<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.127578.7</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Research Article</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Until the dawn: everyday experiences of people living with COVID-19 during the pandemic in Thailand</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 7; peer review: 1 approved, 1 approved with reservations, 1 not approved]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Imkome</surname>
                        <given-names>Ek-uma</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Funding Acquisition</role>
                    <role content-type="http://credit.niso.org/">Investigation</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Moonchai</surname>
                        <given-names>Kamonchanok</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Investigation</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>Mission Faculty of Nursing, Asia-Pacific International University, Muak Lek, Thailand</aff>
                <aff id="a2">
                    <label>2</label>Mental Health and Psychiatrics Nursing, Srisavarindhira Thai Red Cross Institute of Nursing, Pratumwan, Bangkok, 10330, Thailand</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:ekuma@apiu.edu">ekuma@apiu.edu</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>7</day>
                <month>7</month>
                <year>2026</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2022</year>
            </pub-date>
            <volume>11</volume>
            <elocation-id>1560</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>15</day>
                    <month>6</month>
                    <year>2026</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2026 Imkome Eu and Moonchai K</copyright-statement>
                <copyright-year>2026</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/11-1560/pdf"/>
            <abstract>
                <sec>
                    <title>Background</title>
                    <p>This study explores the lived experiences of individuals recovering from COVID-19, aiming to deepen understanding of their meaning-making processes and inform supportive responses in future health crises.</p>
                </sec>
                <sec>
                    <title>Methods</title>
                    <p>Fifteen participants were recruited using purposive and snowball sampling. Data were collected through semi-structured interviews conducted online. Interpretative Phenomenological Analysis (IPA) guided the analytic process, enabling in-depth exploration of how participants made sense of their experiences. Reporting adhered to the COREQ qualitative research guidelines.</p>
                </sec>
                <sec>
                    <title>Results</title>
                    <p>Five superordinate themes emerged: stress, economic and social disruption, social stigma, social support, and the reappraisal of adversity (&#x201c;finding meaning in misfortune&#x201d;). Participants&#x2019; accounts reflected complex and evolving processes of adaptation, shaped by both contextual challenges and relational resources, highlighting how individuals actively interpred and reconstructed their experiences of revovery.</p>
                </sec>
                <sec>
                    <title>Conclusion</title>
                    <p>The findings undersocre the importance of multidisciplinary care approaches that address psychosocial and economic dimensions of recovery. While the results provide in-depth insights into participants&#x2019; lived experiences, implication for policy and practice should be considered within the contextual scope of the study. This findings may inform the development of targeted psychosocial support and integrated response frameworks for future public health emergencies.</p>
                </sec>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>COVID-19</kwd>
                <kwd>Mental health</kwd>
                <kwd>lived experiences</kwd>
                <kwd>phenomenological-hermeneutic approach</kwd>
                <kwd>stress</kwd>
                <kwd>economic impact</kwd>
                <kwd>social stigma</kwd>
                <kwd>social support</kwd>
                <kwd>multidisciplinary treatment strategies</kwd>
                <kwd>multidisciplinary treatment teams</kwd>
            </kwd-group>
            <funding-group>
                <award-group id="fund-1">
                    <funding-source>Thammasat University Research Unit in the innovation of Mental Health and Behavioral Healthcare</funding-source>
                </award-group>
                <award-group id="fund-2">
                    <funding-source>Faculty of nursing, Thammasat University</funding-source>
                </award-group>
                <funding-statement>The author(s) declared that no grants were involved in supporting this work.</funding-statement>
            </funding-group>
        </article-meta>
        <notes>
            <sec sec-type="version-changes">
                <label>Revised</label>
                <title>Amendments from Version 6</title>
                <p>This revised version introduces substantial improvements in response to reviewer feedback, particularly strengthening methodological clarity, analytic rigor, and consistency with Interpretative Phenomenological Analysis (IPA). The manuscript now clearly identifies IPA as the sole analytic framework from the outset, and all previously inconsistent methodological terminology (e.g., content or thematic analysis) has been removed to ensure coherence. The Data Analysis section has been expanded to provide a transparent, step-by-step description of the IPA process, including idiographic case analysis and cross-case synthesis. In addition, the trustworthiness approach has been revised to align with IPA-specific quality criteria (e.g., sensitivity to context, commitment and rigor, transparency and coherence), replacing earlier post-positivist terminology. The Results section has been substantially rewritten to enhance interpretative depth, moving beyond descriptive reporting to emphasize participants&#x2019; meaning-making processes. Findings are now presented as interpretative thematic accounts, with improved idiographic focus and analytic structure. The integration of the Roy Adaptation Model (RAM) has also been refined, positioning it as an interpretative lens embedded within the analysis rather than a separate framework. The Discussion has been strengthened through deeper theoretical interpretation, clearer alignment with IPA principles, and the integration of recent literature (2024&#x2013;2025), particularly in relation to stress, stigma, adaptation, and meaning-making. Conclusions and implications have been revised to avoid overgeneralization and to remain grounded in the study&#x2019;s findings. Additional revisions include language editing for clarity and consistency, improved citation accuracy, and corrections to reference formatting.</p>
            </sec>
        </notes>
    </front>
    <body>
        <sec id="sec1" sec-type="intro">
            <title>Introduction</title>
            <p>The COVID-19 pandemic has exerted a profound impacted global health, with over 219 million cases and 4.55 million fatalities reported as of October 10, 2021. Despite advancements in vaccine development and therapeutic interventions, the virus continues to evolve, posing ongoing challenges for public health systems worldwide. Governments have rapidly implemented containment strategies, including lockdowns and movement restrictions, leading to significant socio-economic disruptions and shifts in daily life. As a result, individuals have adopted various coping mechanisms to manage the uncertainty and instability caused by the pandemic (
                <xref ref-type="bibr" rid="ref23">Nurunnabi 
                    <italic toggle="yes">et al.,</italic> 2020</xref>).</p>
            <p>By May 2022, COVID-19 cases had surged to 512 million globally, with a death toll exceeding 6.25 million (World Meter, 
                <ext-link ext-link-type="uri" xlink:href="https://www.worldometers.info/coronavirus/">https://www.worldometers.info/coronavirus/</ext-link>). Beyond the immediate morbidity and mortality associated with the virus, healthcare systems have struggled to maintain continuity of care, particularly for non-COVID-19 conditions. The pandemic has altered chronic illness management, disrupted emergency services, and contributed to a significant increase in mental health concerns, including stress, depression, and anxiety (
                <xref ref-type="bibr" rid="ref30">Sing Joo, 
                    <italic toggle="yes">et al.,</italic> 2021</xref>). Studies indicate that approximately 20% of COVID-19 cases require oxygen therapy, while 5% develop severe symptoms necessitating intensive care (
                <xref ref-type="bibr" rid="ref35">Wu &amp; McGoogan, 2020</xref>). Although much of the existing literature has focused on acute symptoms, there is growing recognition that COVID-19 has lasting psychosocial consequences. Patients report experiencing persistent symptoms such as fatigue, dyspnea, muscle pain, nausea, and heightened fear, all of which impact their overall well-being and recovery (
                <xref ref-type="bibr" rid="ref4">Davis 
                    <italic toggle="yes">et al.,</italic> 2019</xref>; 
                <xref ref-type="bibr" rid="ref14">Huang 
                    <italic toggle="yes">et al.,</italic> 2020</xref>).</p>
            <p>The mortality rate of COVID-19 has been estimated to range from 1% to 5%, but this varies depending on patients&#x2019; age group and the presence or absence of underlying diseases. The epidemiological distribution of mental health problems and associated factors are heterogeneous among COVID-19 patients. The current evidence suggests that a psychiatric epidemic is co-occurring with the COVID-19 pandemic, which necessitates the attention of the global health community (
                <xref ref-type="bibr" rid="ref12">Hossain, 2020</xref>).</p>
            <p>In Thailand, the pandemic has led to widespread psychological distress, financial instability, and healthcare disruptions. Anxiety, loneliness, and fear of infection have been particularly prevalent, affecting individuals across various demographics (
                <xref ref-type="bibr" rid="ref65">Chutipattana et al., 2022</xref>). Psychological resilience has played a crucial role in mitigating these negative effects, with evidence suggesting that individuals with stronger coping mechanisms experience lower levels of stress and anxiety (
                <xref ref-type="bibr" rid="ref66">Ruengorn et al., 2022</xref>). However, the crisis has also exposed disparities in mental health care accessibility, emphasizing the need for effective interventions that support vulnerable populations (
                <xref ref-type="bibr" rid="ref67">Srichannil, 2020</xref>).</p>
            <p>Between January 2020 and August 2023, Thailand reported over 4.7 million confirmed cases and 34,459 deaths, with more than 139 million vaccine doses administered (
                <xref ref-type="bibr" rid="ref39">WHO, 2023</xref>).</p>
            <p>To date, Thailand&#x2019;s research response has largely focused on epidemiological surveillance, vaccine distribution, and healthcare system capacity (
                <xref ref-type="bibr" rid="ref52">Lerthattasilp, Kosulwit, Phanasathit 
                    <italic toggle="yes">et al.</italic>, 2020</xref>; 
                <xref ref-type="bibr" rid="ref50">Srifuengfung, Thana-Udom, Ratta-Apha, Chulakadabba, Sanguanpanich, &amp; Viravan, 2021</xref>; 
                <xref ref-type="bibr" rid="ref51">Kerdcharoen, Kirdchok, Wonglertwisawakorn, Naviganuntana, Polruamngern, &amp; Chinvararak, 2022</xref>). While these studied provide valuable insights into infection rates and systemic challenges, they often overlook the lived experiences of COVID-19 survivors. Existing qualitative research has largely focused on healthcare professionals, students, and individuals with underlying conditions&#x2014;groups facing occupational burnout, academic challenges, and delayed treatments (
                <xref ref-type="bibr" rid="ref12">Hossain 
                    <italic toggle="yes">et al.</italic>, 2020</xref>; 
                <xref ref-type="bibr" rid="ref23">Nurunnabi 
                    <italic toggle="yes">et al.</italic>, 2020</xref>; 
                <xref ref-type="bibr" rid="ref25">Rathnayake 
                    <italic toggle="yes">et al.</italic>, 2021</xref>; 
                <xref ref-type="bibr" rid="ref30">Sing Joo 
                    <italic toggle="yes">et al.</italic>, 2021</xref>). However, the specific psychosocial adaptation process of survivors themselves remain underexplored, particularly in the Thai and Southeast Asian context.</p>
            <p>This study addresses this critical gap by applying Interpretative Phenomenological Analysis (IPA) and the Roy Adaptation Model (RAM) to examine how COVID-19 survivors in Thailand navigate stress, stigma, and social reintegration. By capturing their lived experiences, the research provides a nuanced understanding of adaptive process shaped by contextual hardships and rational resources. The findings aim to inform the development of targeted psychosocial interventions, enhance mental health service delivery, and support policy framework for post-pandemic recovery. In doing so, this study contributes to a more inclusive and patient-centered approach to public health preparedness and resilience.</p>
            <sec id="sec2">
                <title>Theoretical perspective</title>
                <p>The Roy adaptation model (RAM) serves as the theoretical framework for this study, deepening our understanding of the lived experiences and the impact of COVID-19 cases. The application of RAM in nursing research provides a structured yet flexible approach that enhances qualitative inquiry rather than limiting creativity. By offering a comprehensive model of adaptation, RAM enables researchers to interpret individuals&#x2019; responses holistically, allowing the study to capture diverse perspectives without imposing rigid constraints (
                    <xref ref-type="bibr" rid="ref27">Roy, 2009</xref>, 
                    <xref ref-type="bibr" rid="ref28">2011</xref>). While qualitative research thrives on open-ended exploration, RAM does not stifle creativity, but rather provides an adaptable analytical lens that supports thematic development. The model&#x2019;s focus on focal, contextual, and residual stimuli aligns naturally with participants&#x2019; narratives, ensuring that emerging themes remain participant-driven while maintaining coherence and interpretative depth (
                    <xref ref-type="bibr" rid="ref27">Roy, 2009</xref>).</p>
                <p>RAM (
                    <xref ref-type="bibr" rid="ref26">Roy, 2001</xref>, 
                    <xref ref-type="bibr" rid="ref27">2009</xref>, 
                    <xref ref-type="bibr" rid="ref28">2011</xref>) describes individuals as adaptive systems composed of interconnected elements that function as a unit, influenced by focal, contextual, and residual stimuli (
                    <xref ref-type="bibr" rid="ref27">Roy, 2009</xref>). These adaptive responses may result in positive adaptation (improved health and well-being) or maladaptation (prolonged distress and illness). In this study, RAM serves as a guiding framework to analyze how COVID-19 survivors navigate stress, stigma, and social reintegration, ensuring that mental health interventions are tailored to patients&#x2019; lived realities rather than predefined categories.</p>
                <p>Additionally, our use of interpretative phenomenological analysis (IPA) as the analytic framework, which complements RAM by focusing on participants&#x2019; meaning-making processes. IPA&#x2019;s idiographic and hermeneutic orientatation ensure that interpretations remain grounded in individual lived experiences. While RAM informs the theoretical structure, IPA guides the analytic depth, enabling a dual-layered approach that integrates empirical insight with conceptual rigor.</p>
                <p>By leveraging RAM and IPA in tandem, the study maintains methodological integrity while enriching the interpretative process. This integration facilitates a nuanced exploration of adaptation, ensuring that findings reflect both the complexity of survivor experiences and the theoretical coherence necessary for advancing nursing and public health research.</p>
            </sec>
        </sec>
        <sec id="sec3" sec-type="methods">
            <title>Methods</title>
            <sec id="sec4">
                <title>Design</title>
                <p>This research employed Interpretative Phenomenological Analysis (IPA) to explore the lived experiences of COVID-19 survivors. IPA&#x2019;s idiographic and interpretative stance allowed us to examine how individuals made sense of their illness and recovery experiences.</p>
            </sec>
            <sec id="sec5">
                <title>Participants</title>
                <p>
Fifteen participants were selected through purposeful sampling. As per the inclusion criteria, participants included COVID-19 survivors who had been discharged from the hospital and provided written consent for participation. COVID-19 cases that experienced stress or mental health problems were prevented from giving informed consent, and their participation was thus excluded.</p>
            </sec>
            <sec id="sec6">
                <title>Procedures</title>
                <p>This study employed interpretative phenomenological Analysis (IPA) as the sole analytic framework to explore the lived experiences of COVID-19 survivors. While the philosophical foundation of IPA is phenomenological and hermeneutic, all data collection and analysis procedures adhered strictly to IPA principles as outlined by 
                    <xref ref-type="bibr" rid="ref38">Smith &amp; Osborn (2015)</xref> and 
                    <xref ref-type="bibr" rid="ref58">Smith &amp; Nizza (2022)</xref>. The research team developed semi-structured individual interview questions (
                    <xref ref-type="bibr" rid="ref63">Imkome &amp; Moonchai, 2025</xref>), grounded in an extensive review of the literature focusing on adaptation and emotional responses. The question design was informed by previous research and structured around the Roy Adaptation Model (RAM), aiming to investigate how individuals navigated the psychological, social, and economic challenges posed by the pandemic.</p>
                <p>RAM provided a flexible yet systematic framework for formulating interview questions, enabling the exploration of focal, contextual, and residual stimuli&#x2014;elements crucial for understanding the adaptation process (
                    <xref ref-type="bibr" rid="ref27">Roy, 2009</xref>, 
                    <xref ref-type="bibr" rid="ref28">2011</xref>). This approach allowed participants to freely express their experiences beyond predefined categories, offering deeper insights into their coping mechanisms and psychosocial responses.</p>
                <p>To ensure content validity, the interview guide was critically reviewed by three expert validators specializing in phenomenology and adaptation theory. Their evaluations confirmed that the questions maintained conceptual integrity, remained open-ended, and facilitated authentic narratives from participants.</p>
                <p>The interview questions were aligned with key principles of the Roy Adaptation Model (RAM). For example, questions such as &#x201c;How have you coped with the impacts of the COVID-19 outbreak on yourself, your family, and your community?&#x201d; and &#x201c;Who or what groups have helped you alleviate stress, and in what ways?&#x201d; were designed to examine adaptation across physiological, self-concept, role-function, and interdependence domains, consistent with RAM&#x2019;s core constructs.</p>
            </sec>
            <sec id="sec7">
                <title>Data collection</title>
                <p>Participants were recruited through the nursing offices of a hospital located in a different region of Thailand. Initially, their willingness to participate was assessed via phone calls, after which nurses provided comprehensive information regarding the interview process. Video interviews were conducted via Microsoft Teams at times convenient for participants, following a thorough explanation of the research objectives and the acquisition of both verbal and written informed consent.</p>
                <p>Sampling continued until data saturation was reached, defined as the point at which no new themes emerged across successive interviews. Saturation was confirmed through iterative analysis and peer debriefing sessions, ensuring a comprehensive thematic framework reflective of participants&#x2019; lived experiences. All interviews were conducted by the lead researcher, a psychiatric nurse, in a neutral and supportive environment. Interview durations ranged from 25 to 60 minutes, with strict adherence to data anonymization procedures. In the final step, transcripts were returned to participants for review and correction, ensuring accuracy and validation of their narratives.</p>
            </sec>
            <sec id="sec8">
                <title>Ethical approval</title>
                <p>This project was approved by the Human Research Ethics Committee of Thammasat University (Science), Thailand (COA No. 119/2563). The research adhered to ethical standards established by the Institutional Review Board (IRB) and the Helsinki Declaration (2000). Prior to obtaining informed consent, all participants were informed about the study&#x2019;s objectives, the safe protection of their data, and the associated risks and benefits. Participants were made aware of their right to withdraw from the study at any time.</p>
                <p>Written informed consent was obtained from all participants before data collection commenced. Participation in the study was entirely voluntary, and the anonymity of participants was maintained throughout the research process. Confidentiality strategies were implemented, and identifying codes were assigned to the initial data collected from observations, interviews, and documentary analyses; access to this data was restricted to the research team.</p>
                <p>The data were securely stored on the principal investigator&#x2019;s password-protected computer until the conclusion of the study. After 24 months, all files were permanently deleted using &#x201c;Secure Deletion Shredder,&#x201d; a protected deletion program for Windows.</p>
            </sec>
            <sec id="sec9">
                <title>Consent</title>
                <p>The research scope, risks, and benefits were explained to the participants; they were assured that anonymity and confidentiality would be maintained. They were informed that their participation in the research was voluntary (
                    <xref ref-type="bibr" rid="ref15">Imkome &amp; Moonchai, 2022</xref>). We confirm that we obtained written and verbal consent to use data from the participants included in this study. The interview duration was determined based on the participants&#x2019; preferences, patience, and experiences. All interviews were recorded on video via Microsoft Teams of Thammasat University as a host and confidentially. The system automatically deletes data after recording for a month. The record was kept for a year for data checking and reference. Then, the computer of the researcher deleted the data and format.</p>
            </sec>
            <sec id="sec10">
                <title>Data analysis</title>
                <p>Data were analyzed using IPA following the procedures outlined by 
                    <xref ref-type="bibr" rid="ref58">Smith and Nizza (2022)</xref>. This approach is grounded in idiographic and iterative principles, whereby each transcript is examined in detail to preserve the uniqueness of participants&#x2019; lived experiences before identifying patterns across cases.</p>
                <p>The analysis proceeded through several iterative stages: a) Reading and re-reading: Each transcript was read multiple times to achieve immersion in the data, b) Initial noting: Exploratory comments were developed, focusing on descriptive, linguistic and conceptual aspects, c) Development of emergent themes: Initial notes were transformed into concise themes that capturing essential meaning, d) Searching for connections across themes: Themes were clustered into superordinate themes within each case (idiographic analysis), e) Moving to the next case: Each case was examined independently to preserve its individual context, and f) Cross-case analysis: Patterns across cases were identified to develop shared themes while maintaining sensitivity to divergence.</p>
                <p>This process reflects IPA&#x2019;s double hermeneutic, whereby participants make sense of their experiences, and the researchers interpret these sense-making processes.</p>
                <p>To enhance interpretative depth, the Roy Adaptation Model (RAM) was integrated as a theoretical lens during the interpretative phase. RAM provided a structured framework for understanding adaptive responses across physiological, self-concept, role function, and interdependence modes (
                    <xref ref-type="bibr" rid="ref28">Roy, 2011</xref>).</p>
                <p>Methodological rigor was supported through reflexivity, analytic memoing, and peer debriefing. Member checking was conducted by inviting participants to review transcript summaries for accuracy. All analyses were conducted manually to maintain fidelity to the idiographic and interpretative nature of IPA ensured a balance between participants&#x2019; original accounts and the researchers&#x2019; interpretative engagement.</p>
            </sec>
            <sec id="sec11">
                <title>Trustworthiness of the study</title>
                <p>This study ensure methodology rigor using quality criteria with IPA as recommended by 
                    <xref ref-type="bibr" rid="ref58">Smith et al. (2022)</xref>, including:
                    <list list-type="order">
                        <list-item>
                            <label>1.</label>
                            <p>Sensitivity to context was achieved through engagement with relevant literature and careful attention to participants&#x2019; narrative. Rapport was established through empathetic interviewing conducted by the lead researcher, a trained in psychiatric nurse and therapeutic communication.</p>
                        </list-item>
                        <list-item>
                            <label>2.</label>
                            <p>Commitment and rigor were demonstrate through in-dept data collection and detailed idiographic analysis of each case before cross-case synthesis.</p>
                        </list-item>
                        <list-item>
                            <label>3.</label>
                            <p>Transparency and coherence were ensure through clear documentation of analysis procedures (
                                <xref ref-type="bibr" rid="ref38">Smith &amp; Osborn, 2015</xref>; 
                                <xref ref-type="bibr" rid="ref40">Alase, 2017</xref>), including coding processes, theme development, and interpretative decisions. Peer debriefing and regular analytic discussions supported consistency and reflexivity throughout the research and decision-making processes.</p>
                        </list-item>
                        <list-item>
                            <label>4.</label>
                            <p>Impact and importance were addressed by meaningful and contextually grounded interpretations of participants&#x2019; lived experiences, supported by a comprehensive audit trail, analytic memos, and reflexive journaling.</p>
                        </list-item>
                        <list-item>
                            <label>5.</label>
                            <p>The integration of the Roy Adaptation Model (RAM) further enhanced interpretative depth by situating participants&#x2019; experiences within broader adaptive processes. This combined approach ensured that findings remained grounded in participants&#x2019; accounts while offering theoretically informed insights into participants&#x2019; lived experiences (
                                <xref ref-type="bibr" rid="ref58">Smith &amp; Nizza, 2022</xref>).</p>
                        </list-item>
                    </list>
                </p>
            </sec>
        </sec>
        <sec id="sec12" sec-type="results">
            <title>Results</title>
            <p>This section describes the participants&#x2019; understanding through a structural account of the findings, followed by a theoretical interpretation of the results.</p>
            <sec id="sec13">
                <title>Level 1: Participants&#x2019; demographic data and their self-understanding
</title>
                <p>Out of the 15 participants, 11.33% were unemployed, and 62.5% reported insufficient monthly family income (
                    <xref ref-type="table" rid="T1">Table 1</xref>). During the interviews, all participants exhibited signs of physical survival; however, they demonstrated low levels of psychological integrity, manifesting as stress, fear, anxiety, communication difficulties, sleep disturbances, and impaired decision-making. Some participants were either unemployed or had recently lost their jobs. Nevertheless, they received social support from family, friends, and healthcare providers.</p>
                <table-wrap id="T1" orientation="portrait" position="float">
                    <label>
Table 1. </label>
                    <caption>
                        <title>Demographic COVID-19 cases of informants (N=15).</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="2" rowspan="1" valign="top">Demographic data</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">N (15)</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
%</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="2" rowspan="1" valign="top">Age</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1. &lt; 30 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">13.33</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2. 31&#x2013;40 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">8</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">53.34</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3. 41&#x2013;50 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">13.33</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4. 51&#x2013;60 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">6.67</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">5. &gt; 60 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">13.33</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="2" rowspan="1" valign="top">Gender</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1. Female</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">6</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">40</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2. Male</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">9</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">60</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="2" rowspan="1" valign="top">Marital status</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1. Single</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">5</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">33.34</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2. Couple (living with a partner and/or married)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">26.66</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3. Widow</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">13.33</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4. Divorced/Separated</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">26.67</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="2" rowspan="1" valign="top">Level of Education</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1. Primary school</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">6.67</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2. Secondary education</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">20</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3. Vocational Certificate/Higher Vocational Certificate/
                                    <break/>Diploma</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">7</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">46.67</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4. Bachelor's degree or higher</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">26.66</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="2" rowspan="1" valign="top">Career</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1. Government service/state enterprise employee</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">26.67</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2. Trading or running a personal business</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">11.33</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3. Company employees</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">20</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4. Hire</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">26.67</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">5. Unemployed</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">11.33</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="2" rowspan="1" valign="top">The family income per month (estimated)</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">1. Fair</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">25</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1">
&#x2009;</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">2. Not enough</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">10</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">62.5</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>The data analysis revealed four key themes (see 
                    <xref ref-type="fig" rid="f1">
Figure 1</xref>). Respondents&#x2019; self-understanding at Level 1 underscores their immediate psychological, emotional, and social responses to the challenges posed by COVID-19. The findings indicate that participants experienced significant distress, characterized by heightened levels of stress, fear, anxiety, sleep disturbances, and difficulties in decision-making. These emotional response reflect the participants&#x2019; attempts to make sense of their disrupted realities, aligning with IPA&#x2019;s emphasis on meaning-making. Economic instability and job loss further exacerbated these challenges, leading to increased uncertainty about their futures.</p>
                <fig fig-type="figure" id="f1" orientation="portrait" position="float">
                    <label>
Figure 1. </label>
                    <caption>
                        <title>Themes of the study.</title>
                    </caption>
                    <graphic id="gr1" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/203381/c1e402e5-b35f-4f3d-b1ac-d5e665b5dbdb_figure1.gif"/>
                </fig>
                <p>Despite these adversities, participants demonstrated adaptive coping mechanisms, largely supported by their social networks. Their narratives highlighted a dynamic process of self-awareness: some individuals recognized their personal resilience, while others contended with stigma and feelings of isolation. The data further emphasize the vital role of social support in alleviating emotional strain, contributing to a more stable psychological state for those who actively sought help.</p>
                <p>These findings offer valuable insights into how individuals perceived and processed their experiences, underscoring the necessity for psychosocial interventions aimed at fostering resilience and facilitating reintegration into society.</p>
            </sec>
            <sec id="sec14">
                <title>Level 2: Structural understanding</title>
                <p>The lived experiences of participants following COVID-19 infection revealed a rich tapestry of meaning centered on survival, adaptation, and redefinition of self within a disrupted social and economic landscape. The following superordinate themes emerged from idiographic analysis: Stress, Economic and Social Impact, Social Stigma, Social Support, and Finding Meaning in Misfortune. While each participant&#x2019;s narrative was unique, the following interpretative synthesis highlights both convergences and points of divergence across cases (
                    <xref ref-type="fig" rid="f1">
Figure 1</xref>).</p>
                <p>

