{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:09:26Z","timestamp":1790687366369,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>A substantial number of patients report persisting symptoms after a COVID-19 infection: so-called post-COVID-19 syndrome. There is limited research on patients\u2019 perspectives on post-COVID-19 symptoms and ways to recover. This qualitative study explored the illness perceptions and recovery strategies of patients who had been hospitalised for COVID-19. Differences between recovered and non-recovered patients were investigated. Semi-structured in-depth interviews were held with 24 participating patients (8 recovered and 16 non-recovered) 7 to 12 months after hospital discharge. Data were interpreted using reflexive thematic analysis. Four overarching themes were identified: (I) symptoms after hospital discharge; (II) impact of COVID-19 on daily life and self-identity; (III) uncertainty about COVID-19; and (IV) dealing with COVID-19. Formerly hospitalised post-COVID-19 patients seem to have difficulties with making sense of their illness and gaining control over their recovery. The majority of non-recovered participants continue to suffer mostly from weakness or fatigue, dyspnoea and cognitive dysfunction. No notable differences in illness beliefs were observed between recovered and non-recovered participants<\/jats:p>","DOI":"10.3390\/ijerph192013003","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T22:18:13Z","timestamp":1665526693000},"page":"13003","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["\u201cIt Really Is an Elusive Illness\u201d\u2014Post-COVID-19 Illness Perceptions and Recovery Strategies: A Thematic Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4710-2971","authenticated-orcid":false,"given":"Gerko","family":"Schaap","sequence":"first","affiliation":[{"name":"Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5306-097X","authenticated-orcid":false,"given":"Marleen","family":"Wensink","sequence":"additional","affiliation":[{"name":"Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4766-4333","authenticated-orcid":false,"given":"Carine J. M.","family":"Doggen","sequence":"additional","affiliation":[{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands"},{"name":"Clinical Research Centre, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job","family":"van der Palen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands"},{"name":"Section Cognition, Data and Education, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald E.","family":"Vonkeman","sequence":"additional","affiliation":[{"name":"Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands"},{"name":"Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Bode","sequence":"additional","affiliation":[{"name":"Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Taquet, M., Dercon, Q., Luciano, S., Geddes, J.R., Husain, M., and Harrison, P.J. (2021). Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med., 18.","DOI":"10.1371\/journal.pmed.1003773"},{"key":"ref_2","unstructured":"Office for National Statistics (2022, May 23). Prevalence of Ongoing Symptoms Following Coronavirus (COVID-19) Infection in the UK, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/bulletins\/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk\/6may2022."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.arcmed.2021.03.010","article-title":"Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals","volume":"52","author":"Pavli","year":"2021","journal-title":"Arch. Med. Res."},{"key":"ref_4","unstructured":"World Health Organisation (2021). A Clinical Case Definition of Post COVID-19 Condition by a Delphi Consensus."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16144","DOI":"10.1038\/s41598-021-95565-8","article-title":"More than 50 Long-term effects of COVID-19: A systematic review and meta-analysis","volume":"11","author":"Perelman","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/jmv.27309","article-title":"Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)\u2014A systematic review and meta-analysis","volume":"94","author":"Malik","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e005427","DOI":"10.1136\/bmjgh-2021-005427","article-title":"Characterising long COVID: A living systematic review","volume":"6","author":"Michelen","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"De Sire, A., Moggio, L., Marotta, N., Agostini, F., Tasselli, A., Drago Ferrante, V., Curci, C., Calafiore, D., Ferraro, F., and Bernetti, A. (2022). Impact of Rehabilitation on Fatigue in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis. Appl. Sci., 12.","DOI":"10.3390\/app12178593"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s10865-016-9782-2","article-title":"The Common-Sense Model of Self-Regulation (CSM): A dynamic framework for understanding illness self-management","volume":"39","author":"Leventhal","year":"2016","journal-title":"J. Behav. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.2147\/COPD.S109227","article-title":"Illness perceptions and coping determine quality of life in COPD patients","volume":"11","author":"Tiemensma","year":"2016","journal-title":"Int. J. COPD"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1177\/1049732311413781","article-title":"An Illness Perception Model of Primary Care Patients\u2019 Help Seeking for Depression","volume":"21","author":"Elwy","year":"2011","journal-title":"Qual. Health Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Corbett, T., Groarke, A.M., Walsh, J.C., and McGuire, B.E. (2016). Cancer-related fatigue in post-treatment cancer survivors: Application of the common sense model of illness representations. BMC Cancer, 16.","DOI":"10.1186\/s12885-016-2907-8"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rivera, E., Corte, C., Steffen, A., DeVon, H.A., Collins, E.G., and McCabe, P.J. (2018). Illness representation and self-care ability in older adults with chronic disease. Geriatrics, 3.","DOI":"10.3390\/geriatrics3030045"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e001075","DOI":"10.1136\/bmjresp-2021-001075","article-title":"Patient symptoms and experience following COVID-19: Results from a UK-wide survey","volume":"8","author":"Buttery","year":"2021","journal-title":"BMJ Open Respir. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101143","DOI":"10.3399\/bjgpopen20X101143","article-title":"Finding the \u2018right\u2019 GP: A qualitative study of the experiences of people with long-COVID","volume":"4","author":"Kingstone","year":"2020","journal-title":"BJGP Open"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ladds, E., Rushforth, A., Wieringa, S., Taylor, S., Rayner, C., Husain, L., and Greenhalgh, T. (2020). Persistent symptoms after COVID-19: Qualitative study of 114 \u201clong COVID\u201d patients and draft quality principles for services. