Introduction

A family is the most potent context to promote, develop, or disrupt individuals' health over a life span [1]. Family members support each other socially, emotionally, and economically to varying degrees [2]. Familial patterns and interactions are dynamic and formed by socio-cultural, economic, and political conditions [3]. As a stressor originating from outside the family system, the COVID-19 pandemic has led to high rates of illness and death and numerous changes and side effects in daily life [4,5]. Even the families not directly exposed to the virus are likely to experience the indirect effects COVID-19 [6]. As COVID-19 continued to spread, the virus and its related problems appeared to be more than biomedical concerns [3]. To reduce COVID-19 prevalence, governments have advised the entire human population to "stay at home." [7].

The COVID-19-induced lockdown is a public health measure to minimize virus transmission [8]. Worldwide, over 100 countries had a complete or partial lockdowns[9]. The COVID-19-induced lockdown has considerably changed millions of people’s daily lives and routines all over the world [10]. Although the lockdown minimize physical harm , it may substantial harm people’s well-being [11]. For instance, problems between spouses or other family members, familial caregivers, and primary health providers of the community can be problematic [3]. A survey study by Biroli reported a high percentage of disruption during the COVID-19-induced lockdown in family patterns life, displayed by new work patterns, allocations of chores, and household tensions [10]. Lebow’s study reported relational improvement and deterioration during the lockdown [12]. Other studies reported increased domestic violence [13,14,15,16,17] and psychological impacts on the public [17,18,19] during natural disasters and the COVID-19 pandemic. However, a comprehensive understanding of the family experience of being locked up and staying at home was latent.

One application of qualitative research is the description of the unknowns. On the other hand, available quantitative methods do not provide sufficient insight into intimate relationship experiences, but a qualitative descriptive scheme permits understanding their experience [20]. Previous studies have indicated that understanding the psychological and behavioral reactions to emerging infectious diseases plays a crucial role in managingoutbreaks [21,22]. Understanding how COVID-19 disease affects family life is important [23]. Therefore, this study sought to explain family members’ experiences of individual memories and coping with the COVID-19-induced lockdown.

Methods

This exploratory descriptive qualitative research was conducted by conventional content analysis. A purposive sampling was continued by achieving data saturation, reaching 29 samples.

In-depth semi-structured interviews were conducted with the family members who had the experiences of staying at home during the COVID-19-induced lockdown. Several open-ended questions guided the researcher in gathering the information. The following questions were asked to achieve more in-depth information (Box 1).

This study included amily stayed at home during the COVID-19-induced lockdown, but without any COVID-19 infected members in their families. We intended to investigate the healthy family members’ experiences of forced lockdown without the tension of COVID-19 infection. We researched the whole atmosphere of family without considering a specific age.

Data collection

Prior to the interviews, we sent the informed consent form electronically to the participants. We interviewed them after they agreed. The interviews were conducted via WhatsApp video chats and lasted about 20 to 60 minutes. The interview environment was calm and devoid of disruptive factors. The first author (SS, Ph.D.) interviewed with the permission of the participants, and a voice recorder documented all the interviews. Then, the first author gave the coded audio file of the interviews to the second author without mentioning the participant’s characteristics. The second author (MM, MSc.) transcribed the recorded interviews. The interviews were analyzed by the first author, and the coding and the coding process was reviewed and revised by the third author (YP, MA.) and the second author (MM). All the authors are experienced researchers in qualitative research and are academic faculty members. This is particularly true for the first and second authors, who have conducted several qualitative content analysis studies and are experts in community health nursing and adult health nursing respectively. During the interviews, the analysis of the interviews was also performed. The sampling continued to achieve data saturation. The data saturation was achieved by 29 samples. The data collection was conducted from October 2020 to February 2021 through in-depth and semi-structured interviews in a secluded and quiet environment according to the convenience of the participants. The first author requested the participants to determine the interview time so that they would be convenient with the time and place. Also, she interviewed in a calm environment via WhatsApp video chat. Content analysis presented by Graneheim and Lundman was used to analyze the data [24]. MAXQDA software was applied.