                    <bold>

                        <italic toggle="yes">Stress: Disruption of Safety, Control, and Identity</italic>
</bold>
                </p>
                <p>Participants described stress not merely as reaction to physical illness but as a profound&#x2019; disrupted of their sense of safety, control, and personal identity. The experiences of infection was embedded within a broader context of uncertainty, isolation, and fear, which collective changed participants; assumptions about stability in everyday life. Rather than being a transient emotional response, stress appeared as an ongoing process of negotiating unpredictability and vulnerability.</p>
                <p>For many participants, isolation during infection intensified feelings of uncertainty and existential insecurity. One participant reflected:</p>
                <p>&#x201c;It is stressful to be alone in the room. It was not easy to go out and find food. The city was locked down; what would happen next? Will our family be okay? Will the people who live in the community hate us?&#x201d; (Cl. 1)</p>
                <p>This account illustrates how stress extended beyond immediate physical concerns to encompass worries about family, community judgment, and future consequences. From an interpretative perspective, the participant&#x2019;s narrative reflects a rupture in perceived continuity&#x2014;where familiar social structures and routines could no longer provide reassurance. The experience of being physically separated from others appeared to amplify a sense of psychological disconnection, contributing to heightened anxiety.</p>
                <p>Similarly, another participant described the progression of illness alongside increasing psychological distress:</p>
                <p>&#x201c;I felt like I would not survive. After being admitted to the hospital, I was completely unconscious for about 40 days.&#x201d; (Cl. 9)</p>
                <p>Here, stress is intertwined with a perceived confrontation with mortality. The participant&#x2019;s account suggests that the illness triggered a shift from everyday concern to existential threat, where the boundary between survival and death became uncertain. This reflects a deeper level of meaning-making in which stress is not only experienced physically but interpreted as a challenge to one&#x2019;s continued existence and identity as a &#x201c;healthy person&#x201d;.</p>
                <p>Across cases, participants&#x2019; narratives indicate that stress was shaped not only by the disease itself but by the broader social and situational context&#x2014;including lockdown measures, uncertainty about recovery, and fear of social reactions. In this sense, stress can be understood as a multidimensional experience, combining physiological discomfort, emotional instability, and social insecurity.</p>
                <p>From an interpretative standpoint, these experiences can be understood as disruptions in participants&#x2019; sense of self and agency. The inability to predict outcomes or maintain control over daily life required individuals to continuously reinterpret their circumstances. This aligns with IPA&#x2019;s emphasis on meaning-making, where participants actively attempt to reconstruct coherence in the face of disorienting events.</p>
                <p>Viewed through the lens of the Roy Adaptation Model (RAM), stress can be interpreted as a focal stimulus that activated adaptive processes across multiple modes, particularly self-concept and interdependence. Participants&#x2019; accounts suggest that stress functioned as a triggering condition requiring psychological and social adjustment. However, the extent to which individuals were able to adapt varied depending on the availability of support, personal coping resources, and the severity of disruption experienced.</p>
                <p>Overall, stress in this study is not simply an emotional response to illness but represents a complex, evolving process of negotiating uncertainty, redefining identity, and seeking stability within an altered reality.</p>
                <p>

                    <bold>

                        <italic toggle="yes">Economic and social impact: Disruption of Security, Role Stability, and Future Orientation</italic>
</bold>
                </p>
                <p>Participants experienced the economic and social impact of COVID-19 as a profound disruption to their sense of security and stability in everyday life. Beyound the physical illness, the pandemic altered participants&#x2019; ability to maintain employment, fulfill social roles, and sustain their livelihoods. These disruptions were not mearly practical challenges but were deeply intertwined with participants&#x2019; sense of identity, responsibility, and perceived future.</p>
                <p>Across accounts, financial instability emerged as a persistent source of psychological strain. Participants described how job loss, reduced income, and limited access to resources created a sense of ongoing vulnerability. One participant shared:</p>
                <p>&#x201c;When there was no job, there was no money. I kept saving money until I could not manage it. Shops were closed, so it was not easy to buy food. My salary was reduced when I returned to work because we were expected to help the company financially. Our expenditures remained the same, but our incomes were smaller.&#x201d; (Cl. 1)</p>
                <p>This narrative reflects more than economic hardship; it signals a breakdown in the expected balance between effort and reward that structures everyday life. From an interpretative perspective, the inability to maintain financial stability may have the threatened participants&#x2019; sense of competence and autonomy, particularly for those who identified strongly with their working roles of family responsibilities.</p>
                <p>Similarly, another participant stated:</p>
                <p>&#x201c;COVID-19 is affecting work. I closed shop; cannot open now; no money.&#x201d; (Cl. 13)</p>
                <p>Although brief, this account conveys a stark and immediate collapse of economic security. The simplicity of the statement reflects the abrupt and uncontrollable nature of the disruption, where participants were left with limited capacity to influence their circumstances. This suggests a shift from a position of agency to one of constraint, where external conditions dictated their ability to act.</p>
                <p>In addition to financial strain, participants described broader social consequences linked to economic instability. Reduced income and unemployment were associated with concerns about family well-being, social obligations, and community conditions. For example, one participant reflected on wider societal effects, suggesting that economic hardship could lead to increased social tension and insecurity:</p>
                <p>&#x201c;Maybe there are robbers and thieves because they do not have a choice.&#x201d; (Cl. 3)</p>
                <p>This account illustrates how participants extended their interpretation of personal hardship to a broader social context, highlighting a perceived erosion of social order. Such narratives suggest that economic disruption was experienced not only individually but collectively, influencing how participants understood their place within society.</p>
                <p>From an interpretative standpoint, the economic and social impact of COVID-19 can be understood as a disruption to participants&#x2019; role function within the Roy Adaptation Model. The inability to work or contribute financially challenged established identities as providers, workers, and community members. At the same time, these disruptions also affected the self-concept mode, as participants grappled with feelings of inadequacy, uncertainty, and diminished control over their futures.</p>
                <p>Overall, participants&#x2019; accounts suggest that economic and social consequences of COVID-19 were not isolated stressors but formed part of a broader process of destabilization. This process required individuals to reinterpret their roles, renegotiate their sense of responsibility, and confront uncertainty about the future. In this sense, economic disruption became a key site of meaning-making, where participants attempted to understand not only what had changed in their lives, but what those changes implied for who they were and who they might become.</p>
                <p>

                    <bold>

                        <italic toggle="yes">Social stigma: Disrupted social identity and experiences of moral exclusion</italic>
</bold>
                </p>
                <p>Participants described social stigma as a deeply distressing aspect of their experience, extending beyond fear of illness to feelings of rejection, moral judgment, and social exclusion. Being identified as &#x201c;infected&#x201d; appeared to alter how others perceived and interacted with them, resulting in a disruption of their social identity and sense of belonging. Rather than being treated as individuals recovering from illness, participants often felt reduced to a symbolic representation of risk and contamination.</p>
                <p>For many, stigma manifested through distancing behaviors and exclusion from everyday social spaces. One participant recalled:</p>
                <p>&#x201c;My mother gave them a gift and they returned it as if afraid it was infected with COVID-19.&#x201d; (Cl. 8)</p>
                <p>This account illustrates how ordinary acts of social connection became reinterpreted through the lens of fear and contamination. The rejection of a gift, typically a symbol of care and reciprocity, suggests a breakdown in shared social meaning. From an interpretative perspective, this reflects not only fear of infection but a deeper symbolic distancing, where the participant&#x2014;and by extension their social identity&#x2014;became associated with danger.</p>
                <p>Similarly, participants described more explicit forms of exclusion and social rejection:</p>
                <p>The room was locked when he returned to his condo; the owner had kicked him out.&#x201d; (Cl. 11)</p>
                <p>This experience represents a more extreme disruption of social belonging, where individuals were not only avoided but actively excluded from their living environment. Such accounts suggest that stigma operated at both interpersonal and structural levels, affecting participants&#x2019; access to fundamental aspects of daily life such as housing and community membership.</p>
                <p>Participants also interpreted these experiences as forms of social judgment, where infection was perceived as a moral or personal failing. One participant reflected:</p>
                <p>&#x201c;You will be stigmatized by society as an infected person. Let us go together and not live in a normal society.&#x201d; (Cl. 13).</p>
                <p>This narrative highlights how stigma was internalized as a threat to one&#x2019;s status within society. The idea of being unable to &#x201c;live in a normal society&#x201d; suggests a perceived transition from inclusion to marginalization, where participants questioned their place within the social order. From an IPA perspective, this reflects an ongoing process of meaning-making in which individuals attempt to understand how they are positioned&#x2014;and repositioned&#x2014;within their social world.</p>
                <p>Across accounts, stigma was not experienced as a single event but as a cumulative and evolving process. Participants described anticipating negative reactions from others, which influenced their behavior, interactions, and willingness to disclose their illness. This anticipatory dimension of stigma suggests that social exclusion was not only externally imposed but also internally negotiated, shaping how participants navigated relationships and sought to protect themselves from further rejection.</p>
                <p>Viewed through the lens of the Roy Adaptation Model (RAM), stigma can be interpreted as a residual stimulus, encompassing broader social and cultural attitudes that influenced participants&#x2019; adaptive responses. These experiences affected both the self-concept mode, through feelings of shame, fear, or diminished self-worth, and the interdependence mode, by disrupting relational connections and social support systems.</p>
                <p>Overall, participants&#x2019; accounts suggest that social stigma profoundly affected their sense of identity and belonging. The experience of being labeled, avoided, or excluded required individuals to renegotiate their social position and reconstruct meaning in the face of altered interpersonal relationships. In this context, stigma was not merely a social reaction to illness but became a central component of the lived experience of COVID-19 recovery, shaping how participants understood themselves and their place within society.</p>
                <p>

                    <bold>

                        <italic toggle="yes">Social support: Reconstructing connection and restoring emotional stability</italic>
</bold>
                </p>
                <p>Participants described social support as a central resource in navigating the uncertainty and emotional strain associated with COVID-19. Beyond practical assistance, support from family, friends, and healthcare providers played a crucial role in restoring a sense of connection, security, and psychological balance. These interactions were not merely functional but carried significant emotional and symbolic meaning, helping participants reinterpret their experiences and regain a sense of belonging.</p>
                <p>For many participants, maintaining communication with family members provided a sense of continuity amidst disruption. One participant reflected:</p>
                <p>&#x201c;I call home every day, and I jog to my room to watch television.&#x201d; (Cl. 2)</p>
                <p>This account suggests that everyday interactions&#x2014;such as phone calls or shared activities&#x2014;served as stabilizing anchors in a context otherwise marked by isolation and uncertainty. From an interpretative perspective, these practices may represent an effort to preserve relational identity, where participants reaffirmed their roles as family members despite physical separation. The act of reconnecting with familiar relational patterns appeared to mitigate feelings of isolation and reinforce emotional resilience.</p>
                <p>Support from friends also played an important role in shaping participants&#x2019; emotional responses. One participant recalled:</p>
                <p>&#x201c;He said hey, it is okay. You can take care of yourself. It is not a problem. He wanted to encourage us and not make us more stressed.&#x201d; (Cl. 5)</p>
                <p>This interaction reflects a shift from anticipated judgment to acceptance, suggesting that supportive communication helped to counteract fear and self-blame. The reassurance offered by others enabled participants to reinterpret their situation not as a personal failure, but as a shared human experience. In this sense, social support functioned as a protective mechanism, reducing emotional burden and facilitating a more compassionate self-understanding.</p>
                <p>Healthcare providers were also frequently described as significant sources of support, not only through clinical care but through their interpersonal approach. Participants emphasized the importance of respectful communication, attentiveness, and continuity of care. These experiences appeared to foster trust and confidence during a period of vulnerability. For example, one participant noted:</p>
                <p>&#x201c;The doctors and nurses took good care of the patients, spoke well, cared for them, and encouraged them. They gave us medicines, checked the temperature and pressure, and always called to tell us. They provided detailed treatment care. The medical team is perfect.&#x201d; (Cl. 4)</p>
                <p>Such accounts suggest that professional care extended beyond medical treatment to include emotional reassurance and validation. From an interpretative standpoint, healthcare interactions contributed to restoring a sense of safety and predictability, which had been disrupted by illness and uncertainty.</p>
                <p>Across narratives, social support can be understood as a dynamic process that enabled participants to move from states of fear and isolation toward connection and reassurance. Importantly, support was not only received but actively sought, indicating participants&#x2019; agency in managing their emotional and social needs. This highlights the relational nature of coping, where adaptation occurs through interaction rather than in isolation.</p>
                <p>Viewed through the lens of the Roy Adaptation Model (RAM), social support can be interpreted within the interdependence mode, where relationships function as key adaptive resources. These connections provided both emotional and informational support, facilitating participants&#x2019; ability to cope with stress and restore psychological equilibrium. At the same time, support also reinforced the self-concept mode, as participants experienced themselves as valued, cared for, and socially connected.</p>
                <p>Overall, participants&#x2019; accounts suggest that social support was not simply an external resource but a meaningful relational process that helped reconstruct a sense of belonging and emotional stability. In the context of COVID-19, where isolation and uncertainty were pervasive, supportive relationships played a vital role in enabling participants to make sense of their experiences and regain a sense of continuity in their lives.</p>
                <p>

