CHAPTER 1

THE PROBLEM AND ITS SETTING

Introduction

“The best investment you’ve ever made is your own Health”. Covid-19

was one of the most significant pandemics in world history and in accordance

with this, patient with chronic diseases are susceptible to the virus which

increases the fatality rates case which becomes the number one cause of death

globally. The COVID-19 pandemic has a major impact on the capacity of health

systems to continue the delivery of essential health services. While health

systems around the world are being challenged by increasing demand for care of

COVID-19 patients, it is critical to maintain preventive and curative services,

especially for the most vulnerable populations, such as children, older persons,

people living with chronic conditions, minorities and people living with disabilities

(WHO, 2022). Amidst the Pandemic, Health became the primary concern and it

varies on how a person sustained his lifestyle. Each individual seeks to have a

high quality of care they deserve to improve health outcomes regardless of their

age, race, gender, religion, education, civil status, and others that may contribute

to and affect their access to health care.

The scale and severity of the Covid-19 pandemic clearly rises to the level

of a public health threat that could justify restrictions on certain rights, such as

those that result from the imposition of quarantine or isolation limiting freedom of

movement. Broad quarantines and lockdowns of indeterminate length rarely

meet these criteria and are often imposed precipitously, without ensuring the

protection of those under quarantine- especially at-risk populations. Because

such quarantines and lockdowns are difficult to impose and enforce uniformly,

they are often arbitrary or discriminatory in application. Governments have broad

authority under international law to ban visitors and migrants from the countries.

However, domestic and international travel bans historically have often had
limited effectiveness in preventing transmission, and may in fact accelerate

disease spread if people flee from quarantine zones prior to their imposition

(Human Rights Watch, 2020).

Chronic diseases became part of patients’ lives. There are patients,

particularly those who had serious chronic diseases are forced to change their

lifestyles to prioritize their lives. Nevertheless, patients with chronic diseases find

new alternatives to develop coping strategies to manage stressful situations

regardless of their condition.

Pandemic has direct and indirect effects on people with chronic diseases

such as underutilization of stress on the healthcare system. Due to stringed

policies and threats of contracting the virus, patients with chronic diseases faced

limited access to healthcare. Heavy disruption in outpatient services due to the

relocation of medical personnel has impacted access to health care. Patients

with chronic diseases postponed health care seeking due to fear of getting

infected with Covid-19. In addition to morbidity and mortality rates, high rates of

community spread and various mitigation efforts including stay-at-home

recommendations disrupted lives and created social and economic hardships

(Centers for Disease Control and Prevention, 2021).

According to World Health Organization, Heart disease has remained the

leading cause of death at the global level for the last 20 years. The number of

deaths from Heart Disease increased by more than 2 million since 2000, to

nearly 9 million in 2019. On the other hand, deaths because of ischemic heart

diseases accounted for 99.7 thousand cases or 17.3% of the total deaths in the

country putting it as the number one killer for chronic diseases among Filipinos.

In addition, Hypertension which was amounted to around 734.6 thousand cases

was the leading chronic disease in Eastern Visayas Region which contributed to

the morbidity rate per 100, 000 population. In addition, according to Calbayog

City Health Office, pneumonia (in all forms) is the leading cause of mortality
among non-communicable diseases in Calbayog with a total of 1,441 cases as of

2021. Patients with chronic diseases require regular disease management and

close follow-up to reduce risks of adverse health outcomes. The outbreak of the

pandemic created significant barriers to diagnosis, treatment and follow-up of

chronic diseases. Delivering regular and routine comprehensive care for chronic

patients was disrupted due to closures of healthcare facilities, lack of public

transportation or reduction in services (Fekuda, 2021). The lockdown of different

services also decreased referral, access and hospitalization resulting in

inadequate ongoing care for chronic conditions among needy patients. As the

results of Covid-19 on health care system, patients needing chronic follow-up

postponed their follow-up. This disruption of care has a long-lasting impact on

chronic health outcomes that likely surpass the duration of the Covid-19

pandemic (Danhieux, 2020).

The COVID-19 pandemic has highlighted inadequacies in health systems

around the world and has demonstrated the need to strengthen primary care

capacity to ensure safe and comprehensive Chronic Diseases Management now

and in the future. If primary care is to achieve its goals of chronic disease

prevention, early detection and ongoing monitoring during the pandemic and

beyond, then attention to enabling equitable access to telehealth and the

transition of patients to the confident use of digital tools to support their CDM is

needed (Parkinson, 2022).

The phenomenological study was used to identify phenomena particularly

lived experiences of patients with chronic diseases during the Pandemic in

Calbayog City. Theoretically, phenomenological research focuses on the

paradigm of individual knowledge about certain phenomena and describes the

essence of their lived experiences. This study focuses on how patients with

chronic care were affected during the pandemic, healthcare utilization services

and available opportunities for better chronic disease management during the
pandemic in resources limited setting. Because of Covid-19 Pandemic,

researchers sought that there are arising problems engaged with health that

served as barriers to patients-healthcare relationships. This phenomenological

study leads to the description and interpretation of the essence of patients lived

experiences thus recognizing the meaning and significance of pedagogy,

sociology, and psychology according to the experiences collected from the

patient.