At the end of each interview, the recorded statements of the participants were repeatedly listened, and their statements were verbatim transcribed. Each written interview was read several times to understand the participants' experiences and perceptions. Later, the meaningful information and related statements were underlined, whereby meaningful units/important statements were identified. Then each meaningful unit was reduced to a condensed meaningful unit and the initial codes appeared. The first author (SS) carefully studied the initials codes and categorized them into subcategories based on the similarity of the concept. During this inductive process, similar subcategories were classified into main categories. SS reviewed and discussed this coding process and the emergence of the main categories by the third researcher. Finally, the main categories were defined as expressing the hidden content of the text. We also asked an expert in qualitative research (NB) to review the coding process. This study applied four rigor criteria including credibility, confirmability, transferability, and dependability as recommended by Lincoln and Guba [25].

For credibility, the extracted codes were referred to the participants and with their confirmation, the findings were validated (member check). The researchers also referred the extracted codes to an expert in qualitative research (NB) and the credibility of the research findings was confirmed by her (peer check). She has a Ph.D. in Reproductive Health and is an experienced researcher in the qualitative research and community-based services.

Confirmability was achieved by bracketing (excluding preconceptions) and reporting and recording the research steps and decisions made during it, so that other researchers can follow it and the research can be an audit trail. For the dependability of the findings, the data analysis process was performed by more than one researcher. Transferability was provided by a variety of samples with different demographic characteristics.

This study was approved by the Ethics Committee of Lorestan University of Medical Sciences with the ethics code LUMS.REC.1399.204. Therefore, we confirm that all the study processes were performed following relevant ethical guidelines and regulations as follows: Obtaining the electronic written informed consent due to the lockdown, keeping anonymity and confidentiality in the interview process and data analysis, coordinating with and satisfying the participants in choosing the time and place of the interview, getting permission from the participants to record their voices, assuring the participants that they would be free to participate in the research, and providing the participants with the research results.

Results

The participants of this study were family members with varying family roles and educational levels. They were 29 persons with a mean age of 37.5 years old (Table 1).

The findings of this study included 100 codes and five themes: Taking advantage of opportunities, coping mechanisms, social aspects, outcomes, and economic aspects. Each of them had subcategories (Table 2).

Taking advantage of opportunities

The theme of taking advantage of opportunities had two sub-categories: Increasing intimate communication in the family and compensation and progress. Each of them had subcategories. Some of the participants experienced an increase in intimate communication in the family. The participants stated that lockdown and staying at home caused them to help their spouse with household chores, created a greater sense of cohesion and intimacy between family members through increased time for children and spouse, and increased emotional intimacy with the spouse.

The participants shared their experience of compensation and progress during the lockdown. They experienced more opportunities to achieve interests, to increase children’s computer knowledge and skills, and to deal with backlogs, and they also found opportunities and conditions to adapt to personal crises such as divorce. One participant talked about the usefulness of the lockdown in being less accountable to people about personal crises such as a family divorce.

Coping mechanisms

The participants tried to adjust to the lockdown conditions. These included creating fun and creativity at home, trying to spend leisure time, sports, reading books, music, increasing patience and tolerance, and forced Internet communications.

Social aspects

The participants reported positive and negative social aspects. Positive social impacts included reducing people’s curiosity about others' private lives due to COVID-19 mental preoccupation, changing people’s lifestyles toward keeping health protocols, quitting bad and harmful habits, and moving toward healthy behaviors.

On the other hand, negative social impacts included severing social ties, diminishing meetings, not being able to share their joys and sorrows with friends in person, and exclusively virtual contact with relatives and friends. The participants avoided close interaction with people.

