Discussion

This study achieved a 100% response rate. This may be because this study attributes its success to a clear and concise questionnaire, pre-testing for construct and face validity, and effective communication by researchers emphasizing the survey’s benefits, confidentiality, and anonymity. Accessibility was ensured by 7 researchers and 125 health volunteers visiting participants’ homes, allowing for immediate completion or within 2 weeks at the participants’ convenience. Incentives of 100 baht (approximately three dollars) for participants were offered.

This study found that about half of the participants felt the effects of COVID-19 and subsequent governmental policy measures affected them at the highest level. The weighted effects of the impact of the COVID-19 pandemic and policy measures were different.

More than 60.0% of participants felt the economic impact of the COVID-19 pandemic and the policy measures were the most profound, including a decrease in income, being furloughed from work, or being unemployed. The findings are consistent with global reports ^{10,Reference Sumner, Hoy and Ortiz-Juarez11} and studies from the US ^{Reference Parker, Horowitz and Brown12} and Thailand. ^{Reference Sumner, Hoy and Ortiz-Juarez11,Reference Satayanurug, Visetpricha and Pintobtang13,22}

The impact from the COVID-19 pandemic and policy measures had significant effects on people’s daily activities including international travel, domestic travel, shopping at the mall, grocery shopping, visits to beauty salons, dining out, attending parties, outdoor exercise, visiting banks, entertainment, meeting close friends, and meeting romantic partners. These findings are congruent with systematic reviews ^{Reference El Keshky, Basyouni and Al Sabban1,Reference Haleem, Javaid and Vaishya2} and studies from Turkey ^{Reference Ali, Yilmaz, Fareed, Shahzad and Ahmad23} and the US. ^{Reference Giuntella, Hyde, Saccardo and Sadoff24}

Some participants in this study also had psychological problems including anxiety about layoffs, stress from unemployment, anxiety about finding a job, stress from being temporarily furloughed from work, and depression from being alone. This is similar to findings from studies conducted in the US, ^{Reference Giuntella, Hyde, Saccardo and Sadoff24} Spain, ^{Reference Rodríguez-Rey, Garrido-Hernansaiz and Collado25} Italy, ^{Reference Saladino, Algeri and Auriemma26} and Thailand. ^{Reference Kasatpibal8,Reference Apisarnthanarak, Siripraparat and Apisarnthanarak16,Reference Thatrimontrichai, Weber and Apisarnthanarak27–Reference Apisarnthanarak, Apisarnthanarak, Siripraparat, Saengaram, Leeprechanon and Weber29}

This study also found that some participants had problems related to their education including delays in their graduation, not being able to attend tutoring, not having access to devices and accessories for online learning, lack of support for online learning, lack of Internet access for online learning, and lack of skills for online learning. This is congruent to findings from studies in Spain, ^{Reference Sintema4} Saudi Arabia, ^{Reference Alghamdi30} and Thailand. ^{Reference Kasatpibal8}

Participants in this study also reported problems with access to healthcare services, which was similar to studies from Chile, ^{Reference Núñez, Sreeganga and Ramaprasad31} Nigeria, ^{Reference Okereke, Ukor and Adebisi32} and Thailand. ^{Reference Kasatpibal8}

In addition, this study found that participants had difficulty accessing infection prevention supplies due to a shortage of masks ^{Reference Ji, Fan, Li and Ramakrishna33,Reference Kampf, Scheithauer, Lemmen, Saliou and Suchomel34} and alcohol-based hand sanitizers. ^{Reference Kampf, Scheithauer, Lemmen, Saliou and Suchomel34}

Some participants in this study had issues with cultural/traditional or community ways of life including decreased support for each other in community activities, decreased religious activities, increased screening and surveillance of people in quarantine (PIQ) from other areas, inability to practice traditions and culture, and increased screening and surveillance of PIQ living in the community. This is on par with studies from the WHO, ⁷ France, ^{Reference Raude3,Reference Raude6} Ghana, ^{Reference Osei-Tutu, Affram, Mensah-Sarbah, Dzokoto and Adams35} and Thailand. ^{Reference Kasatpibal8}

