En Route to Recovery: Diversity and vulnerability in care work during and after the COVID-19 pandemic
Lead Research Organisation:
King's College London
Department Name: Social Science, Health and Medicine
Abstract
The COVID-19 pandemic has placed unprecedented strains on formal and informal care work, worldwide. Paradoxically, the pandemic created new jobs and possibilities in care work, but the jobs remain physically and mentally strenuous, low paid, and often with fixed term, precarious contracts and high turnover rates. These jobs present significant health risks for workers, given the potential to contract and spread the virus.
Our project will focus on employees performing vital COVID-19 related jobs: providing individual care to vulnerable clients in both organisational and home settings. We will examine how diverse people (in Finland, Canada, Scotland/UK and South Africa) who work/have worked in formal and informal care address challenges by collaboratively examining their ideas to ease risks and develop opportunities to deliver and receive care.
Specifically, we will analyse how care workers in precarious positions (women, LGBTI2S people, and migrant status or minority ethnic people) are experiencing COVID-19 crises in their work, and how they see a post-pandemic future. Our research is based on the United Nations (UN) research recovery roadmap and this Call's focus on reducing inequalities and vulnerabilities, and building a resilient, inclusive, and sustainable society. We will apply both quantitative and innovative qualitative methods to investigate how care sector workers have experienced the pandemic and how they see their post-pandemic times at work.
Research participants will explore their working lives during and after the pandemic. We will conduct a cross-cultural narrative analysis with an intersectionality approach using longitudinal participatory methods (photovoice and soundsourcing). This information will be supplemented with a systematic literature review and secondary data. In collaboration with stakeholders, we will develop policy recommendations and share good practices with institutions and services responsible for care workers. Our collaborative approach with all stakeholders will provide sustainable suggestions and policy recommendations that should have worldwide application.
Our project will focus on employees performing vital COVID-19 related jobs: providing individual care to vulnerable clients in both organisational and home settings. We will examine how diverse people (in Finland, Canada, Scotland/UK and South Africa) who work/have worked in formal and informal care address challenges by collaboratively examining their ideas to ease risks and develop opportunities to deliver and receive care.
Specifically, we will analyse how care workers in precarious positions (women, LGBTI2S people, and migrant status or minority ethnic people) are experiencing COVID-19 crises in their work, and how they see a post-pandemic future. Our research is based on the United Nations (UN) research recovery roadmap and this Call's focus on reducing inequalities and vulnerabilities, and building a resilient, inclusive, and sustainable society. We will apply both quantitative and innovative qualitative methods to investigate how care sector workers have experienced the pandemic and how they see their post-pandemic times at work.
Research participants will explore their working lives during and after the pandemic. We will conduct a cross-cultural narrative analysis with an intersectionality approach using longitudinal participatory methods (photovoice and soundsourcing). This information will be supplemented with a systematic literature review and secondary data. In collaboration with stakeholders, we will develop policy recommendations and share good practices with institutions and services responsible for care workers. Our collaborative approach with all stakeholders will provide sustainable suggestions and policy recommendations that should have worldwide application.