Outcomes

In this theme, the participants experienced gratefulness, pleasure, happiness, concerns, psychological aspects, and damage and challenge to the family’s foundation.

In the subcategory of gratefulness, pleasure, and happiness, the participants stated learning to enjoy life, developing help and cooperation sense, appreciating each other’s existence, being grateful for health, and being satisfied with the lockdown.

The participants stated concerns such as unhappiness with society due to the weakening of social relations and economic problems, worries about the stability of this situation, the need to manage cyberspace, trying to seek information on COVID-19 disease, closure of gyms and low suitable mobility and physical activity, and increased poverty and crime/social harm.

The participants also experienced anxiety, intensification of loneliness and isolation, changes in mood and energy, sleep-wake patterns disruption, helplessness feelings, and an increase in the risk of problematic Internet use.

From the participants’ point of view, one of the outcomes of the COVID-19 lockdown, was damage to the foundation of the family. This subcategory includes a time for unspoken words, increased conflicts in family relationships and referring to family counselors, increased divorce, and family members' abuse to women, children, and the elderly.

Economic aspects

The participants cited cost-savings, recession/job loss/financial downturn, and low-income families' unaffordability to prepare electronics for education. The cost-saving category includes a reduction in transport expenses, a decrease in the cost of education and schooling for children, and a reduction in holiday expenses, and family visits.

Discussion

This study provides an insight into families expiriences’ during a pandemic-related lockdown. The COVID-19 pandemic and its related lockdown have affected various aspects of family life. The findings of the present study contain five categories.

Taking advantage of opportunities

In this study, some participants noted the impact of the lockdown and staying at home on increasing communication and intimacy in the family. Other studies confirm that many families have reported their family priorities to be an increase in cohesion and a deeper understanding of their values [26].

The participants stated the subcategory of compensation and progress during the lockdown. They experienced more opportunities to achieve interests, increase children’s computer knowledge and skills, deal with backlogs, and found opportunities and conditions to adapt to personal crises such as divorce, and to increase creativity. Other studies confirm that many people point out that the experience has permitted them to return to their past hobbies or find a new interesting hobby. They have spent more time with their families, which has been very positive [26].

The participants noted an increase in children/students' computer knowledge and skills during the holidays. Tejedor et al. study showed that empowering and supporting students is necessary for suitable digital literacy. In the global condition of the lockdown, students have the opportunity to pursue individualized learning pathways [27]. Additionally, they experienced reduced social interactions and, as a result, reduced curiosity in private life and questioning the cause of divorce, which led to their success in coping with this crisis. One of the participants mentioned that she felt a reduction in cultural pressure on divorce due to COVID-19 mental preoccupation, which she described as a favorite condition for better adjustment to the divorce case. We did not find any related studies in this regard. Although the present study implicitly mentioned stress and the need for help and counseling, privacy and calm environment/atmosphere during the lockdown was more important.

Lebow’s study reported that divorce faces challenges during the lockdown, and there is a need for compromise and help in adjusting for divorced parents [28]. This discrepancy can be due to the differences among societies, where divorce is relatively stigmatized in Lorestan province in Iran. When facing challenges, people primarily rely on the family. In this regard, the lockdown, the lack of social interactions, and school and workplace closure has helped to adapt to this challenge away from the curiosity of others.

Coping mechanisms

The participants referred to coping mechanisms to adjust to the lockdown conditions, including fun and creativity activities at home, trying to spend leisure time, exercise, book study, music, increasing patience and tolerance, and increasing Internet communications and online social networking. Other studies also suggested that people cope with the lockdown stress by engaging in specific activities during the lockdown period, including music, meditation, sport, exercise, cooking, and reading books [29].