                    <bold>

                        <italic toggle="yes">Finding meaning in misfortune</italic>: 
                        <italic toggle="yes">Reconstructing self through growth and reinterpretation</italic>
</bold>
                </p>
                <p>Participants&#x2019; narratives revealed a shift from initial perceptions of misfortune toward a more complex process of meaning-making, in which the experience of COVID-19 was gradually reinterpreted as a source of personal insight, growth, and renewed purpose. This transformation did not occur immediately but appeared to emerge over time, as participants reflected on their experiences and began to integrate them into a broader narrative of their lives.</p>
                <p>Initially, many participants framed infection as an unjust and disruptive event, often accompanied by feelings of helplessness and questioning. However, as their experiences unfolded, some began to reinterpret these difficulties in more constructive ways. One participant described this shift:</p>
                <p>&#x201c;It was good luck in bad luck. We felt lucky because we could not find an experience like this. Advertising for life insurance companies and interviews with other agencies, including this interview and conducted research, is something that other people cannot do because they have not been infected. I am fortunate in the misfortunes that I have to face in this life.&#x201d; (Cl. 1)</p>
                <p>This account reflects a reframing of adversity, where misfortune is no longer understood solely as loss, but as an experience imbued with value and opportunity. From an interpretative perspective, this suggests an active reconstruction of meaning, in which participants seek coherence by embedding suffering within a narrative of personal growth. The paradoxical expression &#x201c;good luck in bad luck&#x201d; illustrates this tension, indicating that participants simultaneously acknowledged hardship while attributing positive significance to it.</p>
                <p>Similarly, another participant described a movement from initial despair toward a sense of contribution and purpose:</p>
                <p>&#x201c;At first, I felt unlucky. There was a feeling of&#x2019;why so unlucky.&#x2019; But I was lucky enough to enter the treatment process until finally recovering and going out to live a normal life. I think that COVID-19 also brings good things, such as getting to know the medical system in Thailand. There is a line between the patient group and doctors in the medical personnel and equipment system. I will ask a lot because I want to know and check it out on Facebook. We will ask and check with the doctor. After getting the information, try to share it on Facebook with some friends. This infection was helpful. It is not just a punishment. It allows us to spread good things and benefit others.&#x201d; (Cl. 5)</p>
                <p>This narrative highlights a transition from self-focused distress to outward-oriented meaning. Recovery was not only experienced as physical healing, but as an opportunity to engage with others, share knowledge, and contribute to society. From an IPA perspective, this reflects a shift in identity&#x2014;from passive recipient of illness to active agent of change&#x2014;suggesting that meaning-making involved redefining one&#x2019;s role and value within a broader social context.</p>
                <p>Across participants, this process of finding meaning often involved integrating both positive and negative elements of the experience. Rather than denying suffering, participants appeared to reinterpret it in ways that allowed them to re-establish a sense of control and coherence. This aligns with the concept of cognitive and existential reframing, where individuals reconstruct their understanding of events in order to sustain psychological stability.</p>
                <p>Importantly, meaning-making was also relational and contextual. Participants&#x2019; opportunities to reflect, share their experiences, and receive validation from others appeared to facilitate this transformation. In this sense, finding meaning was not solely an internal process but was shaped through interaction with social and healthcare systems that supported reinterpretation and recovery.</p>
                <p>Viewed through the lens of the Roy Adaptation Model (RAM), this theme can be understood within the self-concept mode, where individuals renegotiate their identity and personal values in response to adversity. The reinterpretation of illness as an opportunity for growth suggests adaptive cognitive processing, where individuals integrate challenging experiences into a more resilient and coherent sense of self. At the same time, elements of the interdependence mode are evident, as participants&#x2019; desire to support others and contribute to society reflects a restoration of relational connectedness.</p>
                <p>Overall, participants&#x2019; accounts suggest that finding meaning in misfortune represents a crucial adaptive process in the aftermath of COVID-19. Through reinterpretation, reflection, and engagement with others, individuals were able to transform experiences of disruption into sources of insight and purpose. This process highlights the capacity for psychological growth within adversity, illustrating how individuals actively reconstruct meaning to navigate and integrate challenging life events.</p>
            </sec>
            <sec id="sec15">
                <title>Level 3: Theoretical interpretation</title>
                <p>Adaptation is a concept that has been used to realize participants&#x2019; experiences, and further illumination can be gained through the Roy adaptation model (
                    <xref ref-type="bibr" rid="ref26">Roy, 2001</xref>, 
                    <xref ref-type="bibr" rid="ref27">2009</xref>)
                    <italic toggle="yes">.</italic> Based on this model, the participants&#x2019; stress, economic and social impact, social stigma, social support, and a sense that finding meaning in misfortune can be interpreted.</p>
                <p>This model is based on the four dimensions as the person submitted to a scheme, including the stimulus, which generates the coping mechanisms and results that make up the individual, family, and community response. This scheme focuses on three stimulus types: 1) focal stimuli, which require stimulation, including fatigue, dyspnea, high fever, and cough, i.e., the signs and symptoms of COVID-19; 2) contextual stimuli, which can be defined as comorbidities; and 3) residual stimuli, which are described as internal and external factors, such as stress from unemployment, viral infodemic, financial problems, social stigma, and lack of appropriate Personal Protective Equipment (PPE).</p>
                <p>Adaptative behavior is assessed in four modes: physiological, self-concept, role function, and interdependence. Additionally, the subdivided models are regulators, including the physiological mode, which we describe as the situation and function of people infected by COVID-19. This is pertinent since the body&#x2019;s homeostasis is directly related to the lower probability of worsening symptoms. Secondly, the cognate coping mechanisms are self-concept, role function, and interdependence. The self-concept mode defines coping and highlights psychological and spiritual aspects. Indeed, considering the context of stress generated by this pandemic, asking for emotional support in chaotic times eases anguish and favors psychological well-being. The coping mechanism that complements the role function mode refers to the individual&#x2019;s ability to understand their role in the world and the self-knowledge of their role in society. During the pandemic, this acknowledgment is necessary because the population does not participate in essential services; instead, it supports control measures when it fulfills social isolation measures such as visiting the hospital after an appointment.</p>
                <p>In contrast, in the scope of essential services, health professionals, for example, legitimize their functional importance when they perform their duty with technical skills and humanity. The coping mechanism of the interdependence mode includes the affective demands of everyone. In fact, with a social distancing policy, it is common to observe anguish in the community, which has a particular need related to complete well-being. However, information and communication technologies can be alternatives to increasing physical distancing and its repercussions on the population&#x2019;s biopsychosocial health. For the interdependence mode, social support from family and multidisciplinary treatment teams can decrease the experience of fear around the transmission and conditions related to COVID-19. Social stigma increases the participants&#x2019; stress, which increases the severity of COVID-19 (
                    <xref ref-type="bibr" rid="ref30">Sing Joo 

                        <italic toggle="yes">et al.,
</italic> 2021</xref>).</p>
                <p>In conclusion, the theoretical interpretation of COVID-19 case perceptions showed that participants experienced stress, economic and social impact, stigma, and social support during the global COVID-19 pandemic. The participants&#x2019; adaptive process promoted their mental integrity and positively affected their health. Nonetheless, they discussed their existential perceptions during the interviews, raising questions about work and the future during crises. Knowledge gathered from this point of view will help plan to fight such crises in the future.</p>
            </sec>
        </sec>
        <sec id="sec16" sec-type="discussion">
            <title>Discussion</title>
            <p>This study explored the lived experiences of individuals recovering from COVID-19 using IPA, with a focus on how participants made sense of stress, disruption, stigma, support, and recovery. The finding reveal that recovery from COVID-19 is not solely a biomedical process but a complex psychological and social journey, shaped by ongoing meaning-making and adaptive response.</p>
            <sec id="sec17">
                <title>Dirsupted stability and existential stress</title>
                <p>Participants&#x2019;experiences of stress extended beyond immediate physical symptoms and reflected a broader disruption of safety, predictability, and control. Isolation, uncertainty, and fear contributed to a sense of existential vulnerability, requiring participants to continuously reinterpret their circumstances.</p>
                <p>These findings are consistent with recent qualitative evidence showing that pandemic-related stress is deeply tied to disruptions in daily routines, uncertainty, and psychological instability (
                    <xref ref-type="bibr" rid="ref72">Dewa et al., 2024</xref>; 
                    <xref ref-type="bibr" rid="ref77">Sanatkhah et al., 2025</xref>). Importantly, the present study extends this literature by demonstrating how stress is not only experienced but interpreted, as participants attempt to restore coherence in their disrupted life narratives. From an IPA perspective, this reflects an active process of meaning-making in response to uncertainty.</p>
                <p>

                    <bold>Economic disruption and threats to role identity</bold>
                </p>
                <p>The economic and social consequences of COVID-19 were experienced as deeply destabilizing, particularly in relation to participants&#x2019; role as workers and providers. Job loss and financial insecurity were interpreted as threats to personal identity, autonomy, and future stability.</p>
                <p>This aligns with recent findings linking financial strain to psychological distress and reduced well-being in Covid-19 contexts (
                    <xref ref-type="bibr" rid="ref11">Hertz-Palmor 
                        <italic toggle="yes">et al.,</italic> 2021</xref>; 
                    <xref ref-type="bibr" rid="ref20">Nicola 
                        <italic toggle="yes">et al.</italic>, 2020a</xref>). However, more recent work further highlights how such disruptions reshape individuals&#x2019; perceptions of identity and agency during recovery processes (
                    <xref ref-type="bibr" rid="ref75">MacLean et al., 2025</xref>). In the present study, participants&#x2019; accounts suggest that economic hardship is not merely situational but deeply embedded in identity reconstruction and future orientation.</p>
                <p>

                    <bold>Social stigma and disrupted belonging</bold>
                </p>
                <p>Social stigma emerged as a particularly powerful component of participants&#x2019; experiences, affecting both interpersonal relationships and self-perception. Participants described being avoided, judged, or excluded, leading to a rupture in their sense of belonging and social identity. These experiences were often interpreted as moral judgment, where infection became associated with blame or social failure.</p>
                <p>These findings are consistent with recent qualitative studies demonstrating that COVID-19-related stigma continues to impact individuals&#x2019; social relationships and access to care (
                    <xref ref-type="bibr" rid="ref74">Fahim et al., 2025</xref>; 
                    <xref ref-type="bibr" rid="ref76">Nyaaba et al., 2025</xref>). Furthermore, stigma has been shown to influence long-term health outcomes by reinforcing social isolation and psychological distress (
                    <xref ref-type="bibr" rid="ref72">Damant et al., 2025</xref>). From an IPA perspective, stigma is not only externally imposed but internally processed, shaping how participants reinterpret their identities and social positions.</p>
                <p>

                    <bold>Relational support as a process of restoring stability</bold>
                </p>
                <p>In contrast, social support was experienced as a key resource for restoring emotional balance and a sense of connection. Support from family, friends, and healthcare providers enabled participants to reinterpret their experiences in less threatening ways and regain a sense of security and belonging. Importantly, support was not only received but actively sought, reflecting participants&#x2019; agency in managing their recovery.</p>
                <p>These findings are consistent with previous studies highlighting the protective role of social support during the pandemic (
                    <xref ref-type="bibr" rid="ref21">Nicola et al., 2020b</xref>; 
                    <xref ref-type="bibr" rid="ref25">Rathnayake et al., 2021</xref>). Recent research continues to emphasize the protective role of relational support in mitigating stress and promoting psychological resilience during and after COVID-19 (
                    <xref ref-type="bibr" rid="ref72">Dewa et al., 2024</xref>). Importantly, this study contributes by showing that support is not simply received but actively co-constructed through interaction, reinforcing participants&#x2019; sense of identity and relational belonging.</p>
                <p>

                    <bold>Meaning-making and psychological growth</bold>
                </p>
                <p>A key findings of this study is participants&#x2019; ability to reinterpret their experience of COVID-19 as meaningful rather than purely negative. Many participants described a shift from initial distress toward a sense of growth, gratitude, or renewed purpose, reflecting processes of post-traumatic growth observed in COVID-19 contexts (
                    <xref ref-type="bibr" rid="ref70">Azoulay et al., 2025</xref>). This process of &#x201c;finding meaning in misfortune&#x201d; represents an active reinterpretation of adversity, whereby individuals integrate difficult experiences into a broader narrative of personal development.</p>
                <p>These findings resonate with earlier literature on post-traumatic and post-stress growth during the COVID-19 pandemic (
                    <xref ref-type="bibr" rid="ref24">Qi &amp; Sheng, 2022</xref>; 
                    <xref ref-type="bibr" rid="ref9">Guti&#x00e9;rrez-Cobo et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref13">Hu et al., 2021</xref>). More recent qualitative research further suggests that recovery is not a linear return to a pre-illness state, but rather involves redefining identity and adjusting to a &#x201c;new normal&#x201d; (
                    <xref ref-type="bibr" rid="ref75">MacLean et al., 2025</xref>). This perspective is consistent with emerging evidence highlighting meaning-making as a central component of psychosocial adaptation following COVID-19 (
                    <xref ref-type="bibr" rid="ref73">Eberhardt et al., 2024</xref>).</p>
                <p>From an IPA perspective, meaning-making represents a dynamic process of identity reconstruction, in which individuals actively reinterpret adversity to restore coherence, continuity, and psychological equilibrium. Rather than remaining passive recipients of distress, participants in this study demonstrated agency in reshaping their experiences into sources of insight and personal growth. This interpretative process underscores the transformative potential of adversity and highlights the role of narrative integration in supporting long-term psychological adaptation.</p>
                <p>

                    <bold>Interpretation through the Roy Adaptation Model</bold>
                </p>
                <p>The findings can be further understood through the Roy Adaptation Model (RAM), which highlights how individuals respond to environmental stimuli through adaptive processes. Stress and stigma function as focal and contextual stimuli, while social support serves as a key adaptive resource within the interdependence mode.</p>
                <p>Recent studies also support the role of adaptive processes in shaping recovery trajectories and psychological outcomes in COVID-19 contexts (
                    <xref ref-type="bibr" rid="ref72">Damant et al., 2025</xref>). In this study, meaning-making represents adaptation within the self-concept mode, where individuals actively reconstruct identity and personal meaning in response to disruption.</p>
            </sec>
            <sec id="sec18">
                <title>Limitations</title>
                <p>The interview was conducted during community quarantine and after the participant was discharged from the hospital. The participants may have had stress and anxiety about their health status, long COVID, work, and economic problems; this may have prevented the authors from fully understanding the studied phenomena. In addition, the research consisted of a homogenous population of only 15 participants. Thus, a similar study that included these participants might have revealed different perceptions of experiences. The small sample size also increased the risk of bias.</p>
            </sec>
        </sec>
        <sec id="sec19" sec-type="conclusions">
            <title>Conclusions</title>
            <p>The findings highlight nuanced, context-lived experiences of participants, suggesting the need for tailored psychosocial support strategies. While the study provide insight into adaptive process, broader policy implications should be interpreted cautiously, given the idiographic nature and limited sample of the study.</p>
            <sec id="sec20">
                <title>Implications for nursing and health</title>
                <p>