| Title | Capturing moments from What's Next Symposium |
| Description | Capturing moments with the panel, speakers, and audience using photography to bring live to the event. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2024 |
| Impact | Building continued interest in the Symposium and key people within audience asking "What's next" in terms of further engagement either through digital or in person. |
| Title | Care Stories |
| Description | Working with a graphic designer, we produced an illustrated policy briefing paper around the low or no cost ways to improve retention from the perspective of the workforce. These images highlight core findings and experiences captured through our data collection, and then both individual and group images were created and put throughout the briefing paper. We also produced a research poster template, flyer and postcard using the images to summarise our key messages. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2025 |
| Impact | The briefing paper was published by KCL, summarised in various blogs and will be shared widely by other national organisations including Scottish Care. Postcards and flyers are being distributed amongst care homes and care organisations, including those who participated in data collection and contributed to the ethnographic fieldwork. We will also continue to work with the graphic designer, KS, on other projects due to the highly positive experience and feedback we got on the illustrations and style. |
| URL | https://www.kcl.ac.uk/ghsm/assets/care-stories-policy-briefing-paper.pdf |
| Title | Developing new perspectives on researching care work |
| Description | Poster and interactive cartoons |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2024 |
| Impact | Care homes (n=6) participated in co-design workshops (n=6). Running the workshops showed that: (1) interdisciplinary collaborations are fruitful but time is needed for a consolidation of shared understanding (2) building trust is essential to research (3) qualitative research can produce useful and actionable messages for all stakeholders, (4) time is needed for cross sectoral and cross discipline conversations on our problem statements and (5) Participatory approaches are high-yielding. We have developed two impact projects from this work on Care Stories https://www.kcl.ac.uk/ghsm/assets/care-stories-policy-briefing-paper.pdf and Time for Quality Care https://www.kcl.ac.uk/creating-more-time-for-quality-care |
| URL | https://www.kcl.ac.uk/research/healthier-working-lives-for-the-care-workforce |
| Title | Poster for Recruitment Campaign |
| Description | Poster was created to attract interest in care homes to take part in the Research. |
| Type Of Art | Artwork |
| Year Produced | 2023 |
| Impact | Helped recruit a number of workers to take part in Research and helped bring awareness to the Research project |
| Title | Research Poster - Advanced Care Research Centre (ACRC) |
| Description | Research poster briefly detailing the aims, methodology, and outcomes of the project to present at the ACRC symposium. Main focus will be current key findings around the devaluation of the care workforce; how to recruit to retain staff, and retain staff in order to aid recruitment; and the potential for collaborative, participatory research to better connect policy makers and the workforce and create more sustainable impact. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2024 |
| Impact | Impacts will be the design and production of the poster, which will be both a physical and digital artefact, which will be used at the ACRC symposium - to network with relevant individuals, as well as spark discussion around the project outcomes and "what next" for research in the domiciliary care sector |
| Title | Valuing Caring: Domiciliary Care Work in England's 'Care Crisis' during and post Covid-19 |
| Description | Poster to generate conversations |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2024 |
| Impact | Generated conversations which subsequently underpinned the development of our impact project policy and practice changes to support the over 50s working in residential and domiciliary care; Creating more time for quality care https://www.kcl.ac.uk/creating-more-time-for-quality-care |
| URL | https://www.kcl.ac.uk/research/healthier-working-lives-for-the-care-workforce |
| Title | Wales Direct Poster was created to attract interest in care to take part in the Research. Presented in Welsh to appeal to the local community. |
| Description | Bought interest to the local community in Wales and poster was eye catching to attract audience. |
| Type Of Art | Artwork |
| Year Produced | 2023 |
| Impact | Helped drove interest to take part in the research project using QR Codes. |
| Description | This Transatlantic-Partnership grant involved collaboration between teams in the UK, Finland, South Africa and Canada (funded by Canada, SSHRC, Finland, AoF, South Africa, UK, ESRC) examining the experiences of care workers during and after the Covid pandemic. We showed substantial similarities between the experiences of care workers of differing types in these contrasting socio-economic environments. In all four countries the care workforce: is strongly feminised; is low paid; of low social status; has poor career opportunities; faces problems of recruitment and retention; experiences racial discrimination. Nevertheless, care workers' show strong commitment to caring for their clients. An edited book has brought together the findings of all the teams Bowlby, S. et al (2025) Vulnerabilities In Paid Care Work: Trans-national experiences, insights and voices, Bristol: Policy Press The ESRC funded UK team explored how the low social valuation of care work and care workers manifests in low pay, the low status of care work, the low self-esteem of many care workers and the apparent low salience of national and local social care policy. These characteristics lead to multifaceted problems for workers, care