The participants cited increased patience and tolerance as mechanisms for adapting to the lockdown and staying at home. We did not find any related studies in this area. The participants were communicating with their friends and relatives who lived in other places through Internet communications or social networks such as WhatsApp, and they tried to maintain a network of friends and neighbors. Watson et al. study reported an increase in digital communication technologies in people’s homes during the shutdown. Video calling software is of particular importance for many people, allowing them to get closer and more connected with their friends and family when performing daily programs and special events [30]. Cauberghe’s study reported social media as a major source during a lockdown for many people to cope with a lack of social communication [31].

Social aspects

The participants reported the experienced social aspects of the lockdown. The participants stated a decrease in people’s curiosity about private life due to COVID-19 mental preoccupation, a change in people’s lifestyles toward health, and the abandonment of harmful habits, including smoking, as positive social impacts. These findings align with Galli’s study, reporting that the COVID-19 lockdown has resulted in changes in lifestyles [32].

The participants experienced negative social impacts including severing social ties, diminishing meetings, not being able to share joys and sorrows with friends in person, and contacting relatives and friends virtually. We did not find any related studies in this area. In our opinion, virtually communicating with relatives and friends is similar to a double-edged sword, which helps to adapt to the lockdown. Moreover, since it does not replace real and face-to-face communication, it can be harmful culturally.

The participants experienced anxiety, loneliness, isolation and intensification, changes in mood and energy, sleep-wake patterns disruption, helplessness feelings, frequent disputes and arguments in the family, and an increase in the risk of problematic Internet use. Anxiety - as a key theme and one of the negative psychological aspects, includes fear of sickness, stress of leaving home, washing obsession, and cleanliness stress.

Other studies have confirmed that COVID-19 has resulted in increased uncertainty and concerns, partly caused by disappointing news from all over the world [3,12]. In addition to threatening the physical health of people, COVID-19 causes numerous worries and affects the mental health [33], which is complicated by isolation induced by the lockdown [34]. Concerning the experience of high-stress levels during pregnancy in our study, the findings of Zhang’s study have similarly reported the experience of moderate to severe anxiety in pregnant women during the early stages of the pandemic [35]. All the participants experienced various degrees of anxiety which could be a trigger for the emergence of other conditions.

Some of the family members reported feeling of loneliness and isolation, which were dependent upon the degrees of social interactions before the lockdown or their personality traits since some did not experience such feelings. Other studies have reported the isolation induced by the lockdown as an unpleasant experience, which can lead to sadness and even impose substantial mental illness on those suffering from the isolation [17]. This social isolation will result in chronic loneliness and boredom, which can devastate physical and mental health if prolonged enough [34].

The participants reported impatience and boredom during the lockdown. Generally, a lockdown is an unpleasant experience since it comes with consequences such as separation from loved people, insecurity financial problems, and impatience [17,36].

The participants in our study reported loneliness exacerbation among older people, and this has been confirmed by other studies. The reverse quarantine, in which older adults were separated from the other family members to prevent infection, was the major reason for loneliness [37].

Some of the participants experienced anger and depression. This finding is in line with a review study by Torales indicating that the lockdown increased depression, anxiety, post-traumatic stress disorder, and insomnia in the general population [38].

The present study indicated that excessive social network use, cyberspace abuse, and increased risk of the problematic use of the Internet and digital devices including tablets, phones, and personal computers in children are some of the consequences of the lockdown and staying at home. Dong’s study evidenced Internet overuse in Chinese children and adolescents during the pandemic. The COVID-19 pandemic has mainly affected Internet use in various ways, including recreational Internet use frequency and duration and stay-up use rate [39]. Cauberghe’s study has indicated that, teenagers during the lockdown use social media to respond and adapt to feeling of loneliness and anxiety. Social media are a major source to adapt to a lack of social communication during the lockdown [31].

The participants in our study reported disturbances in sleep and biological rhythm. Other studies have suggested that people may have trouble sleeping and focusing on their household chores during the lockdown [40]. Ara’s study confirmed that family members had sleep disorders during the lockdown, possible due to job loss, online classes, fear of being infected with the virus, and depression, among others[41]. Other studies have indicated that people experience sleep disorders during the pandemic [42,43].

