During the study period, data from n=4,849 clinic visits (2,500 visits before clinic restructuring due to CVOID-19 and 2,349 visits after restructuring) were analysed and fifteen qualitative interviews were conducted.
Table 2 presents the demographical profile of the fifteen participants interviewed. Over two thirds of participants had two or more chronic conditions. Ten participants were referred to the outpatient chronic care clinic from the hospital setting, the remaining came from community referrals (i.e., General Practitioner).
Qualitative participant profile
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Mean age, years (range, SD)
61.20 (38-80, 12.90)
Female, n (%)
Ethnicity, n (%)
Highest education level, n (%)
No formal/primary level education
Diploma and above
Marital status, n (%)
Employment status, n (%)
Retired or unemployed
Medical history, n (%)
Systemic lupus erythematosus
Abbreviations: SD - Standard deviation.
Five main themes emerged from analysis of the interview data.
Theme 1: Adapting lifestyle in the COVID-19 era.
During the interviews, most of the participants reflected on a great number of changes to their lifestyle because of COVID-19. Adaptations spanned an increase and preference for more home cooking, an avoidance of grocery shopping and adoption of home-exercise.
ID16: “Normally before COVID at least can do some exercise outside but now not outside just do simple exercise at home”
Participants reported feelings of nervousness in catching the disease, particularly if there was an underlying condition. Nervousness appeared to be a main driver of some adaptations. Lifestyle adaptations were also imposed on participants due to the containment measures (i.e., closure of communal spaces, no in-dining, no socialising between households, working from home) or by pressure from relatives concerned for their parents [the interviewees].
ID5: “At the beginning of outbreak, I felt nervous. I have heart disease, SLE, have problems in [my] immune system…stay at home, avoid going out and get infected from people out there”
ID03: “cannot meet family members now since they are staying at different places. There is no physical meet since then [since covid-19]. Only through phone, there is no face-to-face interaction” [households were not permitted to mix during lock-down]
ID15: “The young one will say don’t go out if you need anything…but sometimes they buy the thing, it’s not what we want”
ID7: “My son also doesn’t want us go out, so he will order online”
Theme 2: Finding reassurance from COVID-19 containment measures.
Most participants were generally concerned about the pandemic situation and apprehensive about visiting the clinic but eventually felt comfortable after visiting the doctors in the hospital. For most, containment measures were felt to be sufficient, and they understood their requirement.
ID8: Of course, they are necessary. To protect yourself your family and others. You never know when the person next to you may…show no symptoms”
ID7: “At beginning, really worried. After first and second visits, I felt like…knowing that they are doing precaution measures, then won’t felt so scared”
While participants were knowledgeable about COVID-19 and precautionary measures, the clinic was not viewed as a source of information or advice regarding COVID-19.
ID2: “They did not specifically explain, but we will understand by ourselves”
[in relation to COVID-19 information provision by the clinic]
ID11: “I mean it will be good if we have more information with regards to what precautions other than the very general precautions that we should take”
Theme 3: Accessibility of Healthcare despite COVID-19.
Participants described generally positive experiences reflecting continued access and continuity of care in the clinic. Most participants stated that their appointment frequency was unchanged, although many participants appointments were temporarily moved to another institution (physicians were prohibited from practicing at multiple institutions during lock-down). While the continued access to care was viewed favourably and participants were generally satisfied, there was some frustration at the inconvenience of changing location.
ID7: “Still can go see doctor.”
ID11: “err of course it is inconvenient, but ermmmm I guess if it really is for some good reason then I’m fine with it”
Due to COVID-19, many healthcare institutions utilised teleconsultations, which were largely accepted as a substitute to clinic consultation.
ID12: “yeah I think, it's a good idea, then we save traveling, and it's safer also”
In other cases, a lack of technological ‘savviness’, the lack of ‘personal touch’ and scepticism regarding its effectiveness were reported as barriers to adoption. Context also appeared to be important to the acceptability of teleconsultation.
ID15: “I rather go there and wait for the doctor to see me…for this skill [using teleconference], it’s quite difficult, all the time I got to get someone to help me”
ID7: “If my condition allows, then I will accept. If my condition get worse, then cannot”
ID14: “I think there won't be any personal interaction and it would be like you're talking to the machine even though the doctor is zooming you (Laughs). I prefer to talk face to face…because you can see the reaction of the person”
Theme 4: Anxiety due to COVID-19.
Participants on one hand reported feelings of anxiety for themselves and others and on the other hand were sympathetic to the status of the healthcare workers. Their concerns for the future, the economic impacts of COVID-19 and the stress imposed on healthcare workers were also expressed.
ID16: “I hope everything will be fine, pity for other people, for children that they cannot go out gather with friends”
ID17: “Due to the economy so bad, I don't want to see it continue…because let's say if I continue, so many months or half a year to work from home, it really affects is very challenging, umm in terms of I don't know whether my work, it can keep on”
Feelings of negativity and frustration with the current situation were common and a strong desire for things to return to normality post COVID-19.
ID13: “I also hope that this disease faster goes away, everyone can go back to normal life. I hope everything will be fine after this no more lock-down or this thing hopefully things will be turn back to normal”
Theme 5: Resilience in lock-down.
A strong sense of resilience surfaced in the interviews. Participants adapted to the changed situation using various coping strategies. Many adopted technological solutions (e.g., telecommunications) so they could continue to socialise while avoiding activities perceived as high risk.
ID15: “Because now of covid-19 we are not suppose to meet in church, then no choice lah…sometime attend on YouTube lah, the sermon on Youtube”
ID14: “I have two good friends and we meet once every month. But now that has been banned, so we contact through phone”
(“lah” is a commonly used phrase in local English dialect (often termed Singlish) which may mean an affirmation, dismissal, or exclamation in different contexts.)
Trust in the government’s actions and an understanding that ‘the restrictions are for our own good’ also helped participants accept the situation and remain resilient.
ID7: “Our Singapore did very well in term of precaution measures, my feeling like become more calm. At the beginning, will feel nervous. But now government will control it, so we won’t feel so worried now”