managers and owners of care businesses • Care workers felt their contribution during Covid had been forgotten and were frustrated at the undervaluing of care work and care workers by society, government, policy-makers and even some care organisation owners. Low pay created acute problems for many. • Managers experienced poor retention, difficulties in recruitment and in ability to invest We identified the need for employers to focus on retention as a key means of lowering high workforce turnover and vacancy rates and improving recruitment. While improvements in pay are needed, we identified several no or low-cost ways of improving retention. Drawing upon this and related projects we developed the Care Stories webpage and PDF to inform employers and workers of low and no costs ways to retain and recruit staff https://www.kcl.ac.uk/ghsm/assets/care-stories-policy-briefing-paper.pdf. This is further explained at https://www.kcl.ac.uk/overview-of-care-stories. New or improved research methods or skills developed: The UK and Canadian teams piloted the 'Photovoice' method: selected care workers use smartphones to send short diary notes and/or pictures reflecting their experiences over a two month period. We showed that the method yields insights into the immediate emotional and practical experiences of individual care workers over time and place. The experience with this method has enabled its improved use in a research project developed out of the T-AP by Bawn (UK team) and Sanderson (Canadian team) and funded by the British Academy. New research areas: Evidence from this study and from Healthier Working Lives for the Care Workforce, also led by McKie, emphasises the need to focus on care worker retention. Better retention leads to better recruitment and a virtuous cycle. There is a need for further focussed research on retention: o using digital innovations to cut the time care workers spend on paper work; o better management; o improving training and career structure; o identifying how wider health and welfare policy can improve retention Particularly noteworthy new research networks/collaborations/partnerships: As noted, Bawn and Sanderson are collaborating on a new British Academy Grant, building on the TA-P research examining the impact of digitisation on other low paid sectors. We have also extended the TA-P network to include German and Dutch researchers and have planned a 2-day workshop aiming to submit research bids on care worker retention and AI/digitisation innovations to UK, European and Canadian funders. |
| Exploitation Route | Through two impact projects: - Care Stories which is completed and can be accessed on the webpage https://www.kcl.ac.uk/ghsm/assets/care-stories-policy-briefing-paper.pdf. Time for Quality Care. As we move into 2025 we have secured funding for an impact project Time for Quality Care which will bring together workers, employers and relevant organisations: https://www.kcl.ac.uk/creating-more-time-for-quality-care |
| Sectors | Education Healthcare Government Democracy and Justice |
| Description | Our research aims to advance care providers' practices by providing ideas for improvement to practitioners and policy makers, thus enhancing the effectiveness of public services and policy, and the quality of life and health of both care workers and clients. A first step has been the publication of a book bringing together the work of our four teams from the UK, Finland, South Africa and Canada: Bowlby, S. et al (2025) Vulnerabilities In Paid Care Work: Trans-national experiences, insights and voices, Bristol: Policy Press. As a Policy Press Short - a series aimed at policy impact - the book addresses an international audience of practitioners and policy makers. We have also brought together these findings with those from Healthier Working Lives for the Care Workforce, also led by McKie, in fashioning two interventions funded by Impact Grants: 1. Care Stories: We have developed an illustrated briefing paper being disseminated online. This outlines how managers can improve retention and encourage care workers to participate in designing improved working practices. This paper is being disseminated through the extensive networks we have established with care practitioners and policy makers. Dissemination has just begun so it would be premature to report on the reception of these ideas. This has been funded by King's College London Impact Award. 2. More Time for Quality Care: We are leading a workshop on 28th March 2025 funded via Kings College, by an ESRC Impact Grant . With a select group of up to 35 care managers, policy makers and practitioners/stakeholders, we will present our findings and debate ways of making innovations in care work to give care workers 'more time for quality care giving'. This is funded by the Social Science and Public Policy Impact Award Fund. |
| First Year Of Impact | 2024 |
| Sector | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
| Impact Types | Societal Policy & public services |
| Description | Faculty Research and Impact Fund 2022 |
| Amount | £9,998 (GBP) |
| Organisation | King's College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 12/2022 |
| End | 08/2023 |
| Description | Faculty Social Science Impact Fund |
| Amount | £12,323 (GBP) |
| Organisation | King's College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 08/2024 |
| End | 09/2025 |
| Description | King's College London: - Faculty Research and Impact Fund 2023 (£ 4998.61; 2023 - 2024) |
| Amount | £4,998 (GBP) |
| Organisation | King's College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 12/2023 |
| End | 07/2024 |
| Description | Marginalised Women at Risk: Experiences and Impacts of Hyper-precarity and the Growth of Digitisation and AI in rural communities |
| Amount | £299,994 (GBP) |
| Funding ID | KF8/230185 |
| Organisation | The British Academy |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 03/2024 |
| End | 04/2026 |
| Title | Care Stories: Illustrated Analysis |
