Inequalities in the Challenges Affecting Children and their Families during COVID-19 with School Closures and Reopenings: A Qualitative Study

Narratives about distributed health literacy during the COVID-19 pandemic

The promotion of health literacy was a key public health strategy during the COVID-19 pandemic. However, the role of social networks and relationships for support with health literacy-related tasks in the context of the COVID-19 pandemic is scarcely understood. Moving beyond traditional notions of health literacy, which focus on individual skills and knowledge, this study uses the concept of distributed health literacy to explore how individuals make meaning of and respond to health literacy and make their literacy skills available to others through their relational and socially situated and lived experiences of the COVID-19 pandemic. Drawing on 89 semi-structured interviews conducted in three European countries (Italy, Portugal, and Switzerland) between October and December 2021, we found narratives of stabilization, hybridization, and disruption that show how health literacy concerning COVID-19 is a complex social construct intertwined with emotional, cognitive, and behavioral responses distributed among individuals, communities, and institutions within socioeconomic and political contexts that affect their existence. This paper opens new empirical directions to understand the critical engagement of individuals and communities toward health information aimed at making sense of a complex and prolonged situation of uncertainty in a pandemic.

Unintended consequences of measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review

BACKGROUND

Throughout the COVID-19 pandemic, schools were a key setting for intervening with public health and social measures (PHSM) to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Consequently, there is a need to assess the varied unintended consequences associated with PHSM implemented in the school setting, for students, teachers, and school staff, as well as for families and the wider community. This is an update of a Cochrane scoping review first published in 2022.

OBJECTIVES

To comprehensively identify and summarise the published literature on the unintended consequences of public health and social measures implemented in the school setting to reduce the spread of SARS-CoV-2. This will serve to identify critical knowledge gaps to inform future primary research and systematic reviews. It may also serve as a resource for future pandemic management.

SEARCH METHODS

We searched MEDLINE, Embase, CENTRAL, PsycINFO, ERIC, and Web of Science on 5 and 6 January 2023. We also searched two COVID-19-specific databases (Cochrane COVID-19 Study Register and WHO COVID-19 Global literature on coronavirus disease). Finally, we reviewed the included studies of all relevant systematic reviews and guidelines identified through the searches.

SELECTION CRITERIA

We included studies that empirically assessed the impact of PHSM implemented in the school setting to reduce the spread of SARS-CoV-2. We imposed no restrictions with regard to the types of populations and specific interventions. Outcomes of interest were consequences that were measured or experienced, but not anticipated consequences. This review focused on real-world evidence: empirical quantitative, qualitative, and mixed-method studies were eligible for inclusion, but modelling studies were ineligible.

DATA COLLECTION AND ANALYSIS

The review was guided by a logic model. In line with the latest Cochrane effectiveness review of school measures to contain COVID-19 and a conceptual framework of PHSM, this logic model distinguishes between measures to make contacts safer (related to individual protection and the physical environment), measures to reduce contacts (related to social interactions, movement, and services) and surveillance and response measures. Unintended consequences comprise the following categories: health and well-being, health system and social welfare services, human and fundamental rights, acceptability and adherence, equality and equity, social and institutional, economic and resource, and ecological. The review team screened all titles and abstracts, then potentially eligible full-text articles, in duplicate. Across the included studies, we summarised and presented types of measures, consequences, and study designs using the predefined categories of the logic model, while allowing for emerging categories.

MAIN RESULTS

We included 60 studies (57 new to this update) from 25 countries. There were 31 quantitative studies, 17 qualitative studies, and 12 mixed-method studies. Most targeted either students (26 studies), teachers and school staff (11 studies), or students and school staff (12 studies). Others evaluated measures aimed at parents (2 studies), staff and parents (1 study), students and teachers (3 studies), or the whole school (5 studies). The measures were related to individual protection (26 studies), the physical environment (20 studies), social interactions (25 studies), services (1 study), movement (3 studies), surveillance (9 studies) and response (7 studies). Nine studies evaluated the combined effect of multiple measures. The main consequences assessed were from the categories health and well-being (29 studies), acceptability and adherence (31 studies), and social and institutional (23 studies). Fewer studies covered consequences from the categories equality and equity (2 studies), economic and resource (7 studies), and ecological (1 study). No studies examined consequences for the health system and social welfare services or for human and fundamental rights.

AUTHORS' CONCLUSIONS

This scoping review provides an overview of the evidence on the unintended consequences of PHSM implemented in the school setting to reduce the spread of SARS-CoV-2. The 60 included studies describe a broad body of evidence and cover a range of measures and unintended consequences, primarily consequences for health and well-being, acceptability and adherence, social and institutional aspects, and economic aspects. The main gaps identified relate to consequences of school measures for the health system and social welfare services, human and fundamental rights, equality and equity, and the environment. Further research is needed to fill these gaps, making use of diverse methodological approaches. Future studies should explore unintended consequences - whether beneficial or harmful - in more depth and over longer time periods, in different population groups, and across different contexts. A more robust evidence base could inform and facilitate decisions about whether, how, and when to implement or terminate COVID-19 risk mitigation measures in school settings, and how to counter negative unintended consequences.

FUNDING

This publication was partially funded by the German Federal Ministry of Education and Research (BMBF) within the Network of University Medicine (NUM) 1.0, Grant No. 01KX2021 in the context of the project CEOsys, and NUM 2.0, Grant No. 01KX2121 in the context of the projects PREPARED and coverCHILD.

REGISTRATION

The protocol is registered on the Open Science Framework (osf.io/bsxh8). The previous review is published in the Cochrane Library (10.1002/14651858.CD015397).