Outcomes

The participants stated the positive impacts of the lockdown such as movement toward expanding the worldview and a sense of pleasure and happiness.

The expansion of the worldview subcategory describes understanding death reality, taking advantage of the short opportunity of living, a sense of help and cooperation development, and understanding life and world beauties, which we callnurturing awareness toward encircling the environment and others. No relevant studies were found in this area.

The participants stated a sense of contentment and happiness including satisfaction, intimacy, and gratefulness for being healthy. In our study, the people who were not being financially anxious enjoyed the lockdown and being together. Spending more time with spouses during the lockdown increased marital satisfaction [44]. In contrast, the lockdownharmed happiness in Greyling’s study [11]. Happier people are more likely to comply with the lockdown and staying at home. The findings of the study confirm that previous and current happiness predicts compliance with the lockdown, and a higher level of happiness strengthens this relationship [45].

The participants experienced unhappiness with the state of society due to the weakening of social relations and economic problems, worries about the stability of this situation, the need to manage cyberspace, reduced intimacy, trying to obtain information about COVID-19 disease, delays in medical follow-up, closure of gyms and low suitable mobility and physical activity, eye injuries from working with electronic devices, and increased poverty and crime/social harm.

Physical inactivity, sedentary lifestyle, loneliness, and social isolation in which public interactions become limited can all affect a person’s general health [46]. The literature shows that people may experience unpleasant psychological consequences including anger, post-traumatic stress disorder, and depression in such situations. Length of stay at home, fear of infection, worries about life necessities, concerns about receiving on-time information, money loss, and the stigma associated with the epidemic can cause mental disorders [47].

The participants expressed concern about the closure of gyms and art classes, which caused reduced mobility and entertainment. Huber’s study showed that many opportunities, such as athletic programs, fitness centers, and sports clubs, have been suspended [48], which can cause psychological and physical consequences for family members, especially children [46].

The participants referred to the damage and challenges of strengthening the family foundation during the COVID-19 lockdown, including having time for unspoken words, increasing differences in family relationships, more visits to family counselors, increasing divorce, called the “Covidivorces”, and mistreatment of women, children, and the elderly. Other studies have reported increased domestic violence during the COVID-19 lockdown. Zhang’s study has primarily attributed this increased domestic violence to the widespread lockdown, which exacerbates conflicts, economic distress, and pandemic tensions in families, and also to the insufficient support for domestic violence victims during the COVID-19 pandemic [49]. Given the current health consequences of the COVID-19 crisis, children in high-risk families may be more likely to be abused [50].

Economic aspects

The participants referred to the economic aspects of the lockdown including cost savings, job loss, financial decline, and inability to prepare tablets and computers for virtual education in the poor. Numerous studies have reported economic challenges in different countries during the pandemic-related lockdown period [17]. Although it has limited the COVID-19 spread, the shutdown has resulted in an economic crisis, especially the unspoken misery it has created among the workers' class [37].

Given that the researchers in the present study are community health and adult health nurses, these findings can help them to acquire new insight into families’ conditions in forced lockdown induced by pandemics.

Limitations

This study’s interviews were conducted via WhatsApp video chat due to the lockdown regulations. Therefore, we could not have the benefits of face-to-face interviews, including recording field notes and considering non-verbal communication such as body language that could be more trustworthy. Since this study has been done in a local area, the generalizability of these findings may be limited.

Concluding remarks

The participants in this study noted the pros and cons of the lockdown and tolerated some changes to cope with the COVID-19 pandemic-induced lockdown. As a double-edged sword phenomenon, these changes in different dimensions of family members’ lives, can have positive or negative effects and, over a long period of time, my become internalized in people’s lives and culture. Will the COVID-19 pandemic change the course of human life altogether? Policymakers must design and implement programs in line with this change in the public’s lifestyles so that families are not damaged.