinion of better compensation during a pandemic due to their heavy workload (Akkuş et al, 2021;Cho et al, 2021).…”

Healthcare resilience - A meta-narrative systematic review and synthesis

“…But because healthcare systems serve communities, community capacities are equally important. This may include resource management and allocation [111]. However, while capacities are easily measured, focusing on them alone runs the risk of ignoring wider determinants and dependencies, and recent studies have highlighted the inadequacies of focusing on physical capacities in healthcare [71].…”