Statement of the Problem

This study focuses on the lived experiences of chronic patients during

pandemic in Calbayog City.

Specifically, it seeks to answer the following questions:

1. What are the lived experiences of patients with chronic disease during the

pandemic?

2. What is the essence of being a patient with chronic disease during the Covid-

19 Pandemic?

3. What output can be proposed at the end of the study?

Theoretical Framework

The focus of this study will be lived experiences of patients with chronic

diseases during the pandemic, specifically in Calbayog City. A variety of theories

support the phenomenon of patients' lived experiences with chronic diseases.

The Human Becoming theory as the core theory, as well as two supporting

theories, the Theory of Self-Care for Chronic Illness and the Chronic Disease

Self-Management theory, will be the focus of this research. Patients' lived

experiences will be anchored using the Parse Theory of Human Becoming. While

the chronic illness will be based on the Tiny Jaasmar Theory of Self-Care for

Chronic Illness, the coping strategies and mitigators will be grounded in Kate

Lorig's Chronic Disease Self-Management. In addition to that, there are also few

theories and model that greatly support the concept of the study such as the

Callista Roy’s Adaptation Model and Tipping the Scales Theoretical Model by

Mor Saban, Vicki Myers, Osnatt Luxenburg and Rachel Wilf-Miron.

According to Rosemarie Rizzo Parse, Human Becoming Theory is a

combination of biological, psychological, sociological, and spiritual factors, and

states that a person is a unitary being in continuous interaction with his or her

environment. The Human Becoming Theory of Nursing is a model that focuses

on the quality of life of the patient and sees the patient not as different aspects of

a whole, but as a person (Nursing Theory, 2020). Parse’s work focuses on the

human universe-health process, which she regards as a phenomenon of concern

for the discipline of nursing, as well as on co-created human experiences. This

theory guides nurses in their practice to focus on the quality of life as it is

described and lived by individuals. It enhances the understanding of lived

experiences of an individual specifically the lived experiences of people with

chronic diseases during the pandemic. Pandemic becomes a public health

emergency that requires lower healthcare capacity for those patients who have
chronic diseases. The Human Becoming Theory will differentiate the situations in

the context of accessing healthcare, identifying the level of stress and anxieties

and demounting coping mechanisms in order to survive.

Moreover, as previously indicated, there are two other theories that

significantly support this research. To start with Tiny Jaasmar Theory of Self-

Care for Chronic Illness. In chronic illness, self-care is a fundamental and integral

part of treatment and patients who engage in self-care have significantly

improved clinical outcomes, with better quality of life, fewer hospitalizations, and

longer survival (N.H. Jonkman et al., 2016). Tiny Jaarsma described self-care as

the process of sustaining one's health by engaging in health-promoting behaviors

and managing disease. The goal of self-care monitoring is recognition that a

change has occurred. Recognition is facilitated by somatic awareness or somatic

perception defined as sensitivity to physical sensations, bodily activity and self-

care management (Jurgens, Lee, & Riegel, 2015). The emergence of COVID 19

emphasizes the connections between crisis and self-management, patients

adapted to service changes and poor self-management because of the changes

COVID 19 pandemic brought.

On the other hand, one supporting theory has been mentioned the

Chronic Disease Self-Management proposed by Kate Lorig. This theory

describes the process in which individuals actively cope with their chronic

diseases in the context of their daily lives (Miller, Lasiter et.al, 2015). One of the

most important strategies to reduce the burden of chronic disease is supporting

individuals with self-management. There have been positive effects on health of

self-management support for people with chronic disease, and that includes

health-related quality of life.

In relation to the current study, in the context of the management

necessary for a chronic illness, this article discusses a middle-range theory of

self-care that tackles the process of preserving health through health-promoting

behaviors and will contribute meaningfully in the following core ideas such as

self-care management, self-care monitoring and self-care maintenance of

individuals with chronic diseases during the COVID 19 Pandemic. The Theory

itself will also determine the factors that affect these patient’s ability to take care

of oneself such as experience, skill, motivation, culture, confidence, habits,

function, cognition, help from other and availability to care.

One also of the theory to be considered is the Tipping the Scales

Theoretical model to describe the differential effects of the COVID-19 pandemic

on mortality. The theoretical model is designed to enable a better understanding

of the components, the relationship between them and their contribution to the

outcome – individual mortality risk during times of health crisis. The model is

composed of three components: external pressures, individual & community

resources and outcomes. At a time of great upheaval such as the present

pandemic, numerous external pressures or changes exert influence on

individuals and communities, affecting their behavior and way of life, and

ultimately health outcomes and survival chances. These external pressures can

include Environmental factors (e.g. changes in pollution levels, traffic, climate,

access to green space), Economic factors (e.g. high unemployment rate,

government handouts, failing economy), Political/Organizational factors (e.g.

restrictions on movement, lockdowns, instability) and Social factors (e.g. social

distancing, isolation, sense of community). These factors may influence direct

health effects such as the chance of being exposed to and getting sick with

COVID-19 (manual employment, travelling on public transport); as well as

indirect health effects (mental health effect of lockdowns, social isolation, poorer

control of chronic disease). Individual resources that a person possesses include

wealth (including finances, property, savings); health (both physical and mental;

comorbidities); employment (stability, income, job satisfaction, flexibility - the

latter being particularly relevant to the current pandemic, manifested for example
as the ability to work remotely); and social support (both practical and emotional).

