Quality of life, capability wellbeing, financial strain and physical activity in the short and medium term COVID 19 post-lockdown phases in the UK: a repeated cross-sectional study

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 wellbeing 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 wellbeing. This study explored how HRQL, capability wellbeing 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 wellbeing.

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 and 27 schools in each wave respectively, and completed validated questionnaires measuring HRQL (adults - EQ-5D-5L, children - CHU9D), capability wellbeing (adults – ICECAP-A) and family financial strain (adults – Family Financial Strain Scale FESS). Children also completed questions on capability wellbeing. Weekday minutes of moderate-to-vigorous physical activity (MVPA) was 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 wellbeing between waves. In addition, the moderating effect of financial strain, and the mediating effect of MVPA on HRQL and capability wellbeing 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 wellbeing (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 : 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 was 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 wellbeing 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 wellbeing 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’.

Study registration:
The project was listed on the Research Registry (project 6646).

Funding statement:
This project was funded by the National Institute for Health and Care Research (NIHR) PHR programme and will be published in PHR Journal; Vol. XX, No. XX. See the NIHR Journals Library website for further project information.