                    <bold>

                        <italic toggle="yes">Policy implications</italic>
</bold>
                </p>
                <p>The findings highlight the need for a holistic approach to COVID-19 recovery that addresses psychosocial, relational, and economic dimensions. Interventions should support identity reconstruction, stigma reduction, and relational continuity, rather than focusing solely on symptom management.</p>
                <p>At the policy level, efforts to reduce stigma and improve access to mental health services remain critical, particularly in digital and community settings (
                    <xref ref-type="bibr" rid="ref74">Fahim et al., 2025</xref>). Future research should further explore long-term meaning-making and adaptation processes across diverse sociocultural contexts.</p>
            </sec>
        </sec>
        <sec id="sec21">
            <title>Ethical approval</title>
            <p>Ethical approval was obtained from the Ethics Review Committee for Research Involving Human Research Participants (COA No. 119/2563) on 20 October 2020.</p>
        </sec>
        <sec id="sec22">
            <title>Consent</title>
            <p>The authors obtained written and verbal informed consent from all participants to use their data in this study.</p>
        </sec>
        <sec id="sec23">
            <title>ORCID IDs</title>
            <p>Ek-Uma Imkome 
                <ext-link ext-link-type="uri" xlink:href="https://orcid.org/0000-0001-5714-4249">https://orcid.org/0000-0001-5714-4249</ext-link>
            </p>
        </sec>
    </body>
    <back>
        <sec id="sec24" sec-type="data-availability">
            <title>Data availability</title>
            <sec id="sec25">
                <title>Underlying data</title>
                <p>Figshare: Until the Dawn: The Impact of COVID-19, 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.21369810">https://doi.org/10.6084/m9.figshare.21369810</ext-link> (
                    <xref ref-type="bibr" rid="ref15">Imkome &amp; Moonchai, 2022</xref>).</p>
                <p>The project contains the following underlying data:
                    <list list-type="bullet">
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Demographic questions</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Field notes</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Participant information</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Semi-structured interview questions</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Raw data</p>
                        </list-item>
                    </list>
                </p>
                <p>Data are available under the terms of the 
                    <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution 4.0 International license</ext-link> (CC-BY 4.0).</p>
            </sec>
        </sec>
        <ack>
            <title>Acknowledgments</title>
            <p>This research was supported by Thammasat University Research Unit in the innovation of Mental Health and Behavioral Healthcare and funded by the Faculty of Nursing, Thammasat University.</p>
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    <sub-article article-type="reviewer-report" id="report411576">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.183939.r411576</article-id>
            <title-group>
                <article-title>Reviewer response for version 5</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Sidiq</surname>
                        <given-names>Mohammad</given-names>
                    </name>
                    <xref ref-type="aff" rid="r411576a3">3</xref>
                    <xref ref-type="aff" rid="r411576a4">4</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0003-2448-8971</uri>
                </contrib>
                <contrib contrib-type="author">
                    <name>
                        <surname>Sharma</surname>
                        <given-names>Jyoti</given-names>
                    </name>
                    <xref ref-type="aff" rid="r411576a1">1</xref>
                    <xref ref-type="aff" rid="r411576a2">2</xref>
                    <role>Co-referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-6510-3903</uri>
                </contrib>
                <aff id="r411576a1">
                    <label>1</label>Physiotherapy, School of Allied Health Sciences, Galgotias University (Ringgold ID: 357911), Greater Noida, Uttar Pradesh, India</aff>
                <aff id="r411576a2">
                    <label>2</label>Physiotherapy, SAHS, Galgotias University, Greater Noida, India</aff>
                <aff id="r411576a3">
                    <label>3</label>Physiotherapy, School of Applied Medical Sciences, Tishk International University, Erbil, Kurdistan Region, Iraq</aff>
                <aff id="r411576a4">
                    <label>4</label>Galgotias University, Greater Noida, Uttar Pradesh, India</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>17</day>
                <month>9</month>
                <year>2025</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2025 Sharma J and Sidiq M</copyright-statement>
                <copyright-year>2025</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport411576" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.5"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve-with-reservations</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>Major Points of Evaluation</p>
            <p> 1. Is the work presented clearly and accurately, and does it cite the current literature?</p>
            <p> Partly.</p>
            <p> - The form of the manuscript is generally good writing and organization, although the methodological descriptions differ across different versions (references to 'phenomenological-hermeneutic approach,' 'content analysis,' 'thematic analysis,' and IPA). This lack of consistency is confusing regarding the analytic framework.</p>
            <p> - The introduction and discussion, relevant literature, including Thai studies, and international qualitative research are mentioned, but the motivation for the knowledge gap is not very strongly justified. There are already a number of qualitative studies on the Thai and regional context of provisions of healthcare for people who have contracted the novel coronavirus (COVID-19).</p>
            <p> Recommendation: The authors should take care of methodological consistency by being clear in their message that IPA is the only analytical framework. They should also refine the logic for novelty in that their research must stand in the context of existing Thai and Southeast Asian faults.</p>
            <p> 2. Is the study design appropriate? Is the work technically sound?</p>
            <p> Partly.</p>
            <p> - The use of IPA can be suitable to have lived experiences explored. However, technical soundness is undermined by the use of mixed methodological terminology and the use of post-positivist requirements for trustworthiness (credibility, dependability, and transferability) rather than IPA's interpretivist indicators of quality.</p>
            <p> - The results section is predominantly descriptive in nature, without much interpretative analysis or depth, and has long quotes. The relationship between the data, themes, and the Roy adaptation model could be more clearly made.</p>
            <p> Recommendation: The authors need to enhance analytic interpretation, going beyond descriptive reporting. They should undergo a consistent IPA-specific application of rigor criteria (sensitivity to context, commitment, transparency, and impact) and demonstrate how the Roy Adaptation Model adds further insight and not merely be appended.</p>
            <p> 3. Are enough details of methods and analysis given that others will be able to replicate?</p>
            <p> Partly.</p>
            <p> - Strengths: Ethical approval, informed consent, and sampling and interview procedures are presented. Audit trails, member checks, and peer debriefing are mentioned.</p>
            <p> - Weaknesses: Data is saturated, but the explanation for this saturation is mentioned but not fully explained in the context of IPA. The analytic steps (e.g., idiographic case analysis, theme development, and cross-case synthesis) are not consistently described, leaving an ambiguity for replication.</p>
            <p> Recommendation: The authors should include step-by-step details of the IPA process (i.e., the process of coding and theme development) with examples and further details of how saturation was established.</p>
            <p> 4. If applicable, is the statistical analysis, including its interpretation, appropriate?</p>
            <p> Not applicable.</p>
            <p> - This is a qualitative study; there is no need for statistical analysis.</p>
            <p> 5. Are all the source data underlying the results available such that full reproducibility is possible?</p>
            <p> Yes.</p>
            <p> - The authors have deposited demographic questions, field notes, interview questions, and raw data on Figshare under a CC-BY license, which is a transparent and reproducible license.</p>
            <p> 6. Are the conclusions well supported by results?</p>
            <p> Partly.</p>
            <p> - are conclusions based on their experience as a participant and generally supported by the themes identified.</p>
            <p> - However, the leap from descriptive accounts of participants to more holistic policy and intervention recommendations (i.e. income support, psychosocial training, integrated recovery frameworks) is not warranted given the depth of analysis.</p>
            <p> Recommendation: Authors should exercise caution with the inferences they draw and make sure the implications for policy are based on their findings and not extrapolated beyond them.</p>
            <p> Overall Recommendation</p>
            <p> This study deals with one of the interesting issues and has used the appropriate qualitative methodology. However, it needs further clarification and strengthening of its analytic rigor and commentitude interpretations so that it becomes scientifically sound.</p>
            <p> Major Changes Needed (that should be covered):</p>
            <p> - Effectively establish method performance, ensuring explicit reference to IPA as the method of analysis and eliminate contradictory language (eg, content/thematic analysis).</p>
            <p> - Include in detail the steps of IPA procedures (coding, idiographic analysis, cross-case synthesis) in order to increase transparency and replicability</p>
            <p> - Strengthen interpretation within the results, moving beyond descriptive quotes to an interpretive involvement with the meaning-making of the participants, i.e., analytical engagement with the results.</p>
            <p> For the effort of it, this appears as an afterthought rather than being explicitly showing how the Roy adaptation model informed interpretation</p>
            <p> - Reframe conclusions to avoid overgeneralization and insure that policy recommendations are directly based on the outcomes of the study</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>No</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Yes</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Partly</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Musculoskeletal Physiotherapy, Public Health, SDGs, cross-sectional studies, RCTs.</p>
            <p>We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment14689-411576">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>None.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>30</day>
                    <month>9</month>
                    <year>2025</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Dear Reviewer,</p>
                <p> </p>
                <p> We sincerely thank you for your thoughtful and constructive feedback on our manuscript. We have carefully considered each of your comments and made substantial revisions to improve the clarity, methodological consistency, and analytical rigor of the study. Below is a point-by-point response to your comments, along with a summary of the revisions made.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer Comment 1: Methodological Consistency</bold>
                </p>
                <p> 
                    <italic>The methodological descriptions differ across versions (references to 'phenomenological-hermeneutic approach,' 'content analysis,' 'thematic analysis,' and IPA). This lack of consistency is confusing.</italic>
                </p>
                <p> 
                    <bold>Response</bold>: We have revised the manuscript to consistently reflect 
                    <bold>Interpretative Phenomenological Analysis (IPA)</bold> as the sole analytic framework. All references to other approaches have been removed or clarified as philosophical foundations of IPA.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer Comment 2: Justification of Knowledge Gap</bold>
                </p>
                <p> 
                    <italic>The motivation for the knowledge gap is not strongly justified.</italic>
                </p>
                <p> 
                    <bold>Response</bold>: We have strengthened the introduction to emphasize the lack of IPA-based studies on COVID-19 survivors in Thailand and the novel integration of the Roy Adaptation Model (RAM) as an interpretive lens.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer Comment 3: Rigor Criteria</bold>
                </p>
                <p> 
                    <italic>The use of post-positivist requirements for trustworthiness is inconsistent with IPA&#x2019;s interpretivist indicators.</italic>
                </p>
                <p> 
                    <bold>Response</bold>: We have replaced post-positivist terms with IPA-specific indicators of quality: 
                    <bold>sensitivity to context, commitment and rigor, transparency and coherence, and impact and importance</bold>, as recommended by Smith et al. (2022).</p>
                <p> </p>
                <p> 
                    <bold>Reviewer Comment 4: Interpretative Depth in Results</bold>
                </p>
                <p> 
                    <italic>The results section is predominantly descriptive, with long quotes and limited interpretative analysis.</italic>
                </p>
                <p> 
                    <bold>Response</bold>: We have added analytical commentary to participant quotes and explicitly linked emergent themes to meaning-making processes and RAM domains.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer Comment 5: IPA Analytic Steps</bold>
                </p>
                <p> 
                    <italic>The analytic steps are not consistently described, leaving ambiguity for replication.</italic>
                </p>
                <p> 
                    <bold>Response</bold>: We have added a detailed description of the IPA process, including initial reading, annotation, theme development, idiographic case analysis, and cross-case synthesis.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer Comment 6: Overgeneralized Conclusions</bold>
                </p>
                <p> 
                    <italic>Policy recommendations are not sufficiently grounded in findings.</italic>
                </p>
                <p> 
                    <bold>Response</bold>: We have revised the conclusion to ensure that policy implications are directly based on participants&#x2019; narratives and adaptive challenges, avoiding broad extrapolations.</p>
                <p> </p>
                <p> 
                    <bold>Additional Improvements</bold> 
                    <list list-type="bullet">
                        <list-item>
                            <p>We removed redundant and repetitive sentences to improve clarity and flow.</p>
                        </list-item>
                        <list-item>
                            <p>We ensured that all references to RAM are explicitly tied to the interpretative process rather than appended.</p>
                        </list-item>
                    </list> We hope these revisions adequately address your concerns and improve the scientific quality of our manuscript. Thank you again for your valuable feedback and support.</p>
            </body>
        </sub-article>
        <sub-article article-type="response" id="comment16367-411576">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>6</day>
                    <month>6</month>
                    <year>2026</year>
                </pub-date>
            </front-stub>
            <body>
                <p>We sincerely thank the reviewer for the thoughtful and constructive evaluation of our manuscript. We have carefully considered all comments and undertaken substantial revisions to improve methodological consistency, analytic rigor, and interpretative depth. Our detailed responses are provided below.</p>
                <p> </p>
                <p> 1.The manuscript shows inconsistency in methodological descriptions (phenomenological-hermeneutic, content analysis, thematic analysis, IPA). The rationale for the knowledge gap is not sufficiently justified.</p>
                <p> 
                    <bold>Response:</bold>
                </p>
                <p> We appreciate this important observation and have made substantial revisions to ensure methodological clarity and conceptual coherence. 
                    <list list-type="bullet">
                        <list-item>
                            <p>The manuscript now clearly identifies Interpretative Phenomenological Analysis (IPA) as the sole analytic framework, and all references to content analysis and thematic analysis have been removed throughout the manuscript.</p>
                        </list-item>
                        <list-item>
                            <p>The term &#x201c;phenomenological-hermeneutic&#x201d; is now used only to describe the philosophical underpinning of IPA, rather than as a separate method.</p>
                        </list-item>
                        <list-item>
                            <p>We have revised the Introduction to strengthen the justification for the study by clarifying the knowledge gap. Specifically, while prior research in Thailand and Southeast Asia has focused on healthcare systems and specific populations (e.g., healthcare workers, students), limited attention has been given to the lived experiences and meaning-making processes of COVID-19 survivors themselves.</p>
                        </list-item>
                        <list-item>
                            <p>We further strengthened the Discussion by incorporating recent qualitative research (2024&#x2013;2025) to situate the study within the broader regional and international context.</p>
                        </list-item>
                    </list> These revisions improve clarity and strengthen the study&#x2019;s contribution.</p>
                <p> </p>
                <p> 2. Mixed methodological terminology and inappropriate trustworthiness criteria weaken technical rigor. Results are overly descriptive and lack interpretation. RAM integration is unclear.</p>
                <p> </p>
                <p> 
                    <bold>Response:</bold>
                </p>
                <p> We fully agree with the reviewer and have implemented extensive revisions:</p>
                <p> - Methodological consistency 
                    <list list-type="bullet">
                        <list-item>
                            <p>All inconsistent terminology has been removed, ensuring full alignment with IPA as the sole analytic approach.</p>
                        </list-item>
                    </list> - Trustworthiness criteria 
                    <list list-type="bullet">
                        <list-item>
                            <p>We have replaced post-positivist criteria (credibility, transferability, etc.) with IPA-specific quality criteria, including: 
                                <list list-type="bullet">
                                    <list-item>
                                        <p>Sensitivity to context</p>
                                    </list-item>
                                    <list-item>
                                        <p>Commitment and rigor</p>
                                    </list-item>
                                    <list-item>
                                        <p>Transparency and coherence</p>
                                    </list-item>
                                    <list-item>
                                        <p>Impact and importance (Smith, 2011; Smith et al., 2022)</p>
                                    </list-item>
                                </list> </p>
                        </list-item>
                    </list> This ensures epistemological consistency with IPA.</p>
                <p> </p>
                <p> -&#x00a0;Results: interpretative depth 
                    <list list-type="bullet">
                        <list-item>
                            <p>The Results section has been substantially rewritten: 
                                <list list-type="bullet">
                                    <list-item>
                                        <p>Reduced excessive quotations</p>
                                    </list-item>
                                    <list-item>
                                        <p>Strengthened interpretative commentary</p>
                                    </list-item>
                                    <list-item>
                                        <p>Emphasized participants&#x2019; meaning-making processes</p>
                                    </list-item>
                                    <list-item>
                                        <p>Ensured alignment with IPA&#x2019;s double hermeneutic approach</p>
                                    </list-item>
                                </list> </p>
                        </list-item>
                    </list> - Integration of RAM 
                    <list list-type="bullet">
                        <list-item>
                            <p>The Roy Adaptation Model (RAM) has been repositioned as an interpretative lens embedded within both Results and Discussion, rather than an appended framework.</p>
                        </list-item>
                        <list-item>
                            <p>RAM concepts (self-concept, role function, interdependence) are now explicitly used to deepen interpretation of participants&#x2019; experiences.</p>
                        </list-item>
                    </list> These changes significantly strengthen analytic rigor and technical soundness.</p>
                <p> </p>
                <p> 3. Analytic procedures and saturation are insufficiently described for replication.</p>
                <p> </p>
                <p> Response:</p>
                <p> We have revised the Data Analysis and Data Collection sections to improve transparency: 
                    <list list-type="bullet">
                        <list-item>
                            <p>Added a clear, step-by-step description of the IPA analytic process, including: 
                                <list list-type="bullet">
                                    <list-item>
                                        <p>Reading and re-reading</p>
                                    </list-item>
                                    <list-item>
                                        <p>Initial noting</p>
                                    </list-item>
                                    <list-item>
                                        <p>Development of emergent themes</p>
                                    </list-item>
                                    <list-item>
                                        <p>Idiographic case analysis</p>
                                    </list-item>
                                    <list-item>
                                        <p>Cross-case synthesis</p>
                                    </list-item>
                                </list> </p>
                        </list-item>
                        <list-item>
                            <p>Clarified the concept of data saturation in IPA: 
                                <list list-type="bullet">
                                    <list-item>
                                        <p>Emphasized that saturation reflects depth of experiential insight, rather than numerical completeness</p>
                                    </list-item>
                                    <list-item>
                                        <p>Explained how iterative analysis and peer debriefing confirmed that no new experiential meanings emerged</p>
                                    </list-item>
                                </list> </p>
                        </list-item>
                    </list> These revisions improve methodological clarity and replicability.</p>
                <p> </p>
                <p> 4. Conclusions extend beyond the data; policy implications may be overgeneralized.</p>
                <p> </p>
                <p> Response:</p>
                <p> We appreciate this important feedback and have revised the Conclusion and Implications sections accordingly: 
                    <list list-type="bullet">
                        <list-item>
                            <p>Removed overgeneralized claims</p>
                        </list-item>
                        <list-item>
                            <p>Ensured all implications are directly grounded in participants&#x2019; accounts and themes</p>
                        </list-item>
                        <list-item>
                            <p>Reframed policy suggestions as context-specific and exploratory, rather than universal recommendations</p>
                        </list-item>
                        <list-item>
                            <p>Explicitly acknowledged the idiographic and context-bound nature of IPA findings</p>
                        </list-item>
                    </list> These changes ensure that conclusions remain appropriately cautious and evidence-based.</p>
                <p> </p>
                <p> 5. Further strengthening of analytic rigor and interpretation is required.</p>
                <p> </p>
                <p> Response:</p>
                <p> We have carefully addressed this overarching concern through: 
                    <list list-type="bullet">
                        <list-item>
                            <p>Strengthening methodological consistency (IPA only)</p>
                        </list-item>
                        <list-item>
                            <p>Enhancing interpretative depth throughout Results and Discussion</p>
                        </list-item>
                        <list-item>
                            <p>Providing a clear analytic process</p>
                        </list-item>
                        <list-item>
                            <p>Embedding theoretical interpretation (RAM) within findings</p>
                        </list-item>
                    </list> Taken together, these revisions ensure that the manuscript now demonstrates clear methodological alignment, robust analytic rigor, and strong interpretative engagement consistent with IPA standards.</p>
                <p> </p>
                <p> </p>
                <p> We sincerely thank the reviewer for their detailed and constructive feedback. The revisions undertaken in response have significantly improved the clarity, rigor, and contribution of the manuscript. We respectfully submit the revised version for reconsideration.</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report383174">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.181459.r383174</article-id>
            <title-group>
                <article-title>Reviewer response for version 4</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Srichannil</surname>