These resources determine the individual’s resilience and ability to adapt to

change (Saban and Myers, 2021)

This theory will illuminate the fundamental mechanics and human actions

that affect their health status. The model can assist in prioritizing efforts towards

vulnerable populations specifically those people suffering from chronic diseases

by enhancing and improving preparedness throughout the board. Beyond the

established socioeconomic level, the model suggests other elements, such as

social, psychological, and communal resources, which may affect the impact of

pandemic.

Finally, the Roy Adaptation Model of Callista Roy and Environment Theory

of Florence Nightingale. Sister Callista Roy’s model sees the individual as a set

of interrelated systems that maintain a balance between various stimuli. The Roy

Adaptation Model sees the person as a biopsychosocial being in continuous

interaction with a changing environment. The environment includes focal,

contextual and residual stimuli. A focal stimulus is the confrontation with one's

internal and external environment. Roy’s model incorporated concepts from

Adaptation-level Theory of Perception from renowned American physiological

psychologist Harry Helson, Ludwig von Bertalanffy’s System Model, and Anatol

Rapoport’s system definition. First, consider the concept of a system as applied

to an individual. Roy conceptualizes the person in a holistic perspective.

Individual aspects of parts act together to form a unified being. Additionally, as

living systems, persons are in constant interaction with their environments.

Between the system and the environment occurs an exchange of information,

matter, and energy. Characteristics of a system include inputs, outputs, controls,

and feedback (Gonzalo, 2021).

By relating this into current study, these Model specify the importance of

human adaptation to a certain stimulus. By relying on particular habits and

coping mechanisms, many COVID-19 patients lessened the severity of their

illness during the illness and the recovery process, becoming more at peace and

better able to handle the disease but many patients were weary and felt

powerless as a result of the prolonged treatment process, the ensuing

quarantine, the required stay at home, and other factors. Helplessness and

Limitations Prolonged treatment process caused many patients to feel tired and

helpless about the situation and also distance themselves from many of their

daily activities and recreation, and this issue put much pressure on patients.

More likely theories stated give significant ideas on how the research will

go through, the study will depend on the recent theories that has been conducted

a years ago to come up with an efficient hypothesis of what could be the possible

outcome and implementation shall be conducted. In order to fill the gaps of

existing ideas, the theories that has been stated will solely be examined to come

up with an efficient proposal, assessment, and solutions at the end of the study
Significance of the Study

The researchers employed a qualitative research method by means of a

phenomenological design interview approach that permitted researchers to

scrutinize lived experiences of patients with chronic diseases during the Covid-19

Pandemic and to narrate individual experiences of the phenomenon. Through

this phenomenological study, the researcher hoped to dispense information that

will help not only the target participants but also people and future researchers.

Patients with chronic diseases had different experiences, particularly

during this pandemic and these experiences may affect their individual condition

which may exacerbate certain phenomena. Thus, this phenomenological study

will be utilized to understand patients' experiences that may impede chronic

disease prevention and disrupt disease management. Generally, this study will

identify lived experiences of patients with chronic diseases during the pandemic

in Calbayog City which will be beneficial to the following:

Patients with Chronic Diseases. This study will help patients with

chronic diseases to understand the meaning of their lived experiences. It

provides sufficient awareness, and sensitivity to the area of rationalizing

expressive and creative ideas through concrete lived experiences.

Health Professionals. This study will be beneficial to the health

professionals as it will give them the idea of managing the difficulty of treating

patients with chronic diseases with the threat of the Covid-19 Pandemic.

Family. The recovery of patients with chronic diseases should not only be

placed in the hands of the health professionals but also in the patient’s family.

The family will also be beneficiaries of this study as this will give them knowledge

and provide solutions to reducing the struggles of their relatives diagnosed with

chronic diseases.
 Researchers. This study will serve as a guide for future researchers on

the same topic and give them ideas pertaining lived experiences of patients with

chronic diseases.

Department of Health. This will help the DOH to ensure quality health

care. To raise priority accorded to patients with chronic diseases in national,

regional and local health and development plans. To strengthen health systems

ad increases access to quality medicines, products and services and to promote

and support research and development for patients with chronic diseases during

Covid-19 pandemic.

Community. The study will be beneficial to the community because

awareness and understanding of the people about lived experiences of patients

with chronic diseases is crucial for acceptance. This study will also make them

knowledgeable in engaging programs offered by the government.