Participants in this study also experienced familial problems including lack of caregivers for bedridden family members, older adults, and children; a decrease in community relationships; a decrease in sexual activity and pregnancy among teenagers; a decrease in family relationships; fear of engaging in sexual activities with a spouse or romantic partner; arguments with a romantic partner; and having a broken family or divorce. These findings are congruent with one systematic review ^{Reference Alghamdi30} and another study done in Thailand. ^{Reference Kasatpibal8}

As determined by this study, the overall weighted effects of the impact of COVID-19 and policy measures were statistically different. The strength of this effect varies among different categories. In the case of being affected by the COVID-19 pandemic, people in urban areas, such as Bangkok and Chonburi, were affected by changes in education more than other categories, which further affected the economy. This is due to the fact that parents have to take time off work to take care of their children attending school online at home. On the other hand, people in rural areas such as Chiang Mai, Nakhon Ratchasima, and Yala found that their cultural/traditional or community ways of life and daily activities were impacted more than other categories. The policy measures affected the economy and mental health as reported by people in urban areas, including Bangkok and Chonburi. People in rural areas, including Chiang Mai, Nakhon Ratchasima, and Yala, reported that daily activities remained an important aspect of their lives. People in Nakhon Ratchasima and Yala reported that cultural/traditional or community ways of life were of higher importance than other categories, which was different from Chiang Mai where access to healthcare services and infection prevention supplies were most important.

The impact on cultural/traditional or community ways of life and daily activities led to reduced interactions within the community and changed the social norms of people who lived in rural areas and usually had close relationships. The economic and psychological impacts result in a reduced quality of life and, in some cases, may lead to suicide.

This study’s findings can be used to develop policies or other methods to reduce the impact of future pandemics on the population. They can also be used as a guide when looking at the severity of aspects of the impact of COVID-19 and policy measures, especially in urban and rural areas where impacts are different depending on peoples’ lifestyles, cultural/traditional or community ways of life, and social norms. Policymakers should develop strategies to provide appropriate support based on how the categories are affected in specific areas (rural vs. urban). If the dominant impact is caused by the COVID-19 pandemic, the government should focus on reducing the spread of COVID-19 and decreasing the incidence of new cases. If the dominant impact is caused by policy measures, especially the country lockdown by which people were hit hardest, the government should focus on changing policies as appropriate based on the prevalence of COVID-19 and ensuring the balance of the 7 categories, especially the economy, daily activities, and cultural/traditional or community ways of life. Information from this study can be used to devise policies in accordance with the dynamics of the COVID-19 pandemic. The government should change policies and adopt measures appropriately to the pandemic situation and balance these measures with other goals such as the economy, education, and way of life. The government should adopt disease control measures based on risk areas instead of implementing a comprehensive lockdown of the entire country.

Based on our literature review and to the best of our knowledge, this is the first study that has looked at the impact of the COVID-19 pandemic and compared the impact of the pandemic and government policy measures. The impacts of the COVID-19 pandemic and policy measures are interconnected, as the latter are responses to the challenges posed by the pandemic, yet they also have distinct characteristics and implications. Recognizing the dynamic of the pandemic and policy effectiveness is crucial, as it makes identifying and comparing their actual effects challenging. Researchers addressed this complexity by explaining impact definitions to participants before questionnaire completion, allowing time for questions and answers.

The results of this study are strengthened by it being a multi-site study with a large sample size and geographic and demographic variability in Thailand. It is important to recognize that individuals within these regions may not be representative of all Thai citizens. The limitation, however, is that it used a self-reported questionnaire which may lead to information bias. This was mitigated by the high content validity of the questionnaire as well as informing all participants about the importance of accuracy when responding to the questions.