                        <given-names>Chomphunut</given-names>
                    </name>
                    <xref ref-type="aff" rid="r383174a1">1</xref>
                    <role>Referee</role>
                </contrib>
                <aff id="r383174a1">
                    <label>1</label>Department of Psychology, Chulalongkorn University, Bangkok, Bangkok, Thailand</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>18</day>
                <month>6</month>
                <year>2025</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2025 Srichannil C</copyright-statement>
                <copyright-year>2025</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport383174" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.4"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>The revised version of this article has taken further steps toward improvement. However, significant methodological concerns remain unresolved, particularly in relation to the claimed use of Interpretative Phenomenological Analysis (IPA).</p>
            <p> First, while the authors describe their approach as a &#x201c;phenomenological-hermeneutic approach,&#x201d; they do not clearly state that IPA is the central analytic method until later in the paper. If IPA is indeed the primary analytic framework, this should be explicitly stated early in the methodology or design section. Furthermore, in the results section, the authors state that &#x201c;major themes were derived from content analysis,&#x201d; which introduces confusion, as content analysis is a distinct methodological approach and not typically aligned with IPA. Clarification is needed regarding the analytic procedures used.</p>
            <p> Second, the criteria employed to demonstrate trustworthiness &#x2014; credibility, transferability, dependability, and confirmability &#x2014; are drawn from Guba and Lincoln&#x2019;s post-positivist paradigm, which is not epistemologically aligned with the interpretivist foundations of IPA. This raises important concerns regarding methodological congruence. In IPA, methodological quality is more appropriately demonstrated through IPA-specific criteria (see Smith, 2011; Smith et al., 2022). I would recommend either re-framing the quality assurance criteria to align with IPA or reconsidering the analytical framework itself.</p>
            <p> </p>
            <p> Finally, these inconsistencies also affect the reporting of findings, particularly with respect to the idiographic focus, depth of interpretation, and analytic structure expected in IPA research. The current presentation of results relies heavily on a sequence of participant quotes, with limited interpretative engagement.</p>
            <p> </p>
            <p> In summary, I encourage the authors to revisit the issues of methodological alignment, analytic clarity, and consistency with the claimed use of IPA. These concerns should be addressed before the article can be considered methodologically sound.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>No source data required</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>No</p>
            <p>Reviewer Expertise:</p>
            <p>Counseling Psychology</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment14115-383174">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>20</day>
                    <month>6</month>
                    <year>2025</year>
                </pub-date>
            </front-stub>
            <body>
                <p>We sincerely appreciate the reviewer&#x2019;s insightful comments and the opportunity to strengthen the methodological transparency of our study. We have made the following revisions and clarifications: 
                    <list list-type="order">
                        <list-item>
                            <p>
                                <bold>Clarifying the Analytic Approach</bold>
                            </p>
                            <p> We acknowledge the prior ambiguity in our description of the analytic method. To address this, we have now explicitly stated in the 
                                <italic>Design</italic> section that 
                                <italic>Interpretative Phenomenological Analysis (IPA)</italic> is the central analytic framework guiding our study. We have removed the ambiguous term &#x201c;phenomenological-hermeneutic approach&#x201d; in favor of consistently referring to IPA throughout the methodology.</p>
                        </list-item>
                    </list> Additionally, in the 
                    <italic>Results</italic> section, we have removed the phrase &#x201c;major themes were derived from content analysis,&#x201d; recognizing that content analysis is a distinct technique not epistemologically aligned with IPA. We now clarify that themes were developed inductively through iterative engagement with the data in accordance with IPA procedures, as outlined by Smith and colleagues (Smith &amp; Osborn, 2015; Smith et al., 2022).</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;&#x00a0;2
                    <bold>. Ensuring Methodological Congruence</bold>
                </p>
                <p> &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; The reviewer correctly notes that our original quality criteria (credibility, transferability, dependability, confirmability) are drawn from the Guba and Lincoln framework, which is situated within a post-positivist tradition. In response, we have revised the 
                    <italic>Trustworthiness</italic> section to reflect IPA-specific markers of rigor and coherence, including: 
                    <list list-type="bullet">
                        <list-item>
                            <p>
                                <italic>Sensitivity to context</italic> (e.g., attention to the socio-cultural and historical context of COVID-19 in Thailand),</p>
                        </list-item>
                        <list-item>
                            <p>
                                <italic>Commitment and rigor</italic> (e.g., detailed iterative coding, sustained interaction with transcripts, analytic depth),</p>
                        </list-item>
                        <list-item>
                            <p>
                                <italic>Transparency and coherence</italic> (e.g., a clear audit trail of interpretative processes, bracketing of researcher assumptions),</p>
                        </list-item>
                        <list-item>
                            <p>
                                <italic>Impact and importance</italic> (e.g., the study&#x2019;s implications for public health and psychosocial interventions in pandemic recovery).</p>
                        </list-item>
                    </list> These standards reflect the interpretivist foundations of IPA and have replaced the prior post-positivist criteria.</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;3.&#x00a0;
                    <bold>Enhancing Interpretative Engagement in Results</bold> 
                    <list list-type="bullet">
                        <list-item>
                            <p>Highlighted 
                                <italic>how participants make meaning</italic> of their experiences,</p>
                        </list-item>
                        <list-item>
                            <p>Emphasized nuanced distinctions between individual cases,</p>
                        </list-item>
                        <list-item>
                            <p>And reinforced the emergent nature of themes, rooted in both participant narratives and theoretical interpretation.</p>
                        </list-item>
                    </list> 
                    <list list-type="order">
                        <list-item>
                            <p>To strengthen idiographic depth and analytic richness, we revisited the 
                                <italic>Results</italic> section to ensure that participant quotes are not merely descriptive but are actively interpreted through the lens of the Roy Adaptation Model within the IPA framework. We have:</p>
                        </list-item>
                    </list> As IPA values idiographic nuance, we have retained individual voice while offering layered interpretations of participants&#x2019; adaptation processes across physiological, psychological, and social domains.</p>
            </body>
        </sub-article>
        <sub-article article-type="response" id="comment16368-383174">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>6</day>
                    <month>6</month>
                    <year>2026</year>
                </pub-date>
            </front-stub>
            <body>
                <p>We sincerely thank the reviewer for these insightful and constructive comments. We have carefully considered each point and have undertaken substantial revisions to address the concerns regarding methodological alignment, analytic clarity, and consistency with Interpretative Phenomenological Analysis (IPA). Our responses are detailed below.</p>
                <p> </p>
                <p> 
                    <bold>Comment 1: Lack of clarity regarding IPA as the central analytic framework and inconsistent terminology (e.g., phenomenological-hermeneutic, content analysis)</bold>
                </p>
                <p> 
                    <bold>Response:</bold>
                </p>
                <p> We appreciate this important observation and have made significant revisions to ensure full methodological clarity. 
                    <list list-type="bullet">
                        <list-item>
                            <p>The manuscript now explicitly identifies IPA as the sole analytic framework at the outset of the Design/Methods section, ensuring that the study&#x2019;s methodological orientation is clear from the beginning.</p>
                        </list-item>
                        <list-item>
                            <p>We have removed all references to &#x201c;content analysis&#x201d; and &#x201c;thematic analysis&#x201d; throughout the manuscript to eliminate confusion and ensure consistency with IPA.</p>
                        </list-item>
                        <list-item>
                            <p>The term &#x201c;phenomenological-hermeneutic&#x201d; is now used only to describe the philosophical foundation of IPA, rather than as a separate analytic approach.</p>
                        </list-item>
                    </list> Additionally, the Results section has been revised to ensure alignment with IPA, removing previously ambiguous statements (e.g., references to content analysis) and clearly presenting findings as interpretative thematic accounts derived through IPA procedures.</p>
                <p> </p>
                <p> 
                    <bold>Comment 2: Use of trustworthiness criteria not aligned with IPA epistemology</bold>
                </p>
                <p> 
                    <bold>Response:</bold>
                </p>
                <p> We thank the reviewer for highlighting this important issue regarding epistemological consistency. 
                    <list list-type="bullet">
                        <list-item>
                            <p>The previous use of Guba and Lincoln&#x2019;s trustworthiness criteria (credibility, transferability, dependability, confirmability) has been removed.</p>
                        </list-item>
                        <list-item>
                            <p>We have reframed the Trustworthiness section in accordance with IPA-specific quality criteria, drawing on Smith (2011) and Smith et al. (2022), including: 
                                <list list-type="bullet">
                                    <list-item>
                                        <p>Sensitivity to context</p>
                                    </list-item>
                                    <list-item>
                                        <p>Commitment and rigor</p>
                                    </list-item>
                                    <list-item>
                                        <p>Transparency and coherence</p>
                                    </list-item>
                                    <list-item>
                                        <p>Impact and importance</p>
                                    </list-item>
                                </list> </p>
                        </list-item>
                        <list-item>
                            <p>Existing methodological practices (e.g., reflexivity, peer debriefing, member checking) have been retained but are now conceptually aligned with an interpretivist paradigm, ensuring full methodological congruence with IPA.</p>
                        </list-item>
                    </list> 
                    <bold>Comment 3: Limited idiographic focus and insufficient interpretative depth in the Results</bold>
                </p>
                <p> 
                    <bold>Response:</bold>
                </p>
                <p> We fully agree with this observation and have undertaken a substantial revision of the Results section. 
                    <list list-type="bullet">
                        <list-item>
                            <p>The Results have been completely restructured in accordance with IPA principles, removing the previous level-based format and replacing it with interpretative thematic accounts.</p>
                        </list-item>
                        <list-item>
                            <p>We have reduced the reliance on extended participant quotations and instead embedded quotations within a stronger interpretative narrative.</p>
                        </list-item>
                        <list-item>
                            <p>Each theme now emphasizes: 
                                <list list-type="bullet">
                                    <list-item>
                                        <p>Participants&#x2019; meaning-making processes</p>
                                    </list-item>
                                    <list-item>
                                        <p>Interpretative engagement by the researchers</p>
                                    </list-item>
                                    <list-item>
                                        <p>Connections between individual experiences (idiographic focus) and shared patterns</p>
                                    </list-item>
                                </list> </p>
                        </list-item>
                        <list-item>
                            <p>The revised Results now demonstrate greater depth of interpretation, consistent with IPA&#x2019;s double hermeneutic approach, where the researcher interprets participants&#x2019; sense-making processes.</p>
                        </list-item>
                    </list> 
                    <bold>Comment 4: Overall concerns regarding methodological alignment and analytic consistency</bold>
                </p>
                <p> 
                    <bold>Response:</bold>
                </p>
                <p> In response to this overarching concern, we have undertaken a comprehensive review of the entire manuscript to ensure full methodological coherence.</p>
                <p> Specifically, we have: 
                    <list list-type="bullet">
                        <list-item>
                            <p>Ensured that IPA is consistently applied across all sections (Abstract, Methods, Results, Discussion)</p>
                        </list-item>
                        <list-item>
                            <p>Expanded the Data Analysis section to provide a clear, step-by-step account of the IPA process (idiographic analysis, theme development, cross-case synthesis)</p>
                        </list-item>
                        <list-item>
                            <p>Strengthened interpretative depth in both Results and Discussion, particularly with regard to meaning-making, identity reconstruction, and adaptation</p>
                        </list-item>
                        <list-item>
                            <p>Revised the integration of the Roy Adaptation Model (RAM) so that it functions as an interpretative lens embedded within the analysis, rather than as a parallel or competing framework</p>
                        </list-item>
                    </list> These revisions ensure that the manuscript now reflects a coherent, theoretically grounded, and methodologically rigorous application of IPA.</p>
                <p> </p>
                <p> We sincerely appreciate the reviewer&#x2019;s careful and insightful evaluation, which has been instrumental in improving the rigor and clarity of this manuscript. We believe that the revisions have fully addressed the concerns raised and have strengthened the study&#x2019;s methodological integrity, analytic depth, and overall contribution.</p>
                <p> </p>
                <p> We respectfully submit the revised manuscript for reconsideration.</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report383175">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.181459.r383175</article-id>
            <title-group>
                <article-title>Reviewer response for version 4</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Kin</surname>
                        <given-names>Cheah Phaik</given-names>
                    </name>
                    <xref ref-type="aff" rid="r383175a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-2615-5217</uri>
                </contrib>
                <aff id="r383175a1">
                    <label>1</label>Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman, Petaling Jaya, Selangor, Malaysia</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>19</day>
                <month>5</month>
                <year>2025</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2025 Kin CP</copyright-statement>
                <copyright-year>2025</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport383175" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.4"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>Revisions have been made accordingly.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Partly</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>No</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Partly</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>NA</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.</p>
        </body>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report209256">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.155443.r209256</article-id>
            <title-group>
                <article-title>Reviewer response for version 2</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Kin</surname>
                        <given-names>Cheah Phaik</given-names>
                    </name>
                    <xref ref-type="aff" rid="r209256a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-2615-5217</uri>
                </contrib>
                <aff id="r209256a1">
                    <label>1</label>Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman, Petaling Jaya, Selangor, Malaysia</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>3</day>
                <month>10</month>
                <year>2023</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2023 Kin CP</copyright-statement>
                <copyright-year>2023</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport209256" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.2"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>
                <list list-type="order">
                    <list-item>
                        <p>Because this study was done in Thailand, it is helpful to describe the situation there during the pandemic to help readers understand the context in which this study was based.</p>
                        <p> </p>
                        <p> COMMENTS: &#x201c;During the COVID-19 pandemic in Thailand, patients have faced problems such as fear, loneliness, boredom, anger, anxiety, insomnia, and a feeling of taboo. Patients have also been concerned about the effect of being quarantined on their psychological well-being and the risk of infecting family members and community members.&#x201d;</p>
                        <p> </p>
                        <p> This statement was added by the authors to provide contextual and background information. However, no reference was provided. As the study is based in Thailand, the authors must explain the context with conviction and support. Given the many papers published about the Covid (and lockdown) situation and issues faced in Thailand, many references are available.</p>
                    </list-item>
                    <list-item>
                        <p>The knowledge gap needs to be further established and supported to justify the need for this investigation and the significance of this study. 
                            <list list-type="order">
                                <list-item>
                                    <p>It is important that the researchers provide support for this statement -&#x00a0;"Besides, a few studies have explored the needs of COVID-19 cases, their stress and adaptation to the disease, and health support."</p>
                                </list-item>
                                <list-item>
                                    <p>In this regard, it would also be appropriate to refer to past studies that have been done in Thailand, as well as in other countries to establish the need to conduct this investigation and fill this knowledge gap.</p>
                                    <p> </p>
                                    <p> </p>
                                    <p> COMMENTS: &#x201c;Researchers primarily conducted epidemiological studies and clinical trials during the initial crisis response to the pandemic. However, qualitative research is needed to provide the nuance and detail of COVID-19 patients&#x2019; lived reality and contextualized experiences due to the knowledge, understanding, advanced nursing intervention, medication, alternative treatment, and psychosocial intervention were lacking.&#x201d;</p>
                                    <p> </p>
                                    <p> The authors described the gap. Proof or support is needed to establish this gap. There are existing studies that have reported on the experiences/perspectives/ impact of Covid among survivors. There are also studies have reported the impacts, perspectives and experiences on other specific segments e.g. nurses, students, patients, people with a certain type of disease (e.g. HIV/AIDS, diabetes) while other studies have reported on broader or more general segments.</p>
                                    <p> </p>
                                    <p> Therefore, it is not clear how this study contributes to existing knowledge. The authors need to describe and establish this gap, justifying the need for this study, and thereby explaining the new or novel ideas that this study provides.</p>
                                </list-item>
                            </list> </p>
                    </list-item>
                    <list-item>
                        <p>Theoretical framework -&#x00a0;While it is helpful to use a theoretical framework to guide this work, the researchers need to explain how this model is not stifling this study that uses qualitative methods, ensuring that it does not limit creativity or the exploration of alternative perspectives, but rather enhances understanding and provides a structured approach to the research.</p>
                        <p> </p>
                        <p> COMMENTS: There was no response from the authors on this feedback.</p>
                    </list-item>
                    <list-item>
                        <p>Methods 
                            <list list-type="order">
                                <list-item>
                                    <p>In the same vein (ie. No. 3), please explain how the interview questions were developed.&#x00a0;</p>
                                    <p> </p>
                                    <p> COMMENTS: &#x201c;Third, semi-structured individual in-depth questions were developed by reviewing the literature on the concept of stressful life events, adaptation and emotions. The three validators checked the content and comments.&#x201d;</p>
                                    <p> </p>
                                    <p> The authors have added the statement above. As I have commented earlier, &#x201c;In the same vein (ie. No. 3)&#x201d; as the authors had used a theoretical framework (as mentioned in No. 3 above), but it is not clear how or where. Was &#x201c;concept of stressful life events, adaptation and emotions&#x201d; adapted from the Roy Adaptation Model? If yes, I think some critique and justification are also needed for No. 3 above.</p>
                                    <p> </p>
                                    <p> Also, this also needs to be explained further how this model was adopted in this study, while using the IPA approach.</p>
                                </list-item>
                                <list-item>
                                    <p>This statement can be rephrased to make it clearer. Does it also mean that the authors have designed the interview questions by drawing upon the instrument/findings from these studies? - "The phenomenological-hermeneutic approach was applied through discussions after examining and interpreting lived experiences and perceptions related to the COVID-19 pandemic (
                                        <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/my/referee/report/193387#ref1">Al Kalaldeh&#x00a0;
                                            <italic>et al.,</italic>&#x00a0;2018</ext-link>;&#x00a0;
                                        <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/my/referee/report/193387#ref8">Graor &amp; Knapik, 2013</ext-link>; Kvale &amp; Brinkmann, 2014)."&#x00a0;</p>
                                    <p> </p>
                                    <p> COMMENTS: The instrument needs to be described. If the questions cannot be shared or published, then a more detailed description of what questions were asked would help.&#x00a0;</p>
                                </list-item>
                                <list-item>
                                    <p>"Ethical approval was obtained from the Ethics Review Committee for Research Involving Human Research Participants (COA No. 119/2563)" - Please state more specifically which committee this refers to e.g. the University of ???&#x00a0;Ethics Review Committee for Research Involving Human Research Participants&#x00a0;</p>
                                    <p> </p>
                                    <p> COMMENTS: Noted with thanks.</p>
                                </list-item>
                                <list-item>
                                    <p>Please state when these interviews were carried out as this is a cross-sectional study.</p>
                                    <p> </p>
                                    <p> COMMENTS: No response was given to this suggestion.</p>
                                </list-item>
                                <list-item>
                                    <p>Please describe how the authors ensured data trustworthiness</p>
                                    <p> </p>
                                    <p> COMMENTS: The authors mentioned &#x201c;Trustworthiness was describing&#x201d;</p>
                                    <p> </p>
                                    <p> in their response to the suggestion. It is not explained how, for example, criteria such as credibility, transferability, dependability or confirmability are ensured. However, the author did mention that &#x201c;A good rapport, member check, peer debriefing, and researcher triangulation reflect the trustworthiness of this study. The researcher analyzed the transcripts independently using an IPA framework (