Hospitals. This study will help the hospitals in developing new theories,

treatments that will improve the number of people recovering from the disease

and improving quality of life of people.

Scope of Limitations of the Study

The general intent of this research is to understand the lived experiences

of people with chronic diseases during the midst of Covid-19 crisis and consider

every aspect of participant’s personal information that has an impact on their day

to day lived experiences. It seeks to identify the common problems and propose

possible solutions. This qualitative phenomenological study focuses on the lived

experiences of patients with chronic diseases who had difficulty accessing health

care during the pandemic in Calbayog City. The following limitations include:
 The researchers limit their proposed sample size to 20-30 participants.

Patients diagnosed with Chronic Diseases in Calbayog City at the time of the

Pandemic were the intended participants.

Due to the stringed policies during the Pandemic, the data gathering will

be limited to the selected barangays in Calbayog City, which has high cases of

chronic diseases. The main data collection method will be through interviews and

video recordings.

The researchers selection process will use purposive and criterion

sampling and each participant will be given the same questions and approach

throughout the interview.

The duration of the study will be conducted within the first semester of the

school year 2022-2023.

 CHAPTER 2

RELATED LITERATURE AND STUDIES

This chapter presents the related literature and studies on patient

experiences during pandemic in Calbayog City. These were taken from different

academic websites, books, published and unpublished thesis and other

publications and were assembled to supply additional information related to this

phenomenological study.

Related Literature

Because it has an impact on the patient's overall health, caring is a crucial

notion in the nursing profession (Jang et al., 2022). The COVID-19 pandemic has

required a swift and significant adjustment in where, when, and how care is

sought in order to lower the risk of virus transmission for those who are living

with chronic diseases (Singh et al., 2021). According to the World Health

Organization, chronic diseases are not contagious. They progress slowly and

have a long duration. A confluence (reciprocal effect) of COVID-19 pandemic

and chronic diseases was reported by people with chronic conditions in the

context of difficulty accessing healthcare, sedentary lifestyle, and elevated stress

and anxiety. Patients' first-hand accounts of the pandemic offer crucial insights

that can help with the shift to a hybrid environment of online consultations and

"distance" clinic visits (Kavita et al., 2021). Leading chronic diseases are greatly

influenced by health-harming behaviors, including cigarette use, inactivity, poor

dietary habits, and excessive alcohol consumption (National Center for Chronic

Disease Prevention and Health Promotion, 2021). Due to the Covid 19

Pandemic, the quality of goals and patient care in societies and healthcare

systems is now determined by the lived experiences of patients with chronic

diseases. Understanding patients' actual experiences helps to shape their

perception of treatment.
 The COVID-19 pandemic has posed extraordinary difficulties and a

disproportionate threat to humanity, particularly to the lives, interpersonal

connections, and general wellbeing of older people. No one knows how long this

pandemic will endure or how it will affect older folks living in tight spaces given

the spread of the new coronavirus and its effects on human health (Adhikari et

al., 2020). People who perceive greater risks are more inclined to engage in

preventative behaviors, according to theories of decisions regarding health

behavior. Therefore, the perception of risk will probably influence how people

choose to follow prevention and mitigation strategies, such as choosing to get

vaccinated against COVID-19 to lower risk (Bruine et al., 2020).

Because of the specific characteristics of COVID-19 and the need to

protect public safety, it will be challenging for everyone to provide care in this

circumstance. The COVID-19 pandemic's need for keeping social distance most

likely caused isolation, loneliness, psychological stress, and other detrimental

health issues. According to the guidelines of the Ministry of Health and Medical

Education, counseling centers and home care services are required to provide

the necessary training to families so they can provide care services for patients

at home. This is due to the importance of home care follow-up and self-care

education to patients and families. Therefore, future interventions to address

stress and health difficulties resulting from caregiving through the pandemic

combined with the generally observed challenges can be informed by a greater

understanding of how the pandemic has affected home caregivers (Akbarbegloo

and Sanaeefar, 2022).

According to Pleguezuelos et al., there was a decrease in the number of

patients seen in primary care facilities and emergency rooms for exacerbations

of other chronic diseases during the lockdown.2020).Two levels of the

ecosystem of care for patients with chronic illnesses appear to have been

disrupted by COVID-19 lockdown measures. In the beginning, medical

appointments were postponed or canceled, leading to self-medication practices

without medical supervision or the storage of medicines necessary for managing

the chronic condition (Ricadat et al.,2021).Although some pain clinicians and

researchers have raised the alarm about the numerous vulnerabilities of these

patients and the need to ensure continuity of pain management during the

pandemic, policymakers have not paid much attention to the specific

consequences of the COVID-19 pandemic on people who live with chronic pain

(Dassieu et al.,2021) .