| Description | We worked collaboratively with graphic designer KS, post-doctoral researchers and communications specialists to conduct secondary analysis of ethnographic data in a collaborative, visual way that could be turned into digital illustrations and illustrate key findings and impacts. Using a shared google drive and 'real-time' miro board, the team contributed various documents, images, mood-boards and examples of work which was filtered down, discussed and analysed over a series of months and eventually combined into one collaborative document (an illusrated policy briefing paper summary) and multiple individual images. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | As well as the shared digital miro board and various design mood boards documenting our shared process, we produced an illustrated policy briefing paper, summary flyers and postcards of key findings, and individual visuals which have been used in various social media posts and blogs. |
| URL | https://www.kcl.ac.uk/ghsm/assets/care-stories-policy-briefing-paper.pdf |
| Title | Photo-Sound-Voice |
| Description | A hybrid methodology using photo-voice and sound-sourcing methods - where participants share a combination of brief audio-diaries and symbolic images that capture feelings and experiences around a specific topic (e.g. challenges faced at work). Participants are encouraged to use WhatsApp for this due to ease of use, and strong encryption; this creates one source of data, captured in a more 'conversational' style. These transcripts and images are then brought together in an 'exit interview' where the process and content of their data are discussed in depth. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | Data collection is ongoing using this method. Participants have already shared positive outcomes from using it - particularly that it is easy to use, especially through WhatsApp - and we have gained strong, highly personal, emotive data 'in-situ' as opposed to in a more formal interview setting. We hope that this methodology can be used in future research projects, and intend to produce research outputs, and guidance for other researchers, on how to best utilise it to address issues of inclusivity and capture hard-to-reach populations. |
| Title | Thematic analysis of co-design methods |
| Description | This is when the collected data is analysed inductively using the pre-existing questioning framework used and coding the data using Excel. In tandem with this the same information is also coded deductively to also harness the information provided that are provided by the participants. These are all then coded in a coding tree with 'themes' and smaller 'codes/nodes' which are all specifically defined and contextualised. Researchers also cross-coded their transcripts to audit repetitive themes. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | This method of using co-design with specific definitions and data points elucidates the data and makes it more useable for outputs, such as events, publishing journals and book chapters. |
| Title | Hybrid methodology: sound-sourcing and photovoice |
| Description | This project is using an innovative combination of sound-sourcing, also called 'audio-diaries', and photovoice. Both of these innovative methodologies enable researchers to explore participants' lived experiences 'in-situ' and gain more immediate reactions to events or feelings. Sound-sourcing involves the participant recording audio-diaries related to a pre- determined specific topic (for example: 'key challenges faced at work') whereas photovoice involves a participant taking photographs that represent the topic or issue. Participants will offered a number of different ways they can physically record the audio files or take the photographs, adjusted to their own technological preferences and understanding. We expect most would use their own mobile phone camera or recording application on the phone - or even a social media platform such as WhatsApp. After completing their entries, these individuals will then be invited to personal exit interviews, where they can expand on any concerns or comments raised, as well as the data collection process itself. These exit interviews will be heavily led by the participant's individual audio-diaries and photographs, where these items are used as prompts for more unstructured discussion of their significance, allowing for deeper expansion or clarification of the 'key issues' as dictated by the participant. In our novel approach, we will then complete a combined narrative analysis of the audio and photo files simultaneously, and use a combination of audio clips and images together to highlight key issues in dissemination of findings and project outputs. We will also include questions around the process of using and participating in this combined methodology in our interviews, which will be analysed separately as well. This data will then be used to produce outputs related to this new methodology specifically, and the reactions and experiences of both participants and researchers. |
| Type Of Material | Data analysis technique |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | This innovative combined methodology would offer a new way to explore narrative identity, personal anecdotes and capture emotions in more real-time - where images and audio can be used together to fully capture and portray participants' experiences to academic and lay audiences. We would expect to use the data captured in all project outputs (including research papers, at conferences and policy-focused outreach), but also analyse the process and produce recommendations for future use of this methodology in future research and across other disciplines. |
| Title | Qualitative Interviews |