                                        <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/articles/11-1560/v2#ref38">Smith &amp; Osborn, 2015</ext-link>;&#x00a0;
                                        <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/articles/11-1560/v2#ref40">Alase, 2017</ext-link>).&#x201d; Authors could explain these procedures in relation to one or more of the data trustworthiness criteria. It is also helpful to explain how each was carried out i.e. &#x201c;a good rapport, member check, peer debriefing and researcher triangulation.&#x201d;</p>
                                </list-item>
                                <list-item>
                                    <p>Please provide support and justification for the data analysis methods employed.</p>
                                    <p> </p>
                                    <p> COMMENTS: As procedures were using the IPA framework, how was the Roy Adaptation Model</p>
                                </list-item>
                            </list> </p>
                    </list-item>
                    <list-item>
                        <p>Results 
                            <list list-type="order">
                                <list-item>
                                    <p>Table 1 - The marital status "Couple" means living with a partner or married?</p>
                                    <p> </p>
                                    <p> COMMENTS: &#x201c; Table 1 - The marital status "Couple" means living with a partner and/or married.</p>
                                    <p> </p>
                                    <p> Noted with thanks. This makes it clearer.</p>
                                </list-item>
                                <list-item>
                                    <p>Level 1 - It would be helpful to describe the results found about the respondents Self-Understanding.</p>
                                    <p> </p>
                                    <p> COMMENTS: No response provided. No explanation is found in the paper.</p>
                                </list-item>
                                <list-item>
                                    <p>Is Figure 1 showing the results of this study? What does this statement mean - "Apply from Roy, 2011"? There may be a typo or grammatical mistake here.</p>
                                    <p> </p>
                                    <p> COMMENTS: No response provided</p>
                                </list-item>
                                <list-item>
                                    <p>It is not clear why the Results of the analysis are labelled as "Level". This is not a conventional way to report the results of a qualitative study. Labelling each theme/category as a "level" indicates a hierarchy. Is this the intention, if so, the hierarchy is not clear.</p>
                                    <p> </p>
                                    <p> COMMENTS: No response provided.</p>
                                </list-item>
                                <list-item>
                                    <p>The sub-themes in Leval 2 appears confusing. From the formatting of the paper, it appears that within "Level 2: Structural understanding", there are Stress; Economic and Social Impact; Social Stigma; Social Support; Sometimes, bad luck brings good luck. Are these sub-themes all of the same level sub-themes under "Level 2"? Or are some of them of a third level sub-theme?&#x00a0;</p>
                                    <p> </p>
                                    <p> COMMENTS: No response provided.</p>
                                </list-item>
                            </list> </p>
                    </list-item>
                </list>
            </p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Partly</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>No</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Partly</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>NA</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment10904-209256">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>I declare that the authors have no competing interests as defined by F1000Research, or other interests that might be perceived to influence the results and/or discussion reported in this paper.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>16</day>
                    <month>1</month>
                    <year>2024</year>
                </pub-date>
            </front-stub>
            <body>
                <p>We appreciate your thorough evaluation of our work, strengthening our quality and clarity. We have carefully reviewed the comments. As suggested, we would like to provide a point-by-point response. We are confident that with your support, our manuscript will meet the high standards of F1000Research. If you have any more suggestions, please do not hesitate to contact us. We are eager to work collaboratively to ensure the success of our manuscript.</p>
                <p> </p>
                <p> 1.&#x00a0;Because this study was done in Thailand, it is helpful to describe the situation there during the pandemic to help readers understand the context in which this study was based.COMMENTS: &#x201c;During the COVID-19 pandemic in Thailand, patients have faced problems such as fear, loneliness, boredom, anger, anxiety, insomnia, and a feeling of taboo. Patients have also been concerned about the effect of being quarantined on their psychological well-being and the risk of infecting family members and community members.&#x201d;</p>
                <p> This statement was added by the authors to provide contextual and background information. However, no reference was provided. As the study is based in Thailand, the authors must explain the context with conviction and support. Given the many papers published about the Covid (and lockdown) situation and issues faced in Thailand, many references are available.</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response: </bold>
                    </italic>Thank you very much. We added information and the references were addressed as the list below:</p>
                <p> &#x201c;During the COVID-19 pandemic in Thailand, people have faced problems such as stress, fear, loneliness, boredom, anger, anxiety, insomnia, a feeling of taboo, and low health literacy (Suwanaphant et al., 2020; Choompunuch et al., 2021; Boondiskulchok et al., 2022; Suanrueang et al., 2022; Taweewun et al., 2022). Moreover, people have also been concerned about the effect of being quarantined on their psychological well-being, acute health conditions, the risk of infecting family members and community members, and the sorrows and worries that influence jobs and income (Yongthasaneekul &amp; Thammaboosadee, 2021; Wongtanasarasin, Srisawang, Yothiya, &amp; Phinyo, 2021; Hall, Sanchez, Da, Bennett, Powers, &amp; Warren, 2022)&#x201d;.</p>
                <p> </p>
                <p> References</p>
                <p> 1. Taweewun Srisookkum, Somkid Juwa, Orathai Katkhaw, Tienthong Takaew, Saengduean</p>
                <p> Phromkaewngam, Naphat Prapasuchat. Health literacy, anxiety and stress among people during Coronavirus-2019 pandemic at the northern of Thailand. J Public Hlth Dev. 2022;20(3):221-235 (https://doi.org/10.55131/jphd/2022/200318)</p>
                <p> 2. Suanrueang P, Suen MW, Lin HF, Er TK, Michaela M, Jamora Q. The impact of the covid-19 pandemic on anxiety, health literacy, and eHealth literacy in 2020 related to healthcare</p>
                <p> behavior in Thailand. J Public Hlth Dev. 2022;20(1):188-202. doi:10.55131/jphd/ 2022/</p>
                <p> 200115.</p>
                <p> 3. Boondiskulchok S, Weerametachai S, Leesri T. Prevalence and associated factors of stress and depression among SARS-Cov-2 patient in field hospital, Saraburi hospital. Regional Health Promotion Center 9 Journal. 2022; 16(2).</p>
                <p> 4. Choompunuch B, Suksatan W, Sonsroem J, Kutawan S, In-udom A. Stress, adversity quotient, and health behaviors of undergraduate students in a Thai university during COVID-19 outbreak. Belitung Nursing Journal. 2021;7(1):1-7. doi: 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.33546/bnj.1276">https://doi.org/10.33546/bnj.1276</ext-link>
                </p>
                <p> 5. Suwanaphant K, Seedaket S, Vonok L, Assana S, Wawngam W, Kingsawad K, On-Kail P. Factors associated with stress due to corona virus disease 2019 (COVID-19) pandemic among students of the Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute. Journal of Health Science Research. 2020; 14(2):138-4.</p>
                <p> 6. Wongtanasarasin, W., Srisawang, T., Yothiya, W., &amp; Phinyo, P. (2021). Impact of national lockdown towards emergency department visits and admission rates during the COVID-19 pandemic in Thailand: A hospital-based study. EMA - Emergency Medicine Australasia, 33(2), 316-323&#x2013;323. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1111/1742-6723.13666">https://doi.org/10.1111/1742-6723.13666</ext-link>
                </p>
                <p> 7. Yongthasaneekul, T., &amp; Thammaboosadee, S. (2021). Emotion and Worry Measurement Comparison of United Kingdom and Thailand During The First COVID-19 Lockdown Situation. 2021 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), Bioinformatics and Biomedicine (BIBM), 2021 IEEE International Conference On, 2924&#x2013;2930. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1109/BIBM52615.2021.9669723">https://doi.org/10.1109/BIBM52615.2021.9669723</ext-link>
                </p>
                <p> 8. Hall LR, Sanchez K, Da Graca B, Bennett MM, Powers M, Warren AM. Income Differences and COVID-19: Impact on Daily Life and Mental Health. Popul Health Manag. 2022 Jun 1; 25(3):384&#x2013;91. https://doi.org/10.1089/pop.2021.0214 PMID: 34652228</p>
                <p> </p>
                <p> 2. The knowledge gap needs to be further established and supported to justify the need for this investigation and the significance of this study. 
                    <list list-type="order">
                        <list-item>
                            <p>It is important that the researchers provide support for this statement</p>
                        </list-item>
                    </list> - &#x201c;Besides, a few studies have explored the needs of COVID-19 cases, their stress and adaptation to the disease, and health support.&#x201d; 
                    <list list-type="order">
                        <list-item>
                            <p>In this regard, it would also be appropriate to refer to past studies that have been done in Thailand, as well as in other countries to establish the need to conduct this investigation and fill this knowledge gap.</p>
                        </list-item>
                    </list> COMMENTS: &#x201c;Researchers primarily conducted epidemiological studies and clinical trials during the initial crisis response to the pandemic. However, qualitative research is needed to provide the nuance and detail of COVID-19 patients&#x2019; lived reality and contextualized experiences due to the knowledge, understanding, advanced nursing intervention, medication, alternative treatment, and psychosocial intervention were lacking.&#x201d;</p>
                <p> The authors described the gap. Proof or support is needed to establish this gap. There are existing studies that have reported on the experiences/perspectives/ impact of Covid among survivors. There are also studies have reported the impacts, perspectives and experiences on other specific segments e.g. nurses, students, patients, people with a certain type of disease (e.g. HIV/AIDS, diabetes) while other studies have reported on broader or more general segments.</p>
                <p> Therefore, it is not clear how this study contributes to existing knowledge. The authors need to describe and establish this gap, justifying the need for this study, and thereby explaining the new or novel ideas that this study provides.</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response: </bold>
                    </italic>Thank you for pointing out the important issue. According to your comment, we added the information and references on the past studies that have been done in Thailand.</p>
                <p> &#x201c;Researchers primarily conducted epidemiological studies, descriptive studies, and clinical studies during the crisis response to the pandemic in Thailand (Lerthattasilp, Kosulwit, Phanasathit et al., 2020; Srifuengfung, Thana-udom, Ratta-apha, Chulakadabba,&#x00a0; Sanguanpanich, &amp; Viravan, 2021; Nitchawan, Pantri, Chayut, Yingrat, Nongnuch, &amp; Chotiman , 2022; Suwanbamrung, Pongtalung, Trang, Nam, &amp; Phu, 2023; Phu, 2023). This is quantitative, and the results show the volumes and relationships of factors of all units of analysis in the whole picture. However, qualitative research is needed to provide the nuance, detail, individual problems, and individual needs of COVID-19 patients&#x2019; lived reality and contextualized experiences to gain more knowledge and deep understanding to design an advanced nursing intervention, medication-taking style, alternative treatment, and psychosocial intervention. The qualitative research results can provide the clinical information for the new or novel ideas of nursing care that meet this target population&#x2019;s needs and problems.&#x201d;</p>
                <p> </p>
                <p> Reference</p>
                <p> 1. Suwanbamrung, C., Pongtalung, P., Trang, L. T. T., Nam, T. T., &amp; Phu, D. H. (2023). Levels and risk factors associated with depression, anxiety, and stress among COVID-19 infected</p>
                <p> adults after hospital discharge in a Southern Province of Thailand. Journal of Public Health</p>
                <p> and Development, 21(1), 72-89&#x2013;89. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.55131/jphd/2023/210106">https://doi.org/10.55131/jphd/2023/210106</ext-link>
                </p>
                <p> 2. Srifuengfung, M., Thana-udom, K., Ratta-apha, W., Chulakadabba, S., Sanguanpanich, N., &amp; Viravan, N. (2021). Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety. Journal of Affective Disorders, 295, 353-365&#x2013;365. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1016/j.jad.2021.%2008.044">https://doi.org/10.1016/j.jad.2021. 08.044</ext-link>.</p>
                <p> 3. Nitchawan Kerdcharoen, Pantri Kirdchok, Chayut Wonglertwisawakorn, Yingrat Naviganuntana, Nongnuch Polruamngern, &amp; Chotiman Chinvararak. (2022). Mental health problems of asymptomatic or mildly symptomatic COVID-19 patients in hospitel in Thailand: A cross-sectional study [version 2; peer review: 2 approved]. F1000Research, 11, 1089. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.12688/f1000research.125998.2">https://doi.org/10.12688/f1000research.125998.2</ext-link>
                </p>
                <p> 4. Lerthattasilp T, Kosulwit K, Phanasathit M, et al., Psychological impacts on patients with COVID-19 in a Thai field hospital. Arch. Clin. Psychiatry. 2020; 47(6): 215&#x2013;217.</p>
                <p> 5. Phu, D. H., Maneerattanasak, S., Shohaimi, S., Trang, L. T. T., Nam, T. T., Suwanbamrung, C., Kuning, M., Like, A., &amp; Torpor, H. (2023). Prevalence and factors associated with long COVID and mental health status among recovered COVID-19 patients in southern Thailand. PLoS ONE, 18(7 July). 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1371/journal.pone.0289382">https://doi.org/10.1371/journal.pone.0289382</ext-link>
                </p>
                <p> </p>
                <p> 3. Theoretical framework - While it is helpful to use a theoretical framework to guide this work, the researchers need to explain how this model is not stifling this study that uses qualitative methods, ensuring that it does not limit creativity or the exploration of alternative perspectives, but rather enhances understanding and provides a structured approach to the research.COMMENTS: There was no response from the authors on this feedback.</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response:</bold>
                    </italic> We apologize for the short description of the manuscript&#x2019;s last version because it related to the APC charge. We have added the suggested content to the manuscript on the theoretical framework parts.&#x00a0;</p>
                <p> &#x201c;The Roy adaptation model (RAM) applied this study&#x2019;s theoretical framework, which deepened our understanding of the lived experiences and the impact of COVID-19 cases. In addition, applying RAM in nursing research will guide the quality of care and provide data to estimate the results. Moreover, RAM is practical to all areas of nursing and frequently applied in the theoretical framework of qualitative studies of COVID-19 cases (Day&#x0131;lar, Dogan, G&#x00fc;ler, &amp; Carroll, 2022).</p>
                <p> RAM ( Roy, 2001, 2009, 2011) points out that people are adaptive systems defined as a whole and covered of parts that function as a unit; the whole is influenced by surrounding focal, contextual, and residual stimuli (Roy, 2009). People become resilient by adapting to external environments and internal environments of the individual&#x2019;s experience (Roy, 2009). The constant change in the environment stimulates people to drive toward adaptive responses, which consist of a) positive responses to stimuli, which are defined as adaptation results in health, both physical and emotional, and b) negative responses, which are defined as maladaptation results in illness. According to RAM, the nursing goal is to promote four adaptive modes of person, thus contributing to the quality of life and health by assessing behaviors and factors that impact adaptive performance and intervening to increase environmental interactions (Roy, 2009). Contextual, focal, and residual stimuli are three environmental stimuli that impact adaptation (Roy, 2009, 2011a). While the focal stimulus is the internal or external stimulus that most impacts and directs an individual&#x2019;s attention, a contextual stimulus is the internal or external impetus affecting the situation, contributing to the behavior triggered by the focal stimulus (Roy, 2009, 2011a). Contextual stimuli are inferred from a person's events, stressful life events, or illness processes. Residual stimuli are stimuli that are in a person&#x2019;s internal or external environment. Residual stimuli become contextual or focal once they have been validated by the person experiencing the impact of the stimulus. The adaptive and stimuli are primary elements of understanding individual COVID-19 cases, their adaptation, and their life strategies for enhancing adaptation.&#x201d;</p>
                <p> Reference</p>
                <p> 1. Day&#x0131;lar Candan H, Dogan S, G&#x00fc;ler C, Carroll K. Roy adaptation model: theory-based</p>
                <p> knowledge and nursing care with a person experiencing COVID-19. Nurs Sci Q. 2022; 35(3): 304-310. doi:10.1177/08943184221092434</p>
                <p> 2. Roy C. (2011a). Research based on the Roy adaptation model: Last 25 years. Nursing Science</p>
                <p> Quarterly, 24(4), 312-320. https://doi.org/10.1177/0894318411419218</p>
                <p> </p>
                <p> </p>
                <p> 4.Methods 
                    <list list-type="order">
                        <list-item>
                            <p>In the same vein (ie. No. 3), please explain how the interview questions were developed.</p>
                        </list-item>
                    </list> COMMENTS: &#x201c;Third, semi-structured individual in-depth questions were developed by reviewing the literature on the concept of stressful life events, adaptation and emotions. The three validators checked the content and comments.&#x201d; The authors have added the statement above. As I have commented earlier, &#x201c;In the same vein (ie. No. 3)&#x201d; as the authors had used a theoretical framework (as mentioned in No. 3 above), but it is not clear how or where. Was &#x201c;concept of stressful life events, adaptation and emotions&#x201d; adapted from the Roy Adaptation Model? If yes, I think some critique and justification are also needed for No. 3 above. Also, this also needs to be explained further how this model was adopted in this study, while using the IPA approach. 
                    <list list-type="order">
                        <list-item>
                            <p>This statement can be rephrased to make it clearer. Does it also mean that the authors have designed the interview questions by drawing upon the instrument/findings from these studies? - &#x201c;The phenomenological-hermeneutic approach was applied through discussions after examining and interpreting lived experiences and perceptions related to the COVID-19 pandemic (Al Kalaldeh et al., 2018; Graor &amp; Knapik, 2013; Kvale &amp; Brinkmann, 2014).&#x201d;</p>
                        </list-item>
                    </list> COMMENTS: The instrument needs to be described. If the questions cannot be shared or published, then a more detailed description of what questions were asked would help.</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response: </bold>
                    </italic>Thank you very much. The questions were shared in English version n Figshare: Until the Dawn: The Impact of COVID-19, https://doi.org/10.6084/m9.figshare.21369810 ( Imkome E-u, &amp; Moonchai K, 2022). 
                    <list list-type="order">
                        <list-item>
                            <p>&#x201c;Ethical approval was obtained from the Ethics Review Committee for Research Involving Human Research Participants (COA No. 119/2563)&#x201d; - Please state more specifically which committee this refers to e.g. the University of ??? Ethics Review Committee for Research Involving Human Research Participants</p>
                        </list-item>
                    </list> COMMENTS: Noted with thanks. 
                    <list list-type="order">
                        <list-item>
                            <p>Please state when these interviews were carried out as this is a cross-sectional study.</p>
                        </list-item>
                    </list> COMMENTS: No response was given to this suggestion.</p>
                <p> Author response: Thank you for pointing this out. A cross-sectional study is another project. We had to remove the sentence from this manuscript. 
                    <list list-type="order">
                        <list-item>
                            <p>Please describe how the authors ensured data trustworthiness</p>
                        </list-item>
                    </list> COMMENTS: The authors mentioned &#x201c;Trustworthiness was describing&#x201d;</p>
                <p> in their response to the suggestion. It is not explained how, for example, criteria such as credibility, transferability, dependability or confirmability are ensured. However, the author did mention that &#x201c;A good rapport, member check, peer debriefing, and researcher triangulation reflect the trustworthiness of this study. The researcher analyzed the transcripts independently using an IPA framework (Smith &amp; Osborn, 2015; Alase, 2017).&#x201d; Authors could explain these procedures in relation to one or more of the data trustworthiness criteria. It is also helpful to explain how each was carried out i.e. &#x201c;a good rapport, member check, peer debriefing and researcher triangulation.&#x201d;</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response:</bold>
                    </italic> Thank you very much for your comments. We added the Trustworthiness of the study as the content below:</p>
                <p> To ensure data trustworthiness, phenomenological methods such as reflexivity, member checking, and auditing are often among the most highly used procedures to maximize trustworthiness. Member reflections instead of traditional member checking and incorporated peer debriefing to ensure rigor in interpretative qualitative research were used. Feedback and reflections are participant validation of results and an opportunity for further elaboration of findings from participants in the co-construction of the phenomenon with the authors (Flynn &amp; Korcuska, 2018; Smith &amp; McGannon, 2018). Member reflections were primarily incorporated upon completion of the study analysis. All participants were contacted via phone and joined a Microsoft Teams discussion of the summary of the findings.</p>
                <p> The authors conducted peer debriefing (Smith &amp; McGannon, 2018) to process the study. The construction of knowledge through critical feedback that encouraged reflection upon and investigation of alternative interpretations emerging from the data was the peer debriefing process that included data collection or analysis and aided in probing the thinking around the research process and analysis (Given, 2008) as weekly during data collection and monthly during data analysis and interpretation.</p>
                <p> &#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0; The trail of the audit was established as initial notes; step-by-step methods for recruitment, data collection, and analysis; annotated transcripts; tables of themes that developed; the final report; and all field notes (J.A. Smith et al., 2022; J. Smith et al., 2009). Field notes recorded details of what was seen, heard, thought, and experienced throughout data collection (Groenewald, 2004). Field notes were divided into four categories, each in separate files. The first was the Interview environment and atmosphere, i.e., objective recordings of what happened, who was involved, what activities occurred, and what was seen or heard. The second was the behavior and the data from the participants. For this process, the notes were recorded immediately after the conclusion of each data collection session. In these notes, the first author documented reflections on personal experiences related to the data and attempts to derive meaning through reflection on the data. The third was obstacles encountered in interviews. The fourth was the planning for the following interview. The final file contained research notes summarizing procedures, events, and study progress.</p>
                <p> Reference</p>
                <p> 1. Flynn SV, Korcuska JS. Credible Phenomenological Research: A Mixed&#x2010;Methods Study. Couns&#x00a0;Educ Superv. 2018; doi.org/10.1002/ceas.12092.2</p>
                <p> 2. Smith B, McGannon KR. Developing rigor in qualitative research: problems and opportunities&#x00a0;within sport and exercise psychology. Int Rev Sport Exerc Psychol. 2018; doi.org/10.1080/1750984x.2017.1317357.</p>
                <p> 3. Given LM. The SAGE Encyclopedia of Qualitative Research Methods. SAGE Publications, Inc. eBooks. 2008; doi.org/10.4135/9781412963909.</p>
                <p> 4. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological analysis: Theory, Method and&#x00a0;Research. SAGE; 2022.</p>
                <p> 5. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological analysis: Theory, Method and&#x00a0;Research. SAGE Publications; 2009.</p>
                <p> &#x00a0; 
                    <list list-type="order">
                        <list-item>
                            <p>Please provide support and justification for the data analysis methods employed.</p>
                        </list-item>
                    </list> COMMENTS: As procedures were using the IPA framework, how was the Roy Adaptation Model</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response: </bold>
                    </italic>Thanks for the interesting query. The Roy Adaptation Model was applied as the theoretical framework for this study. 
                    <list list-type="order">
                        <list-item>
                            <p>Results</p>
                        </list-item>
                    </list> 