Understanding the perception of COVID-19 risk is becoming increasingly

important as hospitalizations and deaths continue to rise worldwide (Bavel et

al.,2020) and the implementation of preventative measures like hand washing,

physical distance, avoiding public places, wearing face masks, testing, and

vaccination (Golestaneh et al.,2020).Although the COVID-19 pandemic has

already brought about significant changes in the healthcare system, it continues

to present challenges for medical professionals, healthcare systems, and

authorities. It is of the utmost importance to ensure that patients' perspectives

are heard and taken into consideration because healthcare changes were almost

entirely driven by professionals and may have a significant impact on how care

will be provided in the future (TA et al.,2021).In an effort to slow the spread of the

Corona Virus disease (COVID-19), the majority of nations' governments and

public health authorities implemented a number of measures. In order to put the

pandemic ahead of health resources, lockdowns were imposed and ongoing

healthcare consultations were postponed or canceled. Despite their positive

containment effects, such measures posed new obstacles for the population

already struggling with chronic conditions (Cuschieri and Mamo, 2021).

The routine health care systems are also disrupted by the COVID-19

pandemic, which affects entire societies. A collective shift toward acute care for

COVID-19 patients with severe presentation in hospitals and the optimization of

infection control in the community were required as a result of the unprecedented

scale of this pandemic's impact. Patients with chronic diseases' continuity and

quality of care have been affected by this extensive effort to contain the

pandemic and reduce subsequent mortality and morbidity (Danhieux et al.,2020)

The World Health Organization (WHO) has focused on increasing medication

adherence. In a well-known report, the WHO stated that "increasing the

effectiveness of adherence interventions may have a far greater impact on the

population's health than any improvement in specific medical treatments"

(Piekarz, Langran, & Donyai, 2021).

In terms of phenomenology, it is understood not only as a method that

allowed for a novel approach to knowledge that produced the best results when

applied to the social or human sciences, but also as a practice that preceded

scientific work. As a strategy, it is proposed to address the following concerns:

how to study this subjectivity and approach its inherent production of meaning

(Guillen, 2019). The researcher must consider the subject's own beliefs and

feelings in order to comprehend the lived experience from the subject's

perspective. Before putting these ideas aside, the researcher must first

determine what they anticipate finding; the term for this procedure is bracketing.

It is only possible to see the experience through the eyes of the person who has

experienced it when the researcher puts aside her or his or her own ideas about

the phenomenon (Anonymous, 2018).Local and national efforts to improve

service delivery for patients and their families during and after the outbreak may

benefit from a better understanding of the lived experiences of patients. In

preparation for the current resurgence of COVID-19 and future pandemics,

healthcare workers will also benefit from the perspectives of those who receive

their care (Liu, 2021).

During the COVID 19 pandemic, dementia patients, typically older adults,

also faced challenges. British Columbia University researchers investigated the

experiences and requirements of dementia patients and their care partners.

Concerns were expressed about their care partners, who said that they were

unable to visit the person they were caring for during long-term or palliative care.

Additionally, participants stated that the pandemic resulted in an overall rise in

stress levels as well as an increase in feelings of loneliness and isolation. The

majority of participants reported using technology to socially connect with loved

ones, connecting with others at least twice per week. They also encountered

difficulties brought on by the pandemic as a result of the restrictions they were

subjected to. According to Tam, Mallorie T., Dosso, Jill A., and Robillard, Julie M.

(2021), caregivers play a crucial role in determining healthcare priorities for

dementia patients in order to restore their health and quality of life.

Separation from family members and loneliness brought on by EOL

assistance (from unknown caregivers) and environments characterize the

experiences of COVID-ICU patients. According to Bartoli et al., a

phenomenological study on the relatives of COVID patients who were

hospitalized in the ICU, the lack of communication and information between

leaving home and being hospitalized in the ICU caused family members to be

afraid.2022).

Disruptive vs. incremental transformation: Wenger's book "COVID-19 and

the Cardiovascular Community" provides a perspective on three simultaneous

pandemics: Social injustice, economic disruption, and COVID-19.Social and

health care disparities were exacerbated by the COVID-19 pandemic; There

were millions of job losses; Financially, many small businesses and industries

have been decimated; and education, research, and clinical care have all been

altered in scientific research and medicine. But it acknowledges that there were a

lot of successes and important shifts, like the rapid adoption of telemedicine, that

can change the way health care is delivered to a large number of people and

possibly make it easier for more people to get care. Patients' reluctance to
receive treatment was one of the disparities that were revealed. Patients who

self-quarantined in order to avoid going to the emergency room and being

exposed to COVID-19 compromised numerous improvements in acute coronary

and stroke care that had been made over the previous five decades

(Anonymous, 2021).

According to all of the information that was gathered from the related

literature that is related to the study that will be done, people in different parts of

the world who have chronic illnesses have had trouble getting healthcare

because of restrictions that were put in place and because they are more likely to

get the virus. They found new ways to get healthcare, which made them eligible

for more opportunities.

