Mothers’ experience of caring for home-quarantined children after close contact with COVID-19 in Korea: an exploratory qualitative study

Study design

This is an exploratory qualitative study to understand experiences of mothers who had children requiring home quarantine. The description of the study was reported according to the Consolidated Criteria for Reporting Qualitative Research [18].

Participants

The participants in this study were mothers who cared for their home-quarantined school-aged children due to close contact with COVID-19 patients. The inclusion criteria were being the child’s primary caregiver and a resident of Korea, fluent in the Korean language. The study excluded those who entered Korea after the COVID-19 outbreak and foreigners or expatriates. We used purposeful sampling and snowball sampling to recruit participants who could richly elaborate on their experiences. To recruit participants, recruitment advertisements were posted on nationwide online community for mothers, and people who were judged suitable for the study were also recommended by acquaintances. The target number of participants was estimated according to Polkinghorne [19] and nine mothers were included in this study.

Data collection

Data were collected through in-depth, semi-structured interviews from October 2020 to January 2021. The interviews were conducted face-to-face in an independent space near the participant’s home (n=2) or workplace (n=3), and via online platforms (n=1) or telephone (n=3) for those reluctant to participate in face-to-face interviews. The average time taken for interviews was about 60 minutes face-to-face and 40 minutes for online platform or telephone. Researchers delivered the research statement and consent form via email, and the interview schedule and location were set after submitting the consent signed by the participants to the research team. When researchers interviewed the participants face-to-face, we followed the COVID-19 prevention guidelines by wearing a mask, washing hands, and maintaining distance. Interviews were audio-recorded with permission, transcribed verbatim with IDs instead of real names, and supplemented with observational field notes. The main questions included, “How did you feel when you came to know that your child had to take a screening test for COVID-19 because of close contact? What was the situation at that time? How did you feel during the 2 weeks of home quarantine?” The questions allowed participants to freely speak about their psychosocial experiences. During the interview, probing questions were used as necessary, and any ambiguous part was reconfirmed with the participant to ensure that the content was accurate. The recordings were transcribed on the day of the interviews. We conducted an additional online platform interview with one participant to clarify some specific content. Since collection and analysis were conducted simultaneously, data collection was completed when new ideas were not being generated during the analysis process and data saturation was determined.

Data analysis

We identified repeated meanings and patterns of appearance and analyzed them using thematic analysis to reveal the phenomenon through interpretation [17]. The collected data were analyzed as follows: First, we independently familiarized ourselves with the data by repeating the full and partial reads of the transcripts. Second, after independently reading the transcripts of the first participant, initial coding of extracts were done, highlighting the mother’s psychosocial experience. Based on this, we formed the first coding scheme through a meeting, which was independently applied to transcripts to identify potential themes and gather all data relevant to each potential theme. Next, independent full and partial reads of the transcripts was repeated and we shared impressions on whether the themes worked in relation to the coded extracts. The themes became relatively clear in this process over 10 research meetings, as similarities and differences were revealed in participants’ thoughts, feelings, and behaviors. This was followed by generating clear definitions and names for each theme. In addition, vocabulary was revised by reviewing overlapping concepts to clarify the derived themes. Research meetings were conducted weekly to revise the coding scheme, which was performed iteratively. When new themes were drawn, the process of returning to the raw data and comparing them was repeated. Finally, the manuscripts were prepared by selecting vivid statements.

Research rigor

Based on trustworthiness proposed by Lincoln and Guba [20], we sought to increase rigor [20,21]. First, to ensure credibility, we transcribed the recorded interview without omission or distortion of data and conducted an interview debriefing within the research team to prevent subjective interpretation during data analysis. In addition, the strategy of further clarifying the results of the conceptualization process was repeated by reviewing, and feedback from two participants. Second, to increase transferability, this study had no restrictions, such as of age or region, in recruiting various participants. Additionally, immediate transcription was done to ensure a dense and rich description of each participant’s context and situation in this study. Third, to ensure dependability, the same interview guide was used for interview consistency and the analysis process of the study, i.e., the “interview content, meaning, and theme formation,” was specifically described. Fourth, we wrote field notes and analytical memos at the end of each interview and referred to them during analysis to increase confirmability. To have a neutral research attitude, we went through the process of asking for colleagues’ feedback on the concepts derived from within the research team.

