Public Health Research (Sep 2024)
Quality of life, capability well-being, financial strain and physical activity in the short- and medium-term COVID-19 post-lockdown phases in the UK: a repeated cross-sectional study
Abstract
Background The COVID-19 lockdowns had negative effects on children’s and adults’ mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being. Methods Cross-sectional data were collected in May–December 2021 (Wave 1) and January–July 2022 (Wave 2). Children (aged 10–11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults – EQ-5D-5L, children – CHU9D), capability well-being (adults – ICECAP-A) and family financial strain (adults – Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored. Results Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA. Limitations and future work Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL. Conclusions There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the UK’s ‘cost of living crisis’. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847. Plain language summary Why did we do this study? We know that the COVID-19 pandemic negatively affected people’s mental and physical health. But we don’t know how quality of life, well-being and pressure on family finances changed for people after the lockdowns were lifted and society reopened. We also wanted to know if these changes were related to how physically active people were. What did we do? Children and a parent/carer answered questions about their quality of life, well-being and family budget pressures. Physical activity data were also collected using devices worn on their waists. We did this in 2021, when society started to reopen after lockdowns, and a year later in 2022 when all restrictions were gone. We explored differences in quality of life, well-being and pressure on family finances between 2021 and 2022. We then looked at whether any of these differences were because of changes in physical activity, and if financial strain was related to quality of life. What did we find? We did not find any differences in quality of life or well-being between 2021 and 2022. Financial strain increased slightly. As financial strain increased, quality of life and well-being decreased. This was worse for those experiencing most financial difficulties. Physical activity did not seem to explain differences in quality of life. What does this mean? If family finances are stretched, it might be difficult for families to pay for activities that will help their children be more active. We have also found that family financial difficulties are related to quality of life and well-being.
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