                    <list list-type="order">
                        <list-item>
                            <p>Table 1 - The marital status &#x201c;Couple&#x201d; means living with a partner or married?</p>
                        </list-item>
                    </list> COMMENTS: &#x201c;Table 1 - The marital status &#x201c;Couple&#x201d; means living with a partner and/or married.</p>
                <p> Noted with thanks. This makes it clearer. 
                    <list list-type="order">
                        <list-item>
                            <p>Level 1 - It would be helpful to describe the results found about the respondents Self-Understanding.</p>
                        </list-item>
                    </list> COMMENTS: No response provided. No explanation is found in the paper.</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>&#x00a0;Author response: </bold>
                    </italic>We added the results found about the respondents' Self-Understanding below:</p>
                <p> &#x201c;All participants show physical survival during the interview. The participant has a low level of psychic integrity. They have stress, fear, anxiety, communication problems, sleep problems, and poor decision-making. Some of them have no job or have lost a job. However, they receive social support from significant others and health care providers.&#x201d; 
                    <list list-type="order">
                        <list-item>
                            <p>Is Figure 1 showing the results of this study? What does this statement mean - &#x201c;Apply from Roy, 2011&#x201d;? There may be a typo or grammatical mistake here.</p>
                        </list-item>
                    </list> COMMENTS: No response provided</p>
                <p> Author response: Thank you very much. It is a typo. We removed it from the manuscript. 
                    <list list-type="order">
                        <list-item>
                            <p>It is not clear why the Results of the analysis are labelled as &#x201c;Level&#x201d;. This is not a conventional way to report the results of a qualitative study. Labelling each theme/category as a &#x201c;level&#x201d; indicates a hierarchy. Is this the intention, if so, the hierarchy is not clear.</p>
                        </list-item>
                    </list> COMMENTS: No response provided.</p>
                <p> </p>
                <p> 
                    <italic>
                        <bold>Author response:</bold>
                    </italic> Thank you for your comment. We intended to label the analysis results as &#x201c;Level,&#x201d; which starts with general data, structural understanding, and Theoretical interpretation.&#x00a0; Please provide your idea to make this manuscript more straightforward. 
                    <list list-type="order">
                        <list-item>
                            <p>The sub-themes in Level 2 appears confusing. From the formatting of the paper, it appears that within &#x201c;Level 2: Structural understanding&#x201d;, there are Stress; Economic and Social Impact; Social Stigma; Social Support; Sometimes, bad luck brings good luck. Are these sub-themes all of the same level sub-themes under &#x201c;Level 2&#x201d;? Or are some of them of a third level sub-theme?</p>
                        </list-item>
                    </list> 
                    <italic>
                        <bold>Author response: </bold>
                    </italic>Thank you very much. All the themes that you mention are the sub-themes of level 2. Structural understanding, a major theme derived from content analysis, was evident across interviews and included stress, economic and social impact, social stigma, and the concept that bad luck occasionally brings good luck.</p>
                <p> -------------------------------------------------------------------------------------------------------------</p>
            </body>
        </sub-article>
        <sub-article article-type="response" id="comment13830-209256">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>30</day>
                    <month>4</month>
                    <year>2025</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Reviewer&#x2019;s comments: 
                    <list list-type="order">
                        <list-item>
                            <p>Because this study was done in Thailand, it is helpful to describe the situation there during the pandemic to help readers understand the context in which this study was based.</p>
                            <p> </p>
                            <p> COMMENTS: &#x201c;During the COVID-19 pandemic in Thailand, patients have faced problems such as fear, loneliness, boredom, anger, anxiety, insomnia, and a feeling of taboo. Patients have also been concerned about the effect of being quarantined on their psychological well-being and the risk of infecting family members and community members.&#x201d;</p>
                            <p> </p>
                            <p> This statement was added by the authors to provide contextual and background information. However, no reference was provided. As the study is based in Thailand, the authors must explain the context with conviction and support. Given the many papers published about the Covid (and lockdown) situation and issues faced in Thailand, many references are available.</p>
                        </list-item>
                    </list> Author response:</p>
                <p> </p>
                <p> We have strengthened the contextual description of the COVID-19 pandemic in Thailand by incorporating relevant references that document the psychological and social challenges faced by patients during this period. Specifically, we have cited studies that examine the impact of quarantine, fear, loneliness, and anxiety on individuals, as well as research addressing concerns about infecting family and community members. These references provide empirical support for our discussion and enhance the credibility of our findings.</p>
                <p> Furthermore, we have refined the narrative to ensure that the contextual background is presented with clarity and conviction. By integrating these references, we aim to provide a more comprehensive understanding of the environment in which our study was conducted, thereby reinforcing the methodological integrity of our research.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments</p>
                <p> </p>
                <p> 2. The knowledge gap needs to be further established and supported to justify the need for this investigation and the significance of this study.</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;a. It is important that the researchers provide support for this statement -&#x00a0;"Besides, a few studies have explored the needs of COVID-19 cases, their stress and adaptation to the disease, and health support."</p>
                <p> </p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;b. In this regard, it would also be appropriate to refer to past studies that have been done in Thailand, as well as in other countries to establish the need to conduct this investigation and fill this knowledge gap.</p>
                <p> </p>
                <p> COMMENTS: &#x201c;Researchers primarily conducted epidemiological studies and clinical trials during the initial crisis response to the pandemic. However, qualitative research is needed to provide the nuance and detail of COVID-19 patients&#x2019; lived reality and contextualized experiences due to the knowledge, understanding, advanced nursing intervention, medication, alternative treatment, and psychosocial intervention were lacking.&#x201d;</p>
                <p> </p>
                <p> The authors described the gap. Proof or support is needed to establish this gap. There are existing studies that have reported on the experiences/perspectives/ impact of Covid among survivors. There are also studies have reported the impacts, perspectives and experiences on other specific segments e.g. nurses, students, patients, people with a certain type of disease (e.g. HIV/AIDS, diabetes) while other studies have reported on broader or more general segments.</p>
                <p> </p>
                <p> Therefore, it is not clear how this study contributes to existing knowledge. The authors need to describe and establish this gap, justifying the need for this study, and thereby explaining the new or novel ideas that this study provides.</p>
                <p> </p>
                <p> Author response:</p>
                <p> Thank you for your insightful feedback. We have revised the manuscript accordingly to strengthen the justification for this study and establish the knowledge gap more clearly in the introduction parts.&#x00a0;</p>
                <p> </p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> 3. Theoretical framework -&#x00a0;While it is helpful to use a theoretical framework to guide this work, the researchers need to explain how this model is not stifling this study that uses qualitative methods, ensuring that it does not limit creativity or the exploration of alternative perspectives, but rather enhances understanding and provides a structured approach to the research.</p>
                <p> </p>
                <p> Author response:</p>
                <p> We have revised the manuscript to clarify how the application of the Roy Adaptation Model (RAM) enhances understanding rather than limiting creativity or alternative perspectives. The revisions ensure that RAM is used as a guiding framework that supports qualitative inquiry without restricting the emergence of diverse themes and lived experiences.</p>
                <p> In the Theoretical Perspective section, we now explicitly discuss how RAM provides structure for interpreting psychosocial adaptation while maintaining flexibility in exploring participants' unique narratives. Rather than prescribing rigid categories, RAM serves as an interpretive lens that allows for thematic development and multidimensional analysis, ensuring that the phenomenological nature of the study remains intact.</p>
                <p> We have emphasized that our phenomenological-hermeneutic approach fosters open-ended exploration, allowing themes to emerge organically from participants&#x2019; lived experiences. The use of RAM helps categorize adaptation processes without stifling creativity, ensuring that alternative perspectives, such as unexpected benefits and resilience factors, are fully captured.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> 4. Methods</p>
                <p> a.&#x00a0;In the same vein (ie. No. 3), please explain how the interview questions were developed.&#x00a0;</p>
                <p> </p>
                <p> COMMENTS: &#x201c;Third, semi-structured individual in-depth questions were developed by reviewing the literature on the concept of stressful life events, adaptation and emotions. The three validators checked the content and comments.&#x201d;</p>
                <p> </p>
                <p> The authors have added the statement above. As I have commented earlier, &#x201c;In the same vein (ie. No. 3)&#x201d; as the authors had used a theoretical framework (as mentioned in No. 3 above), but it is not clear how or where. Was &#x201c;concept of stressful life events, adaptation and emotions&#x201d; adapted from the Roy Adaptation Model? If yes, I think some critique and justification are also needed for No. 3 above.</p>
                <p> </p>
                <p> Also, this also needs to be explained further how this model was adopted in this study, while using the IPA approach.</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> We have updated the manuscript to provide a detailed explanation of the development of interview questions, including specific examples, and their foundation in both existing literature and the Roy Adaptation Model (RAM) within the Procedures section.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> b.This statement can be rephrased to make it clearer. Does it also mean that the authors have designed the interview questions by drawing upon the instrument/findings from these studies? - "The phenomenological-hermeneutic approach was applied through discussions after examining and interpreting lived experiences and perceptions related to the COVID-19 pandemic (
                    <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/my/referee/report/193387#ref1">Al Kalaldeh&#x00a0;
                        <italic>et al.,</italic>&#x00a0;2018</ext-link>;&#x00a0;
                    <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/my/referee/report/193387#ref8">Graor &amp; Knapik, 2013</ext-link>; Kvale &amp; Brinkmann, 2014)."&#x00a0;</p>
                <p> </p>
                <p> COMMENTS: The instrument needs to be described. If the questions cannot be shared or published, then a more detailed description of what questions were asked would help.&#x00a0;</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> We are providing a more detailed description of the specific questions asked during the interviews. While we may not be able to share the exact questions due to confidentiality concerns, we have included a sample of the questions in the Procedures section.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> c. "Ethical approval was obtained from the Ethics Review Committee for Research Involving Human Research Participants (COA No. 119/2563)" - Please state more specifically which committee this refers to e.g. the University of ???&#x00a0;Ethics Review Committee for Research Involving Human Research Participants&#x00a0;</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> We have added the following information regarding ethical approval:</p>
                <p> "This project was approved by the Human Research Ethics Committee of Thammasat University (Science), Thailand (COA No. 119/2563). The research adhered to ethical standards established by the Institutional Review Board (IRB) and the Helsinki Declaration (2000). Prior to obtaining informed consent, all participants were informed about the study's objectives, the safe protection of their data, and the associated risks and benefits. Participants were made aware of their right to withdraw from the study at any time.</p>
                <p> Written informed consent was obtained from all participants before data collection commenced. Participation in the study was entirely voluntary, and the anonymity of participants was maintained throughout the research process. Confidentiality strategies were implemented, and identifying codes were assigned to the initial data collected from observations, interviews, and documentary analyses; access to this data was restricted to the research team.</p>
                <p> The data were securely stored on the principal investigator's password-protected computer until the conclusion of the study. After 24 months, all files were permanently deleted using &#x201c;Secure Deletion Shredder,&#x201d; a protected deletion program for Windows."</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> d. Please state when these interviews were carried out as this is a cross-sectional study.</p>
                <p> </p>
                <p> Author response:</p>
                <p> We sincerely appreciate the reviewer&#x2019;s comment and would like to apologize for any confusion caused. We would like to clarify that this study is purely qualitative and does not utilize a cross-sectional design. The mention of "cross-sectional" was an unintentional typographical error.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> </p>
                <p> e.Please describe how the authors ensured data trustworthiness</p>
                <p> </p>
                <p> COMMENTS: The authors mentioned &#x201c;Trustworthiness was describing&#x201d;</p>
                <p> </p>
                <p> in their response to the suggestion. It is not explained how, for example, criteria such as credibility, transferability, dependability or confirmability are ensured. However, the author did mention that &#x201c;A good rapport, member check, peer debriefing, and researcher triangulation reflect the trustworthiness of this study. The researcher analyzed the transcripts independently using an IPA framework (
                    <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/articles/11-1560/v2#ref38">Smith &amp; Osborn, 2015</ext-link>;&#x00a0;
                    <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/articles/11-1560/v2#ref40">Alase, 2017</ext-link>).&#x201d; Authors could explain these procedures in relation to one or more of the data trustworthiness criteria. It is also helpful to explain how each was carried out i.e. &#x201c;a good rapport, member check, peer debriefing and researcher triangulation.&#x201d;</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> We appreciate the reviewer&#x2019;s valuable feedback and have revised the manuscript to provide a detailed of Trustworthiness on the Trustworthiness parts.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> 5. Please provide support and justification for the data analysis methods employed.</p>
                <p> COMMENTS: As procedures were using the IPA framework, how was the Roy Adaptation Model</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> Thank you for your valuable feedback. We appreciate the opportunity to clarify the rationale behind our data analysis approach. To address this, we have incorporated the following explanation:</p>
                <p> Our analytical framework was structured into progressive levels to capture the evolving adaptation trajectory of participants. Level 1 focused on self-perception and emotional responses, serving as the foundation for subsequent thematic development. Level 2 explored structural influences, such as stigma and social support, which shaped individual coping strategies. Finally, Level 3 integrated adaptation strategies within the broader theoretical framework, ensuring a multidimensional perspective without imposing hierarchical constraints.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> 6.&#x00a0;Results</p>
                <p> a. Table 1 - The marital status "Couple" means living with a partner or married?</p>
                <p> COMMENTS: &#x201c; Table 1 - The marital status "Couple" means living with a partner and/or married.</p>
                <p> Noted with thanks. This makes it clearer.</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> Thank you for your acknowledgment. We appreciate your review and are glad the clarification helps improve the understanding of our study.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> b. Level 1 - It would be helpful to describe the results found about the respondents Self-Understanding.</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> Thank you for your feedback. We appreciate the opportunity to clarify our findings.</p>
                <p> At Level 1 analysis, self-understanding captures participants' perceptions of their experiences with COVID-19. Respondents reported psychological distress&#x2014;stress, anxiety, sleep disturbances, and impaired decision-making&#x2014;exacerbated by financial instability and job loss. Social support played a critical role in moderating emotional strain, with individuals who engaged support systems demonstrating greater psychological stability.</p>
                <p> Self-understanding evolved throughout their adaptation process. Some participants recognized personal resilience, while others struggled with stigma and reintegration. By analyzing this dimension, our study highlights the need for psychosocial interventions that foster emotional resilience and facilitate long-term recovery.</p>
                <p> We hope this addresses your concerns and strengthens the discussion in our manuscript.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> c. Is Figure 1 showing the results of this study? What does this statement mean - "Apply from Roy, 2011"? There may be a typo or grammatical mistake here.</p>
                <p> </p>
                <p> Author response:</p>
                <p> Thank you for your review. "Apply from Roy, 2011" was a typographical error.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> d.&#x00a0;It is not clear why the Results of the analysis are labelled as "Level". This is not a conventional way to report the results of a qualitative study. Labelling each theme/category as a "level" indicates a hierarchy. Is this the intention, if so, the hierarchy is not clear.</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> Thank you for your feedback. The use of "Level" in our analysis aligns with the Interpretative Phenomenological Analysis (IPA) framework, which emphasizes a layered, progressive interpretation of participants' lived experiences. The "Level" structure moves from descriptive self-understanding (Level 1) to thematic development (Level 2) and theoretical interpretation (Level 3). This approach ensures a deeper exploration of adaptation processes while maintaining methodological rigor. It does not imply a rigid hierarchy but reflects a structured analytical progression.</p>
                <p> </p>
                <p> Reviewer&#x2019;s comments:</p>
                <p> e.&#x00a0;The sub-themes in Leval 2 appears confusing. From the formatting of the paper, it appears that within "Level 2: Structural understanding", there are Stress; Economic and Social Impact; Social Stigma; Social Support; Sometimes, bad luck brings good luck. Are these sub-themes all of the same level sub-themes under "Level 2"? Or are some of them of a third level sub-theme?&#x00a0;</p>
                <p> </p>
                <p> &#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;&#x200b;Author response:</p>
                <p> Thank you for your feedback. We appreciate the opportunity to clarify the organization of sub-themes within "Level 2: Structural Understanding."</p>
                <p> All sub-themes&#x2014;Stress, Economic and Social Impact, Social Stigma, Social Support, and Sometimes, Bad Luck Brings Good Luck&#x2014;are of the same level within Level 2. They represent distinct dimensions of participants&#x2019; experiences and adaptation during the pandemic and were identified through thematic analysis.</p>
                <p> The hierarchical structure of the results is based on the Interpretative Phenomenological Analysis (IPA) framework, where Level 1 focuses on individual self-understanding, Level 2 develops structural themes from shared experiences, and Level 3 applies theoretical interpretation using the Roy Adaptation Model. Within Level 2, the sub-themes were derived from content analysis and do not represent further subdivisions but rather interconnected aspects of adaptation processes.</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; -------------------------------------</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report209257">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.155443.r209257</article-id>
            <title-group>
                <article-title>Reviewer response for version 2</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Srichannil</surname>
                        <given-names>Chomphunut</given-names>
                    </name>
                    <xref ref-type="aff" rid="r209257a1">1</xref>
                    <role>Referee</role>
                </contrib>
                <aff id="r209257a1">
                    <label>1</label>Department of Psychology, Chulalongkorn University, Bangkok, Bangkok, Thailand</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>2</day>
                <month>10</month>
                <year>2023</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2023 Srichannil C</copyright-statement>
                <copyright-year>2023</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport209257" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.2"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>In this revised article, more information about the research procedures have been provided but it appears that this research still lacks methodological consistency and accuracy. It remains unclear what methodology has actually been used in this research. Although IPA (Interpretative phenomenological analysis) was added in this version, the data analysis, quality criteria, as well as the reporting of research findings do not align with IPA. Due to the significant lack of methodological rigor of this paper, it is not approved.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>No source data required</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>No</p>
            <p>Reviewer Expertise:</p>
            <p>Counseling Psychology</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment10903-209257">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>I declare that the authors have no competing interests as defined by F1000Resesarch, or other interests that might be perceived to influence the results and/or discussion reported in this paper.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>16</day>
                    <month>1</month>
                    <year>2024</year>
                </pub-date>
            </front-stub>
            <body>
                <p>We want to thank you for your insightful comment. We hope that with your comments, our manuscript will meet the high standards of F1000Research. We provide a response below. 
                    <list list-type="order">
                        <list-item>
                            <p>Introduction parts</p>
                        </list-item>
                    </list> &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; 1.1 We added information and the references were addressed as the list below:</p>
                <p> "During the COVID-19 pandemic in Thailand, people have faced problems such as stress, fear, loneliness, boredom, anger, anxiety, insomnia, a feeling of taboo, and low health literacy (Suwanaphant et al., 2020; Choompunuch et al., 2021; Boondiskulchok et al., 2022; Suanrueang et al., 2022; Taweewun et al., 2022). Moreover, people have also been concerned about the effect of being quarantined on their psychological well-being, acute health conditions, the risk of infecting family members and community members, and the sorrows and worries that influence jobs and income (Yongthasaneekul &amp; Thammaboosadee, 2021; Wongtanasarasin, Srisawang, Yothiya, &amp; Phinyo, 2021; Hall, Sanchez, Da, Bennett, Powers, &amp; Warren, 2022)".</p>
                <p> </p>
                <p> References</p>
                <p> 1. Taweewun Srisookkum, Somkid Juwa, Orathai Katkhaw, Tienthong Takaew, Saengduean</p>
                <p> Phromkaewngam, Naphat Prapasuchat. Health literacy, anxiety and stress among people during Coronavirus-2019 pandemic at the northern of Thailand. J Public Hlth Dev. 2022;20(3):221-235 (https://doi.org/10.55131/jphd/2022/200318)</p>
                <p> 2. Suanrueang P, Suen MW, Lin HF, Er TK, Michaela M, Jamora Q. The impact of the covid-19 pandemic on anxiety, health literacy, and eHealth literacy in 2020 related to healthcare</p>
                <p> behavior in Thailand. J Public Hlth Dev. 2022;20(1):188-202. doi:10.55131/jphd/ 2022/</p>
                <p> 200115.</p>
                <p> 3.&#x00a0;Boondiskulchok S, Weerametachai S, Leesri T. Prevalence and associated factors of stress and depression among SARS-Cov-2 patient in field hospital, Saraburi hospital. Regional Health Promotion Center 9 Journal. 2022; 16(2).</p>
                <p> 4. Choompunuch B, Suksatan W, Sonsroem J, Kutawan S, In-udom A. Stress, adversity quotient, and health behaviors of undergraduate students in a Thai university during COVID-19 outbreak. Belitung Nursing Journal. 2021;7(1):1-7. doi: 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.33546/bnj.1276">https://doi.org/10.33546/bnj.1276</ext-link>
                </p>