Researcher preparation

The research team primarily consisted of doctoral students who completed a qualitative research methodology class. They participated in workshops and seminars to improve interview skills and gain experience analyzing data and interview methods. An experienced qualitative researcher who taught qualitative research methodology at the graduate level and conducted several qualitative studies oversaw the study process and participated in analytic discussions with the research team. Advice was sought from qualitative researchers in the initial study design. Consensus was reached through team discussions, with the qualitative researcher sharing opinions on the coding system derived after analyzing the first participant interview data, returning to the raw data, and comparing them together. These continuous data analysis meetings contributed to the rigor of this study.

Theme 1: Unable to be relieved due to uncertain situations surrounding me

Theme 2: Blame and hurt toward me, others, and one other

Theme 3: Pulling myself together for my children in my broken daily life

Theme 4: Changes in the meaning of life amid COVID-19

Interpretation

The following is a conceptual discussion of the topics identified in this study: First, the increased burden of working mothers’ difficulties in work-family compatibility and childcare due to COVID-19 do not seem to have been accounted for in home quarantine. Even before the COVID-19 pandemic outbroke, working mothers with young children in Korea were required to play multiple roles, such as work, childcare, housework, and as earners [25]. Subsequently, they experienced difficulties due to insufficient parenting alternatives and a lack of time. In addition, the COVID-19 pandemic has increased the stress of working mothers. Previous study has shown that working mothers have an increased role in preventing and protecting their families from COVID-19 [26]. Most of the participants in this study were working mothers and some could not take 2 weeks off for fear of being fired from their job. It led to the guilt and burden of the mothers. Although various systems in Korea were newly established to promote work-family balance, they were not utilized by the participants [14,27]. Unlike in European countries, the role of the government is essential because labor and care policies are not organically linked, making it difficult to realize policies the existing system [28]. In addition, the participants were anxious about their child’s “probability of confirmed COVID-19” and were confused by the lack of guidelines. In a previous study, perceived COVID-19 threats were associated with negative mental health outcomes [29] and quarantine due to infectious diseases had negative psychological effects on the quarantined person, including posttraumatic stress symptoms, depression, anxiety, confusion, and anger [7,29]. In fact, during the early stages of COVID-19 (April 2020), 17% and 27% of the general population in Ireland and Greece respectively, were reported to have experienced symptoms of posttraumatic stress [30,31]. In our study, onemother expressed feeling more stressed than her father’s death and expressed difficulty in this uncertain circumstance, which was likened to war. This suggests symptoms of posttraumatic stress may have been experienced, although more studies are required to identify this further.

In Korea, based on the experience of the 2015 Middle East respiratory syndrome, expert counseling, recovery programs, and follow-up monitoring are being conducted to provide mental and psychological support for citizens since the early stages of COVID-19 [32,33]. In addition to these efforts, it is necessary to prepare a rapid and accurate response system to prepare for new infectious diseases that may occur in the future. Specifically, allocating resources for psychological support of parents who have to co-quarantine with young children, especially for mothers who balance work-family responsibilities is necessary.

Second, according to the results of a study on quarantine experiences conducted in India, a person with COVID-19 positive has a dual burden not only of physical health problems but also of social stigma from the public [34]. Also, in the study of Lohiniva et al. [35], a history of COVID-19 infection has led to difficulties in going out of the house or interacting with people after quarantine. This was also noted in our study, with some who isolated themselves from outside completely, stating, “I could not even go to the supermarket” or “We just decided to quarantine at home together.” Self-stigma, which is one of the processes of social stigma, may underlie this reaction. Self-stigma is defined as the self-adoption of negative social beliefs and emotions associated with stigmatized group members [36]. A strong sense of social stigma was expressed by our participants, which is a cause for concern as it can lead to psychosocial problems. As people fear unknown diseases and associate their fear with ‘COVID-19 patients’ as well as 'the close contact-others' the social stigma will continue to prevail unless COVID-19 is over [29]. To stop this self-stigmatization process and mitigate its harmful consequences, we must first weaken the factors that induce or promote stigma. Moreover, as seen in participants’ realization such as “We are living so safely through the work of someone who adhered to the home quarantine rules,” it is important to remind the general population that such individual efforts are laudable in preventing the spread of community infection, rather than cause for stigma [7]. In addition, providing accurate and sufficient information about home quarantine to the public reduces uncertainty about infection and can reduce anxiety [37,38]. This will lower the social stigma against those in home quarantine, helping them complete the required period and return to society without having to worry about repercussions.