Related Studies

A semi structured qualitative study were conducted by the American

Society of Nephrology (2022) specifically the Lived Experiences of patients

receiving hemodialysis during the COVID-19 pandemic states that during the

COVID-19 pandemic, hemodialysis patients encountered particular obstacles. If

they become infected, they run a significant danger of death and are forced to

interact with others when they visit the hospital three times a week for life-saving

treatments. These patients who is receiving weekly treatments are the patients

who has chronic kidney disease and nephrotic syndrome. This study shows that

COVID-19 was a problem for some patients, especially when traveling by public

transportation. Hemodialysis patients showed resilience in their ability to adapt to

the new reality of their hemodialysis treatments. Moreover, patients face a series

of challenges in applying self-care strategies for the lifestyle modifications

recommended with hemodialysis, such as diet and exercise. Because of the

difficulties that patients encounter with self-care at home, patient beliefs

regarding their self-care ability play a key role in how they face treatment
regimens. It was well reported that chronic diseases had a negative impact on

overall well-being, with intensified levels of depression, anxiety, and stress.

Beyond these direct consequences, COVID-19 has reshaped the delivery of

chronic care, the non-critical cases are postponed and cancellation of chronic

rehabilitation.

A study done by Leslie C. Hussey (2018), labeled “The lived experiences

of managing uncertainty in chronic illness”, shows that chronic illness is an

increasing concern in the United States as for the CDC reports. Results revealed

themes that individuals with chronic illness do experience uncertainty and that it

impacts almost all aspects of their lives. The individuals expressed changes in

daily activities, the need to plan ahead, altering plans based on symptoms, and

retraining their minds to accept their new normal. Individuals diagnosed with

chronic illness face daily challenges. This uncertainty augments the negative

impact of the state of chronic illness on patients’ quality of life. High levels of

uncertainty can lead to higher levels of perceived stress, depressive symptoms,

as well as poorer emotional well-being. This study examine the correlations

between uncertainty due to chronic disease and patients’ quality of life, keeping

into account the diverse coping strategies adopted and the anxiety/depression

feelings developed during hospitalization. However, Lived Experiences of

Patients with Chronic Diseases during Pandemic in Calbayog City: A

Phenomenological Study focuses on uncertainty and transparency in which

encouraged to admit ignorance, explore paradoxes and reflect collectively not

limited to anything. By thorough evaluation, mystery in lived experiences of

patients with chronic diseases during pandemic will unfold the real-world setting

by identifying and prioritizing there needs and help to build multifaceted evidence

base that the world urgently needs. The said study provides opportunity to a

more in-depth understanding of uncertainty, its exacerbation and required

behavioral changes in response to COVID-19.

 Hailemariam Tadesse, Hordofa Gutema, Yosef Wasihun, Samuel Dagne,

Yonatan Menber, Pammela Petrucka, and Netsanet Fentahun (2021) conducted

a study on "Lived Experiences of Chronic Kidney Disease Patients Receiving

Hemodialysis at Felege Hiwot Comprehensive Specialized Hospital, Northwest

Ethiopia." This study explored the gaps in their understanding that will be filled in

by examining the patients' lived experiences. Moreover, the study examined the

lived experiences of the patients to assist healthcare professionals, researchers,

and policymakers in improving healthcare services and addressing upcoming

issues. The study revealed that the inaccessibility of hemodialysis service was a

major challenge and an extra expense. Restrictions on available foods and

drinks were a double burden that limited participants from using an available

resource. Financial incapability was another challenge raised due to the loss of

income-generating activities. As a result, a feeling of dependency on others was

reported as leading to the development of mental distress Tadesse et al. (2021).

The study showed the lived experiences of patients with CKD receiving

hemodialysis were applicable to the current study because it had to do with the

lived experiences of patients. Although the previous study focused only on

patients with chronic kidney disease, a semi-structured interview was used in

collecting the data and a purposive sampling technique was used in selecting the

participants.

In this study, Van Wilder, L., Pype, P., Mertens, F., et al. conducted a

study on Living with a Chronic Disease: Insights from Patients with a Low

Socioeconomic Status. The study explored how patients with socioeconomic

status experience their chronic diseases and the impact of health-related quality

of life. The study shows that six major themes were identified: a heavy bag to

carry; loss of autonomous life; inner and outer loneliness; emotional imbalance;

unmet need for support; and coping strategies. Patients experienced their illness

as an additional problem on top of all other problems (i.e., financial/social

problems, traumatic life events). In general, the disease burden and non-disease

burden were mutually reinforcing, resulting in greater dependency, greater risk of

social isolation, and greater psychological distress. (2021). This study provides

an analysis of current socioeconomic status of patients with chronic diseases

and the impact of Covid-19 pandemic on their everyday lives. It is important to

recognize people who may have low health literacy especially during times of a

pandemic, because health literacy is an important means of preventing

communicable diseases, such as Covid-19. (Singu, 2020). Thus, the researchers

found this study relevant to the current study because both studies focused on

patients living with chronic disease. However, it differed from the respondents

because the chosen respondents in the present study were patients with chronic

diseases during the pandemic. Due to the lack of resources to prepare and

protect against the coronavirus, the poor face a higher risk of contracting and

subsequently spreading the virus.