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-06001-y"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/S0895-4356(98)00097-3","article-title":"Translation, Validation, and Norming of the Dutch Language Version of the SF-36 Health Survey in Community and Chronic Disease Populations","volume":"51","author":"Aaronson","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Braun, V., and Clarke, V. (2012). Thematic analysis. APA Handbook of Research Methods in Psychology: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological, American Psychological Association.","DOI":"10.1037\/13620-004"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jpsychores.2019.03.185","article-title":"Explaining the long-term impact of chronic Q fever and Q fever fatigue syndrome on psychosocial functioning: A comparison with diabetes and the general population","volume":"121","author":"Reukers","year":"2019","journal-title":"J. Psychosom. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/j.pec.2019.04.016","article-title":"\u201cUnderstand your illness and your needs\u201d: Assessment-informed patient education for people with multiple functional somatic syndromes","volume":"102","author":"Holsting","year":"2019","journal-title":"Patient Educ. Couns."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e056366","DOI":"10.1136\/bmjopen-2021-056366","article-title":"\u2018I can\u2019t cope with multiple inputs\u2019: A qualitative study of the lived experience of \u2018brain fog\u2019 after COVID-19","volume":"12","author":"Callan","year":"2022","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Schiavi, M., Fugazzaro, S., Bertolini, A., Denti, M., Mainini, C., Accogli, M.A., Bedogni, G., Ghizzoni, D., Esseroukh, O., and Gualdi, C. (2022). \u201cLike before, but not exactly\u201d: The Qualy-REACT qualitative inquiry into the lived experience of long COVID. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13035-w"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e18325","DOI":"10.2196\/18325","article-title":"Cognitive bias modification training to improve implicit vitality in patients with breast cancer: App design using a cocreation approach","volume":"5","author":"Wolbers","year":"2021","journal-title":"JMIR Form. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"110715","DOI":"10.1016\/j.jpsychores.2021.110715","article-title":"Stigma perceived by patients with functional somatic syndromes and its effect on health outcomes\u2014A systematic review","volume":"154","author":"Ko","year":"2022","journal-title":"J. Psychosom. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0738-3991(03)00105-8","article-title":"Constructions of chronic pain in doctor\u2013patient relationships: Bridging the communication chasm","volume":"52","author":"Kenny","year":"2004","journal-title":"Patient Educ. Couns."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1177\/1049732315619380","article-title":"Living in Limbo: Contested Narratives of Patients with Chronic Symptoms Following Lyme Disease","volume":"27","author":"Rebman","year":"2017","journal-title":"Qual. Health Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.pec.2010.05.027","article-title":"Finding the right balance of physical activity: A focus group study about experiences among patients with chronic fatigue syndrome","volume":"83","author":"Larun","year":"2011","journal-title":"Patient Educ. Couns."},{"key":"ref_28","first-page":"463","article-title":"Psychological control is a key modulator of fibromyalgia symptoms and comorbidities","volume":"5","author":"Malin","year":"2012","journal-title":"J. Pain Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e047632","DOI":"10.1136\/bmjopen-2020-047632","article-title":"Long COVID and the role of physical activity: A qualitative study","volume":"11","author":"Humphreys","year":"2021","journal-title":"BMJ Open"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Bhogal, J.K., Mills, F., Dennis, A., Spoiala, C., Milward, J., Saeed, S., Jones, L.F., Weston, D., and Carter, H. (2022). The Effects of Messaging on Expectations and Understanding of Long COVID: An Online Randomised Trial. medRxiv.","DOI":"10.1101\/2022.01.18.22269467"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101019","DOI":"10.1016\/j.eclinm.2021.101019","article-title":"Characterizing long COVID in an international cohort: 7 months of symptoms and their impact","volume":"38","author":"Davis","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"pzac005","DOI":"10.1093\/ptj\/pzac005","article-title":"Chronic Fatigue and Postexertional Malaise in People Living with Long COVID: An Observational Study","volume":"102","author":"Twomey","year":"2022","journal-title":"Physical Therapy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2519\/jospt.2021.0106","article-title":"Humility and Acceptance: Working Within Our Limits With Long COVID and Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"51","author":"Gaboury","year":"2021","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/08964289.2018.1517242","article-title":"Optimism and the Experience of Pain: A Systematic Review","volume":"45","author":"Peters","year":"2019","journal-title":"Behav. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"611.e9","DOI":"10.1016\/j.cmi.2021.11.002","article-title":"Female gender is associated with long COVID syndrome: A prospective cohort study","volume":"28","author":"Bai","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"834354","DOI":"10.3389\/fmed.2022.834354","article-title":"Patient-Reported Symptoms and Sequelae 12 Months After COVID-19 in Hospitalized Adults: A Multicenter Long-Term Follow-Up Study","volume":"9","author":"Comelli","year":"2022","journal-title":"Front. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Tleyjeh, I.M., Saddik, B., AlSwaidan, N., AlAnazi, A., Ramakrishnan, R.K., Alhazmi, D., Aloufi, A., AlSumait, F., Berbari, E., and Halwani, R. (2021). Prevalence and predictors of Post-Acute COVID-19 Syndrome (PACS) after hospital discharge: A cohort study with 4 months median follow-up. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0260568"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2223","DOI":"10.1002\/rmv.2223","article-title":"Sex-based differences in severity and mortality in COVID-19","volume":"31","author":"Alwani","year":"2021","journal-title":"Rev. Med. Virol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s40618-020-01383-6","article-title":"Gender susceptibility to COVID-19: A review of the putative role of sex hormones and X chromosome","volume":"44","author":"Foresta","year":"2021","journal-title":"J. Endocrinol. Investig."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13003\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:49:46Z","timestamp":1760143786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,11]]},"references-count":39,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013003"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013003","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,11]]}}}