                <p> 5. Suwanaphant K, Seedaket S, Vonok L, Assana S, Wawngam W, Kingsawad K, On-Kail P. Factors associated with stress due to corona virus disease 2019 (COVID-19) pandemic among students of the Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute. Journal of Health Science Research. 2020; 14(2):138-4.</p>
                <p> 6. Wongtanasarasin, W., Srisawang, T., Yothiya, W., &amp; Phinyo, P. (2021). Impact of national lockdown towards emergency department visits and admission rates during the COVID-19 pandemic in Thailand: A hospital-based study. EMA - Emergency Medicine Australasia, 33(2), 316-323&#x2013;323. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1111/1742-6723.13666">https://doi.org/10.1111/1742-6723.13666</ext-link>
                </p>
                <p> 7. Yongthasaneekul, T., &amp; Thammaboosadee, S. (2021). Emotion and Worry Measurement Comparison of United Kingdom and Thailand During The First COVID-19 Lockdown Situation. 2021 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), Bioinformatics and Biomedicine (BIBM), 2021 IEEE International Conference On, 2924&#x2013;2930. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1109/BIBM52615.2021.9669723">https://doi.org/10.1109/BIBM52615.2021.9669723</ext-link>
                </p>
                <p> 8. Hall LR, Sanchez K, Da Graca B, Bennett MM, Powers M, Warren AM. Income Differences and COVID-19: Impact on Daily Life and Mental Health. Popul Health Manag. 2022 Jun 1; 25(3):384&#x2013;91. https://doi.org/10.1089/pop.2021.0214 PMID: 34652228</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0; &#x00a0; &#x00a0; 1.2 we added the information and references on the past studies that have been done in Thailand.</p>
                <p> "Researchers primarily conducted epidemiological studies, descriptive studies, and clinical studies during the crisis response to the pandemic in Thailand (Lerthattasilp, Kosulwit, Phanasathit et al., 2020; Srifuengfung, Thana-udom, Ratta-apha, Chulakadabba,&#x00a0; Sanguanpanich, &amp; Viravan, 2021; Nitchawan, Pantri, Chayut, Yingrat, Nongnuch, &amp; Chotiman , 2022; Suwanbamrung, Pongtalung, Trang, Nam, &amp; Phu, 2023; Phu, 2023). This is quantitative, and the results show the volumes and relationships of factors of all units of analysis in the whole picture. However, qualitative research is needed to provide the nuance, detail, individual problems, and individual needs of COVID-19 patients' lived reality and contextualized experiences to gain more knowledge and deep understanding to design an advanced nursing intervention, medication-taking style, alternative treatment, and psychosocial intervention. The qualitative research results can provide the clinical information for the new or novel ideas of nursing care that meet this target population's needs and problems."</p>
                <p> </p>
                <p> Reference</p>
                <p> 1. Suwanbamrung, C., Pongtalung, P., Trang, L. T. T., Nam, T. T., &amp; Phu, D. H. (2023). Levels and risk factors associated with depression, anxiety, and stress among COVID-19 infected</p>
                <p> adults after hospital discharge in a Southern Province of Thailand. Journal of Public Health</p>
                <p> and Development, 21(1), 72-89&#x2013;89. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.55131/jphd/2023/210106">https://doi.org/10.55131/jphd/2023/210106</ext-link>
                </p>
                <p> 2. Srifuengfung, M., Thana-udom, K., Ratta-apha, W., Chulakadabba, S., Sanguanpanich, N., &amp; Viravan, N. (2021). Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety. Journal of Affective Disorders, 295, 353-365&#x2013;365. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1016/j.jad.2021.%2008.044">https://doi.org/10.1016/j.jad.2021. 08.044</ext-link>.</p>
                <p> 3. Nitchawan Kerdcharoen, Pantri Kirdchok, Chayut Wonglertwisawakorn, Yingrat Naviganuntana, Nongnuch Polruamngern, &amp; Chotiman Chinvararak. (2022). Mental health problems of asymptomatic or mildly symptomatic COVID-19 patients in hospitel in Thailand: A cross-sectional study [version 2; peer review: 2 approved]. F1000Research, 11, 1089. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.12688/f1000research.125998.2">https://doi.org/10.12688/f1000research.125998.2</ext-link>
                </p>
                <p> 4. Lerthattasilp T, Kosulwit K, Phanasathit M, et al., Psychological impacts on patients with COVID-19 in a Thai field hospital. Arch. Clin. Psychiatry. 2020; 47(6): 215&#x2013;217.</p>
                <p> 5. Phu, D. H., Maneerattanasak, S., Shohaimi, S., Trang, L. T. T., Nam, T. T., Suwanbamrung, C., Kuning, M., Like, A., &amp; Torpor, H. (2023). Prevalence and factors associated with long COVID and mental health status among recovered COVID-19 patients in southern Thailand. PLoS ONE, 18(7 July). 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1371/journal.pone.0289382">https://doi.org/10.1371/journal.pone.0289382</ext-link>
                </p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;2. Theoretical framework We apologize for the short description of the manuscript's last version because it related to the APC charge. We have added the suggested content to the manuscript on the theoretical framework parts.&#x00a0;</p>
                <p> "The Roy adaptation model (RAM) applied this study's theoretical framework, which deepened our understanding of the lived experiences and the impact of COVID-19 cases. In addition, applying RAM in nursing research will guide the quality of care and provide data to estimate the results. Moreover, RAM is practical to all areas of nursing and frequently applied in the theoretical framework of qualitative studies of COVID-19 cases (Day&#x0131;lar, Dogan, G&#x00fc;ler, &amp; Carroll, 2022).</p>
                <p> RAM ( Roy, 2001, 2009, 2011) points out that people are adaptive systems defined as a whole and covered of parts that function as a unit; the whole is influenced by surrounding focal, contextual, and residual stimuli (Roy, 2009). People become resilient by adapting to external environments and internal environments of the individual's experience (Roy, 2009). The constant change in the environment stimulates people to drive toward adaptive responses, which consist of a) positive responses to stimuli, which are defined as adaptation results in health, both physical and emotional, and b) negative responses, which are defined as maladaptation results in illness. According to RAM, the nursing goal is to promote four adaptive modes of person, thus contributing to the quality of life and health by assessing behaviors and factors that impact adaptive performance and intervening to increase environmental interactions (Roy, 2009). Contextual, focal, and residual stimuli are three environmental stimuli that impact adaptation (Roy, 2009, 2011a). While the focal stimulus is the internal or external stimulus that most impacts and directs an individual's attention, a contextual stimulus is the internal or external impetus affecting the situation, contributing to the behavior triggered by the focal stimulus (Roy, 2009, 2011a). Contextual stimuli are inferred from a person's events, stressful life events, or illness processes. Residual stimuli are stimuli that are in a person's internal or external environment. Residual stimuli become contextual or focal once they have been validated by the person experiencing the impact of the stimulus. The adaptive and stimuli are primary elements of understanding individual COVID-19 cases, their adaptation, and their life strategies for enhancing adaptation."</p>
                <p> Reference</p>
                <p> 1. Day&#x0131;lar Candan H, Dogan S, G&#x00fc;ler C, Carroll K. Roy adaptation model: theory-based</p>
                <p> knowledge and nursing care with a person experiencing COVID-19. Nurs Sci Q. 2022; 35(3): 304-310. doi:10.1177/08943184221092434</p>
                <p> 2. Roy C. (2011a). Research based on the Roy adaptation model: Last 25 years. Nursing Science</p>
                <p> Quarterly, 24(4), 312-320. https://doi.org/10.1177/0894318411419218</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;3. MethodsWe added more detail of the Roy Adaptation Model in the theoretical framework. Stressful life events, adaptation, and emotions were also mentioned. Additionally, we added the Trustworthiness of the study as the content below:</p>
                <p> To ensure data trustworthiness, phenomenological methods such as reflexivity, member checking, and auditing are often among the most highly used procedures to maximize trustworthiness. Member reflections instead of traditional member checking and incorporated peer debriefing to ensure rigor in interpretative qualitative research were used. Feedback and reflections are participant validation of results and an opportunity for further elaboration of findings from participants in the co-construction of the phenomenon with the authors (Flynn &amp; Korcuska, 2018; Smith &amp; McGannon, 2018). Member reflections were primarily incorporated upon completion of the study analysis. All participants were contacted via phone and joined a Microsoft Teams discussion of the summary of the findings.</p>
                <p> The authors conducted peer debriefing (Smith &amp; McGannon, 2018) to process the study. The construction of knowledge through critical feedback that encouraged reflection upon and investigation of alternative interpretations emerging from the data was the peer debriefing process that included data collection or analysis and aided in probing the thinking around the research process and analysis (Given, 2008) as weekly during data collection and monthly during data analysis and interpretation.</p>
                <p> &#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0; The trail of the audit was established as initial notes; step-by-step methods for recruitment, data collection, and analysis; annotated transcripts; tables of themes that developed; the final report; and all field notes (J.A. Smith et al., 2022; J. Smith et al., 2009). Field notes recorded details of what was seen, heard, thought, and experienced throughout data collection (Groenewald, 2004). Field notes were divided into four categories, each in separate files. The first was the Interview environment and atmosphere, i.e., objective recordings of what happened, who was involved, what activities occurred, and what was seen or heard. The second was the behavior and the data from the participants. For this process, the notes were recorded immediately after the conclusion of each data collection session. In these notes, the first author documented reflections on personal experiences related to the data and attempts to derive meaning through reflection on the data. The third was obstacles encountered in interviews. The fourth was the planning for the following interview. The final file contained research notes summarizing procedures, events, and study progress.</p>
                <p> Reference</p>
                <p> 1. Flynn SV, Korcuska JS. Credible Phenomenological Research: A Mixed&#x2010;Methods Study. Couns</p>
                <p> &#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0;&#x00a0; Educ Superv. 2018; doi.org/10.1002/ceas.12092.2</p>
                <p> 2. Smith B, McGannon KR. Developing rigor in qualitative research: problems and opportunities</p>
                <p> within sport and exercise psychology. Int Rev Sport Exerc Psychol. 2018; doi.org/10.1080/1750984x.2017.1317357.</p>
                <p> 3. Given LM. The SAGE Encyclopedia of Qualitative Research Methods. SAGE Publications, Inc. eBooks. 2008; doi.org/10.4135/9781412963909.</p>
                <p> 4. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological analysis: Theory, Method and</p>
                <p> Research. SAGE; 2022.</p>
                <p> 5. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological analysis: Theory, Method and</p>
                <p> Research. SAGE Publications; 2009.</p>
                <p> </p>
                <p> &#x00a0; &#x00a0; &#x00a0;6.&#x00a0;Results We added the results found about the respondents' Self-Understanding below:</p>
                <p> "All participants show physical survival during the interview. The participant has a low level of psychic integrity. They have stress, fear, anxiety, communication problems, sleep problems, and poor decision-making. Some of them have no job or have lost a job. However, they receive social support from significant others and health care providers."</p>
            </body>
        </sub-article>
        <sub-article article-type="response" id="comment13828-209257">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>30</day>
                    <month>4</month>
                    <year>2025</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Thank you for your feedback and for taking the time to review our manuscript. We appreciate your insights and recognize the importance of methodological consistency in qualitative research.</p>
                <p> </p>
                <p> In this revised version, we have taken additional steps to clarify the methodology used in our study. Specifically, we employed a phenomenological-hermeneutic approach to analyze the lived experiences of our participants.</p>
                <p> </p>
                <p> Our data analysis adhered to Smith and Osborn's (2015) Interpretative Phenomenological Analysis (IPA) framework. This process involved an iterative cycle of coding that progressed from descriptive to interpretative engagement, ensuring that emergent themes were grounded in participants' lived experiences. We employed bracketing techniques to minimize researcher bias and utilized double-coding verification to enhance reliability. The initial codes were generated based on descriptive responses, then refined through interpretative layers to derive emergent themes, ensuring alignment with IPA principles.</p>
                <p> </p>
                <p> Regarding methodological rigor, we have provided more explicit details on the data analysis process, including the use of COREQ guidelines to enhance transparency. Additionally, we have improved the explanation of quality criteria and ensured that our approach maintains consistency in its application.</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report193387">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.140098.r193387</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Kin</surname>
                        <given-names>Cheah Phaik</given-names>
                    </name>
                    <xref ref-type="aff" rid="r193387a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-2615-5217</uri>
                </contrib>
                <aff id="r193387a1">
                    <label>1</label>Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman, Petaling Jaya, Selangor, Malaysia</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>7</day>
                <month>8</month>
                <year>2023</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2023 Kin CP</copyright-statement>
                <copyright-year>2023</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport193387" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>
                <list list-type="order">
                    <list-item>
                        <p>Because this study was done in Thailand, it is helpful to describe the situation there during the pandemic to help readers understand the context in which this study was based.</p>
                    </list-item>
                    <list-item>
                        <p>The knowledge gap needs to be further established and supported to justify the need for this investigation and the significance of this study. 
                            <list list-type="order">
                                <list-item>
                                    <p>It is important that the researchers provide support for this statement -&#x00a0;"Besides, a few studies have explored the needs of COVID-19 cases, their stress and adaptation to the disease, and health support."</p>
                                </list-item>
                                <list-item>
                                    <p>In this regard, it would also be appropriate to refer to past studies that have been done in Thailand, as well as in other countries to establish the need to conduct this investigation and fill this knowledge gap.</p>
                                </list-item>
                            </list> </p>
                    </list-item>
                    <list-item>
                        <p>Theoretical framework -&#x00a0;While it is helpful to use a theoretical framework to guide this work, the researchers need to explain how this model is not stifling this study that uses qualitative methods, ensuring that it does not limit creativity or the exploration of alternative perspectives, but rather enhances understanding and provides a structured approach to the research.&#x00a0;</p>
                    </list-item>
                    <list-item>
                        <p>Methods 
                            <list list-type="order">
                                <list-item>
                                    <p>In the same vein (ie. No. 3), please explain how the interview questions were developed.&#x00a0;</p>
                                </list-item>
                                <list-item>
                                    <p>This statement can be rephrased to make it clearer. Does it also mean that the authors have designed the interview questions by drawing upon the instrument/findings from these studies? - "The phenomenological-hermeneutic approach was applied through discussions after examining and interpreting lived experiences and perceptions related to the COVID-19 pandemic (
                                        <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/my/referee/report/193387#ref1">Al Kalaldeh&#x00a0;
                                            <italic>et al.,</italic>&#x00a0;2018</ext-link>;&#x00a0;
                                        <ext-link ext-link-type="uri" xlink:href="https://f1000research.com/my/referee/report/193387#ref8">Graor &amp; Knapik, 2013</ext-link>; Kvale &amp; Brinkmann, 2014)."&#x00a0;</p>
                                </list-item>
                                <list-item>
                                    <p>"Ethical approval was obtained from the Ethics Review Committee for Research Involving Human Research Participants (COA No. 119/2563)" - Please state more specifically which committee this refers to e.g. the University of ???&#x00a0;Ethics Review Committee for Research Involving Human Research Participants&#x00a0;</p>
                                </list-item>
                                <list-item>
                                    <p>Please state when these interviews were carried out as this is a cross-sectional study.</p>
                                </list-item>
                                <list-item>
                                    <p>Please describe how the authors ensured data trustworthiness.</p>
                                </list-item>
                                <list-item>
                                    <p>Please provide support and justification for the data analysis methods employed.</p>
                                </list-item>
                            </list> </p>
                    </list-item>
                    <list-item>
                        <p>Results 
                            <list list-type="order">
                                <list-item>
                                    <p>Table 1 - The marital status "Couple" means living with a partner or married?</p>
                                </list-item>
                                <list-item>
                                    <p>Level 1 - It would be helpful to describe the results found about the respondents Self-Understanding.</p>
                                </list-item>
                                <list-item>
                                    <p>Is Figure 1 showing the results of this study? What does this statement mean - "Apply from Roy, 2011"? There may be a typo or grammatical mistake here.</p>
                                </list-item>
                                <list-item>
                                    <p>It is not clear why the Results of the analysis are labelled as "Level". This is not a conventional way to report the results of a qualitative study. Labelling each theme/category as a "level" indicates a hierarchy. Is this the intention, if so, the hierarchy is not clear.</p>
                                </list-item>
                                <list-item>
                                    <p>The sub-themes in Leval 2 appears confusing. From the formatting of the paper, it appears that within "Level 2: Structural understanding", there are Stress; Economic and Social Impact; Social Stigma; Social Support; Sometimes, bad luck brings good luck. Are these sub-themes all of the same level sub-themes under "Level 2"? Or are some of them of a third level sub-theme?&#x00a0;</p>
                                </list-item>
                            </list> </p>
                    </list-item>
                </list> Overall, while the purpose of this paper is rationale and very necessary, this paper lacks the scientific rigour. I would recommend a resubmission.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Partly</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>No</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Partly</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Public Health, education, policing</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment10141-193387">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>31</day>
                    <month>8</month>
                    <year>2023</year>
                </pub-date>
            </front-stub>
            <body>
                <p>This version has addressed reviewer 2's comments by: 
                    <list list-type="order">
                        <list-item>
                            <p>Adding the statement of the situation during the COVID-19 pandemic in Thailand,</p>
                        </list-item>
                        <list-item>
                            <p>the gap of knowledge was address and citation</p>
                        </list-item>
                        <list-item>
                            <p>Adding an explanation of how the interview questions were developed.&#x00a0;</p>
                        </list-item>
                        <list-item>
                            <p>rephrased the statement to make it clearer on the part of procedure</p>
                        </list-item>
                        <list-item>
                            <p>Added the state of the Ethics Review Committee&#x2019;s institution</p>
                        </list-item>
                        <list-item>
                            <p>Trustworthiness was describing</p>
                        </list-item>
                        <list-item>
                            <p>The IPA analysis methods were employed</p>
                        </list-item>
                        <list-item>
                            <p>Table 1 - The marital status "Couple" means living with a partner and/or married.</p>
                        </list-item>
                    </list>
                </p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report175113">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.140098.r175113</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Srichannil</surname>
                        <given-names>Chomphunut</given-names>
                    </name>
                    <xref ref-type="aff" rid="r175113a1">1</xref>
                    <role>Referee</role>
                </contrib>
                <aff id="r175113a1">
                    <label>1</label>Department of Psychology, Chulalongkorn University, Bangkok, Bangkok, Thailand</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>20</day>
                <month>6</month>
                <year>2023</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2023 Srichannil C</copyright-statement>
                <copyright-year>2023</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport175113" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.127578.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve-with-reservations</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>This study used online interviews to explore the lived experiences of 15 COVID-19 survivors, focusing on the impact of COVID-19.&#x00a0;</p>
            <p> </p>
            <p> Data Collection</p>
            <p> </p>
            <p> Data saturation was mentioned, but it is not clear how saturation was reached. Indeed, the question should also be extended to &#x201c;Is data saturation required for using phenomenological-hermeneutic approach?&#x201d;</p>
            <p> </p>
            <p> In terms of recording online video interviews, there should be more information regarding how the issues of confidentiality, data storage, and data safety&#x00a0;have been addressed.&#x00a0;</p>
            <p> </p>
            <p> Data Analysis&#x00a0;</p>
            <p> </p>
            <p> There is an inconsistency in mentioning the use of the methods for analyzing the data in the abstract and other sections. Specifically, in the abstract, the authors stated that &#x201c;using a phenomenological-hermeneutic approach. We used the thematic analysis technique to analyze the data&#x201d;. (The use of &#x201c;thematic analysis technique&#x201d; could also be confused with Thematic Analysis, a range of methods for qualitative data analysis). In the data analysis section, only the phenomenological-hermeneutic approach was stated (Here a citation to &#x201c;Kvale &amp; Brinkmann, 2014&#x201d; was claimed, but this was not on the reference list). However, content analysis was also mentioned in the result section when the authors wrote &#x201c;Major themes derived from content analysis were evident across interviews&#x201d;. The question is thus what is the data analysis method used in the study?&#x00a0;Additionally, the word &#x201c;structural understanding&#x201d; appeared to be redundant in the second and third levels. Please check for accuracy.&#x00a0;</p>
            <p> </p>
            <p> Results&#x00a0;</p>
            <p> It appears that the results were fairly descriptive, mostly done by presenting (translated) quotes from the participants. With the use of the phenomenological-hermeneutic approach, interpretation should be more widely incorporated in the results.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Not applicable</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>No source data required</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>No</p>
            <p>Reviewer Expertise:</p>
            <p>Counseling Psychology</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment10142-175113">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Imkome</surname>
                            <given-names>Ek-uma</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>31</day>
                    <month>8</month>
                    <year>2023</year>
                </pub-date>
            </front-stub>
            <body>
                <p>To respond to the reviewer's comments on Data Collection.</p>
                <p> </p>
                <p> We added the sentence &#x201c;the saturation was reached when no additional data were found&#x201d; on the part of data collection. Additionally, we had to add more information regarding how the issues of confidentiality, data storage, and data safety have been addressed on the part of consent. We have updated Kvale &amp; Brinkmann, 2014 as the reference, and The IPA analysis methods were added.</p>
                <p> </p>
                <p> We removed the redundant &#x201c;structural understanding&#x201d; in the second and third levels for the results&#x00a0;and corrected it for the data analysis part.</p>
            </body>
        </sub-article>
    </sub-article>
</article>