| Description | Qualitative interviews were conducted with individuals involved in the domiciliary care work sector including; care workers, managers of care homes, policy makers and policy experts. Interviewees were approached using a snowball sampling technique as well as based on their expertise and public roles e.g. for policy makers and policy experts approached. Participants were able to join both online, via the phone or in person, depending on what was most suitable for them. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | Researchers were able to collect rich, contemporary and relevant data that provided insights into the realities of domiciliary care work and the policies around it. The quotes/insights used will be used to upcoming publications made, and for the event that all participants have been invited to and will be kept in regular contact/communication for. |
| Description | Pass representation at event and interest in care sector |
| Organisation | Passivhaus Trust |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | Built relationship at the Care Show London and interest in working with Care homes for Eco friendly solutions. Attended final event for Healthier Working Lives |
| Collaborator Contribution | Discussions about working with future grants using green technology or solutions about impact using green energy solutions such as Heat Pump. |
| Impact | Final Event networking |
| Start Year | 2024 |
| Description | Pat O'Connor |
| Organisation | University of Limerick |
| Country | Ireland |
| Sector | Academic/University |
| PI Contribution | Data analysis and review of ideas. The HWL team reviewed the methods and data from HWL ethnographic work and explored the data sets from partner's EU projects. We established a partnership initiative to bring a questioning (third party) perspective to our analysis; a knowledgeable and exploring lens |
| Collaborator Contribution | Professor Pat O'Connor is Emeritus at the University of Limerick and also Visiting Professor Geary Institute UCD, Ireland. She has spent several months reviewing ethnographic and codesign data and working on outputs including publications. Our respective data sets mould and we are considering future initiatives including grant applications and writing. We are working on the broad themes of emotional labour and older workers exploring theoretical contributions. |
| Impact | Article for the journal Social Politics Open Research Area proposed application Horizon 2025 calls Disciplines include sociology, geography, social policy, e-health, politics and economies of care |
| Start Year | 2024 |
| Description | Advanced Care Research Centre, University of Edinburgh, Symposium |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | 150 postgraduate students, policy makers and health practitioners came together to consider engagement across disciplines and sectors to promote policy and practice developments in care work and research. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://usher.ed.ac.uk/advanced-care-research-centre/2024-spring-symposium |
| Description | Interviews with care workers and care management |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | The outcome was a comprehensive understanding on changes needed and current challenges for domiciliary care workers in the UK currently. All participants have also agreed to take part in follow-on workshops and final events to further discussions. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Leaders in Care Conference: Project outreach and networking workshop |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | This invited conference is an opportunity to network with leaders in the adult social care sector, share research projects/outputs, explore new innovations and technology, take part in small focused workshops with relevant leaders, followed by a networking dinner. |
| Year(s) Of Engagement Activity | 2024 |
| Description | More Time for Quality Care: Workshop preparation |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Industry/Business |
| Results and Impact | We will be leading a workshop on March 28th (More Time for Quality Care) for up to 40 leaders from across the adult social care sector - including enterprise, policy makers, technology experts, care business owners and management. This smaller half-day workshop brought together KCL researchers with communications specialists and technology start-up mentors to brainstorm workshop content and logistics. At the event we produced a shared Miro board to help discuss and decide our core team aims, objectives and outputs for the event and beyond, as well as participant lists/wording for all event invites and outreach. |
| Year(s) Of Engagement Activity | 2025 |
| URL | https://www.eventbrite.co.uk/e/workshop-creating-more-time-for-quality-care-tickets-1247304484289?af... |
| Description | Neoliberal epidemics and health politics for a new Gilded Age,' annual Cost of Living Symposium address, British Sociological Association Medical Sociology Conference, Birmingham, 8 September 2016 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | Address based upon and updating the book by co-investigators Schrecker and Bambra (2015) |
| Year(s) Of Engagement Activity | 2016 |
| Description | Policy interviews with policy experts and local/national political figures |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | The collection of information from those involved in decision making to understand how the care policies for elderly care are made and what could be done to further inform the co-design process, and the outreach event that would be hosted in the coming months. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Sound-sourcing Workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Study participants or study members |
| Results and Impact | Workshop with Lakehead University led by Dr Kathy Sanderson around sound-sourcing methodology, also called audio-diaries. We workshopped questions for introductory and exit interviews, heard examples of previous audio diary entries from participants, and discussed how to utilise the method in future research projects. |
| Year(s) Of Engagement Activity | 2022 |