Third, the parents were in charge of their child’s care during home quarantine while being co-quarantined, as mandated by the Korean COVID-19 Response Guidelines [14]. In addition to their existing roles at home and work, they also had to check and report on their children’s symptoms and manage their schoolwork. Moreover, although it is not a government guideline, for those with more than one child, the sibling also had to stay at home due to social stigma rather than because of health guidelines. Therefore, the participants took care of not only the children in home quarantine but also shouldered the role of separating and caring for other children. According to the study of Moon et al. [39], the mother’s parenting duties, as well as her day-to-day work, are greatly increased with COVID-19, which increases the risk of burnout. A mother’s burden can lead to psychological problems in her children, which in the long term extends into adulthood and can affect various areas of life [40]. However, participants tried not to express their stress of burden and anxiety in uncertain situations in front of their child and did not take adequate care of themselves. Since Korean culture values family over individuals [25], most participants put the needs of their children and family before themselves. Despite the burden, our participants endured the situation with the support of their families and could communicate with mothers in similar situations besides receiving help from neighbors. Currently, the government’s support is focused on confirmed patients and home-quarantined individuals, so support for those who provide care, such as mothers, is insufficient. Assessing and supporting maternal burnout related to parenting in disaster situations can enable maintaining positive parenting and reduce burnout [12]. In addition, supportive measures for psychological health care are needed for those who provide care in co-quarantine.

Eventually, some participants noted a remarkable change in thinking that was restructured as positive despite the ongoing pandemic. Participants felt that the efforts of those who have so far followed the home quarantine guidelines had kept the general public safe from the risk of COVID-19. In addition, the participants thought that home quarantine was an effort by individuals and everyone to regain our daily life that was lost. This was similar to posttraumatic growth, a positive psychological change that is subjectively perceived after experiencing a traumatic event in life [41]. A previous study in Greece reported that people had negative experiences similar to posttraumatic stress but a positive experience of posttraumatic growth was possible through an individual’s inner coping ability in COVID-19 pandemic [41]. After the experience in 2-week home quarantine, which became a turning point in discovering the importance of daily life that they were unaware of, people also became to appreciate the meaning of living a healthy life for family and living with others [35,42].

Limitations

In November 2020, when the recruitment of interview participants began, the number of COVID-19 cases increased rapidly in the Seoul metropolitan area in Korea, and the level of social distancing raised. Subsequently, daily life other than essential social and economic activities was restricted. Thus, due to this unforeseen obstacle, recruitment guidance and explanation could not be conducted face-to-face. In addition, as mothers were fearful of the negative social repercussions of experiencing home quarantine, they were reluctant to participate in the study and expose themselves voluntarily. As most mothers who participated in the study preferred indirect contact, more than half of the interviews were conducted via a web-based model or telephone. The results of this study are based on interviews conducted under restrictive circumstances due to the mothers’ reluctance to participate, and hence, may be limited in transferability to other mothers of school-aged children who have experienced home quarantineat times of different COVID-19 intensity. Future research should consider the circumstances of this situation.

In conclusion, this exploratory study on mothers’ experiences in caring for their school-aged children in home quarantine after close contact with COVID-19 persons, found that mothers had to endure 2 weeks of uncertainty as they faced unexpected events and difficulties due to social stigma and increased roles due to work-family compatibility compatibility. However, they were able to persevere with the help of those around them and it was an opportunity to reflect on living precious daily lives together, despite the probability of repeated close contact with COVID-19. Even if the ongoing coronavirus situation ends, new infectious diseases can occur at any time. Mothers may suffer from psychosocial problems, such as anxiety, stress from social stigma, and the burden of working. Thus, it is necessary to improve policies to prevent or reduce such burdens and support mothers. Further research is also needed to identify potential psychosocial problems of co-quarantine mothers.