The study conducted by Parkhide Hassani, Fatemeh-Sadat Izadi-Avanji,

Mahnaz Rakhshan, and Hamid Alavi Majd (2017) found that a phenomenological

study on the resilience of the elderly suffering from chronic disease: a qualitative

study. This study explored the meaning of resilience for hospitalized older people

living with chronic diseases. The researchers identified the elderly’s experiences

and beliefs about the concept of resilience to avoid any biased interpretation of

the findings. This study used a descriptive phenomenological approach and

focuses on the experience of how people experience a phenomenon.

Furthermore, this study is relevant to the present study because the purpose of

their study was to understand the experience of older patients with chronic

diseases. In the same way, the researchers would like to focus on the lived

experiences of patients with chronic diseases during the pandemic. It includes

their experiences with accessing healthcare services due to health protocols

implemented by the Department of Health.

 Muller et al. (2021) conducted a study on the lived experience of

hereditary chronic pancreatitis with a total of 24 participants (17 patients and 7

relatives). They were interviewed individually. The researchers investigate the

experiences of hereditary chronic pancreatitis patients and their relatives. This

study investigated patients' and relatives' understanding of the needs of those

affected, as well as the need for patient-centered chronic condition management.

The reviewed study is relevant to the current study because both studies focused

on the lived experience of patients, and the center of this study is the quality of

chronic illness care, the factors affecting self-management, and the support of

self-management. Similarly, the present study on the lived experiences of

patients with chronic diseases will explore and understand the experiences of

patients with chronic diseases and their challenges during a pandemic. The

previous study and the present study differed in the respondents because only

patients with chronic diseases during the pandemic were chosen as respondents

and a structured interview was used in collecting the data. However, both studies

dealt with the lived experiences of patients with chronic illness.

The study "Living experience of having type 2 diabetes: A

phenomenological research in three villages in rural Northern Saudi Arabia by

Alruwaili, Mofreh A. F." is about the personal experience of patients with type 2

diabetes living in rural settings. The researchers explored their lived experiences,

and the study findings revealed the participants' natural feelings of shock and

denial toward their illness. The participant demonstrated a degree of adaptation

and viewed type-2 diabetes as a matter of destiny. In the early stages, the

participants become more familiar with their disease and express feelings of

acceptance and adaptation, especially during Ramadan. In a similar way to the

pre-study, the researchers explore their personal experiences of adjustment

while patients, being the experts, can give in-depth and fruitful insights. Their

difficulties in accessing well-equipped hospitals and diabetic centers lead to a

lack of education regarding the disease. (2021). This study is relevant to the

present study because it aims to explore their experiences and challenges in

accessing healthcare services and their adjustment because of health protocols

implemented by the DOH during the pandemic.

The study by Singh K, Kaushik A, and Johnson L, about patient

experiences and perceptions of chronic disease care during the COVID-19

pandemic in India: a qualitative study focused on the lived experiences,

challenges that they encountered, their different coping strategies, and the

impact of the COVID-19 pandemic on their economic and social lives. The study

findings indicate that participant experiences during the COVID-19 pandemic

were categorized into four themes: challenges faced during the lockdown;

experiences of the participants diagnosed with COVID-19; preventive measures

taken; and lessons learnt during the COVID-19 pandemic. Participants who

tested COVID-19 positive reported experiencing discrimination and stigma from

neighbors. The previous study explored the patient’s difficulty accessing

healthcare and sedentary lifestyle factors that can increase the patient's stress

and anxiety. This study is relevant to the current study because both studies aim

to explore the patients’ real experiences during a pandemic, and both

researchers’ purpose is to understand the patient’s insight to inform an effective

transition to a mixed realm of online consultations and "distanced" physical clinic

visits.

Faronbi et al. (2019) conducted the study on "Caring for the Seniors with

Chronic Illness: The lived experience of caregivers of older adults focused on the

lived experience of caregivers of older adults in Nigeria. The purpose of this

study is to describe and understand the difficulties caregivers face in caring for

an older adult with chronic illness. This study has revealed the presence of an

obvious, denied, and poorly communicated burden associated with the care of

older adults. This study showed that despite the presence of this burden
associated with caregiving, the commitment to preserve life makes the

caregivers persist in the caring process. Their beliefs that caring for an older

adult is an investment serve as a motivation to continue despite all odds, Faronbi

et al. (2019). The researchers found Faronbi’s research relevant to the present

study because both studies are about patients with chronic illness, and

researchers aim to formulate strategies that can help not only the patients with

chronic illness but also the health providers to be able to give quality care to their

patients. However, the previous study focused on the experiences and insights of

the caregivers giving care to older adults with chronic illness, and a qualitative

design was used in this research conducted with caregivers of older adults with

chronic illness.

The study, Lived Experiences of Patients with Chronic Obstructive

Pulmonary Diseases (COPD)-Qualitative Review, focused on the people living

with COPD who will have physical, psychosocial, and disease-related problems.

These problems will make people feel isolated, immobile, and depressed. Early

identification of the problems will help in developing the plan of care to deal with

people living with COPD, Castelino et al. (2018). The relevance of this study to

the current study is that both studies examined the lived experiences of a patient

with chronic disease and wanted to explore the challenges and related problems

associated with the disease. The previous study differed from the present study

in its way of collecting the data and the respondents that were chosen in

conducting this study.

 CHAPTER 3:

METHODOLOGY

Research Design

This study aims to gain a better understanding of the lived experiences of

patients with chronic diseases during the Covid-19 pandemic. In this qualitative

study, Heidegger Hermeneutic Phenomenology was the research design

selected. Heidegger's approach was widely used in health research.

Hermeneutic Phenomenology was conducted through empirical and reflective

activities. The aim of Hermeneutic Phenomenology is to understand the meaning

of one’s lived experiences through an open, circular, and interrogative way to

understand the phenomenon brought to cognizance. It attempts to uncover the

world experiences of an individual. It also suggests that interpretative

phenomenology aims in offering insights and explores how the participants

respond and make sense of a given phenomenon. This method, allows the

researchers to understand deeper the lived experiences of patients with chronic

diseases during the Covid-19 Pandemic. Lived experiences vary individually, but

if these experiences are compiled together, it will create a complete and

meaningful picture that will allow people to understand their experiences and

reality.
Research Participants

Amidst Covid-19 Pandemic, researchers observe difficulty accessing to

healthcare among patients with chronic diseases. The target participants are 20

to 30 and were chosen by the researchers based on the increase morbidity

cases of chronic disease in Calbayog City.

The inclusion criteria are: (1) participants who are medically diagnosed

with certain chronic diseases, (2) letter of permission to conduct the study among

target participants, and (3) demographic characteristics (age ˃ 18 years old and

male or female gender. Nevertheless, exclusion criteria are: (1) participants who

are living outside the vicinity of Calbayog City, (2) those who doesn’t have

chronic diseases and (3) with hearing and speech impairment.

Data Gathering Procedure

The strategy of inquiry that is use in this study is the Phenomenology

research tradition. A qualitative research design emphasizing actual experiences

of the target respondents. Additionally, it helps researchers understand the

fundamental nature of the event encountered by certain participant group.

A synopsis of data collection and transcript creation will be provided below

before going into detail about the data sets analysis process:

The researchers will construct Letter of permission approved by the

research adviser and coordinator to conduct the study. The letter will be send to

Barangay Captains of selected barangay. Furthermore, researchers will be

sending letter of permission to Barangay Health Center of selected barangay to

obtain health records of patients with chronic diseases. Structured interviews,

observations and recordings are the methods use in collecting data. Before the

interview, the researchers will inform the participants of the purpose of the study

and that their participation throughout the interview will ensure their safety.
Permission to record the interview, taking notes; confidentiality of information and

anonymity of participant’s identity, and their right to withdraw during the interview

will be considered. Moreover, to assure privacy, participants will determine the

setting for the interview. This will allow the participants to feel relax and be more

confident to share their experiences. Participants’ answers will be based on their

real-life experiences of having chronic disease during pandemic, with their

preferred language- English, Tagalog or Waray-Waray. Data obtain from the

participants will be analyze and undergo cluster analysis. Clustering allow to

classify data into groups based on their observed valued of several variables for

each individual and organize data from different factors and parameters involved.

It also allow researchers to identify and define patterns between data elements.

After data clustering, researchers will identify the essence of being a patient with

chronic disease during the Covid-19 Pandemic.

Data Analysis

The data is obtain by conducting structured interviews specifically develop

for patients with lived experiences of chronic diseases during the Covid-19

Pandemic to get insights into how they cope with their diseases. The interview

aim to understand the impact, consequences, and suffering of the patients

brought by their experiences. The researchers conduct a structured interview

that focuses on two aspects: (1) challenges faced by the patient during the

pandemic and its impact on their access to healthcare and (2) undertaking

preventive health measures to prevent exacerbation of patient chronic diseases.

The participants will be ask specific questions. All information will be keep

confidential and anonymous by the researchers. It will also be recorded using

mobile phones.

An interpretative approach is use for data collection and analysis of the

method for qualitative research. All questions pose to participants during the
interview will be ask in their native languages, allowing them to effectively

expresses themselves and gain information. In addition, researchers apply

Colaizzi’s seven steps to analyze the data collected during interview and showed

an active strategy to achieve the description of living experience for those

people. It includes understanding the data and identifying significant statements

which in turn were converted into formulated meanings. The accurate application

of Colaizzi’s process of descriptive phenomenology would provide and

exhaustive description to the body of knowledge about human experience and

therefore would be an effective strategy to establish the basis for future research.

Instrumentation

In this qualitative study, the research instrument use is a combination of

interviews and video recordings. This method allows the researchers to gather all

the necessary information from the patient needed for the study. The researchers

use a structured type of interview, which is straightforward to conduct and

analyze. Asking the same set of questions mitigates potential biases and leads to

fewer ambiguities in analysis. This strategy allows the participant to address their

lived experiences comfortably without missing the main point of the interview.

Two or more combinations of research instrument are ideal to achieve results

effectively, but they must also be realistic.